Identifying Information and Reason for Referral
The client was a 23 year old, single, Caucasian female by the name of Elizabeth
Oekerman (preferred to be called Lizzie) who currently lived in Lynchburg, Virginia with her
roommates (Tessa and Maddie). Lizzie made a self-referral for a clinical intake because she was
dealing with symptoms of ADHD. Lizzie mentioned that “ADHD runs in the family” and she had
been wondering if she had it as well. She specified that the inattentive symptoms were her
main concern in regards to the ADHD symptoms.
Current Situation and Functioning
Lizzie had to go to work, school, and complete homework on a daily basis. Additionally,
she had been working on plans to relocate for her future, but on the weekends she would
watch her boyfriend play hockey for Liberty. Her weekends gave her an outlet for recreation
and it helped reset her mind to be ready to get back to work.
Life skills were assessed and it was revealed that Lizzie was strongest in empathy but
was well-rounded and reported that the other life skills (conflict resolution, negotiation skills,
fairness, etc.) were of average strength. When she was asked about her other strengths she
pointed out that she was independent, honest, asked for help when she needed it, and was
effective at coherent communication. Confrontation had been confessed as a weakness for
Lizzie.
There was no problem with Lizzie’s ability to complete normal activities of daily living
(ADLs). When she had been asked about her coping skills she mentioned that she believed that
she had good stress management skills. She further stated that her emotional regulation coping
is “skewed depending on the situation” and that there were times that she “sat in her feelings
for too long.”
History of the Present Concern(s)
It was previously stated that Lizzie had presented with symptoms of inattention that she
had attributed to ADHD. She had mentioned that she had been busy between her work and
trying to keep up with her school work. She discussed how stressful it had been trying to plan
her move to a different state for her future and it was discovered later that she had additionally
been working to land a practicum site that had brought on stress as well.
Lizzie said that the inattention symptoms had occurred for the last 9-12 months. She
stated that she had been diagnosed as having ADHD since 2014 but noticed her attention had
become worse than it had been in the past or that maybe she did not realize her attention
difficulties as much in the past as she does currently. She mentioned that in her past she and
her parents had been more concerned with her having learning disabilities and therefore she
did not focus on ADHD symptoms.
Lizzie had been asked to rate any current symptoms from none (symptom is not
present at this time), mild (symptom impacts quality of life, but no significant impairment of
day-to-day functioning), moderate (symptom has significant impact on quality of life and/or
day-to-day functioning), or severe (symptom has profound impact on quality of life and/or day-
to-day functioning). She had reported current symptoms of appetite disturbance, sleep
disturbance, fatigue/low energy, mood swings, agitation, emotionality, irritability, anorexia,
conduct problems, hopelessness, elevated mood, significant weight gain/loss, concomitant
medical condition, cannot make decisions, and substance abuse and were rated as mild. She
had further reported that obsessions/compulsions and hyperactivity were of a moderate
intensity. Lastly, Lizzie had reported that poor concentration was of a severe intensity. When
she was asked to further explain her poor concentration she had stated that she felt that her
concentration at work and school was profoundly impacted. She talked about how she felt that
“tasks never got completed” and that she had “lots of competing thoughts” while she worked
and was at school. When obsessions/compulsions were further discussed Lizzie talked about
how “organization” helped her “calm internal chaos.” The current symptom of mild anorexia
had been explained by Lizzie that it had been a loss of appetite due to medication that she had
been taking. She had described her current symptom of moderate hyperactivity in her
statement “I feel the wiggles all the time.” Current symptoms of substance abuse and
concomitant-self medication were asked to be further explained and Lizzie mentioned that her
“caffeine intake can be questionable” and that caffeine replaced medications at times and
alcohol had been used to “mellow out.”
