Identifying Information: Maggie is a 31-year old white, female who lives in upstate New York and is estranged from her husband.
Reason for Referral: Maggie presented for therapy after a brief psychiatric hospital stay for a failed suicide attempt.
Background Information: Maggie’s husband recently left the marriage, after he found out Maggie had been unfaithful, and lying to him about taking birth control. Maggie can’t sleep, thinks about death often, is unhappy and feels depressed all of the time, has little interest in doing things outside of the home, has problems with her appetite, and cannot seem to stop herself from having brief casual sexual encounters.
Family History: Maggie has a fraternal twin brother, Milo, who also has a history of depression and suicide attempts. Maggie and Milo have been estranged for the past 10 year, but recently have reconnected after Milo’s suicide attempt. Milo now lives in Maggie’s home. Maggie and Milo were raised by their father.
Maggie’s mother left the family to start a new family in another state when Maggie was young. Her relationship with her mother has been strained ever since. Maggie’s father committed suicide, by jumping off of a bridge, when she was a teenager. Aside from her brother, Maggie’s father was the only constant support she had in her life until she met her husband, Lance. Lance and Maggie have been married for two years. Lance is good for Maggie, but Maggie seems to do everything she can to sabotage the marriage.
Lance recently left when he found out Maggie had been unfaithful multiple times, and she had been lying to him about taking birth control pills when they were trying to have a baby. Maggie’s brother was sexually molested by a high school teacher when he was 15 years old, and Maggie was the one that reported the molestation that stopped the relationship. Her brother blamed her for the loss of that dysfunctional relationship, and this is what prompted the beginning of Maggie’s and Milo’s estrangement. Maggie has felt some guilt and responsibility over their estrangement.
Social History: Maggie works as a dental hygienist. Maggie does not have any friends, and feels awkward around other people most of the time. She has forced herself in the past to take on outside social activities, such as scuba diving, cooking classes, nature photography, and salsa dancing. However, regardless of her best intentions, these social excursions always lead to brief casual sexual encounters and she feels even worse about herself. Prior to her brother coming back into the picture, her husband was her only friend and support, but now he has left the relationship. Since her brother has come back into her life, there have been good moments where they been able to reconnect with one another, but there has also been very tense moments from things that have happened in the past.
Medical History: Maggie is currently taking birth control pills. Since her recent suicide attempt, Maggie was prescribed Zoloft 20 mg per day, to help alleviate symptoms of depression and suicidal ideation.
Psychiatric History: Maggie was recently released from a brief stay at a psychiatric hospital after recovering from a failed suicide attempt. Maggie weighted herself down and jumped into the deep end of a swimming pool in an attempt to drown herself. Once at the bottom of the pool, Maggie realized she did not want to die and struggled to free herself from the weights. Through previous communication she left with her brother, Milo figured out Maggie’s intentions and was able to get to her in time and free her before she drowned. Prior to the drowning attempt, Maggie admits to contemplating suicide before by taking a hand full of pills. Maggie saw a psychiatrist when she was a teenager, after her father’s suicide, but has not had any psychotherapy since.
Employment History: Maggie is a dental hygienist at a local dental office. Prior to her employment as a dental hygienist, she waited tables at a local pub while attending school.
Mental Status Examination: Maggie presents to session with a slightly blunted and flat affect. She presents in a dysphoric mood, and becomes irritable when she discusses her relationship with her brother and her mother. Client’s form of thought presents as logical, coherent and organized. Her thought content centers on her feelings of hopelessness, and she seems to be periodically preoccupied during the session. Client’s memory is intact, and she is oriented to time, person, place and situation. Client presents slightly hypoactive, and maintains intermittent eye contact throughout. Her speech is laconic. She seems to be guarded and distant when responding. Client exhibits a degree of intropunitive behaviors and thoughts. She displays no signs of hallucinations or psychosis. Maggie presents clean, well-groomed, and appropriately dressed for the session.
