Stopping Hormone Therapy Case Studies
Assessment Immediate Concerns Candice is a 53 year old transgender woman who has just been diagnosed with Chronic Obstructive Pulmonary Disease (COPD), a type of lung disease, after she was taken to the emergency room (ER) for chest pain with shortness of breath, while vacationing with her partner Charles. Candice has been smoking one pack of cigarettes daily for the past twenty-five years, with multiple unsuccessful attempts of cessation. The ER doctor has warned Candice that she can possibly develop emphysema, also a lung disease, if she does not quit smoking soon. Since receiving hormone therapy (Candice underwent gender reassignment surgery in her mid-twenties), she has begun experiencing long term side effects including Type 2 diabetes and gallbladder disease. Currently, Candice is not interested in stopping hormone therapy. Candice’s current support consists of her partner Charles, and a sister she speaks to one-two times annually by phone. Candice’s parents stopped speaking to her since she had gender reassignment surgery. She is employed as a Sous-Chef for a local restaurant, describing her duties as being “high stress”. Candice also states that her co-workers tease her about being transgender,
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leaving her feeling “upset” and “angry” most of the time when she leaves work. A close transgender male-to-female, (MTF) friend of Candice recently passed away, and since this happened, Candice has become isolated, stating she feels “low” most of the time. Prioritizing concerns and issues Candice is currently facing, her health problems are the most alarming. Candice’s smoking habit has contributed to her current diagnosis of COPD, as well as the threat of developing emphysema if she does not quit. Her Type 2 diabetes should also be assessed by her regular physician to impede or slow complications. Regarding her stressors, psychosocial factors should also be considered. Candice’s social support is limited, most of it coming from her partner Charles. A close friend whom Candice possibly had an impactful relationship with recently passed away, in which she has expressed feelings of grief. Contributing to the lack of social supports are coworkers who often tease Candice about her transgender identification.
Treatment Plan Strengths Being a part of the transgender community, Candice has lived her life thus far with great strength and resilience.
With little to no support from biological family, Candice has been able to survive on inner strength and self determination. Her previous attempts at cessation from smoking, including the patch, electronic cigarettes, telephone quit-lines, and hypnotism, also exhibit courage and conviction that she can quit. She has stated that she does not want to stop hormone therapy, because she “can’t live like that” suggests that she has previously experienced the affects of stopping the therapy. Although Candice has endured intolerance from her coworkers, she continues to go to work, also knowing the importance of rest and relaxation by taking
vacations. Treatment Goals Primarily focused on Candice’s physical and mental health, and with the support of her partner Charles, Candice will discuss her COPD diagnosis with her primary physician, with possible referrals for a pulmonologist (lung specialist) and endocrinologist (diabetes specialist). She will identify three to five smoking cessation programs not previously attempted. She will also identify and begin grief counseling/therapy and/or transgender support groups one to three times weekly, relating to her feelings of grief and loss, as well as psychosocial factors related to her transgender identification (the estranged relationship with her parents, and current teasing from coworkers). Candice is currently utilizing ER doctors while on vacation.
Strategies to Achieve Goals
Social Services will monitor and reinforce interventions used to support Candice and Charles in increasing positive coping skills related to grief, loss, and other stressors, as well as support cigarette cessation. These interventions may include referrals to individual and family support groups and/or therapists, and specific cigarette cessation strategies. Referrals to specific specialists such as dieticians in order to help manage Candice’s Type 2 Diabetes and gallbladder disease can also be implemented. Other interventions may include coaching/modeling different forms of positive coping and communication skills, identification of feelings, and practicing specific terms/communication within Candice’s family and social dynamic. Longer term and ongoing goals include continued individual maintenance with grief and loss support services, smoking cessation services, family/individual therapy referrals, as well as transgender community support groups.
Therapeutic Intervention Considering therapeutic interventions, this Social Worker would present psycho-education about how stress and smoking relate, which could be a factor in Candice’s previous unsuccessful attempts with cessation . Introducing beneficial and positive coping skills could improve her chances at quitting for good, as well as assist Candice with improving her general health. Some people use different types of psychoactive drugs, including alcohol, tobacco, and marijuana, in order to cope with stress, and regulate their mood (Kassel, Paronis, & Stroud, 2003). According to the U.S Department of Health and Human Services (USDHHS), cigarette smoke has over 4,000 known chemical agents, and nicotine is the compound more than likely responsible for the behavioral and psychological effects, such as the impact on stress (U.S. Department of Health and Human Services [USDHHS], 1998). Candice’s noted stressors include her job and workload, along with experiencing bulling and teasing by coworkers, and the death of her transgender friend. Candice has also experienced loss when it comes to her parents and sister. She has not spoken to her parents in over twenty-five years, and only speaks to her sister a few times per year. In order for Candice to live a smoke free life, it is imperative that she implements positive and healthy coping skills, which replace smoking, as well as consider grief and loss counseling with an above mentioned therapist. Albert Bandura defines self efficacy as one’s own belief in their ability to succeed at accomplishing a task (Bandura, 1977). Candice’s own sense of belief in her ability to quit smoking could be at risk because she did not have a positive coping mechanism to replace the harmful coping skill which is smoking. Also, since Candice did not succeed at previous attempts, she did not learn what success for her looks like (Becker, DeVillis, Rosenstock, & Stretcher, 1986). This Social Worker could gather information regarding Candice’s previous successes, in order to build off her strengths, what worked for each, and what did not. This Social Worker could also ask Candice about likes and dislikes, suggesting and encouraging positive and pro-social activities such as group exercise classes, meditation, deep breathing, and positive imagery.
