This, however, will remain the choice of the patient, but the hope is that we can bring about a change in her level of consciousness such that she might recognize for herself a benefit in that involvement with the children's fathers. Imperative to helping the patient realize her value in her abilities, skills, and other qualities associated with motherhood and her career that will help her to see her role and herself differently. This will help her with some of the confidence issues that she experiences in meeting new people and going to new places. There is perhaps some minimal issue of panic attack syndrome, but that, too, requires more in depth work and additional sessions to arrive at that conclusion. If the patient's panic about new places and people subsides as we address some of the self-esteem and family issues, then that will not be a problem. if, however, as work brings about positive changes in the patient's consciousness about how she perceives herself as a mother and performer, and the sense of panic continues upon meeting new people or going to new places, then we will have to address that as an aspect of the patient's therapy.

As much progress will made as possible on an outpatient basis, however, at this point in the assessment, the patient's dual diagnosis of alcoholism and drug use is a concern. It may be necessary for the patient to consider a course of inpatient detoxification, to prepare her for the rigors of sobriety. Keeping this patient invested in sobriety is going to be a long measure of success in this case.

It is important that Ms. G. find a level of exercise that is not involved with the work that she performs....

One of the problems with that, is that when Ms. G. is not working, she is not dancing, and she is not benefiting from the exercise, nor is she working to stay in shape to perform the dance and work for which she has become famous and known for. This could be a part of Ms. G's self-esteem, too. The direction we're going to pursue for this, is interesting Ms. G. In an exercise regimen that is not related to her work, and we will help her to understand the relaxation element of a program that is not directly related to her work, but one which helps prepare her for work. This exercise regimen will also increase the patient's energy level and help her balance her work and private life.
Six Week Follow-Up

Six weeks into therapy, and Ms. G. has finally begun to adjust her perception of her behavior and has expressed an interest in the outpatient alcohol and drug treatment program, following a period of detox at an inpatient level of care. Once this is accomplished, Ms. G is confident that she can begin to manage her life and career in a positive way. She is beginning to express positive things that she recognizes in herself about her parenting, and her career. She has manifested fewer symptoms of manic depression, though this is still a potential diagnosis, which cannot be fully assessed until the patient has completed her detox, and begun her outpatient drug and alcohol rehabilitation.

In the interim, the patient will continue her weekly therapy sessions. The patient is more open to talking about herself. She appears less anxious, and she makes eye contact. She is optimistic about beginning an exercise program, and talks about it at length.