Open Possibilities

Setting

Open Possibilities is an outpatient counseling center located in the city of Costa Mesa, California. In total, the center employs about 40 MFT Trainees from various graduate programs throughout California. Open Possibilities is a non-profit organization that operates to assist low income, struggling individuals and families at the clinic, while also maintaining contracts with multiple school districts and homeless shelters to provide counseling services at a low cost. Various elementary, middle, and high schools are contracted with Open Possibilities in Santa Ana, Ocean View (Huntington Beach), and Little Lake (Norwalk) unified school districts.

A homeless shelter, called WISE Place for Women is also contracted with Open Possibilities to provide counseling services at a low cost. MFT Trainees may also see individual adult or child, couples, or family clients at the clinic on a sliding scale fee. The intake process involves a client calling the clinic to ask for services, which they will then be matched to an MFT Trainee based on availability of schedule, and then the MFT Trainee will give the client a call to schedule an intake session. Lastly, Open Possibilities also offers groups such as Teen Anger Management, Teen Substance Abuse, Adult Anger Management, and Parenting classes. Clients’ who attend these various groups may either be court mandated or voluntary. The intake process will be similar to individual counseling, but will be based on clients’ preference of which group (day/time) to join.

Identifying Information

The client is a 14-year old, heterosexual, Hispanic female. She’s currently in 7th grade and is not in a relationship, although she expresses a desire to be in one with a boy from her previous school. The client is the middle child of three. She has an older sister and a younger sister, ages 19 and 10. Both parents are married and living in the same house. About a month and a half ago, client’s grandparents and one of her aunts came from Mexico to live with her family and she complains of not having enough space in the house due to the amount of people living with them. The client was initially referred for counseling by her school guidance counselor dating back to November 2017, for fighting with another female student. The client stated that the reason for fighting was due to a female student spreading rumors about her regarding other male students. She reported not liking what she heard about what was being said, so when she went to confront this student, a physical altercation broke out. Another incident occurred this past February, where client was involved in mutual combat with another female student, after hearing rumors being spread about her and other boys.

Presenting Complaints

The client has difficulty expressing her emotions appropriately. She has a quiet and calm demeanor, but holds a lot of her anger internally. She lets her anger build up until it spills over and she will engage in destructive behaviors. The client was asked about her anger meter, a scale from 1-10; 1 representing no anger, and a 10 representing explosive anger. She stated that she was at a six or seven most days. This represents quite an elevated level of anger for normal functioning. The client also struggles with change. After the altercation with another student in March, she was given a new schedule of classes to avoid conflict with that particular student. She reported refusing to attend one of her classes and was often late to other classes. Back in October 2017, the client was kicked out of her previous school for fighting and has struggled to adjust to the new school. She complains of her peers being different from her previous school in that they tend to spread rumors when female students have male friends. The client also struggles with trust, so this had a compounding effect, in that she struggles making new friends because everyone at the school is “shady” and cannot be trusted.

Behavioral Observations

The client is very consistent in attending session every week. She tends to wear a black or grey hoodie with black or grey pants. She has long black hair, stands at about 5’3” in height, and has a slender build. She often comes into session wearing her backpack while sitting down. Her posture is often relaxed and will lean back in her chair. The client appears to be healthy and doesn’t show any signs of cognitive or intellectual irregularities. She is oriented x3 and shows good insight and focus to stay on topic. The client more often than not appears sleepy when first coming into session and will often avoid eye contact when speaking. She presents with a very quiet and calm demeanor and often looks well composed. During the first session, the client appeared guarded, but has since opened up about her personal life. During the fifth session, the client broke down crying when speaking about all the challenges she’s experiencing in life. The client does not express any homicidal or suicidal ideation nor does she present with any hallucinations or delusions.

Precipitating Factors and History of the Problem

The client has struggled making friends dating back to elementary school. This is due to a combination of inadequate social skills and an irrational belief that other people are untrustworthy. In the 4th grade, client reported self-harming behavior for the first time due to the fact that she had no friends and felt alone. In the 6th grade, client’s uncle passed away due to alcoholism and drug use, which led client to engage in self-harming behavior for the second time. The client reported being close to her uncle and trusting of him and misses him today. She reports of never receiving prior counseling or referral to a support group. Personal matters were dealt within her immediate family. The client did express a need to have a place to express her feelings and emotions outside the family system.

