History of Presenting Problem and Psychosocial History

Mariana and her mother observed that her behavioral and depressive symptoms had developed over the past seven or eight months, about four months after Mariana arrived in the United States from a small, impoverished town in her home country. Mariana was the second of five children born to her biological parents.

Mariana’s mother reported having immigrated to the United States illegally five years ago, along with Mariana’s older sister, seeking a better quality of life. Unable to afford bringing all of her children at once, she left Mariana, then eight, and her younger sister in the care of close family friends. After three years with this family, Mariana and her sister moved in with their maternal aunt. Mariana then reportedly began skipping school and grew increasingly irritable, belligerent, oppositional, and non-compliant with adult requests.

Mariana’s mother reported that Mariana’s father struggled with substance abuse, and when intoxicated he often verbally abused her and, on occasion, the children. The mother’s immigration to the United States was partly an attempt to escape Mariana’s father and remove the children from his care. Mariana’s father remained in the home country for about one year, during which time he had no contact with Mariana or her sister. About a year later, he followed Mariana’s mother to the United States. Although they reside separately, Mariana’s parents have maintained intermittent contact. Prior to reaching the United States, Mariana did not know the details of her parents’ continued relationship, nor that her parents had two more biological children together while Mariana and her parents were separated.

Approximately one year ago, Mariana’s mother arranged for Mariana’s immigration to the United States but could not afford to send for Mariana’s sister as well. Mariana now resides with her biological mother, older biological sister, and two younger biological brothers in a one-room apartment that offers limited space and privacy. Mariana’s mother earns some money working as a cleaning woman. Her father, through odd jobs in supermarkets and restaurants, provides financial support when possible, but the family’s financial resources are limited.

The therapist obtained input from personnel at the middle school where Mariana was enrolled as an eighth-grade bilingual, regular education student. Teachers described her as well-behaved, motivated, and focused in the classroom, receiving average grades of B’s and C’s. Mariana described having had a rich social and extracurricular life in her home country. She particularly enjoyed playing team sports such as basketball. While she currently reported having friends, she had become increasingly isolated and anhedonic over the past seven or eight months, preferring to come home immediately after school to watch television rather than socializing or participating in after-school activities. Based on the intake, the evaluating therapist assigned Mariana a Children’s Global Assessment Score (C-GAS) (Shaffer, Gould, Brasic, et al., 1983) of 55. The scale ranges from 1 to 100, with 100 representing the optimal level of mental health and adaptive functioning, and scores below 61 signifying significant impairment resulting from a psychiatric disorder (Bird, Canino, Rubio-Stipec & Ribera, 1987).

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