Julia´s Case Study

1. Problem Formulation:

Julia a 17 year old who grew up in a stationary living situation in a northeastern suburban town is experiencing problems. She is in her first year of college and is having difficulty relating to others. She has an eating disorder that is affecting her health conditions emotionally and physically. She in not coping with stress with her involvement in track and cross-country because she gained an extra 15 lbs. Her coach asks her to change her diet and watch the junk foods that she consumes. Julia is seeking treatment at this time from pressure from her college. Julia was mandated to attend therapy. Her Dean instructed her to go to the counseling and health center for an evaluation before she could continue practicing with her team. Her current coping skills are not working for her. She is avoidant with her relationships with her roommate, friends and family. She is experiencing insomnia. She is in denial about the extent of her problem. She has started lying to her family and constructing ways not to go home for the holiday. Julia has low self-esteem. My hypothesis is that she has Anorexia Nervosa, insecurity issues, along with severe anxiety disorder. She has pent up emotions that reflect anger turned inward toward self.

2. Treatment Focus:

Julia’s has a history of maladaptive patterns of trying to please her parents and others at the expense of herself. Her internal working model is that she needs to be perfect and be a super achiever. She strived to be a perfectionist taking advanced classes in high school. She engaged in sports because her parents wanted her to do something athletic. She did not join the track program because it was something that she wanted to do. She wanted to find a way t...

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...along with building trust and expressing inner most thoughts from one on one therapy.

6. Impediments to change:

Julia’s personality of being a perfectionist and wanting to constantly please others at the expense of losing herself would be an impediment to change. She may want to please the therapist and not reveal what she is really thinking and feeling. Her denial of the seriousness of her health issues and the dangers that lurk behind her destructive behavior coping style are life threatening. Julia’s pattern of denying help that she so drastically needs may thwart her progress. She longs to be perfect in everything that she attempts and has established eating rituals that are hard to break once habits have been formed. Her robot personality style of living without expressing emotions has created a ruptured sense of self within her internal locus of control.