Leslie is a 35 year old married woman who is separated from her husband. She has two children, ages 10 and 12, and works in the Health Care Field. In addition, she has two master’s degrees and childcare experience. Leslie has an older brother and sister, but little contact with them. Her brother is very involved with their parents while her sister has become close to her in-laws, and has made them her family. Leslie’s son (10 years old) suffers from symptoms of anxiety and was in counseling with the family’s co-parenting therapist, but son’s father refused any further family counseling. The custody conflicts with her husband remind her of her father, her husband often calls her crazy or lazy, and says she is too demanding. Leslie has a “loser” identify fostered by profound paternal neglect, strives to be “good” and works to get attention from several men. Her father’s negative voices even now, are overwhelming and powerful. Father used physical punishment. Her mother suffered from OCD and was a victim of sexual abuse. The children were often locked out of the house on Saturdays and other days could only play in the basement. Father did not challenge mother or attempt to get help for mother, he was primarily focused on work. Leslie has a history of depression with suicidal episodes. Leslie has tried several kinds of therapy, including EMDR and has taken anti-depressants at times, but is not consistent with medication. She feels very isolated, and that her friends that do not have children are not supportive. Leslie waits for her children to go to bed, and then starts drinking. She often drinks late into the evening (usually 4-5 mixed drinks) before she goes to bed. She struggles to get up in the morning, but rarely misses going to work. She frequently has suicidal thoughts after drinking.

Questions:

1. What else would you want to know?

2. Review the diagnostic criteria for Alcohol Use Disorder, Major Depressive Disorder and PTSD. Do you believe any of these disorders are present? Are there other disorders that you would consider?

3. Based on what you read here, and a review of the ACE questionnaire, what is Leslie’s score?

4. Think about the different treatment modalities we have discussed. Where do you think you would want to begin your work with Leslie?

5. What other resources might you consider?