Clarice Precious Jones: Patient History and Therapy Options

Description of Client’s Life and Situation

Clarice “Precious” Jones is a sixteen-year-old child who has suffered from physical and mental abuse from her mother, Mary, and sexual abuse from her father, Carl. The abuse has been life-long, beginning when Precious is three and the latter abuses have led to two pregnancies and two sons, whom Precious names Mongo and Abdul. During her pregnancy, Precious is placed in an alternative school, a place that her principal hopes will help change the girl’s life for the positive.

The family’s home situation is unhealthy and negative on many levels. While her mother works as a bus driver, the family lives in a Section 8 tenement in the ghettos of Harlem and there are not many opportunities for Precious to leave her situation. Her father is a predator and the sexual abuse is not likely to cease and her mother becomes more actively abusive, striking Precious and dropping three-day-old Abdul intentionally after a conflict with her daughter.

At this point, Precious leaves her mother’s residence and, with the help of a teacher, Blu Rain, begins living in a halfway house. However, the peace does not last long and Mary returns to Precious’ life with news that her father has died of AIDS. Precious finds out that while she is HIV positive, Abdul is not, and she struggles with the diagnosis. Mary attempts to regain custody of Precious and reveals more than a decade of child abuse incidences to Precious’ social worker, hoping to convince the woman to help her. With such an extensive history of abuse, the social worker refuses and Precious continues her life without her mother. At the end of the film, Precious is determined to care for herself and her children and is in the process of completing the GED.

Throughout the film, Precious spends time with her social worker, Ms. Weiss, who appears sporadically to help the teen. Their relationship is muddled; a mixture of confidant, social worker, counselor and friend that may have impeded Precious’ progress.The client, Precious Jones, is seeking psychological care to overcome lasting emotional trauma due to abuse and to gain coping skills to maintain positive self-esteem and parenting techniques. She is also currently living with HIV and while she has dealt with the initial diagnosis, she may need support relating to her illness.

Description of Abuses toward Victim

Precious has been a victim of emotional and verbal abuse for most of her life, her mother and father both attempting to manipulate her by using familial guilt and manipulation. On several accounts, Mrs. Jones forces her daughter to consume food even though Precious is not hungry and verbally abuses her on a daily basis. While physical abuse seemed to occur in fewer frequencies than the emotional abuse, the Precious has lived with the constant fear that she will be hit or slapped on a daily basis. One of the worst instances seen in the video is when Mary hits her daughter and then physically harms days-old Abdul in an attempt to manipulate Precious. Precious’ response to the abuse of her son was the catalyst for her leaving the abusive home situation.

Sexual abuse is also apparent in the client’s relationship with Carl, since he is the father of her sons. While it isn’t clear exactly when this started, it is obvious that this abuse has occurred over a long period of time because it seems commonplace for Precious and she does not seek help for it. She does, however, attempt to mask the fact that it is happening and does not openly reveal who the father of her children to her social worker or any other adults.

The parenting style that has been apparent in Precious’ life from her mother has largely been Authoritarian; Mrs. Jones is demanding yet unresponsive to her daughter’s needs (Wolfe, 1987, p.22). When her demands are not met, the mother responds by abusing her daughter, and, when she finds this ineffective, abuses her grandson to illicit the response she desires. Since it is likely that Mrs. Jones has been inflicting this sort of damage on Precious for much of her life, the teen will need guidance in parenting her own child and learn the importance of boundaries.

Toward the end of the film, Mrs. Jones admits to Ms. Weiss that she is aware of the sexual abuse that has occurred as well as the other abuses that have been inflicted on Precious. She is fully aware of the abuse yet done nothing, and approaches the social worker with the plan of getting custody of her daughter and grandson.

Short Term Impacts of Abuse

The short-term impact of abuse on the client is a daily fear of bullying, abuse or harm for herself and for Abdul that keeps her from being able to pursue her education and impedes her ability to be happy. Homelessness can also be an issue for adolescents, since they often leave the abusive situation and have no other place to return to than the abuser’s home. Offering a teen options for living arrangements, such as a halfway house, allows them the environment they need to seek education, work, counseling- or a mixture of the three- without constant consideration of where they will sleep at night (Administration for Children and Families, Office of Planning, Research and Evaluation, 2012).

