Introduction
The client is Alexandra Russell, famously known as Alex from the Maid series (Metzler, 2021). She is a 25-year-old female with a single child, Maddy. Alex’s relational circumstances are shown in the genogram and eco-gram below. Alex has a troubled psychological presentation bordering on depression due to her life situation. The objective of this essay is to detail Alex’s biopsychosocial assessment and a just practice segment where the significant areas of concern in her life will be discussed.
Alex’s Genogram and Eco-Map
Significant Aspects of the Biopsychosocial Model
An individual’s biopsychosocial model entails the social, biological, and psychological conditions that can lead to them developing an illness or psychological impairment. In this case, the client’s psychological element is anguished. The biopsychosocial model, first developed by George Engel in the 1980s, holds that a client’s presenting symptoms can be formulated in terms of 4Ps: predisposing, precipitating, perpetuating, and protective factors. In the subsequent sections, Alex’s biopsychosocial model will be formulated with sufficient evidence to support the context.
Precipitating Factors
These are stressors that cause the symptoms of psychological distress to manifest themselves in a patient. They trigger the symptoms of a psychological breakdown, causing the patient to have depression, anxiety, psychotic episodes, and suicidal ideation. Sometimes, a single event can be the precipitating factor that helps the individual gain perspective on their situation. In the case of Alexa, the precipitating factors are psychological and social since she does not display any inherited psychiatric illnesses.
Psychological Aspects
One particular event causes Alex to realize that her psychological situation is far from ideal. Sean comes home drunk and, in a fit of rage, crashes a glass bowl on the wall near Alex’s face (Metzler, 2021). This stirs in Paula the memories of her mother’s abuse at the hands of Frank. Alex does not want Maddy to go through the same traumatic parenthood as herself, which stirs her into realizing that she has been in an abusive relationship. Thus, this precipitating factor causes Alex to realize that she has a lot of pent-up trauma that is being re-enacted and that she must act for her daughter’s future.
Social Factors
Alexa’s relationship with Sean causes her psychological distress when she realizes that the level of discord is similar to that of her parents. She realizes that if it spirals into Sean inflicting physical harm on her, her psychological status may deteriorate, as in the case of her mother, and her daughter might inherit her generational trauma. Instead of allowing Sean to eradicate her psyche, she chooses to leave with Maddy.
Perpetuating Factors
These are the patient’s circumstances that cause the problem to persist. They could be inherent to the person or externally projected by others. The patients must free themselves from the grip of the perpetuating factors to gather the courage to address the situation. For instance, domestic violence shelters provide refuge to victims of abuse and thus remove them from the home environment, which is unsafe and complicit in their abuse. Similarly, there are no biological perpetuating factors in this case.
Psychological Factors
Alexa has internalized some beliefs about families that make her a prime candidate for continued domestic abuse. Crucially, Alex does not initially recognize Sean’s behaviors as unacceptable, controlling, and violent. It takes her conversations with Danielle to realize that she is a victim of domestic abuse at the shelter. Due to her poor social conditioning from her family set-up, she perseveres with Sean as he descends into alcoholism and alcohol-fueled rages, similar to Hank.
It is only when Alex has Maddy that she starts to notice that her life is panning out somewhat similarly to that of Paula and that Maddy will grow up in an abusive household that she starts to realize she needs to change her socio-environmental setup. Even then, Alex reconciles with Sean despite having left him for a considerable period and moves back in with him. This is evidence that Alex has a lot of psychological work to do before she can learn to leave her perpetuating factors behind. At the domestic violence shelter, Denise informs Alex that, on average, abused women return to their abusive partners seven times before they find the strength to sever ties completely.
Social Factors
Alexa’s poverty is the primary social factor that causes her to suffer abuse. Despite Sean not being very well off himself, being a bartender, he constantly reminds Alexa that she cannot fend for herself and Maddy, and uses it to control her (Metzler, 2021). Additionally, Alex is lowly educated, as she did not finish her college education despite being granted a scholarship to pursue creative writing, which she is passionate about. She also lacks adequate social support from her troubled mother and her father, who was abusive throughout her childhood.
Just Practice (JP) Assessment Framework
Power
The first area of concern with Alex is how she relates to individuals in positions of power relative to her. In many cases, she appears to be unduly submissive and unaware of when others are mistreating and abusing her. She ignores concerning behavior from her boyfriend, Alex, including threats of violence and controlling tendencies. When her cleaning client, Regina, stiffed her, Alex was willing to let it go until Danielle forced her to stand up for herself (Metzler, 2021). She is intimidated by Nate, who is far ahead of her in life, and is constantly taking verbal abuse from her mother, who blames her for all her problems.
History
From Alex’s biopsychosocial assessment, it is evident that her history of trauma is a significant issue of concern. She has unresolved adverse childhood experiences that affect her future relationships, especially with Sean. It is commendable that Alex recognizes this and seeks to shield Maddy from suffering her fate. However, she needs to undergo therapy to learn to separate what happened to her mother from herself in a healthy way.
