Instructions: Using the attached vignette (see at the bottom page) respond to the questions below comprehensively, using an understanding of the literature to support your answers. Draw from concepts and theories discussed in class and in the readings. Please be specific in your discussion. At least 5 scholarly references are required and at least 3 references should come from the word document I’ve attached. APA style is required, as always.
Questions
Using explanatory theories and research learned in this class please …
- Discuss this case in terms of the biological and neurobiological components:
- Which parts of the nervous system and structures in the brain are being impacted and how?
- What is the role of stress?
- What are the biological aspects of trauma, memory, and/or affect regulation that apply to the vignette?
- Apply the role of Polyvagal Theory.
- Discuss this case in terms of the psychological components:
- Using concepts from contemporary psychodynamic theories discuss relevant aspects of the case. You should use one of the following: Fairbairn, Self-psychology, Mentalization, or Contemporary Attachment Theory.
- Discuss this case in terms of the social contexts:
- This might include race, poverty, sexual orientation, ACE’s, caregiver stress, etc.
A comprehensive paper will be mindful of the mutual influence of each component on the others.
Grading
Case of Juana
Juana is a thirty-nine year old woman of Puerto Rican descent. She was born to a single mother in the Harlem neighborhood of New York City. She had a younger brother, Daniel, who is two years younger. Juana did not know her father. Juana’s mother worked two minimum wage jobs and was not available to her children either physically or emotionally. During her early childhood, she was cared for by a maternal aunt who was strict and cold and had a son, Miguel, who was two years older than Juana. The family lived at the poverty level and there were ongoing financial stressors. Juana’s mother could be neglectful and emotionally abusive. Juana felt that her mother’s behavior was her fault. By the time that Juana was in fourth grade, the aunt and cousin had moved out and Juana and Daniel would take care of themselves after school. Juana was close to her brother and felt responsible for taking care of him.
Juana experienced sexual and emotional abuse by one of her mother’s boyfriends beginning at the age of nine. This occurred over a period of three years. The boyfriend threatened that he would physically harm both she and Daniel if she said anything to her mother. After Juana’s mother broke up with the boyfriend, Juana told her mother about the abuse. Juana felt that she must have done something wrong to cause her mother’s boyfriend to treat her that way. While he did not return to their home, Juana was always anxious about seeing him in the neighborhood. Juana struggled in middle school and high school. She did manage to graduate from high school. After graduation, she found a job as a receptionist at an office on the Upper Eastside of New York City. When she was nineteen years old, she met a man, John, through friends who was four years older. He worked in the Facilities Department at the World Trade Center. After dating for a year, Juana found out that she was pregnant. Juana and John married during the first trimester of Juana’s pregnancy. She moved into John’s very small apartment and they seemed to be happy newlyweds. The terrorist attacks of 9/11 occurred during the third trimester of Juana’s pregnancy. John died in the attacks having gone to work early that morning. Juana was devastated by the loss and became severely depressed. She quit her job and went back to live with her mother and brother in Harlem.
Juana’s daughter, Danielle was born pre-term and with a low birth weight. After John’s death, Juana became increasingly isolated from friends. Juana felt constantly on edge and would experience rapid heart rate. While her mother tried to help her with the care of the baby, Juana’s mother developed a drinking problem from the years of stress that she had endured and was unreliable and inattentive to the young infant. Juana struggled financially until she started to receive financial support from the September 11th Victim Compensation Fund (VCF). As John was a low paid employee, the total amount she received was not very much. Not being skilled in financial planning, Juana invested the majority of her money in a restaurant that her cousin Miguel was trying to open. She hoped the restaurant would be successful and would be a source of income for her. Unfortunately, within two years the restaurant closed and she lost all the money she had invested. Juana was depressed and showed signs of PTSD. She had sleep disturbance and had difficulty being attentive to her young daughter. Juana always held on to a picture of John and always wore the NY Yankees baseball cap that Juana bought for him at the first game they went to together. She was unable to work outside the home and remained isolated from friends. She did not want to begin to date because she continued to feel the loss of her husband. Her daughter had health problems thought to be a result of her pre-term birth and low birth weight.
When Danielle began to go to school it was clear from the beginning that she had learning and attentional difficulties. She also was diagnosed with Irritable Bowel Syndrome and Colitis. Danielle also had difficulties with sleep and was always irritable.
When Danielle was eight years old, Juana decided to move to Los Angeles. Her brother Daniel had relocated there three years earlier. He worked in construction and was divorced with no children. Juana and Danielle moved into his small rented house in South Los Angeles. Juana and Daniel had always been close and Juana thought Daniel would provide a support system for her. Danielle had difficulty adjusting to the new environment. The neighborhood was not safe and that made Danielle very anxious.