Developmental and Historical Information

The client was born without complications, a normal, healthy, baby girl. She was the second born out of three sisters. Growing up, the client reports that her parents were often out working and did not spend much time with her even though she would make attempts to try to spend time with them. At the same time, the client reports not being close to her sisters, especially her older sister. There’s a six year age difference between the client and her older sister, and because of that she reports her older sister always being out doing her own thing with her friends instead of spending time with the client. Today, the client reports having an “okay” relationship with her older sister. They spend some time together going to the mall or getting food to eat, which the client describes as a “good time.”

On the other hand, there are also times where her relationship with her older sister is strained because as the client describes, “the things my sister says to me makes me feel worthless.” She’s referencing the times where she misbehaves at school; getting into fights, cutting class, receiving excessive tardiness letters, and getting caught holding marijuana for a friend. There’s periods of times where the client has a good relationship with her older sister, but also periods of times where the relationship is strained. In the 4th grade, the client reported not having any friends and feeling alone and isolated, which led her to her first instance of self-harming behavior. She attributed the reason for the lack of friendships as not being able to trust any of her peers because all they did was gossip. In the 6th grade, the client lost her uncle to alcoholism and drug abuse, which led to the second instance of self-harming behavior. The client reported being really close to her uncle and was very trusting of him. He was someone she was able to talk to and confide with. She took the loss really hard, which brought back feelings of isolation, causing her to self-harm.

The client speaks of being very fond of her cousins and feels comfortable speaking with them about personal matters. She finds comfort and safety when in their presence. Since the 6th grade, the client reports not having made another attempt at self-harm or ideation. Since elementary school, the client reports being an “okay” student academically. She puts effort into her classes, but not as much as she could. She also does not do all her homework. She reports enjoying social science, but dislikes math and language arts. The client transferred from another middle school back in October 2017, after attending the school from 6th grade up until the first few months of 7th grade. The reason for the transfer was because the client got kicked out of the school for fighting with other students. Not even a month attending the client’s current school, and she gets into a fight with a female student. She was suspended for two days. The cause of this fight was because of the female student spreading rumors about the client and a male friend.

This past February, the client was suspended again after being caught with marijuana in her backpack. She was suspended for two days and was required to attend a two day drug program at the school. The client reported that she was only holding the marijuana for a friend. When confronted by her parents about the incident, the client reported running away from home because she did not want to deal with her parents. According to the client, she has never tried drugs or alcohol, but is curious. Asides from her uncle, the rest of her family does not have a history of alcoholism or substance abuse. The client reports being healthy, eating a normal diet, but has not had a medical check-up in a few years. In March, the client was again involved in a fight with a female student due to the spread of rumors via social media. She was suspended for three days. At the present moment, the client reports being single and is not interested in dating anyone at the school. She does have a tendency of bringing up a former love interest at her old school, whom she had a previous short term relationship with, as a person of interest. This person has hurt her in the past, as she found out that he had a girlfriend at the same time they were together. The client feels very conflicted about her feelings for this person.

Social and Cultural Information

The client’s presenting problem or current difficulties stem from a number of social and cultural factors including SES, Hispanic culture, and peer pressure from being a teenager. A person’s SES can have a major influence on their psychological and physical well-being (Decarlo, Wadsworth, & Stump, 2011). The client has both parents in the home, whom work, but is providing for three children. She reports being low SES, in the working class. There is a link between low SES and negative psychological health outcomes (Decarlo, Wadsworth, & Stump, 2011).

They are associated with higher levels of emotional and behavioral difficulties, including social problems such as delinquent behavior and ADHD. Higher rates of aggression, depression, anxiety, attempted suicide, and drug and alcohol dependence is also seen. Low SES is linked to poor academic success due to having less available resources. Children are often at a disadvantage when starting Kindergarten because they have less verbal and literacy skills than those from high SES families. Adolescent’s entering high school have literacy skills about five years behind those from high income families (Sheridan & McLaughlin, 2016). These kids tend to be more absent from school throughout their educational experience. And the dropout rate has steadily increase for those living in poverty. Low income students fail to graduate about five times the rate of middle income families.

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