So, hi Emily, I'm Jamie, it's really nice to meet you.

Hi, Jamie, thanks for seeing me today.

I'm glad you're here.

So, can you tell me a little bit about what brings you in today? Well, to be honest, I really don't know where to start, all I know is that I've been experiencing extreme anxiety, and it's related to an incident that happened at my parents' house, this last week.

Mm.

And it's got me really nervous, and worried, and scared.

Okay, okay, so you're experiencing a lot right now.

Yeah.

Can you tell me a little bit more about the incident that you referred to, that happened last week? Yeah, I went over to my parent's house for an event, they were hosting a birthday party and, you know, the day was going well, but I noticed that things were a little tense between my mom and my dad, and I'm pretty sure that he was probably drinking, before the guests arrived, and by the end of the evening, things were out of control, and he attacked my mother, and it was brutal, and very scary, and I had to intervene.

Okay, and was this a physical attack of your mother? Yes, he had his hands around her throat.

Okay.

And seemed like he was not aware of what he was doing, and I'm really worried that if I had not been there, he might have seriously harmed her or killed her.

Wow.

Yeah.

Sounds like a lot.

It is, I'm not over it.

Mm-hmm.

I'm really glad that you're here, and that you're taking this opportunity to talk about it.

I'm curious in that situation, were the police called? Did the police intervene at all? No, I did not feel that that was something we could or should do.

Okay, okay.

I think that would have caused a lot of problems for my mother later.

And so, we handled it internally, in our home, by separating him from my mother.

Okay, okay.

So I'm curious a little bit about whether this has happened before.

Was this kind of an isolated incident,

or is this something that has been- (sighs)

that has happened before for your family? (sighs) Well, this hasn't happened in a while, but when I think about it, you know, my father did have a problem with alcohol when I was growing up.

I have seen him come at my mother before, but for a long time, things have seemed to be under control, and so this recent event was a surprise.

I thought things were, were getting better.

Okay.

Okay.

And you don't live in the house with your parents right now? I don't, I moved out a few years ago, and this incident has me wondering what has been happening since my absence.

I don't know if this was a series, one of the most recent events in a series, or if this was just an abrupt change, I'm not sure.

Okay, okay.

And you mentioned that your dad was drinking during this incident, and some challenges with alcohol in the past, is that what you had said? Yes, he has struggled with it in the past, but, you know, no one really knows about this.

We've kept it as a private family matter, he is very well respected in the community, he's the principal at a local high school, he's a religious leader and people look up to him.

In fact, I would go so far as to say he can be a little intimidating.

And so, for those reasons, our family problems, we keep them indoors, we don't really discuss them, and I think I and my siblings are a little afraid of what could happen if we share these things.

So the alcoholism has been kept under wraps for sure.

Okay.

I'm curious, specifically, if you've mentioned some of the roles that your dad, your father plays in the community, I'm curious how mental health counseling is perceived by your family, by your culture, by your community.

It's been strongly drilled into us that any problems that we might encounter should be handled spiritually, and there is no real need for any kind of assistance beyond that.

And so, I think my father has tried that route, but for whatever reason, it doesn't seem to be working.

Okay.

So this incident has really shaken things up, enough to kind of, bring you here, and to seek another potential solution.

Yes, I'm very worried about my mother.

She doesn't want to talk about this.

I worry for her safety.

And sometimes she watches my sister's children, and I'm worried about what they could be saying, I'm worried about what my father could do to them.

I don't know how to protect when I'm living far away.

Yeah, okay.

And how far away do you live from your parents? I live a couple of hours away.

Okay, okay.

So, one of the things I kinda want to circle back to is your safety and the situation with the incident at your parents' house for the birthday party.

How did you feel about your safety in that moment? Cause you mentioned that your father's hands were around your mother's neck, and you kind of physically intervened, little curious about your safety.

(Emily sighs)

Well, when I intervened, it didn't seem that my father could see me or hear me.

And that's what's really...

That's another element that is terrifying me, is he seemed to be locked into some type of zone, where no amount of speaking, or reason, could shake him out of it.

And I worry that if it hadn't been my mother, it could've been me, it could've been someone else, and he's a strong man, he's tall, and I mentioned he's an intimidating figure, just by his height alone.

And from things that I've witnessed in the past, He throws things, and he's not afraid to hit his children as well.

I certainly experienced that growing up, but to put his hands around my mother, that was extreme, I never thought he'd go that far.

Sure, okay.

So you mentioned that this has occurred in the past.

I'm curious if you can tell me, maybe your earliest memory where this was a problem, or was an issue, where you experienced physical abuse by your father.

Well, my father has always been a strict disciplinarian, because he has an image to protect, and he wants his family to uphold that image, so, whatever he needed to do to make that happen, or get that message through to us, he would do.

I can't say he was particularly discriminatory about what kind of abuse or how he abused, It was for him whatever he needed to do, to get that message across.

And if he was drinking, it was even more extreme.

Mm-hmm, mm-hmm, okay.

And I'm curious, what have you noticed are some of the impacts of some of those earlier memories, and even in, kinda, conjunction with what happened last week? How does that impact you? How does that affect you? I can be skittish, and scared, and I can have bouts of anxiety when I'm around them, When I'm around my father, I revert into someone that is not my adult self, that I've come to know, I can cower, maybe be very deferential, afraid to stir the hornet's nest, and I've noticed that in my relationships as well.

The hornet's nest is quite vivid.

One of the things, Emily, that I wanted to mention is that, took a lot of guts, for you to come in here today, and so I appreciate you being here, in our work together, We're gonna probably circle back around to some more of those details about the anxiety that you've been experiencing, some of the skittishness.

I'm wondering if you would be okay, if we shifted into a little bit more of your history, so that I can get to know more about you in general, so that we can help to plan what our work together is gonna look like.

That sounds good.

Thank you.

So, can you tell me about other family members? So, specifically your primary family.

So, do you have siblings? I do, I have one sister.

One sister, okay.

Who is quite a few years younger than I am.

Okay.

She has children, that I've mentioned, my mother sometimes watches.

I...

I think we're close, but we mostly bond over the shared experiences of abuse, and volatility in our home, but she lives very close to them, and I worry about burdening her with the family problems, because I'm not there to intervene, or to help, and support both her and my mother.

Okay.

Sounds like quite a bit of pressure for you.

Yes.

Okay, okay.

So one sister, and then some nieces and nephews.

Yeah.

Can you tell me a little bit about your educational history? What was the highest level of education you completed? Well, I graduated from college.

Okay, okay.

And I'm working on my masters.

Oh, that's fantastic, that's a lotta work.

Yeah.

a lot of work.

Are you trying to juggle a job, as well as your master's degree? I am, I am.

And to do that, sometimes I maybe don't check in with my family as often as I should.

Sure, okay.

It's easier not to, so that I can focus on what I need to do.

But after the incident last week, I think I need to, maybe shift my priorities.

Your family's really important to you.

They are.

Okay.

Diagnose the individual in the video based on the symptoms and the DSM-5 diagnostic criteria. Support your diagnosis with a differential diagnosis.

Include a case conceptualization that explains the issues, symptoms, and diagnosis framed in a theoretical lens.