Vignette 3

Isabella has a boyfriend and a best friend with whom she is close. She has an amicable relationship with her ex-husband and son who lives with his father. Isabella misses seeing her married daughter and infant granddaughter as well her adoptive mother, father and brother who all live within a 2-3 hour drive from Isabella. Isabella occasionally dates other men and refers to her relationship with her boyfriend as "friendly and casual" and expresses a desire to marry someone like her ex-husband Sam in the future. Isabella feels she is losing the support of her close friend, who has seen her "through thick and thin", as their lifestyles change. Her friend has remarried, has a new baby and expresses concern about Isabella's drinking. Isabella has established and maintains contact with friends she met in services and at school but she has difficulty maintaining close relationships when she is feeling "down" as she avoids contact, does not answer the phone, makes plans and then does not show up. When in a manic phase, Isabella makes choices that may put her at risk such as drinking and engaging in sexual relations with different partners. Isabella maintains contact with her parents, daughter and granddaughter through weekly letters and e-mail and occasionally phone calls. She is unable to travel to see them because her anxiety and depression make it impossible for to make arrangements to see them. Her mania, depression and anxiety get in the way of her desired "close knit family".

Isabella has a supportive family. They overlook her risk taking behaviors and lack of follow through and continue to maintain contact with her. Isabella experiences great guilt and grief over her failed relationships and seeks approval from others as a part of her neediness. Isabella tries to compensate for lack of familial contact in destructive means with numerous sexual partners. Isabella expresses concern over her inability to reconcile with her brother from who she is estranged because of a debt she failed to repay. Isabella has been unable to differentiate as an adult and continues to seek approval from her parents and brother. She worries obsessively that her parents are disappointed in her and her behaviors. She has been unable to effectively individualize herself from her family. Isabella's parents and daughter are unable to drive to visit Isabella on a regular basis due to health issues. Due to Isabella's emotional deregulation, she is often angry with her mother and believes her mother is repeating generational patterns with her daughter which may be counterproductive to her own relationship with her daughter. Isabella states she wants a stable and happy marriage for her future but has limited insight as to how her risk seeking and poor choices are not helpful in reaching that goal.