• Summary

  • Past History

  • Past relationships

  • Mental State

  • Yep, have put in calendar so I don’t forget 😫 lol, I hope you and your family have had a gd Xmas and have a great new year’s, and thank you for the weekly opportunity to speak with out judgement even when you have challenged me to take a look at my response to situation (at times begrudgingly lol) I am very grateful for your help and as I am straight up lol (ready?) the bits that have been fuckd and I didn’t see how/why/what I could do anything different etc, have all been managed! Due to my skills and your bloody keeping it real for me, thank you.

    I had a fantastic 2 days with my boys and Steve over xmas 😁

  • Circumstances of note

    • Drunken angry phone call.
    • She saw my car and was amazed that i did not drive a fancy hospital car.
  • ?FHx
    Childhood

  • ?she feels Karl took her children to get her back for calling the police on him. This is ?narcissitic.
    also feels parole are judging her.

  • The long case

  • Final submission

    •Psychotherapy Written Case submission form
    •bound and printed case report
    •electronic copy saved in a single file in Microsoft Word format (on CD labelled with the trainee’s name, pseudonym and date of submission)
    •three completed psychotherapy case discussion forms
    •a hard copy of their current medical registration
    •the prescribed fee.

    case report - 12 point font double spaced w number pages firmly bound in a case or sleeve, not with clips, staples etc.\
    word count 8000 - 1000 must appear on cover page

  • Coroline Cook is a 44 year old mother of two boys, with a diagnosis of Major Depressive Disorder and Alcohol Use Disorder currently in remission.

    She is medicated on Venlafaxine and Quetiapine for her depression and sleeping difficulties. She describes mild low mood and anxiety, difficulty coping with current life stressors of faninces, poor social life, lost custody of her children and conflict with her brother (who cares for her children), and her partners family. She describes current themes of low self-esteem, shame about her current life circumstances, anxiety of people judgeing her and irritability around feeling underappreciated and easy to take offence. She has ongoing sleep difficulties with early waking. She will cry, roughly once a day, when she is by herself. She describes minimal suicidal thought or intent other than brief and rare fleeting thoughts of “life just being too hard”. Her energy, concentration and appetite are okay, and she manages to work full-time and see her children every week.

    Regarding her past past psychiatric history she describes having had depression since 16 years of age, and had to have agoraphobia from the age of 17 - 32, was unable to shop or socialise without the aid of alcohol. This resolved at 32 years of age Resolved she had children and venlafaxine was initiated.
    She has had three psychiatric admissions in the past, one when she was 18 for agoraphobia, another aged 23 following a temazepam OD, then one 2 years ago aged 42 following a severe OD which required management in ICU. . At the time she had been drinking heavily for 5 years, was relatively neglectful of her two boys who she was caring for at the time, as a single mother. Following this OD, done whilst her children were home, and given her alcoholism, her brother filed for joint guardianship, she fought this and failed, something she harbours deep resentment for. Her brother has looked after her two children ever since, with his wife at his house, roughly an hours drive from Dunedin. Since this period in her life she has been working hard to recover and get her life back on track. She completed an inpatient drug and alcohol rehabilitation program and has been in remission ever since, with only handful of lapses in the last two years.

    She lives in a boarding house, works full time in administration for a firm, owns a substantial mortgage on a house which is rented out, and generally struggles financially to pay her bills, child support and mortgage, as well as paying for activities with her two boys. She is in constant conflict with her brother and his wife. Something which has recently escalated to the point of ex-communication with her brothers wife, and constant verbal outburst between her and her brother over various care decisions with her two boys and supposed breeches of the joint gaurdianship agreement. Of note though, she currently does not want to become the primary carer of her two boys who are soon to enter adolescence, with her living in a boarding house with limited cash flow, she feels her children are better cared for in their current arrangement, nonetheless, she feels underappreciated and underrespected for her rights as a mother and the efforts she goes to to see her children weekly and to improve wellbeing., She feels constantly regected and vilified for her past OD and alcoholism, something feels she constantly trying to make amends for with little acknowledgement for her efforts. This appars to be a great source of discontent for Coroline.

