Use DSM 5 manual
Below are your first case you will be discussing. Make sure you provide a full diagnosis including any specifiers that may be relevant. I will be monitoring your work carefully for this first group of cases.
The Case of Aleta Austin
Aleta Austin is a 26-year-old woman who was seen by an LPC during her first clinic visit. When asked what brought her in, Aleta explained, “I work as an aide in a nursing home, and I was lifting a patient up from a chair to her wheelchair. Well, anyhow, all of a sudden I felt this terrible and very painful snap in the back of my neck. I lost my balance and fell on the floor. As I was falling, I hit my arm real bad, too. The next thing I knew, I was in the hospital, and they were doing some X-rays and an MRI. The doctors said I sprained my neck, and I might have a hairline fracture of my arm. They put some kind of neck brace on me and said I had to wear it for two weeks. I didn’t need to have a cast on my arm, but I was supposed to be real careful.”
Aleta continued, “I wasn’t allowed to work for six weeks, so I got workmen’s comp—but the checks stopped when the doctors said I could go back to work. It has been four months, and they say that’s too long to have pain for the injury I got. So now I have money problems on top of everything else but I don’t care what they say, I still hurt.” Apparently without realizing it, Aleta was rubbing her neck while she was talking. She went on, “After being discharged by those doctors, I went to see several new ones. I thought, you know, maybe the first ones didn’t know what they were talking about.”
The LPC asked what other doctors Aleta had seen.
“Well, over the past three months,” she replied, “I saw two orthopedic surgeons, one neurologist, two chiropractors, and a massage therapist. I was given lots of different medicines and treatments, but I still didn’t get much relief. One of the doctors said I should see a shrink. He thought my problems were all in my head. Can you beat that?” Aleta sounded very annoyed. “That really steamed me—doesn’t he realize I really want to go back to work and see all my friends again? Not only that, does he think I like being in constant pain? Does he think I like taking all this medicine and not getting any relief from any of it?”
The practitioner asked Aleta about the medications she is currently using.
She answered, “In the beginning, they gave me some pain pills that helped some, but the doctors won’t prescribe anything for me now. They think I’m getting too used to all the pills. Now I can only take over-the-counter stuff like, you know, aspirin, Aleve, Tylenol, Motrin—but they don’t do much good. Nothing seems to help nowadays.”
When asked how she spent her days, she replied, “I pretty much stay inside the house all day long. I have a hard time finding a comfortable place to sit or lay down. My brother, Chad, brought over his favorite recliner chair for me to use, and that does help some. Most of the time I watch TV, sleep, or play with my dogs.” Aleta volunteered that she and her husband are “in the middle of getting a divorce after being married five years.” She stated, “It was his idea, but I guess it’s all for the best. During the time we were married, I realized that I am a lesbian, so … I always felt different from other women and a little confused about this. I tried really hard to justbury these feelings—my family sort of freaked out. It’s so hard to come to terms with this. . . . But I can’t believe he wants a divorce after all the time we’ve been together. He doesn’t know about me being gay, and he told me he isn’t seeing anyone else—he just said he was tired of me being sick all the time. I don’t believe him.” Aleta studied her fingernails for a moment. “Well, like I said, maybe it’s for the best. He’s absolutely no use to me now.”
The practitioner asked Aleta to say a little more about that. As it happens, Aleta’s parents had moved into her home three months ago, “so they could help out while I was recovering,” she explained. “My dad works full-time, as a barber, but he finds the time to mow the grass, run errands, and do the house repairs. I’m starting to get a little behind on my bills, and Dad tries to help out a little in that department, too.” Aleta repeatedly stated she wanted to go back to work; however, she also said, “It’s kinda nice to have Mom and Dad around the house right now. Mom fixes all my favorite foods—[laughing] I know I’m gonna gain ten pounds before she leaves to go back home!”
“You know, my mom told me that when she was younger, she had problems like me. I guess when she was a teenager she had problems with pain in her back for a really long time. Isn’t that weird? Mom said when she was around 20 she had trouble with really bad headaches and something with her breathing—she doesn’t liketo talk about it much.” Aleta related that she once asked her Aunt Dolly (her mother’s oldest sister) about it, and she had just said, “Oh, it’s just something the Walker women get when they are young’uns.” When asked if she had experienced any previous psychological problems such as hallucinations, delusions, depression, suicidal ideation, or anxiety, Aleta laughed, and said, “My lord, no. Aside from this neck and arm pain, my health has been somewhat good.” She described herself having frequent bouts of low back pain, headaches, and “sometimes my jaw hurts real bad, off and on,” she offered, “but overall I don’t have any serious medical problems.”
During the relating of her past medical history, the LPC observed that Aleta’s train of thought had been derailed somehow. Sure enough, she interrupted herself, “You know, I’ve been thinking about the question you just asked, the question about psychological problems. Does sibling rivalry count as a psychological problem?” She continued, “When Chad, my brother, and I were growing up, we fought like we were mortal enemies. I mean we hated each other. I always felt like Chad was Mom’s favorite, so I grew up feeling like a Secondhand Rose, it was awful.” The session continued along these lines for another I5 minutes or so. When the time was up and Aleta was walking out the door, she said to the LPC “You know, it’s really great to have all of my mother’s attention right now because I’m in so much pain.”
