Client Is a Never Married 27-Year-Old African-American

¶ … client is a never married 27-year-old African-American lady who has completed 12 years of formal education. She is currently employed as a retail salesperson in the clothing section at a local department store. Her parents died in an automobile crash six weeks ago and she was very close to them. She stated that she misses her parents very much.

The client reports that her development as a child was normal and that she met all of her developmental milestones at appropriate ages. She has one younger brother whom she sees occasionally. She was an "average" student in school graduating from high school with a C. average. After high school she took several jobs working in the retail industry. She has worked at her current position for the last three years and states that she enjoys her current job.

The client reported a healthy relationship with her parents, teachers, and peers throughout school and currently. Recently, she finds that she does not feel like going out with her friends on weekend s, something she usually does every weekend. She reports having a large number of friends at work and even is still friends with some of her high school friends, many of whom have gotten married and now have children.

The client lives alone in an apartment. She reports working five to six days a week, being active outside of work by spending time with friends, taking several trips a year, and hiking.

The client's medical history significant for type I diabetes diagnosed when she was in high school and bipolar disorder diagnosed when she was 25 years old. She reports that she began to experience periods of the week to 10 days were she could not sleep, would go out and spend money and party, and these periods would be followed by months of feeling really down and depressed. She was referred to a psychiatrist who prescribed Lamictal which has controlled her mood swings. The client does not smoke, drink alcohol occasionally, and has never used illicit drugs.

Presenting problem: Since her parents that she find herself feeling anxious, sad, and unable to "get it together again." The client stated that she was once an avid hiker, but reports since her parents death she has not done much hiking. After her parents funeral she finds herself feeling quite anxious and sometimes depressed. She has been having periods of "nervousness" that have interfered with her ability to sleep, adhere to her diet, and function at work. As a result she has taken off several days, something that she normally does not do. She finds that her motivation is dwindling and she does not feel like going to work, seeing her friends, or doing anything but eating candy bars and watching television. She also finds herself ruminating about her parents and feels lost and is unable to find purpose or meaning of life. She also finds that she is now eating a lot of sugary foods and junk food. She has continued to take her Lamictal as she is afraid that she will suffer even stronger mood swings if she stops. The client has a scheduled follow-up appointment with her psychiatrist in four weeks.

She now wonders if having gotten a college degree would've made her parents happier. She also wonders if she should of had children as now her parents will never see their grandchildren. She has had two boyfriends whom she has been sexually intimate with, but did not want to marry them. She is now wondering if she made a mistake by not getting married and having children so her parents would know that she was happy before they died.

Relevant Behavioral Observations: The client was on time for her appointment. She was a well-dressed, well nourished, and was very cooperative during the interview. She appeared to be of average intelligence and was fully oriented and alert.

Concerns:

Client concerns: Feelings of nervousness, sadness, and rumination over the past

Clinical concerns: Anxiety and depressive symptoms, both cognitive and vegetative

Clinical concerns: Exacerbation of her bipolar disorder

Clinical concerns: Interpersonal isolation

Clinical concerns: Amotivation

Contextual considerations:

Client is craving sweets, not eating properly, and has diabetes. This could lead to a life-threatening situation and also may contribute to her symptoms. Client is also treated for bipolar disorder and there is reason to suspect that she might be experiencing an exacerbation of her bipolar disorder.