The Case of Shiela

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Sheila is a 30 year old Puerto Rican female living with her 3 children in Springfield, Massachusetts. She presents for counseling as one of the requirements from the Department of Children and Families (DCF) in order to regain custody of her children. Her oldest child, Marie, is 15; José is 13; and Angélica, is 4. Marie frequently runs away and engages in high risk drug and sex behaviors. José is disruptive at school, with frequent suspensions for misbehavior. Angélica is in Head Start and doing well. The children are cared for by Sheila’s mother. Sheila works the 3pm to 11pm shift at a local nursing home and earns minimum wage.

Sheila and her mother came from Puerto Rico when Sheila was 5 years old. Her problems began in elementary school, where she was reported to be inattentive, active, and stubborn. Sheila was very bright and was able to remain in school despite escalating anti-authority conflicts. She also began hanging out with gangs and cutting class. At this point in time, the state intervened and Sheila was placed in a number of intervention programs. Sheila began using heroin at age 22 with the father of her two oldest children. Sheila has a number of early arrests but has not been involved in crime or opiates for 5 years. She received her GED and is attending community college, studying to be a medical assistant. She reports that after two years of being with the children’s father, he began to physically assault her. He would emotionally degrade her in front of the children, control her behavior, then verbally attack her and eventually began open and closed fist physical abuse. DCF became involved and criminal charges were filed, resulting in his incarceration.

Sheila reports frequent panic attacks, anxiety, explosiveness, and difficulty sleeping. She is quite thin and very irritable, usually fatigued and easily overwhelmed. However, Sheila is very responsive to her children’s schools when contacted and is an effective advocate for them. Sheila does not date and spends most of her time working and caring for her children’s behavior problems. Upon first interview, Sheila presented as a well-dressed professional woman. However, she was clearly tired, anxious, on edge, irritable, and had very low frustration tolerance. She also reports having many conflicts with people over “stupid stuff” and has very few friends.

Sheila has had a number of therapists in the past, whom she reports as having been of “no help”. She has been prescribed a variety of medications over the years, including: Ritalin, Adderall, Risperidone, “every SSRI,” Lithium, Trazadone, and Seroquel. Sheila is working very hard to manage her life and get her children back, but is very unhappy, resentful, and feels burdened by trying to survive.


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