    She has a partner, Sam, who was recently released from prison after an 18 month sentence for assaulting his ex-partner. They were only partners for three months prior to his incarceration. His parole conditions insist he reside with his parents, and not with Coroline, given the nature of his offence, coroline takes this personally, again feeling judged and regected. Coroline is regarded very poorly by Sams family due to argument she had with Sams father whilst Sam was in jail. His parent evidently drink heavily and his father has a temper, he called Coroline mentally insane after a disagreement, she called him a stipud old drunk and they havent spoken since. She is barely allowed in their house now and, as such struggles to spend time with Sam. This conflictual relationship with Sams family is another source of signifcant distress for Coroline. Again she feels heavily underappreciated for the effort and support she has given Sam during his incarceration and feeling unacknowledged by his parents for this. Sam evidently agrees with her regarding this and is also constantly at conflict with his parents, especially due to thier drinkning and his new sobriety, however any noted conflict by parole may gepardize his relaes conditions and he may be recalled prison, so she feels they are in this sdtrange double bind of trying to appease his parents and keep them happy by putting up with thier horrible treartment of her.. again another source of stress for Coroline.

    She describes a life long history of dysthymia since her Mother left her and her brother with thier alcoholic father when she was 8 years old,only to return several years later to take her brother away, leaving her with a pervasive and long lasting sense of rejection and not being good enough or deserving of her mothers affection. Her alcoholic father appears to have been kind but very selfish and neglectful, prioritising his daily drinking over her well being, expoecting her to maintain and run the household whilst he drank every night, frequently bringing strangers and friends back from the pub each night, through all the years of her schooling until she moved out at the age of 16.

    She drank heavily and smoked alot of canabbis through her late adolescence, used to dress as a goth and describes herself as a nn angry teenager. In her early twenties she grew out of this, gave up drinking, completed her schooling at tafe, started working regularly, and had a period of relative happiness for five years having met and fell in love wih a man who tragically died in a car crash when she was 28 years old. She is still close with this mans family, who she will meet with nearly every year around the anniversary of this mans death, a period of time she finds difficult every year, even 16 years on. She still has dreams of arriving places to find he has just left and describes with melancholy how, on the evening on his death he had tries to call her several times but she hadn’t answered.

    She bagan drinking heavily again 7 years ago whilst in an abusive relationship with and alcoholic ex mongrel mob member. Following her OD two years ago she attended CADS,and then a rehab program which she describes as very formative and taught her to take ownership for her behaviour. She has been relatively sober ever since. Roughly binging once every 3 months, though nil for the past half year. She is aware that any exposure of her drinking will depardize access to her children.

    Imp/ MDD w anxiety, reosanbly well treated on venlafaxine and quetiepine. pervasive themes of of low self-esteem, being judged by others and easy irritability from perceived underappreciation from others, in context of multiple life stressors including shared custody of children and some conflict based relationships,on a background of longstanding dysthymia, two past OD attempts, past alcoholism currently in remission, the tragic death of partner 16 years past, regection by her mother in childhood and neglect by alcoholic father in adolescence. She is future focused and willing to engage in therapy to work through some of her problems.

  • Steve - Current partner just out of jail.

    ?father of the children

    ?Mark - died in a car crash

  • went to rehab and learnt to take ownership of her behaviour rather than blaming the world, very formative time.

  • Assessment

  • Management plan

  • Clinical progress

  • Reformulation

  • Supervision

  • Communication

  • Discussion

  • Demographic

  • Presenting Complaint

  • Past Psychiatric History

  • Drug and Alcohol History

  • Personal History

  • Medical/Forensic/Family Hx

  • Formulation

  • I
    This will usually be a brief introductory statement that places the patient and their problems in
    context. The notion of the patient’s ‘predicament’ may sometimes be helpful in presenting this
    section. Example: ‘Ms Jones, currently a patient on an acute medical ward, has a ten-year
    unremitting history of anorexia nervosa. Her condition has become life-threatening in the
    context of a breakdown in the treatment alliance with her usual psychiatric treating team”.

  • II
    This section highlights the important biological, psychological and socio-cultural aspects of the
    history which have potential explanatory power. In contrast to the preceding section, this
    section provides a more ‘longitudinal’ perspective.
    The concept of ‘vulnerability’ (or predisposing factors) can often be usefully invoked in this
    section.
    It is crucial in this section (and also in the preceding section) to exercise judgement as to which
    aspects of the history are selected and to convey an appropriate sense of emphasis and
    priority. This choice will be dictated to some extent by Section III.

