Robin Henderson is a 30-year-old married Caucasian woman with no children who lives in a middle-class urban area with her husband. Robin was referred to a clinical psychologist by her psychiatrist. The psychiatrist has been treating Robin for more than 18 months with primarily anti-depressant medication. During this time, Robin has been hospitalized at least 10 times (one hospitalization lasted 6 months) for treatment of suicidal ideation (and one near lethal attempt) and numerous instances of suicidal gestures, including at least 10 instances of drinking Clorox bleach and self-inflicting multiple cuts and burns. Robin was accompanied by her husband to the first meeting with the clinical psychologist. Her husband stated that both he and the patient’s family considered Robin “too dangerous” to be outside a hospital setting. Consequently, he and her family were seriously discussing the possibility of long-term inpatient care. However, Robin expressed a strong preference for outpatient treatment, although no therapist had agreed to accept Robin as an outpatient client. The clinical psychologist agreed to accept Robin into therapy, as long as she was committed to working toward behavioral change and staying treatment for at least 1 year. This agreement also included Robin contracting for safety- agreeing she would not attempt suicide.
Robin was raised as an only child. Both her father (who worked as a salesman) and her mother had a history of alcohol abuse and depression. Robin disclosed in therapy that she had experienced severe physical abuse by her mother throughout childhood. When Robin was 5, her father began sexually abusing her. Although the sexual abuse had been non-violent for the first several years, her father’s sexual advances became physically abusive when Robin was about 12 years-old. This abuse continued through Robin’s first years of high school. Beginning at age 14, Robin began having difficulties with alcohol...
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