Janet Case Study

        Janet called the mental-health center to ask if someone could help her 5-year-old son, Adam. He had been having trouble sleeping for the past several weeks, and

Janet was becoming concerned about his health. Adam refused to go to sleep at his regular bedtime and also woke up at irregular intervals throughout the night. Whenever he woke up, Adam would come downstairs to be with Janet.

Her initial reaction had been sympathetic, but as the cycle came to repeat itself night after night, Janet’s tolerance grew thin, and she became more argumentative.

She found herself engaged in repeated battles that usually ended when she agreed to let him sleep in her room. Janet felt guilty about giving in to a 5-year-old’s demands, but it seemed like the only way they would ever get any sleep.

The family physician was unable to identify a physical explanation for Adam’s problem; he suggested that Janet contact a psychologist. This advice led Janet to inquire about the mental-health center’s series of parent-training groups.

             Applicants for the groups were routinely screened during an individual intake interview. The therapist began by asking several questions about Janet and her family. Janet was 30 years old and had been divorced from her husband, David, for a little more than a year. Adam was the youngest of Janet’s three children;

Jennifer was 10, and Claire was 8. Janet had resumed her college education on a part-time basis when Adam was 2 years old. She had hoped to finish her bachelor’s degree at the end of the next semester and enter law school in the fall. Unfortunately, she had withdrawn from classes 1 month prior to her appointment at the mental-health center. Her current plans were indefinite. She spent almost all of her time at home with Adam.

            Janet and the children lived in a large, comfortable house that she had received as part of her divorce settlement. Finances were a major concern to Janet, but she managed to make ends meet through the combination of student loans, a grant-in-aid from the university, and child-support payments from

David. David lived in a nearby town with a younger woman whom he had married shortly after the divorce. He visited Janet and the children once or twice every month and took the children to spend weekends with him once a month.

            Having collected the necessary background information, the therapist asked for a description of Adam’s sleep difficulties. This discussion covered the sequence of a typical evening’s events. It was clear during this discussion that

Janet felt completely overwhelmed. At several points during the interview, Janet was on the verge of tears. Her eyes were watery, and her voice broke as they discussed her response to David’s occasional visits. The therapist, therefore, suggested that they put off a further analysis of Adam’s problems and spend some time discussing Janet’s situation in a broader perspective.

            Janet’s mood had been depressed since her husband had asked for a divorce.

She felt sad, discouraged, and lonely. This feeling had become even more severe just prior to her withdrawal from classes at the university (1 year after David’s departure). When David left, she remembered feeling “down in the dumps,” but she could usually cheer herself up by playing with the children or going for a walk. Now she was nearing desperation. She cried frequently and for long periods of time. Nothing seemed to cheer her up. She had lost interest in her friends, and the children seemed to be more of a burden than ever. Her depression was somewhat worse in the morning, when it seemed that she would never be able to make it through the day.

            Janet was preoccupied with her divorce from David and spent hours each day brooding about the events that led to their separation. These worries interfered considerably with her ability to concentrate and seemed directly related to her withdrawal from the university. She had been totally unable to study assigned readings or concentrate on lectures. Withdrawing from school precipitated further problems. She was no longer eligible for student aid and would have to begin paying back her loans within a few months. In short, one problem led to another, and her attitude became increasingly pessimistic.

             Janet blamed herself for the divorce, although she also harbored considerable resentment toward David and his new wife. She believed that her return to school had placed additional strain on an already problematic relationship, and she wondered whether she had acted selfishly. The therapist noted that Janet’s reasoning about her marriage often seemed vague and illogical. She argued that she had been a poor marital partner and cited several examples of her own misconduct.

These included events and circumstances that struck the therapist as being very common and perhaps expected differences between men and women.

For example, Janet spent more money than he did on clothes, did not share his enthusiasm for sports, and frequently tried to engage David in discussions about his personal habits that annoyed her and the imperfections of their relationship.