Treatment (Psychiatric) History and Family Treatment (Psychiatric) History
Lizzie had experience with outpatient psychotherapy from September 2016 to May 2017
when she was in her senior year of high school. She had received the outpatient psychotherapy
for symptoms of anxiety, depression, and anorexia. She was diagnosed with co-occurring
anxiety and depression along with co-occurring anorexia and substance abuse for cannabis,
caffeine, alcohol, Concerta, and muscle relaxers. Furthermore it was previously stated by Lizzie
that she had been diagnosed with ADHD in 2014. Additionally when she was a toddler she was
diagnosed with sleep apnea, and years after that at 14 years old she was diagnosed with
dyslexia. Lizzie had never been hospitalized but had received talk therapy, participated in empty
chair technique, role play, and took assessments that she can’t recall. The medications that she
had been prescribed and used were from her psychiatrist, Dr. Lance Turner, and the
medications were Concerta for ADHD and Lexapro for the co-occurring anxiety and depression.
Lizzie had taken 27 milligrams of Concerta once a day from September 2014 to May 2017, and
additionally 10 milligrams of Lexapro once a day from August 2017 to December 2021.
When asked about her family’s history of psychiatric and substance abuse disorders,
Lizzie reported that her older brother Nate had a history of substance abuse (polysubstance
use) along with her maternal grandmother (opioid abuse) who had died from overdosing. Lizzie
added that her brothers, Nate and Dan, along with her father (Guy) and her all had ADHD, and
that her father additionally had depression and her mother (Lorie) had postpartum depression.
Moreover she had said that her maternal aunt had a history of thyroid complications and that
her maternal grandparents had Alzheimer’s disease.
Relevant Medical History
Lizzie had stated that she did not have any major medical illnesses but that she was
allergic to pineapples and amoxicillin. When asked who her primary care physician was, she
reported, “Dr. Christie Schoppe.” Additionally Lizzie stated that she was not taking any
medication currently when asked about medication use. Lizzie’s current mental health status
seemed to have been normal/well functioning and when asked about it she had mentioned that
her mental status was “great.”
Developmental History
Lizzie had then been asked if there had been any complications with her mother’s
pregnancy with her and she said that there were no complications and that her health was
perfectly fine. Her mother’s delivery was normal except that her mother went through
postpartum depression. Lizzie’s social, behavioral, and cognitive milestones were normal
except that she had mentioned that she had not learnt how to ride a bike until “a little later
than most kids” had done. She reported behaving normally when she had interacted with peers
and people in authority throughout her elementary days to now. Lizzie stated that she had high
intelligence and did well in school. She had been involved in track and cross country all
throughout her high school experience, she had been a part of the National Honors Society
(NHS) in her junior and senior year of high school, and she was active in Young Life (youth
group) from the 6th grade to her senior year of high school.
Social and Family History
Lizzie is the biological daughter of Guy and Lorie Oekerman (who are still married) and
she is the youngest of three children. She has two older biological brothers, Dan who is 28 and
lives in Kentucky with his wife and Nate who is 24 who lives in Michigan with his roomates. She
described that her earliest memories consisted of going out with her family on Saturdays, her
homeschooling days from prekindergarten to first grade, and the many visits that she and her
family made to her grandparents’ house.
Lizzie’s employment history had been comprised of jobs such as dog, baby, and house
sitting when she was in high school and then she had been a barista and a peer academic
mentor for athletes while she was in undergraduate college years. She currently works as a
Graduate Student Assistant for the School of Education at Liberty University where she is in her
master’s program for mental health counseling. She did not have a military history.
Lizzie’s romantic relationship history started when she was 14 and she stated that she
had boyfriends/flings throughout her high school experience. She had a romantic relationship
from 2017-2018 and then took a break from dating until her current relationship that started in
June 2020.The relationship that she had from 2017-2018 was an abusive relationship ship and
that is why she had gotten out of it. She stated that it was emotionally, physically, and sexually
abusive.
There had been no claims of any legal history from Lizzie when she had been asked
about it and when she had been asked about what she likes to do for recreation she stated that
she liked going for “hot girl walks.” She additionally mentioned that she liked to be social and
have conversations with her close friends. She admitted that it had been harder for her to
maintain her social life with how busy she had gotten but still made efforts to socialize.
