Meredith is a 24-year-old female who comes to the community counseling office where you work as a newly hired mental health counselor. On her intake form, she provided the following information, which is based on her answers to the questions on this form.
Birthdate: 1/22/1980
Home: Whiting, MA
Race: Caucasian
Current job: Assistant to the activities director at a nursing home
Parents: Married, both living, Leek, MA
Father: Works full-time as a business manager
Mother: Works part-time as an office clerk
Parents' histories: Father - heavy use of alcohol, two heart attacks; mother - use of prescription opiates for back pain.
Siblings: Meghan, 22, who is employed full-time in the publishing industry in New York City; Molly, 20, engaged to be married, still in college; Sarah, 18 (Meredith reported during her first session that this sister is "acting weird, washing her hair constantly, scared to go outside, almost seems afraid of everyone and thinks everyone is talking about her - she refuses to go to high school"), and Brian,12, who lives at home.
Medical history: Migraines? [she writes a question mark after migraines], menstrual problems [she writes in "serious cramps"]
Mental health history of patient: None
Substance use history of patient: First use of alcohol during first year of college; drinks during celebrations and weekend parties, uses alcohol to help with sleep. Medications: None, "but I think I need sleep medication" [client's words]
Sexual History: [client left questions related to sexual activity blank]
Extended family information: Uncles on Father's side are two "alcoholics?" [she writes the question mark after the term alcoholics]; father's sister was hospitalized for a mental disorder for two years; "maternal grandmother - early death, question of alcohol use."
What prompted you to make this appointment? Meredith writes: "can't sleep, eat, and my work is suffering because I can't think.... I am stressed out...feeling out of control."
1. Based on what the clinician has learned during the intake, what are some of the symptoms a clinician should look for, or ask about when working with this client during the initial sessions? Explain each symptom.
2. What other historical information might a counselor want to ask about?
3. What might a clinician want to know about Meredith's alcohol use and why?
4. What might a clinician want to know about her eating, sleeping, and stress, and why?
5. What conditions would the clinician want to explore when working with this client? Explain why.
6. If Meredith reported that her friends have said that she is "crazy, talking too fast, hyperactive, and unable to pay attention," what diagnoses would you also explore? Could Meredith be suffering from a substance-induced disorder? Explain.
7. How would the clinician determine if Meredith was experiencing a co-occurring disorder or a single diagnosis?
8. Meredith explains in a future appointment that she is in love with Andy, but is scared that her parents will not like this person. She states that she feels stressed out about someone finding out how much she loves this person. It is noticeable that Meredith is not using pronouns.
What other issues might a counselor want to explore? How does this interact with the diagnosis, or does it?
9. What are the treatment strategies that you might employ with Meredith? Why?