Case Study of Jeanette - Chapter 17

Jeanette, a 54-year-old married African American woman, presented at a community mental health center in rural Georgia with symptoms of depression (weight gain, irritability, social isolation, crying spells). Jeanette's husband is an independent contractor, but construction jobs have been few and far between with the economic downturn, and Jeanette herself is currently unemployed.

Jeanette has one adult daughter with whom she describes a "distant" relationship because her daughter identifies as a lesbian and lives in Atlanta with her girlfriend. Jeanette states that she garners the majority of her social support through her women's group at church, though she notes feeling "guarded" around friends who "don't know too much" about her past. As a child, Jeanette experienced severe physical and psychological abuse from her mother and sexual abuse from her older brother.

Despite having been raised in the 1960s, Jeanette grew up in a childhood home that had no indoor plumbing or heat, and she states that she was too embarrassed to make friends for fear they would find out about her poverty. She dropped out of high school in the 10th grade in order to get a full-time job as a line cook that enabled her to move away from her abusers and support herself.

Jeanette entered therapy at the prompting of her husband, who claims that she "overeats away her pain" rather than facing her past trauma. Jeanette has a history of severe drug abuse, but she indicates that due to Narcotics Anonymous, raising her daughter, and her Baptist faith, she has been able to remain substance-free for 17 years and has instead shifted her coping method to food.

Since her daughter moved away and came out as lesbian, Jeanette reports feeling that she has lost her identity as a mother and homemaker. Jeanette completed her GED after her daughter was born and has since enrolled in a few classes at the community college, but she has little desire to earn her associate degree. To pass the time, she is currently seeking employment, but because of her past involvement with narcotics, she has a criminal record and has been unsuccessful in securing even a minimum-wage position. Jeanette indicates that she would like to work on her anger toward her family of origin, her feelings of helplessness, and her lack of a sense of purpose.

In sessions, she explores the context of her traumatic experiences. Growing up in the rural and racially segregated South, she felt as though she could not report her abuse or rely on law enforcement for support or intervention. Moreover, as a Black woman, she describes feeling pressure not to bring negative attention to her family and community by reporting these assaults. Through therapy she begins to process how these early traumatic experiences may have contributed to her feelings of hopelessness and disempowerment, which eventually led to substance abuse and overeating.

Jeanette feels "trapped" and discouraged by her inability to find employment and notes that her present disempowerment is triggering her to relive past trauma. At the end of her fourth session, Jeanette expresses the desire to set concrete goals for reestablishing her sense of personal mastery while allowing for a more healthy release of anger toward her mother and brother.

Jeanette also notes that she would like to work on her relationship with her daughter but feels "stuck" because of her spiritual beliefs that same-gender romantic relationships are immoral. She fears that if her friends in the Baptist women's group find out that her daughter is a lesbian, she and her husband will be marginalized by their community, and they might also lose the sporadic economic support they receive from religious leaders and food banks run by faith-based organizations.

Jeanette's presenting concerns emerge at the nexus of several poverty- and racism-related factors. How would you describe the influence of these systemic forms of oppression in her life and in her presenting concerns?

A primary element within Jeanette's history is the childhood abuse that appears to have triggered a pattern of withdrawal, depression, and avoidance of emotions via substance abuse. How has the impact of the trauma been exacerbated by the poverty that Jeanette's family faces?

To supplement her husband's sporadic wages, Jeanette and her husband receive support from their church-though this faith-based support feels tenuous, as Jeanette worries that it may be revoked if word of her daughter's sexual orientation reaches members of the conservative church leadership.

How do oppression-related issues intersect in this element of Jeannette's story? How do they contribute to Jeanette's lack of connection to others?