Beck Depression Inventory II (BDI-II): The Beck Depression Inventory II (BDI-II) was administered to Maggie. This screener is a 21-item inventory that rates on a 4-point Likert-type scale, and works to screen for the severity of depression (Yuan-Pang & Gorenstein, 2013). The scores from the screener are calculated to give a total symptom severity score. The symptom severity of clients scoring from a zero to 13 is minimal, from 14 to 19 is mild, from 20 to 28 moderate, from 29 to 63 severe. Maggie scored a 50, indicating severe symptom severity for depression. The BDI-II screener is very consistent with this clinician’s primary diagnosis of Major Depressive Disorder, Severe. This is an inexpensive screener, and has been found to be very effective in screening for symptoms associated with depression (Beck, Steer & Brown, 1996). The BDI-II can be administered as either a self-report or a clinician-administered screener (Beck et al., 1996). Studies conducted in recent years have tested the validity and reliability of the BDI-II cross-culturally, and found no evidence of racial bias (Sashidharan, Pawlow & Pettibone, 2012).
PTSD Checklist (PCL-5): The PTSD Checklist (PCL-5) was administered to Maggie. The PCL-5 is a 30-item inventory that rates on a 5-point Likert-type scale that works to screen for the severity of post-traumatic stress disorder symptoms (Weathers, Blake, Schnurr, Kaloupek, Marx & Keane, 2013). Scores range from zero to 80, and higher scores represent an increased chance the client is experiencing symptoms associated with post-traumatic stress disorder. Maggie scored a 57 on the PCL-5 for total symptom severity, which indicates that although further analysis is warranted, Maggie meets many of the diagnostic criteria for a Post-traumatic Stress Disorder diagnosis and is consistent with this clinician’s diagnostic impression. Conducting a comprehensive psychometric study of the PCL-5, utilizing a trauma population that was cross-culturally diverse, Blevins, Weathers, Davis, Witte & Domino (2015) found the PCL-5 to be psychometrically sound, valid and reliable.
Beck Hopelessness Scale: The Beck Hopeless Scale (BHS) is a 20-item screener that measures aspects of hopelessness in clients, in an effort to screen for suicidal ideation (Beck & Steer, 1978). Scores range from zero to 20, and are also broken into subgroups of focus on feelings about the future, their expectations, and the loss of motivation (Beck & Steer, 1978). Maggie scored a 19 out of 20. The higher the score, the greater the sense of hopelessness, and that puts Maggie at a high risk of a suicide attempt (Beck & Steer, 1978). The BHS should be considered a basis for screening of hopelessness and possible suicide ideation. It should also be important to consider culturally specific interventions that will help reduce hopelessness and promote hopefulness in clients (Hirsch, Visser, Chang & Jeglic, 2012).
Primary Dx: The primary diagnosis for this client is Moderate Major Depressive Disorder, Severe, with moderate anxious distress 296.33 (F33.2). The client’s diagnosis was based on the following criteria, as described in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) (American Psychiatric Association, 2013). The client reports having a depressed mood most of the day, nearly every day with feelings of sadness and hopelessness. The client also has a markedly diminished interest in activities almost every day. Client reports a diminished appetite and insomnia nearly every day. She also has fatigue, feelings of worthlessness, and recurrent thoughts of death with suicide attempts. The symptoms cause the client significant distress and impairment in social and interpersonal situations. The episodes are not attributed to the physiological effects of a substance or medical condition. The client oftentimes feels keyed up or tense, has difficulty concentrating because of worry, and feels like she might lose control of herself.
