CASE SUMMARY WORKSHEET

Therapist: Joshua Gonsher

Age:
Sex:
Racial/ethnic information:
Marital status:
Referral source:

Patient: Ms. K D

Date: November 3, 2014

24
Female
White/Caucasian
Single
Friend

REASON FOR REFERRAL:

Ms. D is in graduate school to receive her PsyD in clinical psychology and feels overwhelmed with the amount
of work. Her sleep and social life are suffering. One of her instructors suggested she speak to a psychologist to
alleviate some of her stress and to help her cope with the great amount of responsibility. Further, Ms. D would
like to learn some interpersonal skills to develop relationships.
DIAGNOSIS:
301.82
V61.21

Avoidant Personality Disorder

Physical Abuse of a Child

PRESENTING PROBLEMS AND CURRENT FUNCTIONING:

Ms. D is a 24-year-old young woman who has been struggling with the pressures of school for just over two
years. She reported feeling overwhelmed with the amount of classwork and outside responsibilities and stated
that she has a high level of anxiety. Ms. D does not have many friends and has come seeking to learn
interpersonal skills. She stated that she wishes she had some real friends (emphasis hers) yet acknowledges that
she does not know what would make a friend close. Ms. D herself provided the symptom description and
history.
DEVELOPMENTAL PROFILE:
History (family, social, educational, medical, psychiatric, vocational):
Ms. D is the oldest of three childrenshe has a younger sister and a younger brotherin an intact family, her
mother and father currently married. Ms. D earned her bachelors and masters degrees and is currently pursuing
a PsyD in graduate school. She is in relatively good, stable health, though she has had a headache for most of
the past two years. Ms. D has stated that her headache never goes away, and she has seen doctors and gotten
an MRI, but there is nothing observably wrong with her brain. It varies in location and intensity, and medication
provides no relief. She has an asthmatic esophagus that may be exacerbated by her food allergies. Her only prior
hospitalization, though, was when she was four years old due to a hernia. Ms. D was born three weeks early and
was so tiny they needed to wrap the diaper around her twice. She was apparently very colicky, but had not other
complications. Ms. D denied any significant history of mental illness though she reported that her parents, while
never officially diagnosed, have realistic anxiety. They both like to get to their destinations with plenty of
time to spare; her father tends to leave much earlier than necessary in anticipation of obstacles (e.g., traffic),
while her mother leaves later though with sufficient time. Her brother has been diagnosed with ADHD, and her
sister has premenstrual dysphoric disorder (PMDD).
Ms. D babysat for a long time when she was in grade school and high school, and then she worked as a grocery
sacker. She was also employed in a bakery where she decorated cakes, ran the cash register, and organized the
baked goods for sale. Ms. D also ran a diversion program at a courthouse for individuals who were not adjusting

properly to reduce their risk of recidivism. She currently works at a prison where she sees inmates in therapy as
part of her educational training.
Relationships (parents, siblings, peers, authority figures, significant others):
Ms. D gets along well with her family though she did complain about her sisters immaturity. Her social circle is
and was virtually nonexistent. In school, she had very few close friends, instead choosing to associate, with two
other girls, with two friends who were the actual close ones: The three would gravitate towards the two, who
were close, and would be on the outskirts. To this day, Ms. D has only the first friend she made whom she
calls close. In school, she thought she had a friend or two.
Ms. D reported no concerns with authority figures though she thought she could run certain aspects of the
bakery better than her boss and got reprimanded when she tried to go above him or when she took too long
decorating a cake.
Ms. D reported never being in an intimate relationship and not having any significant other.
SIGNIFICANT EVENTS AND TRAUMAS:
Ms. D reported no significant events that may have influenced her, but her mother often hit her on her rear end
and back with both ends of a leather belt when she did anything wrong. Ms. Ds mother would also hit Ms.
Ds brother but not as often and not for the same offenses. When she was hit, it was under her clothes. Ms. D
reported no other verbal or sexual abuse.
COGNITIVE PROFILE:
Cognitive Model as Applied to this Patient:
Typical current problems/problematic situations:
Ms. D is a third-year student in a psychology doctoral program. When asked what she does very well or what is
very good at, she answered that she did not know. When asked what she did poorly, she explained that the does
not do a good job at the therapy component of her educational training. She feels as though she does not know
what she is doing that she must be doing something wrong; she gets uncomfortable when people watch what she
does. Ms. D does not usually attend social gatherings (e.g., parties, dances), as there are usually lots of people
present, but when she does, she does not know what do with herself and ends up standing in a corner, watching
people. She finds these situations not fun and not comfortable.
Typical automatic thoughts, affect, and behaviors in these situations:
I cant do this. I dont know what to do. sadness Ms. D feels overwhelmed by her responsibilities in
school.
I should have better relationships and more friends. Im not good at being a friend. I dont know what real
friends are. No one wants to be my friend. sadness/guilt She goes to social events yet frequently only
stands in the corner, questioning her self-worth
Im not a good therapist. Im not even supposed to be here. sadness She feels unworthy of her current
externship placement.
Core Beliefs:
Im worthless. Im no good. Im inadequate and incompetent.

