34
Adrienne Venet DOB 7/1/1982
Vanessa McClain, MA, LAPC
Psychotherapy Note
April 7 Raven 13
A.V. reported that she experiences racing thoughts. Client reports that she has not slept for 72 hours. The client was restless and agitated within the session and reports an inability to relax. The client’s high anxiety level is reelected in increased motor activity, restlessness, and agitation. The client reported a behavior pattern that reflected a lack of normal inhibition and increase potentiality for self damaging activities. The client’s impulsivity has been reflected in sexual acting out. Client gave evidence of a very expansive mood that could easily turn to impatience and irritability if her behavior is confronted. The client displays bizarre patterns of dress. A.V. displays and unusual grooming pattern. The clinical assessment confirmed the presence of the classic signs of mania. Assessment was performed of the client’s ability to remain safe within the community. The client was judged to be unable to remain safe within the community due to her symptoms of mania and was referred for a more restrictive setting. Arrangements for hospitalization were made for the client in a psychiatric setting based on the fact that her mania is so intense that she could be harmful to herself and unable to care for her own basic needs. Client was not willing to submit to voluntary hospitalization, therefore commitment procedures were initiated. Follow up session TBA.
Thursday, July 29, 2010
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33
Adrienne Venet DOB 7/1/1982
Vanessa McClain, MA, LAPC
Psychotherapy Note
April 5 Raven 11
In previous session, referral to psychiatrist was made for the purpose of evaluating the client for a prescription of psychotropic medications. A.V. reports complete change in psychotropic medication as listed: Lithium 900mg, Geodon 160mg, Klonopin 3.5mg, Seroquel 200mg. the client was reinforced for following through on a referral to psychiatrist. Concerns about the client’s medication compliance were communicated to the psychiatrist. Follow up session TBA
Adrienne Venet DOB 7/1/1982
Vanessa McClain, MA, LAPC
Psychotherapy Note
April 5 Raven 11
In previous session, referral to psychiatrist was made for the purpose of evaluating the client for a prescription of psychotropic medications. A.V. reports complete change in psychotropic medication as listed: Lithium 900mg, Geodon 160mg, Klonopin 3.5mg, Seroquel 200mg. the client was reinforced for following through on a referral to psychiatrist. Concerns about the client’s medication compliance were communicated to the psychiatrist. Follow up session TBA
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32
Aprils 3 Raven 9
Adrienne Venet DOB 7/1/1982
Vanessa McClain, MA, LAPC
Psychotherapy Note
A.V. reports that “my dead grandmother keeps coming to visit.” Client explains that this causes her great distress as she is fearful of such delusion. Records indicate that client has a history of various delusions in which she hears the voice of her grandmother along with a woman’s voice she calls Lorinda. Client states that it is the voices of Lorinda that tell her to “cut myself all over and to kill myself.” A.V. reports that the hallucinations of her grandmother and Lorinda speak to her simultaneously. A client report measure was used to further asses the depth and breadth of the client’s phobic responses. The Measures for Specific Phobias (Antony) was used to asses client’s phobic responses. The client report measures indicated that the client’s phobic fear is extreme and severely interferes with her life. It was acknowledged that both real and delusional experiences cause anxiety. The client was provided with support regarding her anxieties and worries, which are related to both the real experiences and the delusional experiences. The client was assisted in identifying specific diagnostic classification for her anxiety symptoms. Utilizing a description of anxiety symptoms such as found in Bourne’s The Anxiety and Phobia Workbook, the client was taken through a detailed review of her anxiety symptoms, diagnosis, and treatment needs. The client has failed to clearly understand and classify her anxiety symptoms and was given additional feedback in this area. A referral to psychiatrist was made for the purpose of evaluating the client for a prescription of psychotropic medications. Follow up session TBA.
Aprils 3 Raven 9
Adrienne Venet DOB 7/1/1982
Vanessa McClain, MA, LAPC
Psychotherapy Note
A.V. reports that “my dead grandmother keeps coming to visit.” Client explains that this causes her great distress as she is fearful of such delusion. Records indicate that client has a history of various delusions in which she hears the voice of her grandmother along with a woman’s voice she calls Lorinda. Client states that it is the voices of Lorinda that tell her to “cut myself all over and to kill myself.” A.V. reports that the hallucinations of her grandmother and Lorinda speak to her simultaneously. A client report measure was used to further asses the depth and breadth of the client’s phobic responses. The Measures for Specific Phobias (Antony) was used to asses client’s phobic responses. The client report measures indicated that the client’s phobic fear is extreme and severely interferes with her life. It was acknowledged that both real and delusional experiences cause anxiety. The client was provided with support regarding her anxieties and worries, which are related to both the real experiences and the delusional experiences. The client was assisted in identifying specific diagnostic classification for her anxiety symptoms. Utilizing a description of anxiety symptoms such as found in Bourne’s The Anxiety and Phobia Workbook, the client was taken through a detailed review of her anxiety symptoms, diagnosis, and treatment needs. The client has failed to clearly understand and classify her anxiety symptoms and was given additional feedback in this area. A referral to psychiatrist was made for the purpose of evaluating the client for a prescription of psychotropic medications. Follow up session TBA.
