1. Client Background and Referral Information

 

Jill is a 45-year-old African American female who lives in an affluent neighborhood on the outskirts of South Carolina. She and her husband are financially stable. They have 4 boys, the older boys are 25 and 28 and they come from a previous marriage of her husband, together, she and her husband have two younger boys 11 and 5 from their marriage. Jill is a physical trainer, business owner, and church's first lady. They recently closed their brick-and-mortar church due to a higher need in Maryland. She and her husband are in the process of relocating to Maryland, they are selling their home and looking for another property in MD which is becoming a little stressful for her on top of her other responsibilities. They will continue their church but in a different capacity, they are establishing a community outreach center and will have online services that reach a multitude of people. With the high demands of her life, she is having difficulty organizing her daily life. Although her life is going in a positive direction, she is struggling with the many hats she is wearing (ex. Wife, first lady, mother, career, student, business owner, etc.). She is experiencing some anxiety. She is feeling overwhelmed and disconnected in her thinking and is not able to organize or prioritize what is important. She is also seeking self-care resources to help her when she starts to feel overwhelmed with her day-to-day life activities. 

 

Jill is a Christian and is open to biblical counseling and prayer during her sessions.

 

2. Strengths and Client Supportive Factors

 

Jill is seeking therapeutic support on her own. She felt the need to speak with a therapist to determine what her next steps would be in her new and already normal roles as a wife, mother, first lady, career woman, business owner, and social media specialist and producer. She feels like she is wearing so many hats that she is not able to give 100 percent in any of her day-to-day responsibilities. Although her responsibilities are all positive, she is experiencing some anxiety. She is feeling overwhelmed and disconnected in her thinking and is not able to organize or prioritize what is important in her life. She is seeking self-care resources to help her organize her daily life activities when she starts to feel some anxiety and is overwhelmed with her day-to-day struggles. 

 

Jill is well-rounded, enjoys meeting people, and is loving her new role as a first lady. She has a magnetic personality that will serve her well with the many hats she is wearing. However, because she is wearing so many hats, she is experiencing some resistance from her boss at her full-time job as a school counselor. She often gets to work late and leaves early due to the high demands of her family. She functions as a single parent when her husband travels and her responsibilities overlap causing her some extremely stressful emotions. 

 

A. Supportive Health Factors:

Jill recently had a physical before our first session in October 2022. She is in good physical health; however, she recently had knee surgery in March 2022 due to a dislocated disc in her lower back area causing pain in her knee. She is slowly recovering and is unable to exercise like she is used to, which was one of her outlets when she felt stressed. 

 

B. Social Supports:

Jill does have great family support in Maryland, which will be helpful when they move back. Her mother lives in Texas and will fly down to help her when her schedule permits. She has several good friends in the area however she feels guilty if she has to ask them for help. She does have two great friends she confides in when she feels anxious, and they support her with whatever she needs. They are her accountability partners, and she will reach out to them if she needs their support.
 

C. Financial Resources:

Jill and her husband are financially stable. They have several streams of income that allow them to live in affluent areas. 

 

D. Emotional-Behavioral Strengths:

Jill’s emotional strength is her ability to bounce back quickly (resilience). She is self-aware based on her ability to continue her everyday life activities along with feelings of anxiety and stress. She is asking for support and resources which shows she can think cognitively by referring herself for therapy. She appears to have good self-control and a stable mood during our first session. However, she is experiencing some anxiety and stress due to all of her newfound responsibilities which, she is trying not to get out of control.

Jill’s lack of organizational skills and time management skills and her many responsibilities are not impeding her success, which shows she has a strong will to do well. She doesn’t like to be a burden or cause conflict with others. She would rather take the brunt of the negativity in a situation than be disliked. She avoids conflict and will get extremely upset if the situation continues, then she will snap and like a pressure cooker which causes major conflict with her friends and family. 

 

E. Cognitive Strengths:

Jill does not exhibit any learning disabilities or deficits. She can work a full-time job, take care of her family, and pursue other avenues of her personal and professional life. She does not exhibit any areas of difficulty with memory. She is mentally able to function normally.

 

3. Client Symptoms or Concerns

 

A. Health Problems: None

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B. Social Difficulties: None

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C. Financial Problems: None

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D. Emotional-Behavioral Difficulties: Jill is having difficulty with organizing all of her new responsibilities. She is feeling anxiety and guilt about not being able to handle everything well. She is wearing several different types of hats and they are all important. She is not sure which ones are more important at this time in her life. She needs support, resources, and positive coping skills to help her determine which direction she needs to go. She feels like she doesn’t have the emotional support she needs, and her husband doesn’t seem to understand her struggles with raising their boys and trying to meet his demands as his wife and their new responsibilities. She wants help with what to take off her plate before it breaks.

 

E. Cognitive Deficits: Jill is having difficulty with time management, organizational skills, and staying focused on her tasks. She feels she is being pulled in so many directions she is going to eventually explode and not be able to do anything well. She is showing some signs of anxiety and stress.

