Monday, June 22, 1998
4 pm. Telephone Conversation with Angelica Alvidrez respecting Nina Alvidrez. Angelica called me to schedule an appointment for her daughter, Nina, who also works at SII. Nina is apparently suffering from acute shyness which is inhibiting her ability to communicate with her superior at work. She's also complained of a mix of physical pains which shift from site to site: a toothache, a headache, a stomach pain, or foot pain. Her mother believes that she's just seeking attention, although she hasn't sought the assistance of a physician for any of these physical complaints. Nina knew that her mother was calling, and agreed to come to a session, but apparently didn't want to make the call herself. I agreed to see her this coming Thursday.

Thursday, June 25, 1998
10 am. First Session with Nina Alvidrez. I met Nina today. She is indeed quite shy. This was a particularly laborious session. Nina hardly spoke and took long pauses when she did speak. She rarely offered information about herself. She fidgeted, picked at her cuticles, and looked at the floor quite a bit. She dressed and acted as if she wanted to be as inconspicuous as possible--it was as if she was trying to blend into her surroundings as much as possible. Her biggest desire seemed to be that she be unnoticed. Although she usually spoke in short sentences without a lot of personal content, she surprised me with a flowery and seemingly well-rehearsed speech about how much she loved her mother. Nina is working as a secretary for Tom Utterman. She's been put in a position where she's required to talk to many strangers on the phone--a task for which I'm sure she's ill-suited. Nina was particularly concerned about succeeding at her job because she wanted her mother to be proud of her. She didn't seem very interested in the job for her own sake. She tried to get away with answering my questions in a minimal fashion, speaking in a low undertone that was quite difficult to discern. About halfway through the session, she became so obviously uncomfortable that she had to leave. After making a speech about how meeting new people is like an adventure, I coaxed her into making a return appointment in two weeks.

Monday, July 13, 1998
9 am. Telephone Call with Nina Alvidrez. I called Nina at work to find out why she skipped her appointment last Thursday. First, Nina was a bit evasive, but then she was effusive with her apologies. She savaged herself with remorse for missing the appointment. I reassured her and we made an appointment for later this week.

Thursday, July 16, 1998
10 am. Second Session with Nina Alvidrez. Nina is very shy and withdrawn. She apparently suffers from an acute sense of personal inferiority. She told me that her brother Rico was the favorite in her family--someone seemingly with the golden touch. She felt that she couldn't compete. I began the session by asking her about the Fourth of July picnic that SII held. She didn't go. She told me that she was sure that she was hated at the office by those that knew her and that those that didn't hate her now would hate her after they met her. She is terrified of asking questions or seeking clarification respecting her job functions and so she probably makes a great number of mistakes, which leads her to fear interaction with her peers even more. It's a vicious cycle. She feels stupid and inept. She seeks help from her mother, but even there, she feels that her mother doesn't have the time to help her. And since her mother works directly for Lloyd Major, she feels that others in the company view her as little more than a spy. She is frozen by social situations which involve initial contact with people unknown to her. Actually, in many ways, her avoidant personality disorder is similar to Thomas Darden's, although Nina additionally suffers from a terrible self-image and poor self-esteem. While Thomas masks his self-loathing in caustic wit, Nina has no such shielding. Her poor opinion of herself is quickly voiced to any who will hear her. But Nina seems to respond well to therapy. Any interest that I show in Nina is immediately met by surprise--it's as if she can't believe that anyone would go out of their way on her behalf. Perhaps, in a non threatening way, therapy gives her a little of the attention that she needs. Nina told me that, while today's session was difficult, she thought that she was growing to trust me. I tried some to initiate some self-esteem exercises to get Nina to realize that everyone has special talents and abilities. While initially receptive, primarily she was skeptical.

Thursday, July 30, 1998
10 am. Third Session with Nina Alvidrez. Nina ran out on our session prior to the end because she's concerned that her boss, Mr. Utterman, will discover that she's sneaking away to therapy sessions. She was adamant that she didn't want the fact that she's seeing a psychiatrist to become known to her employer. We spoke a bit about the issues surrounding work that most distress her. Nina would like to have fewer contacts with people in her work environment. She's quite knowledgeable about the services which deliver to the home and allow her to stay inside and never go out for anything. She mentioned a few that I had never heard of, but she didn't mention "Waiters on Wheels" whose service I've used a few times. I didn't think it was a good idea to mention it to her--she doesn't seem to require much encouragement to become a shut-in. Nina told me that she liked to read books more when she was a child than participate with others in activities. But she feels removed from what she reads and doesn't feel that she can become a part of that fantasy world which seems to exist for her only in books. When I suggested that we could work on making Nina a more active participant in her own life rather than merely a passive observer, Nina took the opportunity to decide that she'd spent too much time with me this session and she bolted for the door.

Thursday, August 13, 1998
10 am. Fourth Session with Nina Alvidrez. Nina described a feeling of hopelessness and loneliness at work. She says that she primarily communicates with her boss, Tom Utterman, through e-mail. He's brusque and doesn't seem to have time for her. As she sees it, he feels she isn't worth the time, even though she's on his staff. In previous sessions, Nina has expressed the wish that she could work at home and minimize her contact with others. Given her general desire for social isolation, I thought it a bit odd that she should crave attention from her boss, but she clearly does. Rachel told me that she has some current suicidal fantasies involving throwing herself from SII's roof. But her suicidal ideation fortunately doesn't rise to the level of a plan of action. Rachel told me that she had an episode two or three years ago in which she intentionally mutilated herself with a pair of scissors. Her parents went against the hospital's advice and refused to have her admitted into a psychiatric facility. Instead, they embarked on a 24 hour watch program--"babysitting" is how Nina thought of it--carried out by the members of her family. However, since that time, her family has never discussed the incident, as if they were all pretending it never happened. It was Nina's sister Maria who discovered Nina after the mutilation. Their relationship has never been the same since. While Nina only brushed upon the emotional issues which allowed her to become self-destructive, she did describe a feeling of depression which begins by rendering the world humorless and then causes her to feel detached from herself. A deep sense of sadness--which Nina describes as "darkness"--overwhelms her. She still feels this way occasionally and her mother has come to recognize the warning signs by Nina's penchant for taking long, very hot showers during these episodes. Nina said that she's not close to feeling that way now, and she promised to let me know if she did. Next session, I'd like to formally evaluate Nina for clinical depression and perhaps recommend a somatic approach as part of her treatment.


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