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31
“Month of Magick, Esbat Raven
Elder Blessing Danu’s maven
Cast the balance, wax and wane
Bounty made from boon to bane.”
April 1 Raven 7
Adrienne Venet DOB 7/1/1982
Vanessa McClain, MA, LAPC
Psychotherapy Note
Client described a pattern of persistent and unreasonable phobic fear that promotes avoidance behavior because of an encounter with the problems stimulus as it provokes an immediate anxiety response. Client’s avoidance of phobic situations is so severe as to interfere with normal functioning. Client has made every attempt to recover from her unreasonable fear, but has been unsuccessful. An initial trust level was established with a client to the use of unconditional positive regard. An objective fear survey was administered to the client to assess the depth and breadth of her phobic behavior including the focus of the fear, types of avoidance, development, and disability. The anxiety disorders interview schedule for the DSM-IV ( dinardo, brown, and Barlow ) was used to assess the client’s phobia concerns. The fear survey results indicate that the clients fear is extreme and severely affairs with her life. The results of fear survey was reviewed the client. The client was assessed in regard to phobic stimulus that precipitates her specific fears and avoidance. A.V. was assessed in regards to the thoughts that go along with specific fears and avoidance. Client was assisted in identifying situations that seem to precipitate her specific fears and avoidance. Follow-up session TBA.
“Month of Magick, Esbat Raven
Elder Blessing Danu’s maven
Cast the balance, wax and wane
Bounty made from boon to bane.”
April 1 Raven 7
Adrienne Venet DOB 7/1/1982
Vanessa McClain, MA, LAPC
Psychotherapy Note
Client described a pattern of persistent and unreasonable phobic fear that promotes avoidance behavior because of an encounter with the problems stimulus as it provokes an immediate anxiety response. Client’s avoidance of phobic situations is so severe as to interfere with normal functioning. Client has made every attempt to recover from her unreasonable fear, but has been unsuccessful. An initial trust level was established with a client to the use of unconditional positive regard. An objective fear survey was administered to the client to assess the depth and breadth of her phobic behavior including the focus of the fear, types of avoidance, development, and disability. The anxiety disorders interview schedule for the DSM-IV ( dinardo, brown, and Barlow ) was used to assess the client’s phobia concerns. The fear survey results indicate that the clients fear is extreme and severely affairs with her life. The results of fear survey was reviewed the client. The client was assessed in regard to phobic stimulus that precipitates her specific fears and avoidance. A.V. was assessed in regards to the thoughts that go along with specific fears and avoidance. Client was assisted in identifying situations that seem to precipitate her specific fears and avoidance. Follow-up session TBA.
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30
March 27 Keolwulf 19
Adrienne Venet DOB 7/1/1982
Vanessa McClain, MA, LAPC
Psychotherapy Note
A.V. described a pattern of fixed persecutory delusions regarding others, their intentions, and possible harm. Client described beliefs that current sexual partner intends to do her harm, but was unable to identify this as a delusion. A.V. has a history of abuse with sexual partners. At the present time client reports that she “is hearing voices all the time.” Client displayed an animated fear of being exploited or harmed by significant other. The client’s intimate relationship is at risk for dissolution due to the increased levels of stress relating to the effects of her erratic behavior. Client has taken steps to remove her from the abusive relationship. Client was referred to Bipolar Disorder: A Guide for Patients and Families by Mondimore to further educate herself on her symptoms of her mental illness. Client was referred to support group for individuals with severe persistent mental illness who have experienced physical and verbal abuse. Follow up session TBA.
March 27 Keolwulf 19
Adrienne Venet DOB 7/1/1982
Vanessa McClain, MA, LAPC
Psychotherapy Note
A.V. described a pattern of fixed persecutory delusions regarding others, their intentions, and possible harm. Client described beliefs that current sexual partner intends to do her harm, but was unable to identify this as a delusion. A.V. has a history of abuse with sexual partners. At the present time client reports that she “is hearing voices all the time.” Client displayed an animated fear of being exploited or harmed by significant other. The client’s intimate relationship is at risk for dissolution due to the increased levels of stress relating to the effects of her erratic behavior. Client has taken steps to remove her from the abusive relationship. Client was referred to Bipolar Disorder: A Guide for Patients and Families by Mondimore to further educate herself on her symptoms of her mental illness. Client was referred to support group for individuals with severe persistent mental illness who have experienced physical and verbal abuse. Follow up session TBA.
