Dr Clarks Referral

Following a routine physical examination, Dr. Clark referred Sylvia to a behavioral health counselor to discuss her drinking. The referral indicates that the physician smelled alcohol on her breath during the examination, and added an alcohol screen to the panel of lab tests ordered. The lab report indicated a blood alcohol level of 90 mg%, and also a slightly elevated GGT level. After introductions, the consultation begins.

Counselor: There's not much information on this referral, Sylvia. Perhaps you could tell me how you understand why Dr. Clark wanted you to talk with me.

Sylvia: I was surprised to hear from her. She called me on the phone after my physical, and said she wanted me to see you because she was concerned about me.

C: Dr. Clark called you personally.

S: Uh huh. Actually it kind of scared me. I thought maybe it was bad news from my tests.

C: So what did she tell you?

S: Well that morning, when I went in for my physical, while she was examining me she mentioned that she smelled alcohol. I thought it was probably the mouthwash that I use, and that's what I told her. She didn't say anything more about it.

C: But then she called you back.

S: I guess she had them test for alcohol. I didn't know she was going to do that. Anyhow she told me that I was over the legal limit for driving. But I swear I didn't have anything to drink.

C: That took you by surprise.

S: Yes. I never drink in the morning. She also told me that one of the other tests was abnormal - for liver, I think - and that's why she wanted me to talk to you.

C: I'm sure this has been on your mind in the meantime. What are you thinking at this point about what she told you?

S: Well, frankly, I don't like being here. I didn't like her checking up on me like that, and I feel like this is none of her business, or yours either for that matter. I didn't really want to come.

C: And yet you did.

S: It did scare me a little. She didn't really explain the lab test to me, except that it might mean I was drinking too much. Did she explain it to you?

C: She did send me the result, and the one she mentioned is called GGT. It's a liver function test - you're right about that - and it is one that goes up when a person drinks a fair amount. It's like a warning light. What do you make of that?

S: I don't like it. I guess that's what she was worried about. I know she means well.

C: She cares about you. And she must have been concerned about the alcohol in your system, too. What time did you go in for your physical?

S: It was first thing in the morning, on my way to work. I just got up, showered, got ready, and went in. I didn't even have breakfast because of the blood tests.

C: So that's a puzzle for you, how the alcohol got there in the morning.

S: I guess it must have been left over. Can that happen? I don't really drink all that much.

C: Sure. It takes some time for the liver to break down alcohol, so it can stay in the body for a while.

S: But she said I was legally drunk! I live way over on the west side, and I work downtown, so I drive in that awful traffic every morning. I felt perfectly fine.

C: Nothing out of the ordinary.

S: No. But she said if I had been pulled over, I could have been arrested.

C: That kind of shocked you.

S: I work for the city, for the mayor's office, and if that happened – well, I could lose my job.

C: All right. Well, I can see why you came in, and I'm glad that you did. All of this is new to you, and you're not happy to be here, but Dr. Clark got your attention. So shall we talk about this a bit?

S: OK, but I don't want to be lectured about drinking.

C: I won't lecture you, I promise. Now if it's all right with you, perhaps you could tell me some about how alcohol fits into your life, into an ordinary day.

S: An ordinary day. I work a long day, and by the time I get home I'm exhausted and ready to relax. I'll usually have some wine while I'm making dinner. If I don't have the kids, I just fix something quick, and then kick back.

C: It makes a difference if the kids are there or not.

S: Well, I'll usually have wine with dinner anyhow, and while I'm cooking, but I mean I make something a little nicer when they are there. I'm divorced. Most of the time he has the kids. That's not how it's supposed to be, but he's always been a control freak.

C: And then after dinner you kick back and relax.

S: Right. I usually just watch television. I don't have energy for much more than that.

C: And how does alcohol fit in there?

S: It helps me relax and just kind of turn off. I'll have some more wine, maybe a martini while I'm watching programs. Then I get tired, go to bed, get up, and do it all over again. That's when the kids aren't with me.

C: And when they are . . .

S: We'll watch TV together, unless they have some homework and then I help them with that. I guess I don't drink as much when they're there. Then in the morning I have to get them to school before work, and it gets pretty hectic. I like it when they're with me, though.

C: You have an arrangement with your ex.

S: We have joint custody, and I'm supposed to have them Monday through Wednesday and every other weekend. But it doesn't happen. Like I said, he's a control freak. He always dominates me - has to have it his way. If he says they don't come over, they don't. So a lot of the time I don't get them.

C: It's not happening the way the court ordered it.

S: Right. But I can't take him to court. I can't afford a good lawyer, and he says if I complain he'll say I'm a drunk and file for sole custody. I can't afford to fight him. (Pause, some tearfulness) I love my kids, and I feel so much better when they're with me. They belong with me.

C: In what ways do you feel better when they're there?

S: I just feel more cheerful. I have something to do. Usually when I wake up in the morning I feel terrible, nervous, exhausted, like I don't want to get out of bed, but I still do. When the kids are there, it's like I have a reason to get up.

C: And those are also days on which you drink somewhat less, when they are with you.

S: Oh, I see what you're getting at. You think one reason I feel worse on other mornings is that I'm drinking too much.

C: Just a possibility.

S: Well, there's probably something to that, but I also miss my kids.

C: It hurts you, too, when they're not with you. And at the same time, you wonder if maybeyou feel worse some mornings because of drinking the night before.

S: I don't think I'm really hung over or anything, but I do feel pretty bad. Headache and so forth. Maybe so. But I'm not an alcoholic or anything like that.

'''STOP!''' Before reading any further, write no more than seven sentences that you would choose to summarize what the client has said thus far. End your summary with a question.