Case Illustration Background Information

Ann was a 35-year-old, divorced, lesbian, living in a rather rural community in Kansas. She was the oldest of three children. Her recollection was of a rather turbulent childhood. Her parents separated and divorced when she was approximately 7 years old. Ann reported great dislike of her father and has had no contact with him. She said that her biological father was a "scam artist and con man." After her parents' separation and subsequent divorce, Ann's mother frequently left her children unattended to go out with friends and boyfriends. Many times, Ann and her siblings stayed home alone, waited in cars while their mother was in a bar, or stayed with friends or family members. Ann reported that her mother used alcohol frequently, and that many men had come to the house for approximately 5-7 years. Eventually, Ann's mother "settled down" and married her current husband of 20 years.

Ann's self-report was of poor quality, because she had difficulty remembering many events in her childhood. She did report that it was chaotic being shifted from home to home, wondering when, or if, her mother would ever come home. At times there was evidence of parental neglect and abuse, in that Ann became the primary caretaker of her siblings and herself, making sure that they all had food, were clean, and did their homework. In Ann's teenage years, evidence of impulsive behaviors began cropping up. Although she did not remember any sexual or physical abuse, Ann had an early onset of sexual activity and promiscuity, mostly with males. She reported feeling confused about her sexuality, but suppressing it, because it "wasn't right." Shortly after high school, Ann married an acquaintance while working at a local hospital. The marriage lasted years, because Ann was unhappy and began socializing with "different" friends. In addition, she reported that she was "running around" instead of staying home with her husband. Eventually, sexual dissatisfaction and relational difficulties associated with Ann's not being home contributed to the decline of the marriage.

While Ann was married, she became involved with a lesbian softball team (i.e., different friends) in an adjacent town. It was through this team that Ann met acquaintances and began participating in lesbian affairs. During this period, frequent "partying" involved various drugs and alcohol. Ann felt that her alcohol, marijuana, and cocaine use had escalated and become problematic. During this time period, Ann was arrested for DWI (driving while intoxicated) and assault; she spent the night in jail. In an attempt to establish some normalcy, Ann moved to Pennsylvania, where she enrolled in a junior college and completed an associates in arts degree, with a major in social services over a 3-year period. The extended time was because Ann worked at the college while attending classes.

While working at the college, Ann engaged in an affair with a college professor that lasted for approximately 1 year, at which point she ended the affair. She was later introduced to "Tom," the father of her 14-year-old son. While Ann dated Tom, she was still involved with her lesbian friends and lovers. She became pregnant and decided to move in with Tom to build a normal lifestyle for their unborn child. For 7 of the 9 years that she lived with Tom there was little communication and no sexual contact. Ann reported being disgusted with Tom, which further repelled her from having sexual relations with men. When she divorced Tom, he asked for and received custody of Brian, age 9. Ann had visitation rights but rarely exercised them, because she felt bad for "surrendering" her son so easily.

Ann had had three jobs in the past 2 years. She reported that because she had difficulty getting along with anyone at her jobs, she had either quit or failed to return to each job. During the past year she had engaged in treatment services for depression and anxiety issues related to her job.

Ann came for therapy while on sick leave from her job. She reported that she could no longer handle the stress of her job or the people at the job site. She was employed as a prison guard in an all-male facility. After a verbal altercation with her supervisor and a failed relationship with a male prison guard, Ann began experiencing panic attacks and an overall depressed mood. She reported that the anxiety also stemmed from prisoners harassing her, but at no time was she physically assaulted. The local psychiatrist Ann was seeing prescribed several anxiolytic drugs, as well as several different antidepres-sants. However, even after frequent medication changes, nothing seems to be working. The doctor suggested that perhaps enlisting the help of a therapist might complement the medication regimen.

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