Of course, one could easily argue that David had not been sufficiently concerned about his own appearance (spending too little effort on his own wardrobe), that he had been too preoccupied with sports, and that he had avoided her sincere efforts to work on their marital difficulties. But Janet blamed herself. Rather than viewing these things as simple differences in their interests and personalities,

Janet saw them as evidence of her own failures. She blew these matters totally out of proportion until they appeared to her to be terrible sins. Janet also generalized from her marriage to other relationships in her life. If her first marriage had failed, how could she ever expect to develop a satisfactory relationship with another man?             Furthermore, Janet had begun to question her value as a friend and parent. The collapse of her marriage seemed to affect the manner in which she viewed all of her social relationships. The future looked bleak from her current perspective, but she had not given up all hope. Her interest in solving Adam’s problem, for example, was an encouraging sign. Although she was not optimistic about the chances of success, she was willing to try to become a more effective parent.

 Social History

            Janet was reserved socially when she was a child. She tended to have one or two special friends with whom she spent much of her time outside of school, but she felt awkward and self-conscious in larger groups of children. This friendship pattern persisted throughout high school. She was interested in boys and dated intermittently until her junior year in high school, when she began to date one boy on a regular basis. She and her boyfriend spent all of their time together. Janet remembered that the other kids teased them about acting as if they were married.

Unfortunately, she and her boyfriend broke up during Janet’s first year in college.

 Janet met David a few weeks afterward, and they were married the following summer. Janet later wondered whether she had rushed into her relationship with David primarily to avoid the vacuum created by her previous boyfriend’s sudden exit. Whatever her motivation might have been, her marriage was followed shortly by her first pregnancy, which precipitated her withdrawal from the university. For the next seven years, Janet was occupied as a full-time mother and homemaker.

             When Adam was 2 years old and able to attend a day-care center, Janet decided to resume her college education. Her relationship with David became increasingly strained. They had even less time than usual to spend with each other.

David resented his increased household responsibilities. Janet was no longer able to prepare meals for the family every night of the week, so David had to learn to cook. He also had to share the cleaning and drive the children to many of their lessons and social activities. A more balanced and stable relationship would have been able to withstand the stress associated with these changes, but Janet and

David were unable to adjust. Instead of working to improve their communications, they bickered continuously. The final blow came when David met another woman to whom he was attracted and who offered him an alternative to the escalating hostility with Janet. He asked for a divorce and moved to an apartment.

 Janet was shaken by David’s departure, despite the fact that they had not been happy together. Fortunately, she did have a few friends to whom she could turn for support. The most important one was a neighbor who had children of approximately the same ages as Janet’s daughters. There were also two couples with whom she and David had socialized. They were all helpful for the first few weeks, but she quickly lost contact with the couples. It was awkward to get together as a threesome, and Janet had never been close enough with the women to preserve their relationships on an individual basis. That left the neighbor as her sole adviser and confidante, the only person with whom Janet felt she could discuss her feelings openly.

             For the next few months, Janet was able to continue her studies. With the children’s help, she managed the household chores and kept up with her work.

She even found time for some brief social activities. She agreed to go out on two blind dates arranged by people with whom she and David had been friends. These were generally unpleasant encounters; one of her dates was boring and unattractive, and the other was obnoxiously aggressive. After the latter experience, she discontinued the minimal efforts she had made to develop new friendships.

 As time wore on, Janet found herself brooding more and more about the divorce. She was gaining weight, and the children began to comment on her appearance. To make matters worse, Claire became sick just prior to Janet’s midterm exams. The added worry of Claire’s health and her concern about missed classes and lost studying time contributed substantially to a decline in Janet’s mood. She finally realized that she would have to withdraw from her classes to avoid receiving failing grades.

             By this point, 1 month prior to her appointment at the mental-health center, she had lost interest in most of her previous activities. Even casual reading had come to be a tedious chore. She did not have any hobbies because she never had enough time. She also found that her best friend, the neighbor, was becoming markedly aloof. When Janet called, she seldom talked for more than a few minutes before finding an excuse to hang up. Their contacts gradually diminished to an occasional wave across the street or a quick, polite conversation when they picked up their children from school. It seemed that her friend had grown tired of Janet’s company.

             This was Janet’s situation when she contacted the mental-health center. Her mood was depressed and anxious. She was preoccupied with financial concerns and her lack of social relationships. Adam’s sleeping problem, which had begun about a week after she withdrew from her classes, was the last straw. She felt that she could no longer control her difficult situation and recognized that she needed help.