Comorbid Dx: The comorbid diagnosis for this client is Post-Traumatic Stress Disorder 309.81 (F43.10). The client’s diagnosis was based on the following criteria, as described in the DSM-5 (American Psychiatric Association, 2013). The client was exposed to the traumatic event of her father committing suicide, and she also dealt with abandonment issues associated with her mother leaving the family at a young age. The client has recurrent and involuntary memories of the traumatic events. The client has dissociative reactions in which she feels as if the traumatic event was recurring. The client has intense psychological distress at exposure to internal and external cues that resemble an aspect of the traumatic events. The client works to avoid distressing memories, thoughts or feelings about the traumatic events. The client has exaggerated negative beliefs or expectations about herself, and distorted cognitions about the cause or consequences of the traumatic events that cause her to blame herself. She is in a persistent negative emotional state most of the time. She has a history to detachment or estrangement from others. She has a persistent inability to experience positive emotions. Client exhibits irritable behavior towards others with little provocation. She exhibits reckless and self-destructive behaviors through risky sexual contact. Client experiences insomnia. The disturbances cause her significant distress in social, occupational and other interpersonal situations.
a. Objective: Verbalize a promise to contact the therapist or some other emergency helpline if a serious urge to self-harm arises.
Intervention: Provide Maggie with a “crisis card” with emergency help telephone numbers, making help available 24 hours a day.
Intervention: Develop a safety plan with Maggie, identifying what she will and won’t do when experiencing suicidal thoughts or impulses.
b. Objective: Cooperate with hospitalization if the suicidal urge becomes uncontrollable.
Intervention: Arrange for hospitalization when Maggie is judged to be uncontrollably harmful to self.
Intervention: Arrange for a hospital legal commitment if necessary to protect Maggie from harm to herself.
a. Objective: Maggie will participate weekly individual therapy sessions.
Intervention: Utilization of cognitive-behavioral therapy to assist with cognitive restructuring strategies to identify and evaluate thoughts associated with suicide.
Intervention: Utilization of emotion regulation strategies, such as action urges and choices, mindfulness, and distress tolerance skills from dialectical behavior therapy.
b. Objective: Maggie will learn to manage her depressive symptoms and will increase her ability to choose and utilize coping skills.
Intervention: Maggie will push herself to stay involved with family and friends, make new social connections, and refrain from isolation by going to the movies, for a walk, or catching up with a friend.
Intervention: Maggie will maintain a healthy and regular schedule for her personal life and for work, in the hope of increasing her concentration and motivation which will in turn increase self-esteem.
(Jongsma, Peterson & Bruce, 2014)
S. Maggie is a 31-year old, white female who presents for therapy after a failed suicide attempt. Client reports her husband of 2 year left her after he found out she had been unfaithful to him multiple times. Client shares she does not know what made her cheat on her husband multiple time, because he is very good to her. Client advised she “does not deserve Lance”, and “he is better off without me”. Client advises she noticed her feelings and actions affecting her more in the last 6 months. That was when her husband said he wanted to have a baby. Client shared that she never really wanted to have kids, because all she would do it “mess it up as much as her mother messed her up”. But she didn’t want to hurt Lance by telling him no to having children, so she has been lying and taking her birth control pills without his knowledge.
Client also advised that in the last month her twin brother has come back into her life, after a 10 year estrangement. He attempted suicide and came to live with her and Lance while he recovered. His suicide attempt and having him back in her life has brought about a lot of unresolved feelings about their relationship, about the loss of father, and the abandonment of her mother. Client can’t sleep, and lies awake in bed all night. Client advised she feels sad, hopeless, and depressed all of the time. Client advises that she has a hard time eating, and periodically uses alcohol as a way of escaping what she is feeling; but she was adamant that she does not consider herself an alcoholic. She has recurrent thoughts of suicide. Client also shares that she realizes the brief, casual sexual encounters she had was a bad thing to do, but she did it anyway. Client has no substantive friends, and rarely socializes.
O. Maggie presents to session in a somber and dysphoric mood. She presents with a slightly blunted and flat affect. Client appears to become irritable at times when discussing her mother and her relationship with her twin brother. Client’s form of thought presents as logical, coherent and organized. Her thought content centers on feelings of hopelessness, and she seems to be preoccupied at times during the session. Client’s memory seems to be intact, and she is oriented to time, person, place and situation. Client presents slightly hypoactive, and maintains intermittent eye contact throughout. Her speech is laconic. She seems to be a bit guarded and distant when responding, particularly when discussing anything about her mother. Client exhibits a degree of intropunitive behaviors and thoughts. She displays no signs of hallucinations or psychosis. Maggie presents to session clean, well-groomed, and appropriately dressed for the session.
