HS 123 - Substance Abuse, Assessment, and Treatment Planning Midterm Exam The Case of Victoria Smith Victoria Smith is a young woman having trouble in coping with the demands being placed on her by her marriage, her family, and law school. This is evident in the multiple problems she is experiencing and that interfere with her successfully fulfilling her roles as wife, daughter, sister, and law student. Prominent among these problems are obsessions and concomitant compulsive behaviors that have their origins in early adolescence. The expectations set for Ms. Smith's behavior by her devoutly religious parents often conflicted with what is generally considered "normal" for adolescent girls. The underlying resentment and anger that developed because of not being allowed to be "like everyone else" and for having to assume responsibility for being caregiver to her younger siblings could not be expressed: doing so would have been contrary to being the perfect, dutiful daughter. Instead, unrealistic fears of accidentally hurting others began to occur, and consequently controls were implemented to keep these fears and unacceptable feelings in check. These maladaptive coping mechanisms were well established by the end of her adolescence and became further ingrained during her years in college, often appearing in other circumstances in which great demands or expectations were made of her. It would appear that her husband's subtle pressure for them to start a family is the most recently imposed expectation or demand. There were a number of attempts to ignore her obsessions or not give in to the accompanying compulsions to act on them. At times, Ms. Smith experienced success from these efforts, but the anxiety and guilt that eventually emerged, as well as her inability to appropriately express angry feelings, have always caused these successes to be rather short-lived. As a consequence, she has found herself giving into the needs and expectations of others, including assuming responsibility for the care of her ailing father and even attending law school in order to meet her husband's expectations to "live up to her potential." All of this has taken a toll on Ms. Smith. Over the past few years, she has described herself as generally not getting much pleasure out of life. This has been accompanied by periods of sleep difficulties, poor appetite, and more recently, by irritability, general fatigue, and difficulty concentrating on her studies and other activities. Also, she is currently experiencing a high level of distress. As a result of her current condition, her relationships with her husband and family have been further strained and her performance in school has suffered. Overall, Ms. Smith feels sad, is critical of herself, and hopeless about ever "ridding myself of those crazy things I do" or experiencing true happiness and contentment in her life.