  • III

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She has ongoing sleep difficulties with early waking. She will cry, roughly once a day, when she is by herself. She describes minimal suicidal thought or intent other than brief and rare fleeting thoughts of \"life just being too hard\". Her energy, concentration and appetite are okay, and she manages to work full-time and see her children every week.\n\nRegarding her past past psychiatric history she describes having had depression since 16 years of age, and had to have agoraphobia from the age of 17 - 32, was unable to shop or socialise without the aid of alcohol. This resolved at 32 years of age Resolved she had children and venlafaxine was initiated. \nShe has had three psychiatric admissions in the past, one when she was 18 for agoraphobia, another aged 23 following a temazepam OD, then one 2 years ago aged 42 following a severe OD which required management in ICU. . At the time she had been drinking heavily for 5 years, was relatively neglectful of her two boys who she was caring for at the time, as a single mother. Following this OD, done whilst her children were home, and given her alcoholism, her brother filed for joint guardianship, she fought this and failed, something she harbours deep resentment for. Her brother has looked after her two children ever since, with his wife at his house, roughly an hours drive from Dunedin. Since this period in her life she has been working hard to recover and get her life back on track. She completed an inpatient drug and alcohol rehabilitation program and has been in remission ever since, with only handful of lapses in the last two years.\n\nShe lives in a boarding house, works full time in administration for a firm, owns a substantial mortgage on a house which is rented out, and generally struggles financially to pay her bills, child support and mortgage, as well as paying for activities with her two boys. She is in constant conflict with her brother and his wife. Something which has recently escalated to the point of ex-communication with her brothers wife, and constant verbal outburst between her and her brother over various care decisions with her two boys and supposed breeches of the joint gaurdianship agreement. Of note though, she currently does not want to become the primary carer of her two boys who are soon to enter adolescence, with her living in a boarding house with limited cash flow, she feels her children are better cared for in their current arrangement, nonetheless, she feels underappreciated and underrespected for her rights as a mother and the efforts she goes to to see her children weekly and to improve wellbeing., She feels constantly regected and vilified for her past OD and alcoholism, something feels she constantly trying to make amends for with little acknowledgement for her efforts. This appars to be a great source of discontent for Coroline. \n\nShe has a partner, Sam, who was recently released from prison after an 18 month sentence for assaulting his ex-partner. They were only partners for three months prior to his incarceration. His parole conditions insist he reside with his parents, and not with Coroline, given the nature of his offence, coroline takes this personally, again feeling judged and regected. Coroline is regarded very poorly by Sams family due to argument she had with Sams father whilst Sam was in jail. His parent evidently drink heavily and his father has a temper, he called Coroline mentally insane after a disagreement, she called him a stipud old drunk and they havent spoken since. She is barely allowed in their house now and, as such struggles to spend time with Sam. This conflictual relationship with Sams family is another source of signifcant distress for Coroline. Again she feels heavily underappreciated for the effort and support she has given Sam during his incarceration and feeling unacknowledged by his parents for this. Sam evidently agrees with her regarding this and is also constantly at conflict with his parents, especially due to thier drinkning and his new sobriety, however any noted conflict by parole may gepardize his relaes conditions and he may be recalled prison, so she feels they are in this sdtrange double bind of trying to appease his parents and keep them happy by putting up with thier horrible treartment of her.. again another source of stress for Coroline.\n\nShe describes a life long history of dysthymia since her Mother left her and her brother with thier alcoholic father when she was 8 years old,only to return several years later to take her brother away, leaving her with a pervasive and long lasting sense of rejection and not being good enough or deserving of her mothers affection. Her alcoholic father appears to have been kind but very selfish and neglectful, prioritising his daily drinking over her well being, expoecting her to maintain and run the household whilst he drank every night, frequently bringing strangers and friends back from the pub each night, through all the years of her schooling until she moved out at the age of 16.