Case Presentation: Ginny

Complete an 8-10 page paper using the questions at the end as a guideline. Please include relevant literature to support your assessment of Ginny.

You receive a call from Ginny, a 21 year old female, married since 2010 to Alex, 25 years old. You had previously seen Ginny 3 months after the stillbirth of her first child, at 7 months gestation. You worked with her over 3 months, with her husband attending a couple of sessions. She was very sad and tearful at the death of her baby in 10/10; she had difficulty sleeping and had no appetite. She had reported heavy drug use during the first 3 months of the pregnancy and felt responsible for the death. She had been using drugs when she had called you after the birth. You had recommended that she go through a drug treatment program, but her insurance would not cover the cost of an inpatient program.

At this time, Ginny has a 2 month old son, Matthew, who is a very fussy, colicky baby-he screams all the time, sleeps for only short periods of time, and refuses to be consoled. He wants to be held all the time, does not eat well, and has gained very little weight. He was born at 8 months gestation and was considered low birth weight. Ginny had dropped out of high school in her junior year, moving out into Alex's apartment. She had been working on her GED but hasn't gone back to her classes since Matthew was born. Ginny also discloses a pattern of compulsive eating and dreams where she feels she is being smothered.

She has recently been attending a local church, and has found their emotionally intense worship services to be very uplifting, but is concerned that the pastor has told her that she can't join the church unless she is willing to tithe and to give a love offering to support his community outreach work. She has given him her extra money each week, but it is coming out of her food money. She has been to a weekly prayer group at the church, and finds the women in the group to be very supportive. She has gone out for coffee after the group once or twice with two of the women, one of whom she knows from the neighborhood. She has invited a friend of hers to go with her; the two women have known each other since Ginny left home.

Alex works as a night manager at a local 24-hour restaurant and sleeps during the day. He was very frustrated with Ginny's reaction to the first pregnancy, and can't sleep at home with Matthew's screaming, so he's moved out and is sleeping at a friend's house. He has a high school diploma. He hangs out with his friends from high school on the weekends-they all drink heavily at these gatherings, and occasionally use drugs. Alex believes that his job has no opportunities for advancement and would like to do something else, but when he has tried to get other opportunities, his lack of higher education has held him back. He has talked about going to the local community college, but when Ginny got pregnant with the second child his plans got put on hold.

Ginny's mother and father were separated when she was in high school; her mother is an alcoholic, but refused to get treatment. Her father was a brittle diabetic, and was in and out of the hospital with wild fluctuations in his blood sugar. He died a month after the miscarriage of her first child. Ginny has no contact with her mother, who was physically abusive to Ginny and her younger sister, Amy, while they were growing up. Amy ran away from home after Ginny moved out and went to live with her father's younger sister in another state. Ginny keeps in touch with Amy sporadically.

Alex has an older brother (35) and an older sister (40), who are both professionals, married; and living in 2 different states. He has little contact with them. His father (69) was a steel worker, who was laid off when the mills closed down in the 80's. He reportedly smoked and drank a lot and spent his free time with his buddies from work. According to Alex, his life centered on sports, and he regularly played the numbers using the neighborhood "bookie". He is now in a nursing home, with severe emphysema. His mother died of a stroke in 1996 when she was 65, a month before she was going to retire from a lifetime of working as a bookkeeper for her older brother's appliance repair shop. She had always dreamed of traveling around the country after her retirement, and had been saving up for a small RV with the money her husband won on the numbers. She was a heavy smoker. Alex has been close to his parents, but rarely visits his father since he was institutionalized after his mother's death.

Alex wants to be more available to Matthew, and dreams about playing ball with him when he's older. He does not know what to do with him now when he's crying; he has never been around babies before and thinks that he might "do it wrong". He has expressed hope that he and Ginny can work things out and dreams about a life when he has a good day job, and Ginny can work part-time and take care of their son.

Ginny would like to talk to you about the problems that she's having with her life right now-it feels like everything is out of control. When you talked to her on the phone, she was tearful, and said, "I don't know how much longer I can go on like this".

Questions for Assessment

1. What persons and systems are involved in Ginny's life? Complete an eco-map.

2. How and in what way are the participants involved?

3. Identify unmet needs or wants.

4. What developmental stage or life transition is relevant to this case situation?

5. Identify the problematic behaviors present in this case scenario. What meaning do the clients ascribe to the various identified problems?

6. How has the client attempted to cope with her problems, and what are the required skills to resolve them?

7. What are the skills and strengths of the client?

8. What external resources are needed?