Gloria Suarez is a 31-year-old single mother who contacted the Gulf Coast Counseling Center concerning therapy for herself. She told the intake worker that she was feeling very down and exhausted and needed to see someone soon. The intake worker scheduled an appointment for her with you, her counselor, in 2 days. Gloria arrived on time for her appointment with you.

  

Intake Interview

  

 Gloria presents as a quiet, young woman who smiles shyly and shakes hands with you in the waiting room. She says that she doesn’t really know why she came today except that she’s been so tired recently. Gloria indicates that she works as a cashier for Ding Dong Discount and has been separated for the past 3 years because she can’t afford a divorce. She feels that since her separation her life has been spinning out of control. A year ago, her older sister died of hepatitis after a long battle with drugs and alcohol. Gloria describes her as a sweet but completely crazy sister. She hasn’t had any contact with her parents since she left home at 18 years old. She states that her father was also an abusive alcoholic and her mother never protected Gloria or her sister from the abuse. When you ask her about her mood, she tells you it’s generally been “blue.” “I seem to be exhausted all the time. Between trying to take care of my kids and working shifts at Ding Dong, I barely know whether its night or day.

  

Do you ever have times when you feel okay or more like you did before the separation?” you ask. Gloria sighs deeply and says, “Actually, yes, every once in a while I have times when I have a lot more energy, but I also get extremely irritable. I scream at my kids and feel very frustrated with my job, but I’m not so tired and down in the dumps. I even go out dancing and enjoy hanging out with my friends.” “How often do you feel that way over a period of a year?” you ask. “Like I said, it’s every once in a while. Most of the time I’m exhausted. I’d say maybe 2 or 3 times a year.” “How long has this feeling of exhaustion been going on this time?” you query. “Probably for the past 3 months,” Gloria responds. “I begin to feel real hopeless about my life and feel like I have nothing to look forward to.” “Do you ever think about suicide?” you question carefully. “To be perfectly honest, I have thought about just taking a bunch of pills and going to sleep forever, but my kids keep me from doing it.” “Have you seen a doctor and gotten a physical exam recently?” you ask. “I took my kids for shots before school started but I don’t have much money,” she responds as she stares out the window. “Have you been feeling suicidal recently?” you ask. “No, it’s been quite a while since I’ve been that down but I try not to think about it. I know my kids need me and that’s what keeps me going.” “What about your appetite?” you ask. “I don’t feel like eating when I get so down but when I’m feeling better, I make up for it,” she says with a smile. “And how well have you been sleeping?” you ask. Gloria seems to relax a bit and says, “I could sleep all the time if I didn’t have to work and get up with my children.” “It sounds like you’ve been coping with all these emotional ups and downs for quite a while. Tell me about how you’ve handled all of this. It sounds like a whole lot to deal with as a single parent.” “Well, I’ll tell you one thing for sure. After my sister died, I wouldn’t touch drugs, and alcohol just reminds me of my dad and how abusive he was.”

  

“You know, you’ve told me a lot about yourself today and it sounds like you could really use someone to talk to further about how to begin feeling better. But, first, I’d really like you to see a doctor for a complete physical and I know someone you could see for a very low cost. Would you be willing to start by going to the doctor?” you ask. “You’re probably right. It’s been a long time since I’ve had a physical,” Gloria responds. “But I’d like to see you again, too.” “Absolutely, we will schedule another appointment for next week and I will give you a card so you can call the doctor’s office and make an appointment with her.” Gloria looks relieved and says, “I’m glad I came in today. I almost skipped it.” “I’m really glad you came today, too,” you respond. “I think I can help you with some of these challenges you’ve been dealing with on your own. There’s times when we all need some extra help.”

  

1. What are some of Gloria’s strengths? 

  

2. What diagnoses would you want to rule out in this case? 

  

3. What resources might be valuable to utilize in this case? 

  

4. Do you think Gloria should be referred to other professionals for further evaluation? If so, to whom would you make a referral?

  

 5. What is your primary diagnosis for Gloria Suarez? 

  

6. What psychosocial and cultural factors could be impacting Gloria?