Within six months of Juana’s move to LA, Daniel was diagnosed with terminal cancer. Juana became his caregiver as he had no one else to rely on. Over the next two years, Daniel’s health deteriorated and Juana’s psychological state did so as well. She was having significant difficulty balancing taking care of her terminally ill brother and her daughter. Juana had difficulty understanding the range of difficulties Danielle was having. Juana was feeling chronically stressed. Juana had developed her own health problems including high blood pressure and asthma and was being treated at the Free Clinic. Juana decided that she needed to get psychological help for herself and Danielle and turned to the LA County Department of Mental Health for services. Her appointment to meet with a social worker was scheduled for the same week that Daniel went on hospice care.
Choose at least 3 references from here
Cozolino, L. (2017). Building and rebuilding the brain: Psychotherapy and neuroscience. In The neuroscience of psychotherapy (3rd ed., pp. 14-33). New York, NY: W.W. Norton.
Cozolino, L. (2017). The neurobiology of attachment. In The neuroscience of psychotherapy (3rd ed., pp. 237-261). New York, NY: W.W. Norton.
Schore, J. & Schore, A. (2014). Regulation theory and affect regulation psychotherapy: A clinical primer. Smith College Studies in Social Work, 842(2-3), 178-195.
Cozolino, L. (2014). The impact of early stress. The neuroscience of human relationships: Attachment and the developing social brain (2nd ed., 258-276). New York, NY: W.W. Norton.
Dana, D. (2018). Befriending the nervous system. In The polyvagal theory in therapy. Engaging the rhythm of regulation (pp. 3-15). New York, NY: W.W.Norton.
Harvard Mental Health Letter (2011). Understanding the stress response, 27(9), 4-5.
Lupien, S., Juster, R., Raymond, C., & Marin, M. (2018). The effects of chronic stress on the human brain: From neurotoxicity, to vulnerability, to opportunity. Frontiers in Neuroendocrinology, 49, 91-105.
Van der Kolk, B. (2014). Running for your life: The anatomy of survival. The body keeps the score (pp.51- 73) New York, NY: Viking Press Publishing Co
Chapman, D., Dube, S., & Anda, R. (2007). Adverse childhood events as risk factors for negative mental health outcomes. Psychiatric Annals, 37(5), 359-364. (Landmark study)
Dominguez, T.P. (2011) Adverse birth outcomes in African American women: The social context of persistent reproductive disadvantage [Special issue: Health disparities and women of color: Closing the gap]. Social Work in Public Health, 26, 3-16.
Gaugler, J., Linder, J., Given, C., Kataria. R., Tucker, G., Regine, W. (2008). The proliferation of primary cancer caregiving stress to secondary stress. Cancer Nursing, 31(2), 116-123.
Hayasaki, E. (2016, September 2). How poverty affects the brain. Newsweek, 40-45. Retrieved from http://www.newsweek.com/2016/09/02/how-poverty-affects-brains-493239.html
Ludwig, J., Duncan, G., Gennetian, L., Katz, L., Kessler, R., Kling, J., & Sanbonmatsu, L. (2012). Neighborhood effects on the long-term well-being of low-income adults. Science, 337, 1505-1510.
Basham, K. (2016). Trauma theories and disorders. In J. Berzoff, L.M. Flanagan, & P. Hertz (Eds.), Inside out and outside in (4th ed., pp. 481-517). Lanham, MD: Rowman & Littlefield.
Cipriani, A., & Cowen, P. (2018). 3, 4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for post-traumatic stress disorder in service personnel. The Lancet Psychiatry, 5(6), 453-455.
Cozolino, L. (2017). Impact of trauma: Biochemical dysregulation and neural network dissociation. In The neuroscience of psychotherapy (3rd ed., pp. 323-341). New York, NY: W.W. Norton.
Levendosky, A.A., Lannert, B. & Yalch, M. (2012). The effects of intimate partner violence on women
and child survivors: An attachment perspective. Psychodynamic Psychiatry, 40(3), 397-433.
Moran, S., Burker, E., & Schmidt, J. (2013). Posttraumatic growth and posttraumatic stress in veterans. Journal of Rehabilitation, 79(2). 34-43.
Van der Kolk, B. (2014). The unbearable heaviness of remembering. The body keeps the score (pp.184- 199). New York, NY: Viking Publishing Co.
Van der Kolk, B. (2014). Developmental trauma: The hidden epidemic. The body keeps the score (pp.149-168). New York, NY: Viking Publishing Co.