Eells – Rochelle Demonstration

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<Title>Rochelle (used with permission from Dr. Tracy Eells)</Title>
<Presenting Information Abbreviation>O Observation</Presenting Information Abbreviation>
<Formulation Abbreviation>A Assertion</Formulation Abbreviation>
<Framework Abbreviation>F Framework</Framework Abbreviation>
<Question Abbreviation>Q Question</Question Abbreviation>
<Additional Abbreviations>H History,M Mechanism,D Diagnosis</Additional Abbreviations>
<Formulation Relationships>supported by, indicates, results in, results from</Formulation Relationships>
<Presenting Information>

Rochelle is a 41-year-old married white woman with two years of college. She has a 16-year-old daughter and a 7-year-old son, both by men other than her current husband. Her firstborn child, a son, died five years ago in a motor vehicle accident at the age of 20. She tells you that the son was the product of a rape when she was 16 years old. Rochelle is currently living with her third husband, a man who works part-time and has chemical dependency problems. They jointly own a home with her husband’s sister who also lives with them and Rochelle’s two surviving children.

Rochelle is referred to you with complaints of depression, anxiety in most situations, difficulty sleeping, and chronic headaches. She has poorly controlled diabetes. She is tearful as she relates her suspicion that her husband is having an affair. She acknowledges that, in a rage, she scratched the length of his car with a key. She also mentions that her sister-in-law plans to move in with someone and will no longer be contributing to house payments. Rochelle has a history of suicidal ideation that did not lead to an attempt, and two psychiatric hospitalizations, both more than 10 years ago and both following threatened overdoses.

She reports that she was raised primarily by her grandmother and older sister, since her mother was with numerous men. Rochelle has few friends, but feels close to those she does have. She complains that she does not see them often because her husband likes her to stay at home. In her first session, Rochelle reports she is motivated for treatment, but does not come to her second appointment and does not call ahead to cancel.

Rochelle’s case raises many questions. Some relate to her symptoms and problems, including:
What are her main problems?
How are they interrelated?
Are there one or more problems that, if successfully addressed, would solve others as well?
What events trigger her symptoms?
Why did she scratch her husband’s car instead of seeking better solutions?
Is she still grieving the loss of her son?

Some questions focus on diagnosis, such as:
What is Rochelle’s diagnosis?
Does she meet criteria for more than one diagnosis? If so, which one should be the primary focus in therapy?

Some questions seek explanations of her behavior, including:
Which theory of psychopathology best fits her case?
How are her family dynamics, both present and past, influencing her current functioning?
Is her diabetes contributing to her mood problems?
What role are her financial circumstances playing in her presentation?
What are her strengths?
What is her risk for suicide?

Some questions focus on treatment planning:
How should one choose which problem or problems to start with in therapy?
How can our knowledge of behavior change help Rochelle?
Is there an evidence-based treatment that can be used with Rochelle?
What evidence-based treatment processes would best benefit Rochelle?

Above all, how does one treat when Rochelle does not come for her appointments?
</Presenting Information>