TRIADD
Teletraining Research and Information around Dual Diagnosis
TRIADD Case Studies
Case 2
CASE STUDIES PRESENTED DURING THE FRENCH TRAINING COURSE
PARIS, JULY 2003
Presented by a training participant
Mme X aged 42 years, has worked in a CAT (Centre d’Aide par le Travail – Centre for supported employment) for two years, part-time. Her timetable is adapted to allow her to look after her 5 year old daughter. Divorced and recently widowed, she has 3 children, 2 of which have been placed in care (Aide Sociale à l’Enfance) following an indication of incest. Her life has been a series of disappointments and failures.The youngest of 11 children, with an alcoholic father and a mother who sometimes forced them to steal, etc., Mme X had a disturbed childhood, lacking affection. She was placed in a children’s home very early on. Mme X has always had significant personality disorders characterised by instability and impulsiveness, with a mild intellectual disability.
She had her first epilepsy attack when she was 8 years old.Mme X had never worked before integrating into the workshop (CAT). For her, this work constitutes a challenge in the development of her behaviour. She has regular psychiatric support from the Medico-Psychological Centre (CMP (Centre Médico-Psychologique), social support from the CCAS (Centre Communal d’Action Sociale – Community Centre for Social Action) and help from the PMI (Protection Maternelle Infantile – Protection for Mothers & Children).
She has numerous professionals mobilised around her. For the moment she is living in fear of her 3rd child being taken away, which leaves her with a permanent sense of instability.When she entered the employment centre, she would tolerate no remarks about her work and was in constant conflict with her colleagues in the workshop.
Since then she has made a lot of progress and is much more integrated in the group. On the social level, the problems have recently started re-emerging since the return of her oldest child (18 years) to her home. He is violent and hits his mother and little sister. Mme X has lodged a complaint about him to the police.In this new situation, Mme X has made a request for a transfer : she wants to return to her home town (place of her disturbed childhood) She therefore wants to escape the commune where she nevertheless has roots for the last 17 years, where she knows everyone, in order to be away from the threat of losing her little girl. On the other hand, she confirms that she is fine at the Workshop and has been able to prove her capacities at work and in managing her home. Her request to leave is ambivalent.
Résumé of the issues
Mme X is a 42 year old woman, mother of three children. The slight learning disability seems to be a consequence of a very complicated life history : disadvantaged socio-economic milieu, major lack of affection, succession of failures. This woman works in a Workshop and receives psychiatric and social support. Clearly her social integration is rendered fragile - among other things by her excesses (impulsive behaviour, aggression…) which could leave a question mark over her place in the Workshop.
Questions discussed in the training course
What is the main problem Mme X has or at least the one which we should decide, with her, to work on first ?How, while respecting the pace, the wishes and the incoherencies of the person, can we bring her to a certain `normality’ in her relationships with others and in her life?
How can we protect this person from herself, since her behaviour always brings about complications, abandonment and even violence ?
How can we promote the adaptation, however fragile, within for example the framework of the workshop (CAT). ?
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