Long Term Impacts of Abuse

The long-term impact of physical abuse is the possibility of an abused woman continuing the cycle of abuse and begin physically abusing her own children. While many studies have shown that evidence of children who were abused as children are not necessarily more likely to abuse their children, it is a key point to consider simply because of the abused child’s models of parenting are very poor (“Cycles of Violence in a Child Physical Abuse”, 1991). While Precious may not use violence, coercion or manipulation in her relationship with Abdul, she may still struggle with understanding what is appropriate and inappropriate for punishment; offering her parenting classes or resources relating to this skill may be advantageous for both Precious and Abdul. Again, this advisement is not based on Precious’ personal actions toward her son, since she has shown herself to be a loving and protective mother, but rather to ensure that Precious has been offered support since she is facing multiple challenges such as socioeconomic status and age. There are some cases where the adolescent shows rage and hatred for the child since he or she is a reminder of the abuse that took place (“Cycles of Violence in a Child Physical Abuse”) so the psychologist must consider this if the mother begins to act out on her child. Again, Precious does not appear to show any proclivities of violence toward her child, signs must be watched for, in case she suffers a setback in her care toward Abdul.

There are also long term physical impacts of the abuse for Precious, especially since the sexual abuse caused two pregnancies and live births. While there is no collected statistics on precisely how many adolescent pregnancies are caused by incest, they are frequent enough that state abortion laws may include leniency in cases of rape or incest (McGregor, Thomas & Read, 2006). Precious’ obesity may also have been caused by her abuse as adult who were abused as children are “more likely to suffer from cardiovascular disease, lung and liver disease, hypertension, diabetes, asthma, and obesity” (Child Welfare Information Gateway, 2013; Felitti & Anda, 2009).

Sadly, one result of the sexual abuse is Precious’ positive test for HIV, spread to her by her father at some time during the abuse. While Abdul did not test positive, this will be a challenge for Precious in the future years as the illness progresses and she becomes more ill. Ensuring that she is aware of medical resources for her is extremely important as she will need continued support and care, both mentally and physically.

There are also long term physical impacts for Abdul, while he is not the focus of this therapy, the therapy will benefit her son as she learns to cope with the abuses. There are also times when the physical abuse may cause harm to the boy. For example, Abdul is purposefully dropped on the ground as an infant by his grandmother, the effects can also be abusive head trauma which may impact brain development and cognitive abilities (Child Welfare Information Gateway, “Long Term Consequences”, 2013). It seems that no lasting damage was done to the infant but if Precious chose to stay in her mother’s apartment it is also likely that Abdul would be in danger of harm as well.

Damage to Children Raised in Abusive Situations

Children in abusive family situations may struggle in several different ways: mentally, emotionally, cognitively and socially. Trauma during the childhood years may have serious implications on children the Child Welfare Information Gateway (2013) states, such as: causing borderline personality disorder, depression, anxiety disorders and other issues, such as high risk of suicide. In fact, data from the same group describes the Adverse Childhood Experiences study (ACE) that found that of women who attempted suicide 58% connected their traumatic childhood to their attempt. Oftentimes, the problems that arise as children because of abuse are perpetuated by the victim as an adolescent or adult. Mental and emotional health issues lead to juvenile delinquency and increase criminal acts as adults (Gold & Sullivan, 2011). Precious seems to have avoided delinquency and has kept herself on a positive path, regardless of the situation that she is in and the people around her notice it; the principal who placed Precious in the alternative school, Blu Rain and Ms. Weiss, her social worker.

Psychologically, abuse victims face a great number of mental health issues, both during the abuse, as well as many years after the abuse. These individuals may suffer from fear and an inability to trust, as well as self-esteem problems and depression because of the harm that was done to them. For example, Precious’ boundaries are so non-existent she seeks to create her own comfort through food and she admits that she has problems with overeating. In relationships, abuse victims may struggle to form relationships or may even choose relationships that are familiar and harmful because of the continuation of abuse (Child Welfare Information Gateway). While Precious may struggle internally with self-image issues, she also seems to be resilient, projecting a tough personality and avoiding long periods of depression. However, one impact of the abuse for Precious is that she will likely face serious difficulties in finding and maintaining healthy social and romantic relationships. While she is drawn to a hospital orderly and his kindness, she is still more likely to find a relationship where the abuse continues. During the film, however, she does not appear to seek a romantic relationship and seeks social relationships with adults in her life, such as her teacher and social worker.

While the close of the films shows Precious still working toward getting her life together, any counselor or psychologist who works with her will also have to be vigilant in watching for signs of post-traumatic stress disorder (PTSD) brought on by triggers in her day to day life. This is especially true if she is in a situation that may involve relationships or dating, since PTSD symptoms may flare up in the form of anger and violence toward her partner because of her previous abuse as a child (Kendra, Bell & Guimond, 2012). The researchers noted that while some of the abuse victims showed few symptoms in everyday life, certain situations triggered attacks of anxiety, rage, violence, depression and other symptoms, especially in young women who were victims of sexual abuse and were now seeking romantic relationships (2012). Desire for a romantic relationship does not appear to be a concern for Precious, however, it does not mean that she may not eventually need consideration and treatment for this particular problem.