Conditional Beliefs:
If I dont know what to say during therapy, then Im a bad therapist.
If my work is not done perfectly, Im a bad student.
If I dont have many friends, then Im a worthless person.
Rules (should/musts applied to self/others):
I must always have my work done perfectly. I must be the perfect student/therapist. I must have many close
friends.
INTEGRATION AND CONCEPTUALIZATION OF COGNITIVE AND DEVELOPMENTAL PROFILES:
Formulation of Self-Concept and Concept of Others:
Ms. D sees herself as an incompetent student, therapist, and friend. She views schoolwork as insurmountable
obstacles over which she cannot climb and that overwhelm her with frustration; she cannot live the life she
wants to.
Interaction of Life Events and Cognitive Vulnerabilities:
Her mother physically abused Ms. D, which prevented a positive relationship from developing; therefore, Ms. D
has always been vulnerable to viewing herself negatively. In school, she felt her lack of social skills prevented
her from making true, lasting friendships; as a future clinician, she feels her clients will not succeed due to her
lack of capabilities. She has attributed the crushing feelings associated with her tremendous amount of
schoolwork to her worthlessness as a student and is constantly unsure of her ability to fulfill her duties.
Compensatory and Coping Strategies:
Ms. D is overcome with fatigue and feels the need to sleep when presented with too much work. She prefers to
clean or bake instead of attempting to complete her assignments. She holds very low, often pessimistic,
expectations of herself.
Development and Maintenance of Current Concern:
was precipitated by her repeated failuresin school, in her first religion, and in her first marriage, which ended
in divorce. Mrs. Q has become self-critical, thinking she cannot help her family, especially her husband, and she
often shirks her responsibilities since she is afraid of failing.
IMPLICATIONS FOR THERAPY
Suitability for Cognitive Interventions (rate low, medium, or high; add comments, if applicable):
Psychological Mindednesslow
Objectivitylow
Awarenesslow
Belief in Cognitive Modelmedium
Accessibility and Plasticity of Automatic Thoughts and Beliefshigh
Adaptivenesslow
Humorlow
Personality OrganizationSociotropic versus Autonomous:

Ms. D has a much higher level of sociotropy than autonomy, viewing her failures as a student, therapist, and
friend as dependent on the dearth of successfully completed assignments and high marks, on how much the
prisoner clients she treats heal and change, and on the quantity and quality of friendships she has. She does not
place high value on her abilities and achievements. Ms. D also demonstrates an inability to function without her
familys approval.
Patients Motivation, Goals, and Expectations for Therapy:
Ms. D does not seem very motivated and has been coasting through life since as far as she can remember. She
seems, however, to expect therapy to help her develop further interpersonal skills.
Therapists Goals:
This therapist will help Ms. D restructure the thoughts that all assignments for school need to be perfect if she is
to be considered a good person by redefining these terms and having her understand the incorrect assumptions
she has been making. He will help Ms. D realize that not every mistake guarantees failure, especially in therapy
with prison inmates. This therapist will also help reveal the great powernegative, but also positiveof her
thoughts to create, translating into more satisfaction in her social, romantic, and professional lives.
Predicted Difficulties and Modifications of Standard Cognitive Therapy:
Ms. D, a very pessimistic woman with low self-esteem, was not very receptive at the time of intake. Anticipated
hurdles or obstacles would include her reliance on sleep and procrastination (i.e., baking, cleaning) as safety
items. As a woman who has been physically abused in the past, she holds the belief that relationships should be
built on painful events, so this therapist, in his safe office, may not be able to establish rapport; at the very least,
the therapeutic alliance may be compromised, as Ms. D does not have any experience with adaptive
relationships. Teaching Ms. D how to stop making maladaptive assumptions about herself, her world, and the
future may prove difficult, as she does not seem to believe change can occur and has stated she does not know
what that would entail.