Formulation
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
?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
Goals for therapy.
Coroline is a 44 year old mother of two young boys She works fulltime, has a partner in jail , and shares gaurdianship of her children with her brother who is thier primary carer. She has a past history of MDD and alcohol use disorder currently in remission. Christine continues to suffer dysthymia, low self-esteem, poor coping with stressors, fequent frustration anger and conflict coping with conflict with people in her life. She is easy to perceive insults and often feels undervalued by those around her, fears being djudged as a failure in life “a crazy alcoholic who had to be locked up lost her children and lives in boarding. I criticism she fears may be true and often levels at herself.
It appears she has been this way most of her life. There is likely a large genetic determination in her temperament upon which her upbringing has shaped. She was raised by an alcoholic father who was neglectful of her needs and a mother who abandoned her at the age of 6, only to return to take her brother away, leaving her alone with her father through adolescence, who treated her as both duaughter and maid as he entertained alcoholics at thier on a near daily basis. As such, during this time, as her sense of self worth was developing her mother and father were trreating her with little appreciaion or value, this may have left her with a pervasive and enduring self of low self worth and the expectation that she will be undervalued and treated poorly by anyone with whom she develops a relationship. As such, she has become hypersensitive to anything that could be perceived as an insult often missinterpreting peoples meaning and intentions, becoming agitated and angry, leading to recurrent conflicts with people, any hostility in return further verifies her initial suspicion of thier ill judgement and intent towards her and further justifies her hostility towards them. This tragic dysfunctional cycle has played itself out time and again and led her to have multiple ad varied conflicts with near everyone in her life over the course of her four decades life, the world of relationships being a torturous and twisted path upon which she constantly stumbles and hurts herself, over time she has retreated, become more isolative, and drawn a defensive shell around herself, not daring to get close to people and show weakness lest she be hurt again. She now lives with a constant sense that the few close relationships she currently has in her life will fall apart tragically and driven by this insecurity often proactively withdraws from people, finding relationships both too difficult and too tiring, finding comfort and peace with only herself for company. Not willing to risk putting herself out in case she gets hurt once again.
Internal drivers to gain wealth/resources, find a mate, to procreate, to care for ones young have unfortunately been thwarted over the years, she has struggled and continues to struggly with each of these fundamental drivers, a sourcs of great distress for her, by which she measures herself to others and finds herself lacking, and lowering her esteem for herself. given her paranoia of others judging her, she naturally assumes the worst possible interpretation of their jusgdement, a judgemtn she has of herself and desperately tries not to beleive, that she is a crazy suicidal alcoholic who lost her children and does not deserve any ones time or affection, in essence, a failure at life.
Another evolutionary driver is at play and causing discontent. a driver to defend her young. she is currently bereft of any significant control over their lives and fights to take care of them as best she can. She meets resistance and ubuse from her childrens primary carers, causing her much frustration and discontent.
Also given her parents mental health problems she has genetic predisposition towards the development of any major mental illness having indeed developed alcoholism and depression in the past.
and risk of developing mental illness
primal drivers, social status, respect, will to power/resource richness, pack is her children/defence of pack.
Ronald Fairbairn’s Six Ego Positions:
-The Whole Ego relating to the Good Object, is the healthy inner child relating to the patient and nurturing inner parent. This is the part of the inner world that object relations therapists try to expand and grow.
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, easy irritabilty, multiple conflict based relationships and difficulty coping with current life stressors such as; faninces, limited social life, the lost custody of her children and conflict with her brother (who cares for her children), and her partners family. She describes themes of low self-esteem, shame about her current life circumstances, anxiety about people judgeing her, irritability about feeling underappreciated and an easyness to take offence at any perceived judgement or insult. She has ongoing sleep difficulties with early waking. She will cry often, when 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 having agoraphobia from the age of 17 - 32, when she was unable to shop or socialise without the aid of alcohol. This resolved at age 32 years when she had children and venlafaxine was initiated and she ceased drinking.
