Case Presentation: Alyson ✓ Solved

Case Presentation Alyson

CASE PRESENTATION – ALYSON

Intake Date: August 2020

Identifying/Demographic Data

Alyson is a 29-year-old, African American female who lives with her partner Cassandra in a townhouse in San Francisco. They have been together for 6 years but have known each other since junior high school. Alyson’s extended family lives in Oakland, California. She has a very close relationship with her mother and older sister.

Chief Complaint/Presenting Problem

Cassandra initiated Alyson coming to her first intake session due to Alyson’s feeling sad, down, and having trouble sleeping. Sometimes she has periods of thinking she is dying with heart palpitations. She gets overwhelmed and starts sweating and feels nauseous. This has brought her to the hospital on two occasions.

History of Present Illness

Alyson reports she has trouble sleeping at night thinking she is losing control of things in her life. She falls asleep then awakens and has trouble going back to sleep. Although this has been ongoing for about a year, now she thinks about her losing control of her life. She has recently gained weight since her life is less active because she does not want to go out. She just finds herself sitting around often daydreaming and not even focused on anything, not even concentrating. Cassandra gets upset that they seemed to have been hibernating much more than they need to since Alyson fears losing control when they do go out.

Past Psychiatric History

Alyson reports she was in therapy for a year with another therapist but was unsure how to work with therapy. The therapist rarely would ask her anything. Sometimes the therapist would sit back and read a magazine, and Alyson knew she was a bad patient. When Cassandra saw that was not helping, Cassandra found a different therapist for her.

Substance Use History

Alyson denies drug or alcohol use.

Past Medical History

Alyson reports feeling ill often. It is disappointing to her that her illnesses (colds, flus, sometimes pain in her joints) comes on so suddenly it stops her from activity that she was planning on and looking forward towards. She visits her doctor which she has been with for 25 years, and he gives her medicine to try and help her illnesses.

Family History Including Medical and Psychiatric

Alyson is the youngest of three children (one brother and one sister), both of whom are married and live in the same community. Alyson believes she is close with both of her siblings and very close to her mother. Alyson works in a library and was recently promoted to a supervisor although there are no other employees in her area. In a collateral consultation with her mother, mom reports Alyson has always been different and has isolated a lot. During summer vacations at the lake, Alyson would prefer hanging around mom or playing by herself rather than join the other kids. Alyson believed the kids were not interested in her since her likes were different than theirs. Alyson reports never feeling as important as her siblings and believes they look at her differently.

Current Family Issues and Dynamics

Alyson really enjoys her job but is always worried that she will be fired. She concerns herself with thinking she is just not doing enough, even though she recently became employee of the month. She has known Cassandra from junior high school. Finally, about 6 years ago Cassandra expressed her feelings for Alyson and they immediately started dating. This comforted Alyson because she has never been to social activities like bars and clubs to meet people. Cassandra encouraged Alyson to get into therapy so they can expand their social circle. Cassandra wants to become involved in the rock and gem club but Alyson refuses. Alyson’s hesitation is that she does not know a lot about gemstones and the others will recognize that. Alyson reports shopping has been a great relief from the time she was working full time but ends up with a lot of returns since she just does not know how to pick out the correct items.

Mental Status Exam

Alyson presented as casually groomed and appeared her stated age. She was coherent and goal directed. Alyson denies suicidal or homicidal ideation. She was dysphoric. Posture was tense. Facial expressions are appropriate to thought content. Motor activity is appropriate. Speech is clear and there are no speech impediments noted. Thoughts are logical and organized. There is no evidence of delusions or hallucinations. Alyson was found to be oriented to three spheres. Fund of knowledge is appropriate to educational level. Recent and remote memory appear intact. The intake itself was challenging and the information seemed to be coerced from Alyson and not easily presented.

Paper For Above Instructions

The case presentation of Alyson illustrates the complex interplay between interpersonal relationships, mental health challenges, and personal history. Alyson’s demographic details indicate a strong familial bond, especially with her mother and sister. Her presenting issues, largely highlighted by symptoms of anxiety and depressive manifestations, are exacerbated by difficulties in her social and interpersonal engagements. It’s crucial to consider the underlying factors contributing to her mental state.

Alyson’s relationship with Cassandra, although supportive, also showcases dynamics where Alyson feels pressured to conform to societal expectations of participation in social activities. The impact of these expectations on Alyson is significant; she experiences functionality challenges that could stem from her worry about losing control when venturing out. Her sleeping troubles and physical health complaints contribute to a cycle of distress that needs to be addressed holistically.

Psychoeducation is a critical element in treating Alyson's concerns. It's vital for her to understand that being unwell socially is a common struggle, and acceptance can alleviate some of the pressure she experiences. Incorporating cognitive-behavioral techniques can assist Alyson in reframing her negative thought patterns. Many individuals in her situation can benefit from learning new coping skills that diminish anxious responses. Regular engagement in guided activities alongside Cassandra may also help Alyson gradually face her fears.

Therapeutic Considerations

It is imperative to take into account Alyson's past experiences with therapy that shaped her perceptions of the therapeutic process. A therapist's passive stance, as she experienced previously, hindered her ability to express herself fully. Thus, a therapist who adopts an active, engaging approach will likely be more effective in facilitating Alyson's healing journey. Establishing a trusting therapeutic alliance will empower Alyson to convey her thoughts without the fear of judgment.

From a medical perspective, her somatic complaints warrant thorough evaluation to rule out any underlying conditions. Chronic illnesses can add layers of complexity to mental health and vice versa. Compiling a comprehensive assessment that weighs both her physical and mental symptoms would enable a more integrated treatment plan.

Cognitive Behavioral Therapy (CBT) can serve as a focal point in her therapeutic approach, teaching her to identify and modify detrimental thoughts and behaviors concerning her anxiety and sleep disturbances. By restructuring her cognitive distortions, she may uncover healthier coping mechanisms and diminish her avoidance behaviors towards group settings like the rock and gem club.

Furthermore, enhancing Alyson and Cassandra's communication surrounding their routines may reduce Alyson’s feelings of inadequacy concerning her relationship dynamics. As Cassandra wants to explore hobbies together, a gradual exposure to new social environments, tempered with Alyson's readiness, will foster an empowering setting for social participation.

The multifaceted nature of Alyson's mental health concerns, infused with her relational history, necessitates a keen and tailored approach. Adopting a person-centered framework while integrating effective therapeutic modalities can pave the path toward her emotional wellness and interpersonal development.

References

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