For instance, Sean’s violence causes her to take Maddy and leave in the dead of night without a cogent plan (Metzler, 2021). This move is evidently reckless and nearly results in the death of Maggy in a car accident one night later. Alex must reflect on her past and learn from it without letting it push her into rash decisions.
Risk and Protective Factors
Predisposing Factors
They are weak points or risk factors in a patient that contribute to the patient’s present predicament. Predisposing factors primarily start exerting their influence at an early age and predispose an individual to future mental instability. Examples include genetic and birth factors that can lead to psychological or psychiatric gaps manifesting themselves to the detriment of the patient’s well-being. They can be biological, psychological, or social, depending on the circumstances.
Biological Aspects
Alex’s mother, Paula, has bipolar disorder, for which she refuses to take treatment. When Alexa leaves her in charge of caring for Maddy, she completely loses track of the task at hand, despite initially being enthused about spending time with her granddaughter (Metzler, 2021). She ignores queries on whether she is taking her medication, confirming that she is clinically diagnosed with a mental illness.
Thus, there is a psychiatric history in the client’s family on her maternal side. However, Alex has not inherited her mother’s bipolar disorder and is relatively mentally stable. However, she does suffer from panic attacks during times of severe stress.
Psychological Aspects
Alex has undergone several traumatic childhood experiences that have contributed to her problems in adulthood. Firstly, her mother was a poor caregiver, as evidenced by Alex narrating that her mother once left her playing on the ice in Alaska by herself when the ice broke, causing her to sink into the freezing water underneath (Metzler, 2021). Additionally, her parents were in a largely dysfunctional relationship during her formative years. In particular, her father, Hank, physically abused Paula in Alex’s childhood. Paula escapes her abusive marriage, causing Alex to grow up without a stable fatherly presence and to have a negative cognition of close male figures in the future.
Social Aspects
Alexa grew up in a low-income set-up due to her mother’s lack of socioeconomic stability. Her mother is a talented artist, a painter, without tangible success in her field. They move a lot, so Alex attends six different high schools as they move from town to town in their squalor. At the family level, Alex lacks a proper social experience as she grows up witnessing her parents’ fights and her mother’s mental instability.
Protective Factors
Patients usually have redeeming factors even in the direst of situations, which they can leverage to get out of their illness or psycho-social conundrum. Such protective factors include skills, qualifications, and support systems that can counteract the precipitating factors, provided the patient is guided in their appropriate use. To her advantage, Alex has protective factors at all three levels of the biopsychosocial model.
Biological Factors
Alex is of sound mind and health and has not inherited bipolar disorder from her mother. Additionally, she is physically robust, as evidenced by her ability to perform demanding cleaning tasks to the satisfaction of her clients as a maid. Crucially, she is a mother, which is a significant support, as it means she is highly motivated to get out of her troublesome situation for her daughter’s sake. Her wealthy boss, whose cleaning she takes care of, Regina, is unable to bear children, which leads to her having significant psychological distress to the extent that she stages a child’s room in her house.
Psychological Factors
It is creditworthy that Alex recognizes that her situation is not ideal for her or Maddy, yet she continues in that environment. She can reflect on her childhood and realize that she cannot continue the generational trauma that threatens her and has already consumed her mother. She also has strong coping skills, as she opens up to friends such as Danielle, Nate, and Regina when she needs to talk and get support.
Social Factors
Alex is academically gifted and talented as a writer, which can help her secure a job. She has also secured admission to a college that can enable her to attain financial independence and upward social mobility. She has friends, such as Danielle, who support her as well and prevent her from losing out to depression during her lowest moments. The social worker at the local facility also assists her greatly by clarifying to her that Sean is abusing her.
Areas of Concern
Self-Assertion Problems
Despite knowing Sean’s drinking problem and tendency towards violent outbursts, Alex lets him back into her life. Sean is routinely exerting dominance over Alex’s future, causing her emotional distress. A case in point is when he returned a car Nate had given to her without her consent to prevent her from leaving him and returning to college. Alex is not used to winning when dealing with individuals she perceives as above her on the social pecking order. Therefore, there is a need to work with Alex on improving her self-perception and her ability to stand up for herself.
Deep-Rooted Family Problems
If possible, Alex should attend family therapy in the presence of her mother and father so that they can work out the darkness from their past together. However, this is difficult since Paula is struggling with a mental health disorder, and Hank is still in denial about the abuse he meted out on his family. However, a family-based intervention is likely to yield the best results and leave all four, including Maddy, with a strong and diverse support system in the future.
Conclusion
In conclusion, Alex can benefit from psychological therapy. She has a lot of credible traits that have enabled her to persevere despite a troubled upbringing and a rough turn that had her getting into a relationship with an abusive man, similar to her mother. A biopsychosocial analysis reveals that several perpetuating factors, such as being in an abusive household, must be resolved for Alex to heal. At the same time, she must be motivated to achieve her potential.
References
Metzler, M. S. (Director). (2021). Maid [John Wells Productions]. Netflix.