\n\nShe drank heavily and smoked alot of canabbis through her late adolescence, used to dress as a goth and describes herself as a nn angry teenager. In her early twenties she grew out of this, gave up drinking, completed her schooling at tafe, started working regularly, and had a period of relative happiness for five years having met and fell in love wih a man who tragically died in a car crash when she was 28 years old. She is still close with this mans family, who she will meet with nearly every year around the anniversary of this mans death, a period of time she finds difficult every year, even 16 years on. She still has dreams of arriving places to find he has just left and describes with melancholy how, on the evening on his death he had tries to call her several times but she hadn't answered.\n\nShe bagan drinking heavily again 7 years ago whilst in an abusive relationship with and alcoholic ex mongrel mob member. Following her OD two years ago she attended CADS,and then a rehab program which she describes as very formative and taught her to take ownership for her behaviour. She has been relatively sober ever since. Roughly binging once every 3 months, though nil for the past half year. She is aware that any exposure of her drinking will depardize access to her children.\n\nImp/ MDD w anxiety, reosanbly well treated on venlafaxine and quetiepine. pervasive themes of of low self-esteem, being judged by others and easy irritability from perceived underappreciation from others, in context of multiple life stressors including shared custody of children and some conflict based relationships,on a background of longstanding dysthymia, two past OD attempts, past alcoholism currently in remission, the tragic death of partner 16 years past, regection by her mother in childhood and neglect by alcoholic father in adolescence. She is future focused and willing to engage in therapy to work through some of her problems.\n\n\n\n\n"},{"_id":"69286f339cb10a4497000016","treeId":"69286ba39cb10a4497000012","seq":7559899,"position":0.5,"parentId":null,"content":"Past History "},{"_id":"7359bbef2b72b1de6f00001e","treeId":"69286ba39cb10a4497000012","seq":9153427,"position":0.5625,"parentId":null,"content":"\nPast relationships"},{"_id":"7359bc3c2b72b1de6f00001f","treeId":"69286ba39cb10a4497000012","seq":9153431,"position":1,"parentId":"7359bbef2b72b1de6f00001e","content":"Steve - Current partner just out of jail.\n\n?father of the children\n\n?Mark - died in a car crash"},{"_id":"692870099cb10a4497000018","treeId":"69286ba39cb10a4497000012","seq":7559901,"position":0.625,"parentId":null,"content":"Mental State"},{"_id":"69286f939cb10a4497000017","treeId":"69286ba39cb10a4497000012","seq":9221233,"position":0.75,"parentId":null,"content":"Yep, have put in calendar so I don't forget 😫 lol, I hope you and your family have had a gd Xmas and have a great new year's, and thank you for the weekly opportunity to speak with out judgement even when you have challenged me to take a look at my response to situation (at times begrudgingly lol) I am very grateful for your help and as I am straight up lol (ready?) the bits that have been fuckd and I didn't see how/why/what I could do anything different etc, have all been managed! Due to my skills and your bloody keeping it real for me, thank you. \n\nI had a fantastic 2 days with my boys and Steve over xmas 😁"},{"_id":"736600062e8755decc000020","treeId":"69286ba39cb10a4497000012","seq":9157879,"position":1,"parentId":"69286f939cb10a4497000017","content":"went to rehab and learnt to take ownership of her behaviour rather than blaming the world, very formative time."},{"_id":"69286cbf9cb10a4497000015","treeId":"69286ba39cb10a4497000012","seq":7559898,"position":1,"parentId":null,"content":"Circumstances of note\n- Drunken angry phone call.\n- She saw my car and was amazed that i did not drive a fancy hospital car.\n- "},{"_id":"736601cc2e8755decc000021","treeId":"69286ba39cb10a4497000012","seq":9157881,"position":2,"parentId":null,"content":"?FHx\nChildhood"},{"_id":"7368b0a92e8755decc000022","treeId":"69286ba39cb10a4497000012","seq":9158416,"position":1,"parentId":"736601cc2e8755decc000021","content":""},{"_id":"7368b0d02e8755decc000023","treeId":"69286ba39cb10a4497000012","seq":9158417,"position":3,"parentId":null,"content":"?she feels Karl took her children to get her back for calling the police on him. This is ?narcissitic. \nalso feels parole are judging her."