Cindy Marques
Psychological Evaluation
Name: Betty WrightSex: Female
Address:123 Main St. New Britain, CT
Parents: Married
Date of Birth: 9/21/82
Age: 24
Grade: Did not complete High School
Date of Examination: Oct. 9 and Oct. 16, 2006
Reason For Evaluation:
Betty Wright is a 24 year old Caucasian female who is currently unemployed. She is not married but has been in a relationship with her boyfriend for the past six months. Betty appeared to be clean, well-groomed, and dressed rather provocatively for this therapy session. She was referred by her current boyfriend who feels that she should work through her life-long issues with men and relationships before she destroys their relationship. Betty states that she is here to appease her boyfriend but she does not plan on staying with him in the future. She also discussed wanting to seek help for cutting. The client was given information about the goals and limitations of therapy, as well as the HIPAA laws, and has given her informed consent to continue with the session.
Background Information and History:
Betty grew up in a household with two parents who are married as well as an older brother. She states that although her parents are married, they do not have a stable relationship because her father is an alcoholic who sexually abused Betty and it started as “far back as I can remember”. She was also sexually abused by her older brother and began dating his friends at the age of twelve. She has since moved from relationship to relationship, each one lasting about six months. Betty states that she seeks money, dinners, and material things from men rather than emotional connections. She states that she usually gets bored quickly with men and simply stays with a man until a better man comes along. Betty has also had a succession of marriages beginning at age seventeen when she married her High School science teacher. She married four times in total and each marriage only lasted a few months.
Betty has an extensive medical and psychiatric history. She states that she does not suffer from a current illness but is waiting for results from an HIV test which she follows up on every six months. Betty states that she has had Chlamydia a few times as well as gonorrhea and genital warts. She has become pregnant twice but terminated both pregnancies. Her first pregnancy was a result of the sexual abuse she endured by her father at the age of ten. During this time, her mother entered her into a Psychiatric Hospital where she remained for a month and received her first abortion. She states that things became worse at home after she was hospitalized because she feels that her mother was jealous of her relationship with her father. She has had no other surgeries or traumatic injuries.
Betty states that she engages in recreational drug use which includes cocaine every few weeks but she enjoys marijuana much more often. With marijuana she says she can forget about her problems and relax. She is adamant that she has never, nor will she ever, try heroin. She claims that she never buys drugs and only takes them when offered to her. Betty also feels that she is not addicted to drugs and can go up to two weeks without smoking marijuana. Betty drinks alcohol on occasion but prefers the effects of marijuana. She has attended Alcoholics Anonymous meetings in the past and although she enjoyed talking about her problems, the meetings did not help her and she was more interested in meeting men there.
Betty states that she uses cutting before using any drug and has been cutting daily since the age of twelve. She claims that cutting makes her feel better because she often feels nothing at all in her everyday life, as if she is numb. Betty states that if she cuts, she feels something and knows that she is alive. She has never been hospitalized for cutting herself and she states that she does not want to end her life by cutting. When asked if she ever cut herself so much that she almost died, Betty said no but she has had infections and wears long sleeves to cover the scars on her arms.
Betty has been prescribed medications in the past but can not remember their names and has stopped taking all of them. She recalls taking Ritalin around age ten or twelve and having the feeling that she was going to “jump out of her skin” so she stopped taking the medication and sold it to a few boys at school. Betty states that she is willing to take medication but feels that none will work for her.
Mental Status Examination:
When Betty was asked about her mood, she stated that she is o.k. and excited about therapy. She enjoys talking to people and finds it fun. On a scale of 1-10, 1 being “not depressed” and 10 being “happy as ever”, Betty said she felt she was at a 5. She claims she is only happy when she has a nice guy who will buy her things and take care of her. Usually she does not feel much of anything and feels empty everyday. Betty does not know why she feels unhappy and empty and knows that she should feel “something” and should experience more things in life. She becomes increasingly more despondent while discussing the fact that she does not look forward to much in her life and claims that “life sucks a little bit”. She feels detached from people and does not understand how happy people feel. She worries about losing her figure and having men lose interest in her because she feels she’d then have to finally get a job and support herself. She says she was traumatized by her childhood but she says she tries not to let it affect her. Betty states that she had suffered from panic attacks as a child when she was being sexually abused by her father. When she would hear him coming to her room, she could smell alcohol and her mind would begin racing. She would also play a game in which she is an angel in heaven looking down at what was happening with her and her father, but she would not feel anything and would be detached from the events taking place.
Betty states that she keeps her mind off of things by cutting herself, having sex, and playing music very loud so it covers her thoughts. The last time she cut herself was the morning of this therapy session. She states that she wanted to get herself “ready” for this appointment and wanted to be “interesting and not dull”.
When Betty was asked about suicide, she states that she feels she would be better off dead and wonders what her parents would think if they found her dead. However she states “I’m not gonna kill myself or anything”. When asked if she thinks about hurting others she states “I dream everyday of my life to cut off my father’s penis, but I would not act on it”. Betty has not been in contact with her father for a few years and does not have a plan to hurt him or herself.
Betty shows no congruence between affect and what she is discussing. Betty discusses horrible life experiences very casually as if she is detached from what happened to her. She shows very little insight into her behavior and how it correlates to her past experiences. She appears to be flirtatious with male therapists and has stated that she prefers them over female therapists. She also appears to be attention-seeking and is not appropriate with boundaries. She also became impatient with certain parts of the session before becoming comfortable. Betty seeks approval and reassurance and wants people to like her.
Cognitive Assessment
Betty states that her memory is good and she remembers everything. However, as a child she says she had periods of time where she does not remember certain events and she is good at forgetting things, this tends to be “situation-specific”. She knows that she was born in Boston, MA and her four husbands names were Eddie, Vic, Ray, and Benjamin. When asked to explain the phrase “All that glitters is not gold”, Betty had a good understanding of the meaning by stating “Things can look fancy on the outside but there’s not a whole lot on the inside”. Three words Betty would use to describe herself are young, sexy, and attractive. Three strengths Betty feels she has are that she believes she is a people-person, she can ‘read’ men, and she can change herself to accommodate others, especially men. As far as her future, Betty worries about losing her looks and men will lose interest in her. However, she has no current plans or thoughts to continue her education or seek employment. She states that she would be interested in careers as a personal shopper or giving makeovers to people. When asked if she practices bad judgment, she says she regrets her marriages and her last husband was a “downer” and a “bible-thumper” religious man. She states that she is an atheist and does not recognize or believe that there is a god. Betty became increasingly angrier when discussing her feelings about god and religion and stated “What kind of god lets children be hurt again and again? It pisses me off.” Noting Betty’s increasing anger, she was asked if she has problems with anger and she states that she has two “modes”: ‘nothing or pissed off’. She appears to be an impatient person and says that stupid people and questions make her angry.
Recommendations:
Betty states that she is interested in coming back to therapy and is willing to go on medication. I will refer Betty to a psychiatrist for medication and further diagnosis. Betty appears to be suffering from an apparent Personality Disorder such as Borderline Personality Disorder as well as Histrionic Personality Disorder. Other possibilities for diagnosis are Obsessive Compulsive Disorder because of cutting and anxiety and her addictions to drugs, alcohol, sex, and shopping. She also may suffer from Post-Traumatic Stress Disorder because of her past sexual abuse. She also appears to be suffering from Depression because of her constant feelings of emptiness and issues with relationships. I recommend that Betty returns for long-term therapy to work through her extensive issues.