Victims of abuse struggle to continue academic pursuits for several reasons: one being that they often do not have the stable structure needed for attending school regularly as well as completing homework and assignments. In the classroom environment, the child or adolescent that experiences early childhood trauma often struggles to fit in and may act out, or inversely, may be withdrawn (Reyome, 1993). The impact of abuse is present in Precious’ academics, although she was placed in a continuation school that has encouraged her success. However, her decision to leave her mother’s apartment and the relating homelessness did also lead to some issues in attending classes. Precious did decide continue her education and pursue a GED, however, there are many other abused young people who do not since the need for shelter and safety far-outweighs the need for education. If Precious is able to complete a level of education she will have more opportunities that will lead to her being able to financially support herself and her son.

Culture and Socio-economic Status

Unfortunately, Precious’ story is not uncommon in the African-American community, with 44% of black women reporting some form of sexual abuse as a child (Urquiza & Coodlin-Jones, 1994). Many more women have grown up in Precious’ situation; being victims of fathers, uncles and brothers with shame causing them to hide the abuse. Her family seems to be of the same mind, Mrs. Jones is aware of the abuse and knows who the father is. The grandmother also knows that there is abuse and does little to prevent it, although she is caring for Mongo, Precious’ first child.

The Jones family also is of lower socio-economic status, the mother is employed outside of the home but does not appear to make enough money to support the family without social and government assistance. Poverty can also lead to other issues that may act as stressors on the family; including lack of child care, poor nutrition, unsafe neighborhoods, inadequate housing, financial strain and lack of privacy (Whipple et al, 1991). Several times throughout the film, Precious has selected low-cost food items to prepare for herself without consideration for the healthiness of the food (Watkins, Hayes, Patterson & Armour, 2011) simply because it was the only food that was available because it was inexpensive and easy to obtain.

Therapy Options

The DSM diagnosis for the primary client is anxiety, self-esteem issues, possible dissociative disorders, sexual abuse, academic problems, an eating disorder and possible PTSD.While there are different options for therapy for Precious, including: psychodynamic psychotherapy, cognitive behavioral therapy, creative artistic therapy, music therapy and group therapy. The recommended approach to therapy for Precious is Game-Based Cognitive-Behavioral Group Therapy (GB-CBT) that has been adapted to be culturally sensitive for her situation; a focus on urban, economically disadvantaged and African American groups. GB-CBT is an “innovative treatment approach [that is focused to serve] economically disadvantaged, urban African-American and Latino victims of child sexual abuse” (Misurell & Springer, 2013). One of the reasons this treatment has been selected is that the African-American community often feels reluctant to seek help for their victimized children or to seek help for their own abuse issues because of mistrust and skepticism regarding treatment (Carter, 2005). However, getting Precious to engage in dialogue with other victims of sexual abuse with individuals of similar background may help her feel less isolated and more willing to attend therapy.

Group therapy may also appeal to Precious because she has already shown improvement from other community groups she has been involved in, such as the young women she meets and gains the support of while preparing to give birth to Abdul. She was able to reach out in ways that she could articulate and these young women understood the situation of being a young, teen mother. Placed in a similar support community of victims of abuse, Precious may find a way to voice her painful upbringing and the struggle that she will have to endure as she faces her HIV positive future.

Art therapy is also another possible therapy for Precious, as she has already shown a desire to express herself in creatively through writing and poetry. Since art therapy has been used successfully as an intervention, the therapist may gain understanding of the family boundaries, her self-concept and her relationships with others. In Terry Pifalo’s article “Mapping the Maze: An Art Therapy Intervention following Disclosure of Sexual Abuse” (2009) the author found that visual mapping:

[S]upported the women’s needs to relate their trauma narratives to others, to identify and process powerful emotions, to develop coping skills, to identify past and future risks for further victimization, and to set goals for the future. This may have been helpful when Precious had newly revealed her abuse to help her articulate what was occurring, however, her writing in her English class has also allowed her to share information about her father’s sexual abuse and also given her an outlet to express herself. While mapping includes a more artistically visual approach, continuing treatment with art therapy may allow Precious to express herself in a medium that she is comfortable with. Since she has opened up about the abuse that occurred, art therapy can help her identify the struggles she is still facing, including developing coping skills for the problems of the past, as well as how to cope with the problems that will occur in the future. As she continues her therapy, artistic expression will also be important in describing her relationships with others, including her son and herself. Sharing her work with other women who have experienced similar abuse may also help Precious understand her own emotions better since she will find some common ground (Pifalo, 2009).

Both of these therapies have potential for Precious as there are several scenes in the film where the audience sees her amazing imagination at work. She imagines she is at a movie premiere while she is being raped, for example, and imagines her mother treating her with the respect of a countess. Using the strengths of her own mind will likely serve Precious well. However, there are also signs of dissociative disorder where Precious hides in her fantasies because she is unable to cope with her current life, so it is important for the therapist to help her focus her attention on using her imagination to deal with her life.