 

4. Timeline and Priority of Symptoms/Concerns:

 

When meeting with Jill for the short time she has been my client, Jill talked about her childhood at length. She has an older sister, who was and is a perfectionist. She is a senior vice president in her company and holds several important positions in the community. She at times makes Jill feel inadequate and not enough. These feelings have spilled over into her adulthood. Even though Jill is successful and doing well in her own right, she still feels like she is in her sister's shadow. Even though Jill has a magnetic personality she still listens to people who tell her negative things about herself even though the things they are telling her may not be true. She wants to fit in and be accepted by others, and at times she will not speak her truth because of her fear of being alone. When she was a child, she said her school counselor in high school told her she would never be successful like her sister. She made her feel inadequate, so for most of her life, she vowed to do her best in everything she did which has caused some anxiety when she cannot meet the goals, she set for herself. Although we did not discuss her sister in our video session, she did discuss this during her intake interview and wanted to include it in her information for future sessions.

 

Jill at this time is having some difficulty with her lack of organizational skills, time management, and overwhelming responsibilities that may lead to some anxious feelings or emotions I had her complete the level 1 Cross-Cutting Symptom Measure Assessment for Adults to determine any feelings of anxiety that she may not have shown in our sessions, but they exist. Based on her ratings she fell in the (low range) which determined a level 2 assessment was not needed at this time. We will revisit this if symptoms become more defined in our session.

 

5. Diagnostic Impressions:

Possible Primary Diagnosis

• A. General Anxiety Disorder (300.0); (F43.20); (ICD 10 CM)  

• B. Adjustment Disorder (309.9) (F43.20 Unspecified); ICD-9-CM I selected to go with these two, based on not enough evidence to determine a more specific trauma diagnosis, but that the effects of her experience have difficulties in multiple domains.

 

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Overall Case Conceptualization (Narrative Summary)

 

Jill can wear multiple hats however she is having difficulty wearing the hats well. She is feeling anxious about her multiple roles and fears she is not making her family a priority when she is being pulled in so many directions. She is functioning as a single parent and feels her husband's schedule is as demanding as hers and she cannot see any relief in sight. She feels like her life is like a roller coaster, going up and down and all around but never stopping enough to let her take a break. Although her life is happy and full of awesome new responsibilities, she is feeling overwhelmed and is asking for resources and coping skills to help her prioritize what is important and what can be set aside for a later time. Due to her full schedule, she felt the need to seek therapy and support to help her understand her feelings of anxiety and how she can support herself while having such a heavy load.

 

Jill has a great personality; she can make people feel welcome and included wherever she goes. She relies on her faith in God and her resilience to help her deal with her daily issues. However lately she realized she needs additional resources to get her through her daily activities. She feels unorganized, cannot seem to manage her time well and she is feeling anxious about not being able to meet these daily demands of her life. As she stated her life is like going into a video arcade and not knowing which way to go, it’s like chaos. Jill is open to incorporating her faith into her sessions and welcomes scriptures and prayer as part of her treatment plans and goals.

 

Although we did not discuss her sister in previous sessions this is a topic we will discuss at a later date. However, based on Jill’s information and possible diagnosis I did have her take a level 1 cross-cutting assessment for adults to determine her level of anxiety. The score was in a low-level range however we will assess her again in the next few weeks to see if the score changes in future sessions.

 

Jill does, on the other hand, enjoy working out (however she is limited at this time due to a back injury); taking walks, watching movies, having a date night with her husband, and enjoying family time. She has a wonderful support group of friends she enjoys spending time with when she has the time. She also enjoys doing community outreach with her husband and hosting pop-up churches on the weekends.

 

Jill just started therapy; we are on our second session. During our first session, we completed her intake paperwork and discussed informed consent, payment, and the therapeutic relationship. During our second session, we began discussing Jill’s issues and concerns and other topics of anxiety. I started by gauging her feelings by giving her a scale from 1 to 10. 10 being I feel great, 1 I feel really bad. Jill selected a range of 5 or 6 at the beginning and 6 or 7 at the end of our session. Her main dilemma is helping her prioritize her life, setting healthy boundaries, and getting some self-care included in her day.

 

Recommendations:

 

Long-Term Goals:

 

1. Resolve conflicted feelings and adapt to the new life circumstances.

2. Balance life activities between consideration of others and development of own interest.

 

Short-Term Goals:

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1. Identify values that guide life’s decisions and determine fulfillment.

Prioritizing her values (Doing the Value Sort Cards) to determine what is important to the client.

A. Reading books about values “31 Strategies for Finding out what really matters most to You by Simon.”

B. Use journaling, and mindfulness as a resource.

C. Help her develop tools to help her organize her day and help her develop time management skills.

2. Increasing communication with significant others regarding current life factors.

A. Teaching communication skills (e.g., I message, “active listening, eye contact) to apply to her current life stress factors.

B. Invite her husband to a session when she feels comfortable and address her stressors, concerns, and encourage open communication to express her feelings.

 

3. Identify five advantages of current life situations.

A.Help her identify at least five advantages to her current life circumstances that may have been overlooked or discounted (opportunity to set healthy boundaries, incorporating the word “No” into her responsibilities when things become overwhelming).

 

Sessions – We will meet a total of 8 – 1-hour sessions per week virtually. We will reassess her progress at the end of week 8.

 

Sharon H. Beatty - LCMHC