Twana M. Williams
The client, Lisa M., is a 58-year-old single Caucasian female. The client has never been married, and has no children. The client presents with Alcohol Dependence, Bulimia Nervosa, Purging Type, and Major Depressive Disorder. At intake the client presents with emotional symptoms of guilt, low self-worth, and shame. The client also exhibits dysfunctional cognitive symptoms such as self-criticism, dichotomous thinking and personalization of past events. The client also exhibits negative behaviors including purging and alcoholism.
The client currently lives in her own home in Naples, FL. The client grew up in Connecticut with four siblings (two brothers and two sisters) and married parents. The client is the eldest child of an intact family. The client survives one older brother and both parents. The client has a familial history of substance abuse; her mother, maternal grandfather and both brothers were alcoholic. The client’s mother was diagnosed with depression and her father was also bulimic.
The client stated that she identifies with her Irish heritage and the Catholic values that she was raised with. The client described her cultural principles as hard working and persistent, but also stated that her culture has influenced her feelings of shame and guilt. The client described a somewhat difficult childhood as her father was a traveling salesman and was often absent from the home. The client stated that she became very heavy during early adolescence and by age 12, she weighed 202 lbs., which led her older siblings and schoolmates to bully her. The client stated that throughout her childhood her mother was emotionally “absent” and gave the client very little attention or positive reinforcement. The client reported that her mother acted as if she were “annoyed or bothered” by the client. The client also said that she was treated differently than her brothers and sisters; “standards were set high” for the client and she was continuously “criticized” by her mother. The client stated that her mother became alcoholic when the client was 13 or 14 and as a result, would do “crazy things” such as fall down when intoxicated. As a result of such intoxication, the client was often forced to care for her younger siblings, which she found “impossible no matter how hard [she] tried.” At age 13, Lisa began babysitting, and she would often drink alcohol that was leftover from the homeowner’s before going out. At age 14, the client stated that she had frequent extreme abdominal pain, which she called “gallbladder attacks” that went undiagnosed for one year. When the client would complain about the pain, she was told to “be quiet” and was called a “drama queen” by her mother. At age 15, the client had her gallbladder removed. Lisa denied any history of sexual or physical abuse during childhood.
The client’s father died in 1998, her brother passed in 2009, and her mother died in 2006. The client moved to Florida roughly nine years ago to care for her mother before she died. The client stated that she had hoped that when she moved to FL after her mother became ill, their relationship would improve and the client would “finally get the love and acceptance [she] needed.” Unfortunately, the client did not; her mother became “even more cold hearted than she was when [the client] was growing up.” The client reported that she feels that she “left too many things unsaid.”
The client stated that she was diagnosed with depression at age 18 and experienced “a lot” of depression throughout her life. The client is currently prescribed Effexor and Trazodone, which she reports have alleviated “some” depressive symptoms, however feelings of guilt and worthlessness persist.
The client stated that she experienced date rape at age 27, and continues to feel a great deal of shame related to the incident. The client stated