She has had three psychiatric admissions in the past, one when she was 18 for agoraphobia, another aged 23 following a temazepam OD, 7 years ago then one 2 years ago aged 42 following a severe OD which required management in ICU. At the time of this OD she had been drinking heavily for 5 years, had been relatively neglectful of her two boys who she was caring for at the time as a single mother. And so, given the OD was done whilst her children were at home, her ongoing depression and psychiatric inpatient stay and her alcoholism at the time, 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, 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 for the last 2 years, with only handful of lapses.
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 thier wellbeing., She feels constantly regected and vilified for her past OD and alcoholism, something feels she is constantly trying to make amends for with little acknowledgement of those 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 an 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 once, 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 judged and underappreciated for the effort and support she has given Sam during his incarceration. 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 jeopardize his release conditions and he may be recalled prison, so she feels they are in this strange double bind of trying to appease his parents and keep them happy by putting up with thier horrible treartment of her.
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 but not her, 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 an 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.
She feels constantly like no matter what she does, or how she tries to change, life will just push her down again, essentially giving her what she deserves, as she fears most of all, that what she thinks other people think of her, may actually be true, that she is a worthless good for nothing alcoholic crazy woman who lives in a boarding house and cant even care for herself let alone her own children. There is this sense that she doesn’t like herself very much, a sort of deep seated self loathing which winds its way through her the narrative of her life all the way back to her childhood seeding from the neglect and undervalued treatment of her father and mother.
That being said, she is doing well. She is sober, she sees her children regularly, she is in a reasonably good relationship with someone who listens and values her, she maintains full time employment, and she is generally getting by. She doesn’t think she is particularly depressed anymore. She realises how much she has undervalued herself for many years and is trying to believe more in herself and not better understand other peoples view points with out putting up her defencive barriers and closing people off. She rarely raises her voice now and tries to facilitate productive communication in situations of conflict. she has come a long way in the last two years, she is future focused and orientated to self improvement. and yeah she’s pretty stable really.
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/Summary
Presenting Complaint
Past Psychiatric History
Drug and Alcohol History
Personal History
Medical/Forensic/Family Hx
Alcoholic lapse with abusive phone call and text.
Coroline Cook is a ? year old mother of two boys who lives alone in a boarding house with a past history of severe major depressive disorder and severe alcohol use disorder in remission. She has shared guardianship of her two children with her brother, with whom her children live. She works full time in administration for a medium sized business. She has a partner Sam, who is in jail, and little in terms of a supportive network of family and friends.
Residual anxiety and depressive symptoms and difficulty coping with stressors.
she has ongoing conflict with her brother regarding custodial issues and management of her children, frequently perceiving lapses from her brother in the guardianship agreement and harbouring a long term resentment of his application and success for shared guardianship and becoming the primary care giver. Her brother’s wife and her have had many fractious arguments, with insults thrown both ways and are now not on speaking terms. Her brother and her maintain a line of communication weekly, and she manages to see her children for ne or two days every week week or so.
She struggles financially. Whilst working full time for approximately $50,00 a year, she has to maintain paymeents on a mortgage for a house she rents out and has to pay for travel and other costs when caring for her children. She states she generally lives paycheck to paycheck.
she feels undervalued at work, feeling she is performing the same role as an executive, though without the title or increased wages.
One concern and difficulty with challenging the guardianship is the cost of a lawyer. Something she believes she can not afford. She also, currently living in a bourding house, believes her brothers house is more suitable for her children to live in. However with the pending release of her partner, she hopes one day to move back into the house which she owns and create a suitable place for her children to stay. Her children are becoming teenagers though, and she believes altimately the choice should be theirs. she also discloses that she is unsure how much would like to become the primary care giver given the energy and effort it taked to raise children and enjoys having free time to herself.never the less, despite acknowledging that her children are better where they are at present,
Her children live with her brother and wife, a forty minute drive from her current residence and place of employment.