Treatment Plan

There are many issues that have brought Precious to seek therapy and she would have benefited from a treatment program many years before now. Working to build her self-esteem would be an instant improvement for the young woman, as she is attempting to navigate an adult world and make decisions on her own. Helping her come to terms with the abuse and dissuade her thoughts about fault and responsibility can help her become a healthier individual, regardless of her past. Teaching Precious to cope with the abuses of the past as well as her current situation are of the most importance, she needs to learn to live in the life she is in while also working to make peace with her past. Treatment for her eating disorder is of absolute importance as she learns to care for herself, she eats to numb her emotions and to control an aspect of her life, but she finds little pleasure in it. She is likely eating to keep men away from her, and perhaps, keep her father away.

Precious has decided to sever all ties with her father and mother and this is likely to be the best course of action for her. The family would benefit from therapy as a whole, since Mr. Jones may begin to prey on young relatives and Mrs. Jones may seek to gain custody of Abdul after Precious is too ill to care for him. The family is the origin of many of Precious’ problems; her mother’s poor mental health meant that she was not able to care for Precious and abused her daughter in harsh and disturbing ways (such as forcing the teen to consume food). The father is a predator of his own daughter and has a history of seeking sexual attention from many different partners. He seems to care little for the child that he fathered, nor does he seek to make amends after his HIV diagnosis. Precious’ goal in her life does not seem to include her mother and father so it would be best to continue this, instead focusing on Precious herself and Abdul, including treatment that works to create a better self-image and parenting and coping skills. The treatment plan may be an extended time as she may need support from a therapist as her life changes.

The client may desire a friendly relationship with her therapist; however, it is more helpful for Precious if she understands the caring but professional nature that is needed to offer her the most support. The child protective service worker will need to be involved to help Precious get the resources that she needs to live; including housing and medical care. Maintaining this communication is also vital as Precious will need more support as the years continue. Intervention may be necessary if Precious becomes too ill to care for Abdul or if she is no longer able to care for herself, physically or mentally.

In conclusion, there are many aspects of Precious’ life that will need to be examined carefully by a therapist to offer the best treatment for this young woman. She will need an individual capable of handling disturbing abuse and coping skills to help her deal with her current situation of being a young, poor, HIV positive mother in an urban environment. While Precious’ struggles are far from over, there is hope for her as she is a resilient and focused individual who can blossom with the right support.

References

Administration for Children and Families, Office of Planning, Research and Evaluation.(2012). Adolescents with a history of maltreatment have unique service needs that may affect their transition to adulthood. Retrieved from http://www.acf.hhs.gov/sites/default/files/opre/youth_spotlight_v7.pdf

Carter, R. T. (2005) Teaching racial-cultural counseling competence: A racially inclusive model. Handbook of racial-cultural psychology and counseling: Training and practice (volume 2, p36-56) Hoboken, NJ: Wiley

Gold, J., Wolan Sullivan, M., & Lewis, M. (2011). The relation between abuse and violent delinquency: The conversion of shame to blame in juvenile offenders. Child Abuse &Neglect, 35(7), 459–467.

Kendra, R., Bell, K., & Guimond, J. (2012). The impact of child abuse history, PTSD Symptoms, and anger arousal on dating violence perpetration among college women. Journal of Family Violence, 27(3), 165-175. doi:10.1007/s10896-012-9415-7

Long term consequences of child abuse. (n.d.). Child Welfare Information Gateway. Retrieved February 2, 2013, from https://www.childwelfare.gov/pubs/factsheets/long_term_consequences.pdf

McGregor, K., Thomas, D. R., & Read, J. (2006). Therapy for child sexual abuse: Women talk about helpful and unhelpful therapy experiences. Journal of Child Sexual Abuse, 15(4), 35-59. doi:10.1300/J070v15n04-03

Misurell, J., & Springer, C. (2013). Developing culturally responsive evidence-based practice: a game-based group therapy program for child sexual abuse (CSA). Journal of Child & Family Studies, 22(1), 137-149. doi:10.1007/s10826-011-9560-2

Pifalo, T. (2009). Mapping the Maze: An art therapy intervention following disclosure of sexual abuse. Art Therapy: Journal of The American Art Therapy Association, 26(1), 12-18.

Reyome, N. (1993). A comparison of the school performance of sexually abused, neglected and non-maltreated children. Child Study Journal, 23(1), 17.

Urquiza, A. J., & Goodlin-Jones, B.L. (1994). Child sexual abuse and adult revictimization with women of color. Violence and victims, 9, 223-232.

Watkins-Hayes, Patterson & Armour. (2011). Precious: Black women, neighborhood HIV/AIDS risk, and institutional buffers. Du Bois Review, 8 (1), 229-232).

Wolfe, D. A. (1987). Child abuse: implications for child development and psychopathology. Newbury Park, Calif.: Sage Publications.