Resources Coordination Considering Candice’s immediate needs, referrals to medical specialists, as well as family therapy, grief counseling, and transgender community support groups will be made. Candice’s success at smoking cessation is critical due to her recent diagnosis, as well as the implementation of positive coping skills. Transgender support groups provided by the Pacific Center for Human Growth in Berkeley, California are provided on a daily basis, offering an array of daily groups for transgender and LGBTQ community members. (Pacific Center for Human Growth, 2017). Specialty groups for MTF identified people, and grief groups for those who have recently suffered a loss, would be considered as a referral for Candice. This organization also offers counseling and psychotherapy including individuals and couples’ counseling.
Considering ongoing and long term goals, couples counseling should continue to be implemented. Candice’s partner Charles could benefit from learning techniques on how to support Candice through physical health problems, as well as assess if he would like individual support for spousal caregivers. With the consent of Candice, considering the sensitivity of her relationship with her parents, this worker would suggest that she invite them to one of the counseling sessions to provide some sort of closure. With the assistance of her therapist, Candice could talk about her feelings about the absence of her parents for several years, as well as listen to their feelings. Since Candice has had the habit of smoking cigarettes for over twenty five years, the cessation program identified by Candice should also be continued. Success with this program can strengthen Candice’s self efficacy when it comes to other aspects of her health, such as managing her diabetes and gallbladder disease.
Legal Mandates/Ethical Standards
Recognizing the dignity and worth of Candice, her feelings and requests should be observed, such as not wanting to stop hormone therapy. Noting her strengths as social workers, we will resolve her physical and emotional conflicts in a socially responsible manner (National Association of Social Workers, 2008). Even though Candice has described a hostile environment at work; enduring teasing from her coworkers, there is no indication of imminent danger or intention to harm herself or others. If this were to take place, social workers are legally responsible to warn potential victims, as well as notify law enforcement. Candice has the potential for developing depression due to her physical health, work related stress, and lack of emotional support from peers and family that should be noted and followed up with a therapist and/or psychologist. If Candice decides to join support groups such as the one earlier mentioned, their legal mandates would apply for their programs and organization.
leaving her feeling “upset” and “angry” most of the time when she leaves work. A close transgender male-to-female, (MTF) friend of Candice recently passed away, and since this happened, Candice has become isolated, stating she feels “low” most of the time. Prioritizing concerns and issues Candice is currently facing, her health problems are the most alarming. Candice’s smoking habit has contributed to her current diagnosis of COPD, as well as the threat of developing emphysema if she does not quit. Her Type 2 diabetes should also be assessed by her regular physician to impede or slow complications. Regarding her stressors, psychosocial factors should also be considered. Candice’s social support is limited, most of it coming from her partner Charles. A close friend whom Candice possibly had an impactful relationship with recently passed away, in which she has expressed feelings of grief. Contributing to the lack of social supports are coworkers who often tease Candice about her transgender identification.
Treatment Plan Strengths Being a part of the transgender community, Candice has lived her life thus far with great strength and resilience.
With little to no support from biological family, Candice has been able to survive on inner strength and self determination. Her previous attempts at cessation from smoking, including the patch, electronic cigarettes, telephone quit-lines, and hypnotism, also exhibit courage and conviction that she can quit. She has stated that she does not want to stop hormone therapy, because she “can’t live like that” suggests that she has previously experienced the affects of stopping the therapy. Although Candice has endured intolerance from her coworkers, she continues to go to work, also knowing the importance of rest and relaxation by taking
vacations. Treatment Goals Primarily focused on Candice’s physical and mental health, and with the support of her partner Charles, Candice will discuss her COPD diagnosis with her primary physician, with possible referrals for a pulmonologist (lung specialist) and endocrinologist (diabetes specialist). She will identify three to five smoking cessation programs not previously attempted. She will also identify and begin grief counseling/therapy and/or transgender support groups one to three times weekly, relating to her feelings of grief and loss, as well as psychosocial factors related to her transgender identification (the estranged relationship with her parents, and current teasing from coworkers). Candice is currently utilizing ER doctors while on vacation.
