Case Study

DB- 48; White British, female Homeless

This person is diagnosed with Bipolar disorder and PTSD (post trauma stress disorder)
D was referred for counselling, after completing the DBT treatment last month which has helped
her with the immediate anger management issues. (The historical anger resulted in physical
fights with family and friends). Last episodes occurred in public where her violent behaviour,
ended her up in being detained in a mental health hospital for 3 weeks episode. This was three
years ago.

D said that DBT only helped me cope with immediate anger issues. In her words, I now wants
a proper counselling to exercise her demons.

History
DB was subjected to sexual abuse from age of 5 to 11. This was by her mothers best friends
husband. Although, she stopped up to this man and told him to stop at the age of 11, she was
never taken seriously by her mother who adored this couple.

The first session she DNAd. She apologised for this. The next two sessions were relentless
verbal attacks on her mother who D was clearly angry with for an extensive period of over 40
years. There was no room for me to manage an interpretative intervention. In
countertransference, I felt like the helpless child who had a lot to clarify or say, but was never
given a chance.

3rd session verbatim

S: Hello Debbie, how have you been since the last session?
D: Oh I have been dreaming a lot!
S: Thats very interesting? What kind of dreams?
D: Well I am dreaming all night, it is strange stuff, but when I wake up, booom its, gone out of
my mind I cant remember, much but I know that it was horrible as I wake up really worried?
S: Do you remember anything?
D: Yes, .. this really horrible feeling and I do remember seeing some dark nasty shadows..?
S: Have you experienced these dreams recently, possibly since the time therapy began.
D: Yes within last one week every day. I wake up founding my heart race, palpitations take over
for the rest of the night. I get traumatised! Then again my life has been a big trauma if there is
not one thing its the another?

S: Yes, I understand, how traumatic your childhood was and how angry this has left you with
your mother. Can we try and make sense of events as they occurred historically which
contributed to you arriving in the homeless unit.

D: I first left home when I was 14 I ran off from my mother. It was 4 weeks before my parents
came looking for me. They knew exactly which stall I worked, down in the (Walthamstow)
market. All they had to do is come and find me there. BUT it took them 4 weeks.

S: Where did you end up at the age of 14?

D: Oh the bloke whose stall I used to manage said, I can have a room, as long as I clean his
place keep it tidy. He was a really nice older man. (angry tone) OH but those parents of mine
could not give a toss, until I think my nan created a fuss. They were not bothered. That is MY
MUM!

S: So Did you return to your family home?

D: Yes because they had legal rights over me. And talk about legal, they made me abort my baby.
I was so far out I could have been killed. My mum, the Mrs. Bouqet did not want her daughter
in the teenage pregnancy business.

S: Can I just ask you to return back to when you came back home, were you pregnant, then!

D: Oh no this is after a year, I was pregnant at 15 with my first boyfriend. I remember no doctors
would perform the abortion as I was too far outmy mum rang so many different hospital to
make sure she has my child aborted. Finally she paid a lot of money to have the job done. It was
dangerous for me but she did not care. She just did it because she had legal rights. SHE RANG
EVERY ABORTION CLINIC IN LONDON UNTIL SHE CONVINCED A DOCTOR WHY IT
WAS THE RIGHT THING TO DO EVEN THOUGH I WAS OVER 5 MONTHS. IT WAS
DANGEROUS!! IT WAS DONE DOWN AT THE HOLLY HOUSE.

S: It must have been traumatic, but perhaps your mum wanted to protect you from a huge
responsibility at that age?

D: NAAAH SHE IS ONLY interested in her image not what happened to me. She signed those
papers off. I could not say anything. I was under her legal obligation. My mum is just a witch!....
(getting heated up). I started feeling uncomfortable as she became very loud.

S: Clearly, you are remain very angry towards your mother..as you we have worked through in
the earlier sessions, I wonder if we can now systematically reflect on your reasons for this huge
anger you cannot move away from?

D: Not angry for the abortion only.. but the Mrs Bouquet did not believe that her best
friends husband molested me when I told her. She called me a compulsive liar.

S: What made your mum call you a compulsive liar?

D: I used to get into trouble at school. Punch other children. My mother was always trying to
stick up for me, I never said I did not hit those children, I did! I used to punch walls. My mum
never asked what troubled me, she was busy with her workmaking her house into an
ornamental museum. Seriously, there are ornament and china plates all around the house. She
has all these expensive plates stuck on every wall, so many. I have lived in fear of breaking
these.

