Vignette

Session One
Sondra is a thin, gaunt, 42 year old female of Hispanic heritage. Her mother killed herself when Sondra was 10 years old. Sondra was raised by her father who she describes as â??an abusive and controlling man.â? Sondra has been widowed and is currently dating a man 15 years her senior who she describes as â??a good man who loves me.â? Sondra is employed as a commercial artist. She tells you that her love of art is what has held her together all of her life. â??It is the only time I experience joy and meaning.â? Sondraâ??s 2 children are grown and in college. Sondra is seeking therapy for what she describes as chronic discontent, low self esteem and bouts of anxiety; â??Sometimes I am afraid to leave the house.â? She also tells you that she has had periods of hopelessness and despair since childhood.

1. Formulate a Differential Diagnosis for Sondra. What are your diagnostic considerations and why? Support your ideas by discussing what you see in the vignette utilizing all course readings thus far. What information would you need to look for to confirm your diagnostic impression and why?

2. Considering the Models of Abnormality outlined by Comer (2007), choose two theoretical models (not used in previous vignette) to explain Sondraâ??s clinical presentation, being sensitive to issues related to women, grief, childhood depression, suicide and repressed memories as they apply to Sondra.

Session Two
Sondra presents in this second session in much better spirits, is quite chatty and disclosive. Her speech is choppy and rapid and she has difficulty staying focused. Sondra tells you that as a child â??I was a fatty as a kid and was teased by the kids at school. I felt like nobody liked me and I wished I couldâ??ve just disappeared.â? She admits to always struggling with her weight and that she would feel on top of the universe in a size 3. â??I would go on shopping sprees to celebrate and then eat a gallon of ice-cream and hate myself.â? Sondra has been in therapy before, was prescribed medication by a psychiatrist and was admitted for in-patient treatment at a mental health facility for an overdose in her early twenties. She denies suicidal ideation at present and admits that sometimes life looks pretty good, but it never lasts. She denies being on medication at present.

1. What diagnostic issues arise during your second session with Sondra? What assessment and intervention techniques might you consider for Sondra at this point in treatment? What referrals might you consider making for her and why?