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29
March 14 Keolwulf 19
“We are like sculptors, constantly carving out of others the image we long for, need, love or desire, often against reality, against their benefit, and always, in the end, a disappointment, because it does not fit them.” –Anais Nin
Adrienne stood in the dark side street and stared up at the candlelit window. The old Victorian house was half covered by overgrown weeds, but she could still see the window on the second floor, although she was not sure whether it was because it was completely visible or because her mind’s eye remembered it being there. She reached down to the gravel amidst broken beer bottles on the curb and found an adequately sized rock to throw at the window. Again she reached down and picked up two more rocks, hitting the window twice more but in rapid succession. The window opened slightly. “Neveah I know you’re there,” she said to the shadow behind the candle in the windowsill. The shadow didn’t move. “C’mon,Neveah, I even did the signal right. Just get the fuck down here.” The shadow in the window moved and the window opened. A figure climbed from the room to the oak tree that stretched beyond the roof, and slid down its branches like rain water. Neveah stood before her, her dark hair hanging at a sharp angle over her green eyes. She stood eye level with Adrienne, clad in all black. She reached out and moved a curl out of Adrienne’s eye. “You know that’s not my name anymore,” she said curtly, and folded her arms. Adrienne rolled her eyes. “Does anyone else but you actually pay attention to the fact that you’ve changed your name based on Egyptian numerology?” Neveah fingered the amber amulet around her neck. “The rest of my coven does not recognize my birth name,” she answered. Adrienne sat down at the base of the oak. Neveah mirrored her action, pulling a pack of Marlboro Reds from her back pocket before sitting cross legged in front of her. Lighting her cigarette, she took a drag and then handed it to Adrienne. Adrienne puffed lightly, and closed her eyes as she exhaled rings of smoke. “I see you haven’t lost your talent,” Neveah said, taking the cigarette from her. “I haven’t lost any of my talent,” she replied, tracing Neveah’s lips with her finger. “Some people would argue that intercourse with men weakens one’s talents,” she challenged. Adrienne chuckled softly. “Is that an offer?”
“Do you want it to be?” Her jade eyes remained unchanged.
“Am I supposed to?”
“You always answer a question with a question.”
“So do you.”
“That’s not the point.”
“I think it is.”
“You don’t want to know what I think.”
“I already know what you think. You think I should leave men alone completely.”
“So?”
“So what if I don’t want to? What if I don’t know if I can?”
“How do you know if you’ve never tried?”
“How do you know if I’ve never tried?”
“I know. But it’s not about what I know. It’s about what you know.”
“What the hell are you talking about?”
“You have bad taste in men.”
“And I don’t have bad taste in women?”
“If I said yes, wouldn’t I be insulting myself?”
“Hadassah doesn’t bother you?”
“No. Deshawn bothers me.”
“I never said he didn’t bother me.”
“If he does why do you stay with him?”
Adrienne inhaled more of Neveah’s cigarette and handed it back to her. “I told him to leave me the fuck alone. I wouldn’t exactly call that staying with him.”
“You’re still with him until you say that it’s over. You have to actually say it. Otherwise he’ll think you’re still together. He’d never get the hint. And it’s ridiculous to stay with him the way things are.”
“Meaning?”
“Why stay with him when you’re in love with his brother?”
March 14 Keolwulf 19
“We are like sculptors, constantly carving out of others the image we long for, need, love or desire, often against reality, against their benefit, and always, in the end, a disappointment, because it does not fit them.” –Anais Nin
Adrienne stood in the dark side street and stared up at the candlelit window. The old Victorian house was half covered by overgrown weeds, but she could still see the window on the second floor, although she was not sure whether it was because it was completely visible or because her mind’s eye remembered it being there. She reached down to the gravel amidst broken beer bottles on the curb and found an adequately sized rock to throw at the window. Again she reached down and picked up two more rocks, hitting the window twice more but in rapid succession. The window opened slightly. “Neveah I know you’re there,” she said to the shadow behind the candle in the windowsill. The shadow didn’t move. “C’mon,Neveah, I even did the signal right. Just get the fuck down here.” The shadow in the window moved and the window opened. A figure climbed from the room to the oak tree that stretched beyond the roof, and slid down its branches like rain water. Neveah stood before her, her dark hair hanging at a sharp angle over her green eyes. She stood eye level with Adrienne, clad in all black. She reached out and moved a curl out of Adrienne’s eye. “You know that’s not my name anymore,” she said curtly, and folded her arms. Adrienne rolled her eyes. “Does anyone else but you actually pay attention to the fact that you’ve changed your name based on Egyptian numerology?” Neveah fingered the amber amulet around her neck. “The rest of my coven does not recognize my birth name,” she answered. Adrienne sat down at the base of the oak. Neveah mirrored her action, pulling a pack of Marlboro Reds from her back pocket before sitting cross legged in front of her. Lighting her cigarette, she took a drag and then handed it to Adrienne. Adrienne puffed lightly, and closed her eyes as she exhaled rings of smoke. “I see you haven’t lost your talent,” Neveah said, taking the cigarette from her. “I haven’t lost any of my talent,” she replied, tracing Neveah’s lips with her finger. “Some people would argue that intercourse with men weakens one’s talents,” she challenged. Adrienne chuckled softly. “Is that an offer?”
