• Treatment Planning
• Ethical and Legal Considerations
• Social Change Implication

The Case Conceptualization of Charlotte:

Charlotte is a 28-year-old single African American female. She states she is heterosexual and was raised in the Christian faith. Charlotte currently resides in her small hometown near Pittsburgh, Pennsylvania. She is currently in counseling at the New Changes Outpatient Behavioral Health Treatment Facility. Charlotte reports seeking treatment for anxiety and depression due to ongoing family-related stressors, lacking self-esteem and motivation. Charlotte has experienced various symptoms over the past 6 months. She is hoping that treatment will help decrease her anxiety and depression symptoms and increase her motivation as well as self-confidence. Charlotte would like to obtain and maintain employment as well as potentially enroll in college.

Charlotte reports sleeping most of the day and eating very little. She states this has worsened over the past 2 weeks. Charlotte reports that her symptoms of anxiety and depression have worsened as well. In session today, she presents as depressed and guarded. Though defensive, she is soft spoken. Today, more so than usual, Charlotte appears disheveled. She casually mentions she has been self-medicating with marijuana. This is the first time she has reported use, and after you inquire further, she admits she has been using since the age of 16. She states it is the only thing that makes her feel better. While she has no history of suicidal behaviors and she denies current suicidal thoughts, she does report experiencing hopelessness in the past and feels she is getting to that point again.

Charlotte reports being classified with a learning disability from an early age and struggled academically throughout high school. Charlotte reports growing up in an upper-middle-class neighborhood. She reports being one of only 20 students of color at the high school she attended and feels she was treated differently as a result. Charlotte reports a history of trauma, stating she was sexually assaulted at a party in high school. She states she was under the influence of alcohol at the time and partly blames herself. Charlotte reports that she has not used alcohol since the assault. Charlotte has not discussed the assault with her previous therapist, family, or friends. She attributes her poor self-image and issues related to self-confidence to the assault and learning disability.

Charlotte talks about stressors related to financial difficulties and is overwhelmed, wondering how she will regain any financial stability and independence. Charlotte is currently unemployed and has been for the past 3 months. She reports a history of working retail and restaurant jobs but has struggled to keep any for very long. Charlotte's parents have provided financial assistance in the past; however, they feel that, at 28 years old, she should be able to live independently. They also disapprove of her decision to not attend college and blame her for her inability to maintain employment. As a result, they have vowed to no longer provide any means of financial support and state it is time she supported herself. Charlotte is currently between places to live and temporarily staying with friends she met at her last job.

Charlotte reports she always felt a great deal of pressure to succeed from her parents, as they are both college graduates and have careers in the medical field. She states the last time she recalls them being proud of her was the day she graduated high school 10 years ago. Comparatively, Charlotte's brother is a veterinarian, and she feels she will never measure up to him in her parents' eyes.

Charlotte has a history of inpatient hospitalization beginning at the age of 24 after she experienced extreme depressive symptoms following a breakup with a boyfriend of 4 years. Charlotte reports that her ex-boyfriend was verbally abusive and called her names such as "stupid" and "lazy." Charlotte denies self-injurious behavior; she reports experiencing explosive behavior at times and has admitted to destroying property at home such as punching holes in walls following an argument with her parents. She feels she learned this behavior from her father, who is an alcoholic with anger issues. She states her mother takes some kind of medication for depression.