A. The Beck Depression Inventory-II (BDI-II) was administered to the client. Maggie scored a 50, indicating severe symptom severity for depression. Client’s results of the BDI-II screener, in conjunction with the client’s subjective accounts, and this clinician’s objective analysis and evaluation of the DSM-5 criterion lead to a primary diagnosis of Major Depressive Disorder, Severe – 296.33 (F33.2). The PTSD Checklist (PCL-5) was also administered to Maggie. This screener assesses for post-traumatic stress symptoms and severity. Maggie scored a 57, which indicates that further analysis is warranted.
Due to Maggie’s subjective accounts of her father’s suicide and the abandonment of her mother, and this clinician’s objective analysis and evaluation of the DSM-5 criterion lead to a comorbid diagnosis of Post-Traumatic Stress Disorder 309.81 (F43.10). The Beck Hopelessness Scale (BHS) was administered to the client. Maggie scored a 19 out of 20. The higher the score, the greater the sense of hopelessness, and this puts Maggie at a high risk of a suicide attempt. Regarding the mention of using alcohol as a coping mechanism, further assessment is warranted and will continue. Clinician utilized active listening techniques (i.e. verbal and non-verbal affirmations, eye contact, head nods), worked to make sure the client felt understood, and worked to build a healthy client-therapist relationship throughout the first session.
P. The initial and primary objective is to stabilize the client’s suicidal ideations and avoid any future suicide attempts. Client’s Hx of suicidal ideation, suicide attempts, and recent hospitalization warrant a proactive and aggressive treatment goal to eliminate future attempts and to help Maggie learn healthier coping skills when dealing with her depressive symptoms. Client will verbalize a promise to contact the therapist or some other emergency helpline if she begins to have a serious urge to harm herself. Maggie will be provided with a “crisis card” which will contain emergency help telephone numbers where she can call for help 24 hours a day. Clinician will work with client to develop a safety plan, and to identify what she will and will not do when experiencing suicidal thoughts and impulses.
Clinician to communicate with Maggie that hospitalization could be on the table again if it is judged that Maggie may uncontrollably harm herself. Clinician will utilize cognitive-behavioral therapy to assist Maggie with cognitive restructuring strategies that will help her evaluate thoughts associated with suicide. The utilization of emotion regulation strategies, such as action urges and choices, mindfulness, and distress tolerance skills will also be utilized with Maggie in an effort to get her to reestablish a sense of hope for herself and for the future. Maggie will be encouraged to identify, challenge and replace her unhealthy thoughts with reality-based, positive thoughts. Client will learn and implement calming and coping strategies to manage her symptoms associated with depression and past trauma. This clinician would like to further explore Maggie’s alcohol consumption to eliminate alcohol use disorder, and plans to administer an alcohol use screener during the next session.
Essay Writing Service Features
Our Experience
No matter how complex your assignment is, we can find the right professional for your specific task. Contact Essay is an essay writing company that hires only the smartest minds to help you with your projects. Our expertise allows us to provide students with high-quality academic writing, editing & proofreading services.
Free Features
Free revision policy
$10Free bibliography & reference
$8Free title page
$8Free formatting
$8How Our Essay Writing Service Works
First, you will need to complete an order form. It's not difficult but, in case there is anything you find not to be clear, you may always call us so that we can guide you through it. On the order form, you will need to include some basic information concerning your order: subject, topic, number of pages, etc. We also encourage our clients to upload any relevant information or sources that will help.
Complete the order form
Once we have all the information and instructions that we need, we select the most suitable writer for your assignment. While everything seems to be clear, the writer, who has complete knowledge of the subject, may need clarification from you. It is at that point that you would receive a call or email from us.
Writer’s assignment
As soon as the writer has finished, it will be delivered both to the website and to your email address so that you will not miss it. If your deadline is close at hand, we will place a call to you to make sure that you receive the paper on time.
Completing the order and download