“Do you want it to be?” Her jade eyes remained unchanged.
“Am I supposed to?”
“You always answer a question with a question.”
“So do you.”
“That’s not the point.”
“I think it is.”
“You don’t want to know what I think.”
“I already know what you think. You think I should leave men alone completely.”
“So?”
“So what if I don’t want to? What if I don’t know if I can?”
“How do you know if you’ve never tried?”
“How do you know if I’ve never tried?”
“I know. But it’s not about what I know. It’s about what you know.”
“What the hell are you talking about?”
“You have bad taste in men.”
“And I don’t have bad taste in women?”
“If I said yes, wouldn’t I be insulting myself?”
“Hadassah doesn’t bother you?”
“No. Deshawn bothers me.”
“I never said he didn’t bother me.”
“If he does why do you stay with him?”
Adrienne inhaled more of Neveah’s cigarette and handed it back to her. “I told him to leave me the fuck alone. I wouldn’t exactly call that staying with him.”
“You’re still with him until you say that it’s over. You have to actually say it. Otherwise he’ll think you’re still together. He’d never get the hint. And it’s ridiculous to stay with him the way things are.”
“Meaning?”
“Why stay with him when you’re in love with his brother?”
28
28
Thursday March 12 Keolwulf 17
Adrienne Venet DOB 7/1/1982
Vanessa McClain, MA, LAPC
Psychotherapy Note
A.V. has experienced sudden and unexpected severe panic symptoms that have occurred repeatedly and have resulted in persistent concern about additional attacks. The client has significantly modified her normal behavior patterns in an effort to avoid panic attacks. The client described fear of environmental situations that she believes may trigger intense anxiety symptoms. A.V.’s fear of environmental situations has resulted in her avoidance behavior directed toward those environmental situations. Client has a significant fear of leaving home and being in open or crowded public situations. A.V.’s phobic fear has persisted in spite of the fact that she acknowledges that her fear is unreasonable. The client described situations in which she has declined involvement with others due to fear of leaving her home. Today’s clinical contact focused on building the level of trust with the client through consistent eye contact, unconditional positive regard, warm acceptance, and active listening. A.V. was asked about the frequency, duration, intensity, and history of her panic symptoms, fear, and avoidance. The client was assisted in identifying specific situations that precipitate panic symptoms. Client was administered psychological instruments designed to objectively assess her level of anxiety symptoms. The client was administered The Anxiety Sensitivity Index (Reiss, Peterson, and Grusky).The client has identified a specific anxiety disorder, which is freestanding from her severe and persistent mental illness, and this was reviewed within the session. Follow up session TBA.
Thursday March 12 Keolwulf 17
Adrienne Venet DOB 7/1/1982
Vanessa McClain, MA, LAPC
Psychotherapy Note
A.V. has experienced sudden and unexpected severe panic symptoms that have occurred repeatedly and have resulted in persistent concern about additional attacks. The client has significantly modified her normal behavior patterns in an effort to avoid panic attacks. The client described fear of environmental situations that she believes may trigger intense anxiety symptoms. A.V.’s fear of environmental situations has resulted in her avoidance behavior directed toward those environmental situations. Client has a significant fear of leaving home and being in open or crowded public situations. A.V.’s phobic fear has persisted in spite of the fact that she acknowledges that her fear is unreasonable. The client described situations in which she has declined involvement with others due to fear of leaving her home. Today’s clinical contact focused on building the level of trust with the client through consistent eye contact, unconditional positive regard, warm acceptance, and active listening. A.V. was asked about the frequency, duration, intensity, and history of her panic symptoms, fear, and avoidance. The client was assisted in identifying specific situations that precipitate panic symptoms. Client was administered psychological instruments designed to objectively assess her level of anxiety symptoms. The client was administered The Anxiety Sensitivity Index (Reiss, Peterson, and Grusky).The client has identified a specific anxiety disorder, which is freestanding from her severe and persistent mental illness, and this was reviewed within the session. Follow up session TBA.
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