Dr Minh Tran

Heritage Medical and Dental Clinic

58 March St

Richmond

NSW 2753

21.01.2025

Re: Susan J Walker (DOB: 18/10/1953) GP MHCP review

Dear Dr Tran,

Thank you for referring Susan Walker for psychological support for “major depression” in September, 2024. Susan attended her first consultation on the 23rd of October 2024. She engaged very well and was able to open up about her current challenges. She had a total of four sessions and is currently doing very well and does not require more at this time. I write to provide you with a report and update.

Initial Presentation

71 year old woman presenting with deterioration in mood and motivation, following psychosocial stressors, including:

Husband's (Geoff) (of 50 year marriage) alcoholism and anger outbursts when intoxicated (he has his own long-standing unresolved trauma issues)

Recent family upset when Geoff became verbally abusive to Susan and their daughter whilst intoxicated

Loss of missionary work, which hd provided a deep sense of purpose

Susan reported the deterioration began during covid, with a gradual loss of motivation to socialise and attend to domestic chores. She stated "I can't be bothered", where once she was dynamic, active and had a strong sense of purpose. She considers that part of the trigger may have been the grief and loss of losing the mission work, particularly the injustice around the way the organisation handled the situation. She reported a sense of betrayal of trust and values as a Christian person.

Susan's coping mechanism was to withdraw and keep things to herself. Her faith keeps her strong and has helped her navigate the difficulties over the years. She has lots of friends, however her main close friend died of cancer 8 years ago and she continues to miss that relationship. Susan enjoys time at the church and helping her daughter with the grandchildren.

Susan's mother had depression and anxiety, with 2 breakdowns with suicidal ideation requiring medical intervention(age 60 and 80). Her MGM had anxiety and depression and was institutionalised for the last 12 years of her life.

Susan described her mood as "blah"

Reactive affect; congruent with mood; smiling, laughing and crying through session

No evidence of alteration in perception

T/F logical and sequential

Oriented to person time and place

Speech normal rate tone and volume

23.10.2024 K10 score: 28/50

Supports

Lives with her husband, Geoff.

Is close with her daughter

Update

A range of psychodynamic tools were utilised to support Susan’s journey of self-discovery. She engaged very well with every process and continued her internal reflections between sessions by journaling. Over the four sessions, Susan developed insight about the underlying stressors and her associated responses, the learning of which she stated made a big difference to her emotional wellbeing. One particular process reminded her of her core values, “that it’s my life and I'm in charge of it; I’m strong and want to stand tall and be a support for others,” which was empowering.

Susan had been reflecting on her previous journals and communicating better with Geoff about how they want to live their lives together going forward. Susan concluded that she wants to focus on her own self-care and find more quiet time for contemplation for spiritual growth. She also wants to be more actively engaged as a grandmother, and to change the pattern in family dynamics from previous generations which grew up without involvement from grandparents.

At the time of her review on the 12th of January, 2025, Susan reported “I’m feeling much better emotionally and in myself.” She attributed this to a change in diet and the therapy. This was congruent with her presentation. She was looking very well; bright and reactive; very optimistic about her life and future

K10: 14/50 (was 28/50)

Susan feels positive about 2025 and has planned trips away with friends and also personal retreats.

Formulation

71 year old retired married woman, presenting with low mood and diagnosis of major depression in background of psychosocial stressors, currently doing very well.

Impression

Situational crisis

Plan

Susan does not require further consultations at this time. She is aware that she can contact me at any time, should she require additional support.

Thank you.

Regards,

Michelle Hookham