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• Identify one issue you want to work on with your client.
• Write a goal statement in SMART goal format.
• Identify and describe an evidence-based intervention/treatment model or approach that you want to implement.

Amella Abraham Case Study

Client Background

Amella Abraham, age 16, is an African American transgender adolescent girl who lives with her parents, Tameika and Dejon Abraham, and her three older brothers, Amante, Asaad, and Audell, in Jackson, Mississippi. Amella was born Amell Dejon Abraham, but even as a young child, she knew she was different than other kids in her school and neighborhood. She preferred to play with dolls and liked to dress up as a young child, much to the glee of her older brother Asaad, who teased and tormented her ceaselessly, calling her names like “little weirdo” or “sissy-homo.” When Amella was younger, her parents simply ignored her “unusual” behaviors. She sometimes heard them talking to each other about her, saying that “he will grow out of this when he gets to school” or “he just needs God’s guidance and clear rules to understand what’s right and wrong.”

Amella’s parents own the Blue Turtle Inn in the Farish Street Neighborhood Historic District of Jackson. The neighborhood, which was a thriving Black-owned business sector in the 1940s, '50s and '60s, physically crumbled after segregation ended. Recently, business leaders have been trying to revive the district, and Amella’s parents want to do their part. Their diner is a favorite lunch spot. Dejon is a trained chef who has earned regional recognition, and Tameika has a degree in hotel and retail management, taking care of the front end of the diner. Both are very focused on making “our life’s work” a success before passing on the business to their children.

Dejon and Tameika are very religious. They attend their neighborhood Baptist church every Sunday and expect all of their sons to accompany them. They believe that regular prayer and moral conduct are important for true salvation. When Amella was very young, they believed that her tendency to dress “girlish” was a phase of exploration and that strong and directive parenting practices would make their son learn his place. Instead, Amella knew by age 3 that she felt like a girl. At age 11, she began using the pronouns she/her/hers and asked to be called “Amella.” Her brothers, 17, 14 and 13 years of age at the time, were all actively involved in playing football or basketball on their respective schools’ teams and had mixed responses. Audell continued to use male pronouns but made a greater effort to spend time with Amella. He knew she didn’t have many friends and hoped that Amella would “come around” if she had a male role model to look up to. Asaad simply laughed at Amella and said that he would call her “Gaymella” or “Ugly-ella” because she acted gay and was ugly … a promise he has stuck to ever since. Amante has tried not to use pronouns at all and quietly calls her “Amella” when no other family members are around.

Amella is offended by Asaad’s rude comments and frustrated by Audell’s efforts to convince her to embrace masculinity but, in her opinion, they are typical “jocks” and not very bright, and she tries to stay out of their way. She is, however, deeply hurt by what she perceives as her parents’ unwillingness to love her unconditionally. Initially, Amella’s

parents were baffled and dismayed by what they considered Amella’s “unnatural” request. They were unsure about how to deal with it and stuck to their strategy of ignoring it along with her “strange” behaviors. However, by age 12, Amella began dressing more explicitly like a girl, which angered her father, who said, “As long as you live in my house, you better not act like a pervert; God made you as a boy, and it is a sin to pretend to be anything different.”

Amella’s mother has been a bit less severe, but she, too, has continued to try to dissuade “my beautiful boy” from “acting like a girl and attracting attention you don’t want.” She has asked Amella to pray every day for God’s forgiveness and guidance. Once she even took her to see their pastor. He commanded Amella to live like God intended her to, and when she voiced the belief that God intended her to be happy as whoever she is compelled to be, he said she was “taken in by the lies of Satan” and asked her to pray with him.

Present Functioning

Things have been very difficult at school lately. Amella enjoys learning and excels at math, but she has had difficulty concentrating on more than one task at a time and is often scolded for forgetting to complete her assignments. Amella has a few acquaintances she sits with at lunch but no one she considers a true friend; the majority of the student body considers her an outcast and treats her accordingly. In the best circumstances, they ignore her, but she also has become the target of both physical and cyberbullying. She has received death threats for being “a pedo” and being a “stain on the community.”

Many of her teachers are also very religious, and most have either directly or more subtly let her know that they do not condone her “indecent and ungodly acts.” They tend to look the other way whenever other kids torment her.

Some time ago, Amella joined an online chat platform in search of a space where she could be herself and talk to others who understand her. There, she was introduced to an engaging multiplayer internet video game and was surprised to discover that she was highly skilled at it due to her ability to hyperfocus.

Amella has been spending more and more time online and has developed friendships with other video game players, several of whom identify as part of the LGBTQ+ community. She is much more comfortable in this virtual world than in the real world and has been staying up into the middle of the night to play and chat to ease her loneliness. She has also begun vaping to “take the edge off” the painful experiences of rejection she endures both at home and at school.

At first, Amella would vape only once or twice a day in a private wooded area on her walk home from school. However, as time passed, she has grown to crave the peaceful feeling vaping provides and has begun to vape much more often. During the past few weeks, Amella has been vaping more than 12 times a day, including in the school bathroom and behind rows of lockers in between her classes. She knows that she is

being reckless and will get in trouble with school authorities if she were to be caught, but her body has begun to feel like it can’t function without nicotine.

She also knows her parents would be deeply disappointed with her if they were to find out, but she feels she has no other way to numb her stress, anger, and pain. A few days after her 16th birthday, everything came to a head. Amella was caught vaping by a teacher, and the school principal called Amella’s parents in for a conference. Amella’s parents were shocked and embarrassed when they arrived at the school. They thought there must have been some kind of misunderstanding and were baffled to learn that Amella apparently had a significant vaping habit and was unsure if she could stop. Amella’s principal and school counselor noted that Amella had also been acting very tired and unfocused at school in recent months and that they had heard about some bullying incidents. They recommended that the Abraham family seek therapy for Amella.