Today you are meeting with Miriam Rosen

Today you are meeting with Miriam Rosen (she, her, hers), a 16-year-old girl, and her parents, Joel and Sarah. Miriam is 5′ 6″ and 97 pounds. She is well-dressed and well-groomed, but her hair is thinning; she is skinny (somewhat gaunt); and she has poor dentation. (Miriam transcriptNarrator: You speak with Miriam alone. Miriam: [silence for 5 seconds] Umm, they are sort of right or whatever. I’m not really hungry. It’s fine though, because I need to lose more weight. I skip Mama’s dinner; they have way too many calories. You know, the classic Jewish grandma’s cooking? That’s my Mom! [nervous giggle] But sometimes I have to eat to get them off my back, you know. So after that I either take a laxative, or puke in the toilet. Either way, it gets them off my back and get to keep losing weight. Narrator: Have you hurt yourself at all? Miriam: [deep breath] Um, yeah. Ok so, when it gets too much, I… I gotta let it out, you know? Back before school started, like last summer, I cut myself you know, here and here, on my thighs? But I’m not trying kill myself or anything. I don’t want to… die! But the cuts, the blood, let’s it all out and I don’t feel so icky afterward. Narrator: Did something happen last summer? Miriam takes a while to respond. Miriam: You won’t tell my parents? Gotta swear you won’t tell them. [waits for affirmation] Uh, almost a year ago, on prom night… these two boys [gulps, some crying in between the rest]… I’ve never told anyone, not even Rachel my best friend, these… two boys took me to a hotel room, upstairs from where the dance was. I thought it was so cool that they wanted to hang out with me. I felt special. They said there was a little party and Stephen, he was my date, he was going to be there, but he wasn’t. And they forced me to… you know, to have sex. I didn’t want to, but I couldn’t stop them. I felt so dirty and so used you know. How could I be tricked like that? My parents won’t understand. We’re Jewish, you know, not Orthodox, but still, my parents said I can’t do it until after I get married. Mom will absolutely flip, you know, and and [sniffling] and I’m just so… ashamed. If Dad finds out, I won’t be his sweet little Miri anymore. So see, I need that release to keep me together, to release the pressure… it’s for them, my mom and dad. Questions From your perspective as Miriam’s psychiatric nurse practitioner, answer the following questions Identify what interview questions you would have used to determine the underlying eating disorder, self-mutilation, and rape. Using the interpersonal therapy model, identify three specific goals for Miriam’s treatment, and in which phase each goal should be accomplished. Sarah, Miriam’s mother, asks why you are choosing interpersonal therapy and how it will be beneficial for Miriam. How do you respond? Compare and contrast it with humanistic-existential or solution-focused psychotherapy. What are the legal and ethical implications for you relative to a patient reporting a sexual assault? What is the best way for you to proceed? Reference your state of practice’s laws.

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