Chapter 1: Tina's World

Before I even finished the first page, my brain started screaming: ETHICAL DILEMMA. After Tina crawled on Perry’s lap and tried to open his zipper, I wondered if he considered referring her to a female clinician. However, if he had referred her to a female clinician, Tina may never have had the chance to adjust her schema of men as sexual predators. In addition, Perry did remove Tina from his lap and did not mention any other sexualized behavior. Food for thought, would he have made a different decision if it was 2018?

I appreciated Perry questioning the conclusions of his first supervisor, Dr. Stine. As a clinician in training, I am inclined to defer to my supervisor’s seasoned opinions. Hopefully, if I was in Perry’s position, I would have had reservations about Dr. Stine’s Attention Deficit Disorder and Oppositional Defiant Disorder diagnosis, as well as his interpretation of Tina’s mother’s lateness as resistance. I learned in my DSM class that African American males are more often diagnosed with a psychotic disorder than a Bipolar Disorder compared to White males. Dr. Stine’s ADD diagnosis made me wonder if he would have been more likely to consider a PTSD diagnosis if Tina was a White child. In the same realm, would he have still considered Sara’s lateness as “resistance” if she was White?

As Perry discussed the probable changes in Tina’s stress response systems, I started thinking about what I’m learning in my Treatment of Substance Use Disorders class. Last week, we discussed how drug use affects neurotransmitter levels and the central nervous system. Studies have concluded that childhood sexual abuse is a risk factor for substance use problems in adulthood (Sartor, Agrawal, McCutcheon, Duncan & Lynskey, 2008; Shin, Hong, & Hazen 2010). As we discussed in class, nature and nurture should be looked at interactively instead of as a dichotomy. In this case, I was wondering how Tina’s exposure to childhood sexual abuse affected the neurotransmitters in her brain. Perry described the effect of stress on rats’ adrenaline and noradrenaline systems and how he observed similar behaviors with Tina. I’d be curious to know if Tina were to ever use substances if she would be more likely to use “downers” to counteract the overactivation of her stress response system.

I felt disheartened when I read that Tina had continued engaging in sexualized activity. However, it reminded me that not every story will have a happy ending. I won’t be able to help EVERY client and “fix” all of their problems. During orientation, I remember my biggest fear was failure. Failure has such a negative connotation; but if we do everything right how do we learn? I learned the most during my first field placement when I made a mistake and discussed it with my supervisor. Of course, it felt better to have a successful moment that resulted in my one-person dance parties. However, failing is a part of the process and my coworkers could only handle my dancing on occasion. 

  

 

References:

Sartor, C. E., Agrawal, A., McCutcheon, V. V., Duncan, A. E., & Lynskey, M. T. (2008). Disentangling the complex association between childhood sexual abuse and alcohol-related problems: A review of methodological issues and approaches. Journal of Studies on Alcohol and Drugs, 69(5), 718-727.

Shin, S. H., Hong, H. G., & Hazen, A. L. (2010). Childhood sexual abuse and adolescent substance use: A latent class analysis. Drug and Alcohol Dependence, 109(1), 226-235.