COUN 5453 Psychopathology

 

“Sad and Alone” – Mrs. Upton** – For Study Purposes only!!

 

“Irene Upton was a 29-year-old special education teacher who sought a psychiatric consultation because “I’m tired of always being sad and alone.”

 

The patient reported chronic, severe depression that had not responded to multiple trials of antidepressants and mood stabilizer augmentation.

She reported greater benefit from psychotherapies based on cognitive behavioral therapy and dialectical behavior therapy. Electroconvulsive therapy had been suggested, but she refused. She had been hospitalized twice for suicidal ideation and severe self-cutting that required stitches.

 

Ms. Upton reported that previous therapists had focused on the likelihood of trauma, but she casually dismissed the possibility that she had ever been abused. It had been her younger sister who had reported “weird sexual touching” by their father when Ms. Upton was 13.

There had never been a police investigation but her father had apologized to the patient and her sister as part of a resultant church intervention and an inpatient treatment for alcoholism and “sex addiction.” She denied any feelings about these events and said, “He took care of the problem. I have no reason to be mad at him.”

 

Ms. Upton reported little memory for her life between ages 7 and 13 years. Her siblings would joke with her about her inability to recall family holidays, school events, and vacation trips. She explained her amnesia by saying “Maybe nothing important happened, and that’s why I don’t remember.”

 

She reported a “good” relationship with both parents. Her father remained “controlling” toward her mother and still had “anger issues,” but had been abstinent from alcohol for 16 years. On closer questioning, Ms. Upton reported that her self-injurious and suicidal behavior primarily occurred after visits to see her family or when her parents surprised her by visiting.

 

Ms. Upton described being “socially withdrawn” until high school, at which point she became academically successful and a member of numerous teams and clubs. She did well in college.

She excelled at her job and was regarded as a gifted teacher of autistic children. She described several friendships of many years. She reported difficulty with intimacy with men, experiencing intense fear and disgust at any attempted sexual advances.

Whenever she did get at all involved with a man, she felt intense shame and a sense of her own “badness,” although she felt worthless at other times as well. She tended to sleep poorly and often felt tired.