S: It seems that you were perhaps afraid of breaking your silence with your mother about your
suffering and by the time you managed to tell her, your anger that had developed, had already
damaged your relationship with your mum?

D: Yes, perhaps, but I was also very angry with myself for not telling that man to stop. A few
months after my 11th birthday, I TOLD HIM TO STOP IT NOW! AND HE DID. I AM ANGRY
FOR NOT TELLING HIM SOONER AS HE DID STOP WHEN I SAID STOP! So why did I
not say it earlier? (very loud high pitch tone).

S: I suppose you were only a child then, who then, perhaps, gradually began to develop an
understanding that you were being abused? It must have been difficult to know what was
happening to you as a child?

D: I did not want to go to their house, but my mother was very trusting of her friend and her
husband. He used to pick his son and me from school and take us home.

S: This is going back 38 years now. Did you inform your school?

D: I told my mother, first who told me that I was a compulsive liar and that to leave the poor
buggers alone. I stopped going to the house though. She said nobody would believe me.

S: How was your relationship with your father? You have not mentioned him at all. It has all
been about your mother?

D: LaughterHysterialHe was never around!

S: What do you mean?

D: He was hardly home. Him and mum did not get on. When he came, he was quiet and never
spoke to me. He did not treat me like a daughter!

S: Any memories of why?

D: Mum was too busy with her ornaments and decorating the house an artificial life. Dad was
hardly there. I dont know why they did not get on. There were fights I hit in my room. I did not
know what to do when I was very young. As I started to grow up to be out on my own, I got
involved with backstreet boys. I had 4 or 5 relationships. Then I married a man at 18, but he was
very violent towards me so this marriage ended on a bad note. I have one boy with him. I met
another man this marriage lasted until he started to abuse me. I also lost one daughter after 17
days of birth. One more son after thisThis man left me as there was a lot of domestic violence.
I started to live in a council house. I had a stall to see me through. My kids are doing well
though. My boys are married I am a grandma but..my daughter hates me. After I lost my
council house..my daughter started to live with my mother. My mother has made my
daughter hate me. My daughter is very bright, not like me She has done10 O levels. I think my
mum is finally created the daughter she wanted. I was rebellious, I got involved with wrong
boys, drugs (marijuana) still take it to help me sleep!

S: D, how did you arrive in the homeless unit?

D: I used to keep a lot of boys off the road, the ones who were known to be bad boys of the area
I protected them by setting up a homely environment. I even turned my living room into a
gym.

D: Were you healing the inner injured person in you?

S: Yes, I was but there was a lot of police visit at my house, but I used to manage them. I told
them, I am keeping these bad boys off the road. I am not harming anyone, but the neighbours got
me kicked out! I lived with another boyfriend for while but once I was in a pub with him, and
this person was just staring at me, I dont know what happened to me I started to ague with him
and punched him in the face and made him bleed. I ended up getting angry with my boyfriend
when we were out in public and there was always fights with public members. He finally left
me. I ended up in this homeless unit. This is the best thing that happened to me.

During late session, it became clearer that D ended up in homeless unit after a number of angry
episodes in public. She ended up being detained and her boyfriend also will not have her back in
is home. At the homeless unit, she was put on a rehabilitation programme, which also includes
DBT. The homeless unit are realising Ds potential after her therapy, that she is fond of rescuing
youth. She has working with youth offending team to guide bad boys off the streets and into
rehabilitation programme. Most of them call her auntie D and visit homeless unit even after
having been settled in community. D is someone very vocal who understands that her childhood
abuse was the basis for a bi polar. At the end of the session, she told me that she has been on
BBC documentary recently. She was also asked to come and sit on a panel with names such as
Anita Dobson from Eastenders to host an event for Womens day. She realises that she has
potential to put things right by helping others. Although, even now when she told her mum that
she has achieved so much in the homeless unit, her mum response was that, I bet you if the
BBC lot find out you were cheating the benefit system whilst your husband was still
home.they would not want to put you on that programme. She said, I can never get my
mother to love me the way I want her as she is really mean woman. I am not the daughter she
imaged. She wanted a pretty girl running in a dress who she can show off to... other. Instead I
became a wicked daughter who used to hit children in the school. I tell my mum, this is her
fault.the way I am. I was the only daughter she had, the only child Mrs. Bouquets
daughter in a homeless unit.hysterical laughter!

In countertransfernce (before D even told me about punching people in public) I had felt that her
rage may get out of control during the session where she may even punch something or even me.
I had to keep diverting her back into the session by introducing some questions to help her focus
back into here and now.