Beth is a 37-year-old woman who lives with her mother and brother in a rented apartment. She is seeking outpatient counseling. You are the intake assessment counselor at a community mental health center. She presents following an argument with her brother and mother after which she considered taking an overdose her clothes of pills and alcohol. She goes on to say that she made a previous attempt several years ago. She was referred to therapy then, but she didn’t like the therapist and says, “I just quit going. My doc says I need to stick with it this time!”
Beth is dressed appropriately for the weather, but are tight and she appears uncomfortable. She tells you that she has been trying to lose weight “forever”. “I’m 5’ 2”, 200 pounds. Nothing fits me!” She suddenly begins to cry. She lets you know that this happens to her all of the time. She is concerned that she has frequent crying spells for no apparent reason. She feels that she has been depressed to some degree since childhood. She states when her mood is especially low, as it has been for the past few weeks, she has difficulty sleeping, feels worthless, “what’s the point?”, and isn’t able to think about the future in a hopeful way. She reports feeling fatigued. She tells you that when she is down, all she does is sleep and eat.
“But it’s not all bad!” She adds that there have also been times when she has felt “good”. She notes that there are times where she has lots of new ideas and where she starts lots of projects but never seems to get around to finishing them. As she talks with you she remembers that during these times she has needed little sleep. After a brief pause, she states that when she has been in that state of mind she has tended to get herself “into trouble” with friends and co-workers. “I get to thinking I’m right. It leads to a lot of battles!” She has lost relationships this way and feels guilty about it. She recounts those episodes as being a “terrible mix of lots of energy and not getting much done … the rest of the time I’m exhausted and down”. She shares with you that she just a few days ago got a creative surge and she worked on her jewelry-making business. “When I’m designing jewelry I can stay up for days. It energizes me! Right now I only need three hours of sleep a night.” She assures you that her jewelry will be sold on the Home Shopping Network soon. She has contacted the Home Shopping Network but has not heard back from them. “But I am sure that I will any time now!”
In exploring Beth’s history, you learn that she left high school at age 17 and eventually earned her GED. She has held two significant jobs throughout her adult life. One was as a cocktail waitress at a local bar where she worked for 7 years. She lost that job when she was hospitalized for “being out of control”. Beth claims her mother “over-reacted” to Beth being upset and angry. Beth tells you the psychiatric inpatient stay was unnecessary. “I would have calmed down fine on my own. But my mother gets scared when I scream and yell a lot.” Beth notes that her mother got concerned because Beth had not slept for a few days, had been talking incessantly, and had purchased $500 worth of jewelry-making supplies.
Beth’s most recent employment ended a year ago due to her having personality conflicts with her boss. She was a waitress at a local restaurant chain. She describes to you in detail how unfairly she was treated, how rude her boss was, and how she could have run the place better if he had just left her alone. When he wouldn’t listen to her suggestions, she left work early one day and never returned. As she tells you this story, her speech is rapid and you have a difficult time following her because she keeps making jokes and puns. Her story is full of examples of her exceptional skill and abilities that went unnoticed by her employer.
Beth tells you she has very few friends. She laments that she has never had a significant love relationship. She dated a little bit in high school. “But nothing ever lasted”, she tells you.
Beth states that she doesn’t drink much at all, and is surprised that she impulsively considered taking an overdose with alcohol. She states she was feeling rejected and not good enough and angry at her family. She feels trapped living with her mother, but has not been able to successfully live on her own. And now that she has no income, she feels that she has no other option. She describes her home life as stressful. Her older brother is an active alcoholic who has become verbally abusive to both Beth and their mother at times.
Eight days ago, Beth’s brother came home drunk again. He staggered into her craft table and spilled all of her beads and jewelry supplies. Beth tells you that this time she had had enough and she ordered him out of the apartment and to get help. Instead of supporting Beth, their mother began chastising Beth for her being angry and aggressive, and ordered her to calm down. Beth felt confused; she believed that she was right in what she was saying to her brother. When she couldn’t convince her mother to agree with her, she became even angrier. “I decided if I couldn’t beat him, maybe I should join him and take a drink with some pills!” Instead though, she went to her bedroom and cried. She wished her father was still alive. Beth’s father died of complications related to alcoholism when she was 17 years old. “I was daddy’s little girl—I miss him so much.”
When asked about her health status Beth says she feels overwhelmed with all the pills she has to take and that this contributes to her negative self-image. Besides being obese and recently diagnosed with diabetes, she also has high blood pressure and high cholesterol. She knows she should exercise but can’t get herself to do it. She has trouble taking all her medication as prescribed and has difficulty saying what her current medication regiment is. “I can’t even get my pills straight! How am I supposed to straighten out my life?”
As you reach the end of the intake hour, Beth reports to you that she feels “down, but safe”. She wonders, “How do you plan to help me?” when she has felt this way her entire life. She seems to not want to be in the session seeing you. She is restless and easily distracted. She is likeable, yet you are left a bit confused and frustrated at the end of the hour. She leaves your office thanking you, but in tears.
1)Use the competency-based assessment model diagram as shown on page 23 of the Gray text. Please list the biological/psychological/social considerations appropriately for this client. Include your assessment of competence (strengths and resources) as shown on the diagram
Biological:
Psychological
Social
1)How might the strengths and resources of this client be used in assessing this client?
2)Please provide a diagnosis for this client. List the numerical code and the DSM 5 diagnosis.
3)What are possible diagnoses requiring additional information for this client? What information is needed and how might you obtain it?
4)Identify the mood episode that Beth is currently experiencing. Explain why you believe this mood episode reflects the symptoms that Beth is presenting with.
