Case

Gillian is a 32-year old woman, who separated from her husband 3 years ago and has been dating a man for the past 8 months, whom she met through an on-line dating service. She mentions that she needs to find new housing as she just recently adopted a dog from a local animal shelter, and her apartment does not allow pets.

Gillian states that her boyfriend tries to be supportive and wants her (and her dog) to move in with him. Gillian says that she has reservations about moving in because at times he can get quite angry, impatient, and they end up fighting. However, she says that if she doesn't move in with him soon, she worries he might get mad.

Gillian shares being depressed on and off for as long as she can remember and has been getting worse over the past few years. She mentions that she has been on a variety of antidepressants to deal with this, however that none of them have been helpful. She claims she was referred to a psychiatrist 6 months ago, who prescribed her with sleeping pills and anti-anxiety meds, the combination of which makes her feel drowsy and "fuzzy-headed". She claims that she feels even worse after taking these meds and is barely coping some days. She says that she skips her medication at times because they don't seem to be doing anything anyway.

Gillian works as an office assistant and has taken 2 stress leaves in the past. She says that she used to like her job a lot, and recently feels incompetent and anxious at work. She claims that she's been missing days of work lately due to feeling extremely anxious and tearful "all the time". She begins to cry as she tells me that she feels like her life is falling apart, and that no one has been able to help. She puts her head into her hands and says that she wants to stop feeling this way.

We discussed the impact of these current symptoms on her life and when she felt more like herself. She shares that her mom died of breast cancer a few years ago and everything changed after that. She has no other family with whom she is in contact.

When asked, Gillian says that she can't cope with how she's feeling and came to your agency because she needs help.

Question:

What challenges do you personally anticipate in establishing a relationship with Gillian over Zoom? How would you address these issues to establish rapport?