},{"_id":"7373af27f791b812fa000024","treeId":"69286ba39cb10a4497000012","seq":9167008,"position":4,"parentId":null,"content":"The long case"},{"_id":"7373af7ff791b812fa000025","treeId":"69286ba39cb10a4497000012","seq":9167009,"position":1,"parentId":"7373af27f791b812fa000024","content":"Assessment"},{"_id":"73753bdcf791b812fa000031","treeId":"69286ba39cb10a4497000012","seq":9167477,"position":0.5,"parentId":"7373af7ff791b812fa000025","content":"Demographic"},{"_id":"73753bfcf791b812fa000032","treeId":"69286ba39cb10a4497000012","seq":9167480,"position":0.75,"parentId":"7373af7ff791b812fa000025","content":"Presenting Complaint"},{"_id":"73753dfaf791b812fa000033","treeId":"69286ba39cb10a4497000012","seq":9167481,"position":0.875,"parentId":"7373af7ff791b812fa000025","content":"Past Psychiatric History"},{"_id":"73753ebbf791b812fa000034","treeId":"69286ba39cb10a4497000012","seq":9167482,"position":0.9375,"parentId":"7373af7ff791b812fa000025","content":"Drug and Alcohol History"},{"_id":"73753f36f791b812fa000035","treeId":"69286ba39cb10a4497000012","seq":9167483,"position":0.96875,"parentId":"7373af7ff791b812fa000025","content":"Personal History"},{"_id":"73753f9cf791b812fa000036","treeId":"69286ba39cb10a4497000012","seq":9167484,"position":0.984375,"parentId":"7373af7ff791b812fa000025","content":"Medical/Forensic/Family Hx"},{"_id":"73753af3f791b812fa00002d","treeId":"69286ba39cb10a4497000012","seq":9167468,"position":1,"parentId":"7373af7ff791b812fa000025","content":"Formulation"},{"_id":"73753b41f791b812fa00002e","treeId":"69286ba39cb10a4497000012","seq":9167486,"position":1,"parentId":"73753af3f791b812fa00002d","content":"I\nThis will usually be a brief introductory statement that places the patient and their problems in\ncontext. The notion of the patient's ‘predicament’ may sometimes be helpful in presenting this\nsection. Example: ‘Ms Jones, currently a patient on an acute medical ward, has a ten-year\nunremitting history of anorexia nervosa. Her condition has become life-threatening in the\ncontext of a breakdown in the treatment alliance with her usual psychiatric treating team”."},{"_id":"73753b8df791b812fa00002f","treeId":"69286ba39cb10a4497000012","seq":9167488,"position":2,"parentId":"73753af3f791b812fa00002d","content":"II\nThis section highlights the important biological, psychological and socio-cultural aspects of the\nhistory which have potential explanatory power. In contrast to the preceding section, this\nsection provides a more ‘longitudinal’ perspective.\nThe concept of ‘vulnerability’ (or predisposing factors) can often be usefully invoked in this\nsection.\nIt is crucial in this section (and also in the preceding section) to exercise judgement as to which\naspects of the history are selected and to convey an appropriate sense of emphasis and\npriority. This choice will be dictated to some extent by Section III."},{"_id":"73753bb5f791b812fa000030","treeId":"69286ba39cb10a4497000012","seq":9167471,"position":3,"parentId":"73753af3f791b812fa00002d","content":"III"},{"_id":"7373afe1f791b812fa000026","treeId":"69286ba39cb10a4497000012","seq":9167010,"position":2,"parentId":"7373af27f791b812fa000024","content":"Management plan"},{"_id":"7373b089f791b812fa000027","treeId":"69286ba39cb10a4497000012","seq":9167011,"position":3,"parentId":"7373af27f791b812fa000024","content":"Clinical progress"},{"_id":"7373b0cbf791b812fa000028","treeId":"69286ba39cb10a4497000012","seq":9167012,"position":4,"parentId":"7373af27f791b812fa000024","content":"Reformulation"},{"_id":"7373b183f791b812fa000029","treeId":"69286ba39cb10a4497000012","seq":9167013,"position":5,"parentId":"7373af27f791b812fa000024","content":"Supervision"},{"_id":"7373b1f2f791b812fa00002a","treeId":"69286ba39cb10a4497000012","seq":9167014,"position":6,"parentId":"7373af27f791b812fa000024","content":"Communication"},{"_id":"7373b22ef791b812fa00002b","treeId":"69286ba39cb10a4497000012","seq":9167015,"position":7,"parentId":"7373af27f791b812fa000024","content":"Discussion"},{"_id":"7373b597f791b812fa00002c","treeId":"69286ba39cb10a4497000012","seq":9167022,"position":5,"parentId":null,"content":"Final submission\n\n•Psychotherapy Written Case submission form\n•bound and printed case report\n•electronic copy saved in a single file in Microsoft Word format (on CD labelled with the trainee’s name, pseudonym and date of submission)\n•three completed psychotherapy case discussion forms\n•a hard copy of their current medical registration\n•the prescribed fee.\n\n\n\ncase report - 12 point font double spaced w number pages firmly bound in a case or sleeve, not with clips, staples etc.\\\nword count 8000 - 1000 must appear on cover page"}],"tree":{"_id":"69286ba39cb10a4497000012","name":"Long Case","publicUrl":"69286ba39cb10a4497000012"}}