2. CLIENT PROFILE:
• “Jennifer”, 22 year old female.
• Diagnosis: Aspergers syndrome (F84.5)
Major depressive disorder, recurrent episode, moderate (F33.1)
Generalized anxiety disorder (F41.1)
Obsessive-compulsive disorder (F42)
• Current Medications: Prozac, 20mg. (Managed by PCP)
• Previous Treatment: Inpatient treatment, partial hospitalization, school counseling, mental health
therapy at a clinic.
• Family History: Jennifer’s family background was of religious (Christian) faith and the college she
attended is faith based. She lived with her parents while in college and her father worked at the
college she was attending. Began college at age 21.
• Risk Assessment: Occasional suicidal ideation (less than 3 times a month), and feelings of
hopelessness but no active plan. (A safety plan was created to identify support people,
emergency phone numbers, strategies for calming down.)
3. PRESENTING SYMPTOMS AT INTAKE
• extreme moodiness, intense emotions
• feelings of sadness that persist daily
• anger outbursts
• lack of motivation and low energy
• sleeping for long periods of time,
irregular sleeping patterns
• poor hygiene
• moderate/low grades in classes despite
studying for long hours with no breaks
• isolating herself/avoiding others,”hiding
out” in her room at home
• anxiety in social situations
• difficulty making and maintaining
friendships
• repetitive behaviors such as frequent
hand washing, repeated negative self
statements, and hoarding items that
were meaningful from the past and
being unable to throw them away
because she felt they had sentimental
value (papers, letters, etc.)
4. SIGNIFICANT HISTORY
• Jennifer was hospitalized (for 2 weeks) at the age of 15 for making a threat of
harm to a (favorite) teacher. At that time, she exhibited signs of major
depression (persistent depressed mood) — she reported feeling sad and lonely
much of the time — and anxiety; (she was worried about others’ opinions of
her), panic-like symptoms when in social situations, and obsessive behaviors
such as hand washing, hoarding, and repetitive thoughts.
• She struggled to make friendships with peers and reported being bullied by
them. She would fixate on teachers and older adults who were kind to her and
she viewed them as “best friends” instead of professional (teacher/student)
relationships.
• Jennifer attended an alternative high school for last two years of high school,
where she received mental health care, social support, attended a social skills
group, received academic support, and was able to graduate with a Regents
diploma. Parents report some sensory processing issues as a child and
difficulty in social situations.
5. TREATMENT GOALS AND STRATEGIES
• Decrease frequency of depressed moods.
• Decrease anxiety/panic symptoms by recognizing triggers, utilizing prevention strategies,
learning mindfulness and grounding techniques to reduce these symptoms.
• Address cognitive distortions and utilize Cognitive-Behavioral-Therapy (CBT) in this
area.
• Decrease obsessive-compulsive behaviors.
• Learn to manage anger and decrease outbursts toward others.
• Decrease social isolation (identify social interests, increase exposure to social situations
with support).
• Improve communication skills with peers/family, increase understanding of social cues,
and appropriate social boundaries.
• Learn and improve self-care skills.
6. OBSERVATIONS
• During course of treatment, Jennifer expressed multiple cognitive distortions in her thinking and
processing of social cues, such as:
• Mind Reading: making assumptions about what others are thinking and that they are thinking
negative things about her.
(Example: “Sally didn't say ‘hi’ to me in class today, so she thinks I’m a terrible person and doesn’t
ever want to be my friend.”)
• Filtering/Overgeneralizing: Only seeing small negative things and missing larger positive things.
(Examples: “I failed a quiz and now I’m gonna fail out of college.”
“Everyone hates me and I will never make friends.”)
• Catastrophizing: She would often think of worst-case scenarios.
“What if I look stupid and everyone laughs at me?”
“What if I end up back in the hospital forever?”
• Black-and-white thinking: She felt anything other than a perfect grade was failing. People either love
her or hate her. Life was either wonderful or terrible.
• Personalization:
(Example: “I didn't feed the cat last night and my mom yelled at me about it. It's my fault her job is so
stressful and she is in a bad mood.”)
7. TREATMENT STRATEGIES
• Engage in reality testing dialogue with therapist to address cognitive distortions:
Examples:
“Did that person really say they hate you?”
“What evidence do you have that everything in your life is terrible?”
“What in your life is good?”
• Identify appropriate communication strategies with parents/peers. Utilize “I”
statements vs. blaming others: “You were rude to me on purpose,” vs. “I feel
left out in group situations, but I would like to join.” (Peers)
“You treat me like a child” vs. “I am an adult and want to be treated like one.”
(Parents)
• Try role-playing social situations with therapist (Eye contact, active listening).
• Recognize connections between emotional well-being/increased anxiety and
isolation leading to increased hoarding behaviors.
8. TREATMENT STRATEGIES
• Journaling, writing about experiences and emotions, and expressing them in creative ways.
• Create a 3-D project about how the teacher she threatened encouraged her to become an
artist. Art helped her process the grief and loss from being removed from this class/school
and attending an alternative high school.
• Use art to express her strengths and not magnify her “weaknesses”.
• Create art to increase self-esteem and self-worth. (Created visual affirmation cards of positive
self statements)
• Use art to explore vivid dreams and nightmares.
• Learn and utilize self-care strategies to improve overall mental health and functioning.
(Willingness to get enough rest, shower regularly, eat balanced meals, etc.)
• Go through collected papers and identify personal letters/cards and sentimental items, and
meaningful items. Dispose of the rest with support. (Created scrapbook with sentimental
items)
• Exposure therapy on a gradual basis for events previously avoided (crowded concerts, cafes,
festivals, etc.)
12. PROGRESS
• Reported less depressed mood over time. Depressed mood decreased to 1-2 times per week, from
everyday at start of treatment. (Utilized mood tracking tools and self report).
• Decreased time feeling sad and lonely. (The client’s time reportedly feeling sad and lonely decreased to
1-2 times per month from 2 times per day.)
• Decreased time spent obsessing/making inaccurate conclusions about what others are thinking and
doing. This behavior was constant/daily when she began treatment, then decreased to a few times a
week, to a few times a month.
• Increased acceptance of having an occasional “bad day” vs. thinking “Everything will be terrible every
day.”
• Increased willingness to engage in role-play/communication dialogue regarding real life situations.
• Decreased isolation:
— Increased willingness to engage in discussion with others about preferred topics (art,
reading, etc.)
— Increased willingness to attend social events and interact with others.
— Reported making/maintaining some friendships with peers.
• Decreased hoarding behaviors when addressing mood, anxiety, and emotional health. Reduction in
behaviors (some willingness to throw out items that were not sentimental).
• Increased involvement in faith/spiritual practices and events.
13. ADDITIONAL TREATMENT RECOMMENDATIONS
• Medical doctor provided ongoing care and medication management
(family worked with medical doctor and Naturopath).
• Academic tutoring to address academic needs.
• Utilize supports offered by the agency who provided case
management, such as social skills training with 1:1 staff in
community.
• Family support through local agency groups and supports.
• Participated in peer groups of interest (Art Club, etc.)
