Vignette Client Information: Alexandria Wright, 37 Years

Vignette

Client Information: Alexandria Wright, 37 years old, female

Description Alexandria Wright is a 37-year-old female who came to Dr. Hidlan for therapy. She is married and has two children, both boys. Alexandria also has three sisters: one older and two younger.

The client mentioned that she had counseling a year ago, but has no history of psychiatric evaluation. Although the client has no official history of diagnosis, she has had some issues relating to her family members. She gets along well with one of her sisters, but not as well with the others. Her sisters view Alexandria as being a "perfectionist" and overly obsessed with organizing things.

Client Mental State

Cognition: Alexandria's thoughts are generally clear and she has a good deal of self-awareness. However, she might be in denial about the extent to which her hyper-organizing is a sign or symptom of an underlying problem. Her thoughts are not, however, out of the ordinary. Thoughts of organizing, and the impulse to organize something, invade her thoughts when she is doing other tasks. Sometimes she gives into those thoughts.

b. Affect: Alexandria has been feeling some anger toward some of her siblings and her brother in law.

c. Mood: the client has been experiencing a great deal of sadness since the death of her father.

d. Behaviors: The client's outstanding behaviors have to do with her organizing. Her sisters have called the client's organizing behaviors "obsessive." The client has organized whole trips with her sisters, and controls every last detail. Alexandria claims to enjoy organizing, but it is clear that this behavior is extreme and bothers her siblings. At the same time, the behaviors probably contribute to Alexandria's talents as an accountant: a career requiring good organizational skills. The client has four closets, and keeps her clothes meticulously organized by color and style. She has taught her children how to organize things as well. The client admits that she has "rituals" of organization including checking every night to make sure the car doors are locked. Yet she does not deem this behavior harmful or pathological.

e. Physiological functioning. The client has no outstanding health issues and has good physiological functioning.

f. Suicidal and homicidal assessment. The client has no history of suicide or suicidal ideation. She is also not experiencing any suicidal ideation. She also has no history of homicidal ideation or aggressive behavior.

g. Social history. The client is married but it is unclear what her social life is like, and whether she has any close friends. She is close with Victoria, who has two girls. Alexandria does not get along as well with her other sisters. She especially clashes with Bruce, her brother-in-law.

h. School history. The client states that she has quite a few academic achievements of which she is proud. First, she graduated Valedictorian in high school, and then got her BA Degree, Magna Cum Laude. After that, she received her MS Degree Magna Cum Laude. The client is a CPA, and passed her certification examination on the first try.

i. Client strength. Alexandria has a strong sense of self and a high self-esteem. Her confidence level is also good, and she has the ability to recall events clearly. She is focused, calm, and intelligent. Alexandria also cares deeply about her family. She does not let her conflicts with her sisters come in the way of dividing the will in a fair manner. Alexandria has a strong moral compass.

5. The client's presented problems include the fact that Alexandria is experiencing flashes of sadness. A few months ago she started having recurring dreams of her father's death. He passed away a year ago. Alexandria has recently been named executor of her father's estate. It is causing her great difficulties relating with her three sisters. Alexandria has been thinking a lot about her father's estate and how to divide the property fairly. She is confident, and knows that her skills as an accountant will help her to make the best possible decisions for her and her siblings. She has their best interests in mind, but they do not necessarily work well together.

6. There are clear legal and ethical issues arising in this case. The psychologist admitted to knowing Bruce, who is the client's brother-in-law. Bruce has been trying to have some power over the execution of the will, and none of the sisters want him to take part in it because of what happened with their grandparents' estate. Moreover, Bruce is not an accountant, and Alexandria knows that her skills make her a suitable executor. The conflict of interest between the client, the psychologist, and Bruce make it questionable whether Alexandria should continue seeing this doctor. Although the psychologist declined Alexandria's request to speak with Bruce, there is no way of knowing the exact nature of the relationship between the psychologist and Bruce. If the psychologist lacks integrity, he could be detrimental to Alexandria's treatment plan.

7. Alexandria did not seem to understand the ethical and legal problems associated with asking her psychologist to speak with Bruce on a personal level. This would violate her confidentiality agreement with the psychologist, and potentially involve the psychologist in a legal conundrum related to how much information he knows about the will. However, Alexandria is intelligent enough to understand the legal issues at stake and think critically about them.

8. Case Conceptualization. The client is experiencing problems communicating. She is also experiencing problems coping with stress. From a cognitive-behavioral therapy framework, it can be determined that these problems are related to faulty modes of thinking, leading to dysfunctional behaviors.

With regards to communication, the client blames her sisters for the problems they experience without taking responsibility for her own role in the relationship. She does not listen to their feedback, and this exacerbates their communication problems. With regards to coping, the client has developed habits that help her cope but these habits (obsessive organization) are dysfunctional and coming in the way of her happiness.

9. Alexandria might not have given herself a chance to emotionally mourn her father, which is why she is sad. She needs to communicate better with her siblings and get them all on the same page. Working together with them would help Alexandria relax and release her from feeling she needs to control everything. Her obsessive organization is related to her need to control.

10. Axis I: Obsessive-Compulsive Disorder, because of her preoccupation with organization, work, perfectionism, and money. Her inflexibility and rigidity also lead to this diagnosis.

Axis II: Obsessive-Compulsive Personality Disorder: Same reasons as above

Axis III: none

Axis IV: none

Axis V: none

11. Long-Term Goals and Objectives of CBT 1. Alleviate the client's pervasive sadness 2. Improve her relationships with her family 3. Reduce her self-destructive behavior. 4. Increase insight into her compulsive behaviors. 5. Become more aware of when and why she feels the urge to organize, and what effect this has on her life and the lives of those around her. 6. she will think differently about pulling her children out of public school.