Assignment: Mental Health Counselor
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A community mental health center includes a licensed clinical social worker, a psychologist who provides testing and other assessments, a child therapist and a staff of five counselors. The center also has a relationship with a psychiatrist at a nearby Free Clinic. A 31-year-old single mother of three children (ages 9, 5 and 3), has been seeing her counselor for four months and has become increasingly anxious over the past weeks. In the last few sessions she has disclosed that she feels frightened all of the time, is unable to sleep through the night, and worries that “something horrible is going to happen.” She admits to having a “couple of drinks” during the evening several times a week. She’s met with the social worker on two occasions to help her secure food stamps and get her children appointments at the local dental clinic. The children are now meeting for play therapy sessions with the child therapist during the time the mother is seeing her own counselor. She had met with the psychologist for an initial visit, but has not returned to complete any of the testing. At the end of the last appointment, the client disclosed that was very worried that she’s a horrible mother and is afraid that her children will be taken away and placed in foster care.
I wanted you to know that I’ve been working with this client’s children for three sessions and the mother has granted permission for you to see the notes of the last session. Let me know if you want to talk about it.
Jane, age 9, Johnny, age 5, and Emma, age 3, met with me for their third counseling session. All children were dressed in clean clothing but Johnny was missing his socks and Emma’s shoes were falling apart. We spent the first half of the session working in the sand tray; the children then wanted to draw pictures. Themes that emerged for Jane centered on control and order; she appears to feel overly responsible for her siblings and very protective of her mother. Johnny’s play included themes of “secrets” and “hiding” – he is wary in the room and reluctant to engage in spontaneous play. Emma is very shy and has not spoken more than a few words in each of the sessions. During this session she was very tearful, which I have not previously observed. I believe it would be useful to consult with Jane’s and Johnny’s teachers.
Hi – I wanted to let you know that your client showed up during the week thinking she had an appointment with you. I spoke with her for about 20 minutes – she was very anxious about some things a neighbor had said to her – but calmed down during our meeting. She appeared to have been drinking. I told her that I’d let you know she had been here.
The client has still not returned to complete the assessment battery. I’d like to rule out Bipolar Disorder and further evaluate what I believe to be either paranoid or delusional thinking. There may be some Axis II features. Do you want me to write up a report now based on my meeting with her or should I wait until the full battery is complete?
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