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Client Name: Nicole Gibson
Age: 25 years old
Ethnicity: African American
Marital Status: Single mother
Children: 2 children, ages 5 and 6
Nicole Gibson is a 25-year-old single mother who has two children, a boy and a girl, aged 5 and
6, respectively. Nicole works for a nonprofit organization that offers programs and services for
at-risk youth. She also participates in a program that allows her to live independently in a lowincome housing unit while attending school and working. Nicole is raising her two children on a
salary of $800 per month and an infrequent child-support check of $200 per month. She travels
by public transportation to work and the day-care center. Traveling from her apartment to
work, including dropping her children at the day-care center, requires her to take several buses
each way every day. Nicole must get up at 4:30 a.m. in order to get her children to day care and
herself to work by 8:30 a.m. She gets home at 7:30 at night, despite the fact that she finishes
her workday at 4:30 in the afternoon.
As a case manager at the housing unit, you meet Nicole during a home visit. Nicole expresses a
desire to obtain counseling to assist her with her life skills and family-of-origin issues that have
made it difficult for her to function well at work. You agree to see her for counseling once a
week for 2 hours. One hour will be used to assist Nicole with life skills such as parenting and
home maintenance skills. The second hour will be utilized for counseling.
Progress Note from Your First Session with Nicole
As a child, Nicole lived with her parents and older sister, Marcia. Nicole’s parents remained
married until she was a teenager. Nicole’s father sexually abused her from the time she was 8
years old through her mid-teens. He forced her to have sexual intercourse with him
approximately three times a week. Several of her father’s friends were allowed to sexually
abuse her as well. Nicole’s mother was physically, verbally, and mentally abusive, often striking
her, calling her names, reading her private journals out loud to other family members, and
watching her in the bathroom. On one occasion, Nicole’s mother struck her across the face with
a belt buckle, leaving a permanent scar above her upper lip. Her older sister was also physically
and verbally abusive to her.
Nicole left home when she was 18 years old and married the father of her two children. She
referred to this as “getting married to escape hell,” stressing the fact that although she couldn’t
stop the “torture” of her family situation, she could leave it behind by getting married. She
stated that she left the marriage because her husband was a very “passive” person, and she
didn’t want to turn into someone like her mother. Before her marriage, she fell in love with a man named Douglas with whom she now has an estranged relationship. Nicole and Douglas
were never sexually involved even though they have been intimately involved on and off for
about 8 years. Nicole stated that sex makes her feel “dirty, ashamed, and sick to her stomach.”
She hasn’t spoken with or seen Douglas for about 6 months, as he will not return her calls.
Nicole has severed all ties with her family of origin since if she speaks with them, she will only
end up “feeling like dirt and getting real mad.” Although Nicole is not involved at the present
time in an intimate relationship, she does find support at her job with coworkers and has one
close friend, Vickie, in whom she can confide. Nicole has had difficulties at her job, however.
She stated that she gets very upset when anyone gets “in her space.” When the pressures at
work becomes more than Nicole can handle, she feels angry and panicky and “just wants to be
During the first session, Nicole stated that she didn’t want to do anything but lie in bed. She
stated that she often cries all weekend, becomes easily angered by her children, and often
resorts to yelling and spanking them. Nicole also stated that she was having difficulty doing
chores (e.g., going to the laundromat or grocery store, cooking, cleaning). There were piles of
laundry in her bedroom and trash everywhere, including old food, which reeked. She stated she
has had difficulty sleeping at night due to recurrent nightmares of “childhood stuff” and always
feels “too tired.” She avoids any situation that reminds her of “family stuff” but is afraid that
she’s turning out just like her mother. Nicole possesses a great deal of intelligence and has the
ability to seek out support and help when it is needed. She also has a very good sense of humor
that she displayed throughout the interview.
Second Session with Nicole
Nicole begins the second session with you by describing a situation that occurred during the
week at work. A male coworker asked her if she would like to go out for dinner after work one
evening, and when Nicole declined the invitation, the co-worker lightly touched her shoulder
and said, “Oh, come on Nicole, you need a little fun in your life.” Nicole states that she
overreacted to this gesture by swinging at the man and striking him on his chest. She tells you
she doesn’t know what came over her, but she felt like she was warding off an attack of some
kind and couldn’t tolerate having this man touch her. When you ask her if this type of thing has
happened on other occasions, she admits that she doesn’t like to be touched by anyone. “It
even bothers me sometimes if my own kids grab me when I’m not prepared for it.” Nicole
states that she was so upset by this incident that she stayed home from work the next day
because she was just “too tired” to get there on time. “My supervisor gets real mad when I’m
late, even though I tell him I can’t do anything about it if the bus isn’t running on time. I just
didn’t want to deal with it the other day.”
You ask her why she thinks she reacted so strongly to her coworker’s touching her the other
day. Nicole pauses for several moments and then sighs deeply. “I think it’s related to all that
‘childhood stuff’ with my father. I just can’t get it out of my head. I think it’s going to haunt me
for the rest of my life.” Nicole describes several depressive episodes to you in which she felt she just couldn’t move because it took too much energy. During those times, she would forget to
eat and would be unable to get to sleep until early in the morning. Her children would
constantly ask her, “What’s wrong, Mommy? Why can’t you play with us?” Nicole states that
her children’s comments made her feel like a “terrible mother.” When you ask her about her
goals for the future, Nicole states that she really doesn’t have any goals, although she would
like to go to college and become a teacher. She says she isn’t sure she’ll live long enough to
complete an education.
1. What diagnosis are you considering at this time, and why?
2. What will be your primary area(s) of assessment at the next session?
3. What are some of Nicole’s strengths?
4. How would you address the client’s suicidal ideations? Conduct a risk assessment.
5. What resources might be available to assist Nicole?
6. What cultural and psychosocial factors may be impacting this diagnosis?