Strategies to Achieve Goals
Social Services will monitor and reinforce interventions used to support Candice and Charles in increasing positive coping skills related to grief, loss, and other stressors, as well as support cigarette cessation. These interventions may include referrals to individual and family support groups and/or therapists, and specific cigarette cessation strategies. Referrals to specific specialists such as dieticians in order to help manage Candice’s Type 2 Diabetes and gallbladder disease can also be implemented. Other interventions may include coaching/modeling different forms of positive coping and communication skills, identification of feelings, and practicing specific terms/communication within Candice’s family and social dynamic. Longer term and ongoing goals include continued individual maintenance with grief and loss support services, smoking cessation services, family/individual therapy referrals, as well as transgender community support groups.
Therapeutic Intervention Considering therapeutic interventions, this Social Worker would present psycho-education about how stress and smoking relate, which could be a factor in Candice’s previous unsuccessful attempts with cessation . Introducing beneficial and positive coping skills could improve her chances at quitting for good, as well as assist Candice with improving her general health. Some people use different types of psychoactive drugs, including alcohol, tobacco, and marijuana, in order to cope with stress, and regulate their mood (Kassel, Paronis, & Stroud, 2003). According to the U.S Department of Health and Human Services (USDHHS), cigarette smoke has over 4,000 known chemical agents, and nicotine is the compound more than likely responsible for the behavioral and psychological effects, such as the impact on stress (U.S. Department of Health and Human Services [USDHHS], 1998). Candice’s noted stressors include her job and workload, along with experiencing bulling and teasing by coworkers, and the death of her transgender friend. Candice has also experienced loss when it comes to her parents and sister. She has not spoken to her parents in over twenty-five years, and only speaks to her sister a few times per year. In order for Candice to live a smoke free life, it is imperative that she implements positive and healthy coping skills, which replace smoking, as well as consider grief and loss counseling with an above mentioned therapist. Albert Bandura defines self efficacy as one’s own belief in their ability to succeed at accomplishing a task (Bandura, 1977). Candice’s own sense of belief in her ability to quit smoking could be at risk because she did not have a positive coping mechanism to replace the harmful coping skill which is smoking. Also, since Candice did not succeed at previous attempts, she did not learn what success for her looks like (Becker, DeVillis, Rosenstock, & Stretcher, 1986). This Social Worker could gather information regarding Candice’s previous successes, in order to build off her strengths, what worked for each, and what did not. This Social Worker could also ask Candice about likes and dislikes, suggesting and encouraging positive and pro-social activities such as group exercise classes, meditation, deep breathing, and positive imagery.
Resources Coordination Considering Candice’s immediate needs, referrals to medical specialists, as well as family therapy, grief counseling, and transgender community support groups will be made. Candice’s success at smoking cessation is critical due to her recent diagnosis, as well as the implementation of positive coping skills. Transgender support groups provided by the Pacific Center for Human Growth in Berkeley, California are provided on a daily basis, offering an array of daily groups for transgender and LGBTQ community members. (Pacific Center for Human Growth, 2017). Specialty groups for MTF identified people, and grief groups for those who have recently suffered a loss, would be considered as a referral for Candice. This organization also offers counseling and psychotherapy including individuals and couples’ counseling.
Considering ongoing and long term goals, couples counseling should continue to be implemented. Candice’s partner Charles could benefit from learning techniques on how to support Candice through physical health problems, as well as assess if he would like individual support for spousal caregivers. With the consent of Candice, considering the sensitivity of her relationship with her parents, this worker would suggest that she invite them to one of the counseling sessions to provide some sort of closure. With the assistance of her therapist, Candice could talk about her feelings about the absence of her parents for several years, as well as listen to their feelings. Since Candice has had the habit of smoking cigarettes for over twenty five years, the cessation program identified by Candice should also be continued. Success with this program can strengthen Candice’s self efficacy when it comes to other aspects of her health, such as managing her diabetes and gallbladder disease.
Legal Mandates/Ethical Standards
Recognizing the dignity and worth of Candice, her feelings and requests should be observed, such as not wanting to stop hormone therapy. Noting her strengths as social workers, we will resolve her physical and emotional conflicts in a socially responsible manner (National Association of Social Workers, 2008). Even though Candice has described a hostile environment at work; enduring teasing from her coworkers, there is no indication of imminent danger or intention to harm herself or others. If this were to take place, social workers are legally responsible to warn potential victims, as well as notify law enforcement. Candice has the potential for developing depression due to her physical health, work related stress, and lack of emotional support from peers and family that should be noted and followed up with a therapist and/or psychologist. If Candice decides to join support groups such as the one earlier mentioned, their legal mandates would apply for their programs and organization.