When Lizzie had been asked about her spiritual/religious history she had said that she
had her first salvation experience at “11/12 years old.” She said that she had been active in the
church in the past more than what she had been currently doing. She stated that currently her
personal faith “has been off and on for the last decade.”
Lizzie had been asked about her support system and she replied that it was comprised
of her two best friends from childhood back in Phoenix, Arizona. She further included the
friends that she had made Lynchburg and other friends in Phoenix and her current romantic
partner (Josh). Lastly, she said that her parents (who lived in Phoenix) were a part of her
support system.
Behavioral Observations and Mental Status Considerations
Lizzie’s appearance had been normal and there had not been anything that was “off”
about her. She had been polite, happy, and helpful. Her mood had appeared to be normal
although she had stated that she had been feeling “nervous” because she was heading to a job
interview right after she was done answering questions about herself from the intake form. She
gave direct responses and sometimes it was too general, but when she was asked to further
explain, she did and it was detailed and helpful.
Lizzie’s primary thought content had been understandable and coherent and there had
been no signs of delusional or obsessive thinking nor had there been any presence of suicidal or
homicidal ideations. She appeared to be present and her mind seemed to be focused and stable
on what had been asked of her. She cooperated well throughout the process of having been
asked questions about herself for the intake form. The quality of the data that had been
obtained from Lizzie may be a bit skewed because she seemed like she held back when she had
answered some questions regarding abuse and answered no to where it had been revealed
later that there had been abuse in a romantic relationship.
Substance Use Assessment
Lizzie had stated that she had used marijuana, alcohol, and caffeine. She had first
started using marijuana daily when she was 19 but stopped using it two years ago when she
was 21. She stated that her first use of caffeine was when she was 6 years old, she currently still
uses caffeine, and she has been taking 200 milligrams daily. The alcohol had first been used
when she was 17 and she currently still has 1-2 beverages once a week. Lizzie reported that she
had used the marijuana and alcohol just for “recreational” purposes and that the “caffeine was
self medication for ADHD.” She mentioned that consequences that arose from using the
substances were that her anorexia relapsed from the marijuana and caffeine use and her
tolerance for marijuana and alcohol increased. Lizzie had stated that she thought that she
needed to cut back on her current use of caffeine. She furthermore stated that some factors
that were related to her substance use was the fact that she had been living with roommates
that were drinking and using marijuana, and because she had realized that, she believed that
when she stopped living with them her substance use became less of an issue.
Risk Assessment
When it came to risk assessment, some risk factors for Lizzie are that she had a busy
schedule, she was anxious and struggled with inattentiveness, she could be hyperactive at
times, she was about to start her practicum, she stopped taking her psychotropic medication
(Lexapro and Concerta), she had been stressing about making plans to move in the future, she
had she had been in an abusive romantic relationship in the past, she drank more caffeine than
she thought she should, she struggled with anorexia, substances, depression, anxiety, and
ADHD. Some protective factors for Lizzie was that she had a stable romantic relationship
(currently), she had support network of friends, family, and her partner, she currently has
roommates that are better influences on her, and she had been doing well in school and was
about to start her practicum.
When it came to suicidal thoughts, plans, behavior, and intent, Lizzie had repeatedly
stated throughout the interview that she never had any of those. Lizzie did not appear to be
suicidal but she did seem to have moderate level of risk factors and fewer protective factors.
According to what she had said regarding suicidal thoughts, plans, behaviors, and intent, Lizzie
had a low risk level for suicide. An intervention for Lizzie would be to go to her outpatient
psychiatrist and talk with him about what she could do for her inattentiveness, poor
concentration, and occasional hyperactivity. Furthermore, she could to stop replacing caffeine
for her psychotropic medication and take them and see if the inattentiveness, poor
concentration, and hyperactivity decrease. Lizzie’s risk level overall would be moderate because
she had many risk factors but no suicidal thoughts, plans, behaviors, and intent.
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