1
© 2021 Walden University, LLC. Adapted from Plummer, S. -B., Makris, S., & Brocksen, S. M. (Eds.). (2014). Social
work case studies: Foundation year. Laureate International Universities Publishing.
Francine
Francine is a 70-year-old, Irish Catholic female. She worked for 40 years as a librarian
in an institution of higher education and retired at age 65. Francine has lived alone for
the past year, after her partner, Joan, died of cancer. Joan and Francine had been
together for 30 years, and while Francine personally identifies as a lesbian, she never
came out to her family or to her colleagues. When speaking to all but her closest
confidantes, Francine referred to Joan as her “best friend” or her “roommate.”
Francine’s bereavement was therefore complicated because she did not feel she could
discuss the true nature of her partnership with Joan. She felt that there was little
recognition from her family, and even some of her close associates, of the impact and
meaning of Joan’s death to Francine. There is a history of alcohol use disorder in
Francine’s family, and Francine used alcohol from late adolescence into her mid-30s.
However, Francine has been in recovery for several decades. Francine has no known
sexual abuse history and no criminal history.
Treatment
Reasons for Seeking Counseling
Francine sought counseling with me for several reasons, including an ongoing
depressed mood, a lack of pleasure or enjoyment in her life, and loneliness and
isolation since Joan’s death. She also reported that she had begun to drink again and
that while her drinking was not yet at the level it had been earlier in her life, she was
concerned that she could return to a dependence upon alcohol. Francine came to
counseling with several considerable strengths, including a capacity to form intimate
relationships, a successful work history, a history of having maintained her sobriety in
the past for many years, as well as insight into the factors that had contributed to her
current difficulties.
Referral to Physician
During our initial meetings, Francine stated that her goals were to feel less depressed,
to reduce or stop drinking, and to feel less isolated. In order to ensure that no medical
issues were contributing to her depression symptoms, I referred Francine to her primary
care physician for an evaluation. Francine’s physician did not find any medical cause of
her symptoms, diagnosing Francine with moderate clinical depression and
recommending that Francine begin a course of antidepressant medication. Francine
was reluctant to take medication and first wanted to try a course of counseling.
Behavioral Activation Technique
In order to help Francine meet her goal of reducing her depression symptoms, I
employed a technique called behavioral activation (BA), which is drawn from principles
of cognitive behavioral therapy and helps to reengage people in pleasant physical,
social, and recreational activities. We began with a small initial goal of having Francine
dedicate at least 5 minutes of each day to an activity she found pleasant or rewarding.
2
© 2021 Walden University, LLC. Adapted from Plummer, S. -B., Makris, S., & Brocksen, S. M. (Eds.). (2014). Social
work case studies: Foundation year. Laureate International Universities Publishing.
Over the following weeks, we increased the time. Francine’s treatment progress was
monitored through weekly completion of the Patient Health Questionnaire (PHQ-9) in
order to determine whether her depressive symptoms were improving.
AA Meetings
I helped Francine address her drinking by reconnecting her with effective coping
strategies she had used in the past to achieve and maintain her sobriety. These
included identifying triggers for the urge to drink and exploring her motivations for both
continuing to drink and for stopping her use of alcohol. Francine began attending
regular meetings of Alcoholics Anonymous™ (AA) and found several meetings that
were specifically for older women and for lesbians. In addition, Francine spoke regularly
with a sponsor who helped her to remain abstinent during particularly stressful moments
during her reengagement in sobriety.
Social Connections
Finally, in order to address Francine’s goal of feeling less lonely and isolated, we
explored potential avenues to increase her social networks. In addition to spending time
with her family, friends, and her AA sponsor, Francine began to visit the LGBTQ center
for the first time in her life and attended a support group for women who had lost their
partners. Francine also began spending time at her local senior center and went there
at least three times a week for exercise classes, other recreational activities, and lunch.
She also began to do volunteer work at her local library once a week.
Over several months of counseling, Francine stopped drinking; significantly increased
her daily involvement in pleasant and rewarding activities, including social and
recreational activities; and reported feeling less lonely, despite still missing her partner a
great deal. Francine’s scores on the PHQ-9 gradually decreased over time, and after 16
weeks of counseling, Francine reported that she no longer felt she needed the session
to move on with her life. In addition, Francine visited her primary care physician, who
found upon evaluation that her depression had lifted considerably and that an
antidepressant was no longer indicated. By the end of counseling, Francine’s focused
work on identifying her depression symptoms and her triggers for drinking equipped her
to better recognize when she might need support in the future and to whom she could
reach out for help if she needed it.
