Client Name: Mikayla
Age: 17 years
Occupation: High school student
Lives with: Mother and Father
Mikayla is a 17 year old girl in her final year of high school. She was referred for therapy by her neurologist due to unexplained seizures. For the past six months Mikayla has been having seizures nearly every day. Her seizures generally last for a few minutes, although on occasion she experiences seizures lasting over 30 minutes. Both her parents and neurologist have observed Mikayla having a seizure and report a pattern of trembling movements, with Mikayla thrashing about quite aggressively with her eyes closed. Despite these jerking movements, Mikayla has never injured herself during a seizure, although there have been occasions in which she has been incontinent. During some of her seizures, Mikayla has been observed to cry out loudly and sob uncontrollably afterwards. Following a seizure, Mikayla reports little memory of the experience and appears somewhat confused. Her parents generally respond by ensuring she is safe whilst having a seizure and taking her to lie down to recover afterwards. At times Mikayla complains of headaches following a seizure which can last several hours. Pain medication does not seem to be effective in treating her headaches. In order to manage the headaches Mikayla usually attempts to “sleep them off”. Mikayla has noticed the headaches are more likely to occur if she has had a difficult day at school or problems at home. Mikayla has undergone numerous tests and been referred to multiple health professionals to determine the cause of her seizures. Despite seeing multiple health professionals, including a GP, paediatrician and 2 neurologists, all medical examinations have been normal, including prolonged video electroencephalogy (EEG) findings. These findings indicate Mikayla does not have epilepsy or another organic cause for her seizures.
Mikayla’s first seizure was observed to occur at home following an argument with her mother. She has also had many seizures at school and over the past few months has spent increased time in the sick bay at school. Mikayla’s school attendance has been poor since the onset of her seizures, with her parents allowing her to stay home from school if she is not feeling well enough to attend. On one occasion, Mikayla was brought to the hospital emergency department from school complaining of heart palpitations, dizziness, and difficulty breathing. These symptoms bothered Mikayla and made her worry she was going crazy. Following investigations, hospital staff provided lots of reassurance that there was nothing medically wrong with her and instructed Mikayla to use abdominal breathing when feeling stressed. However, Mikayla is now reluctant to attend school for fear of having problems breathing or having a seizure.
For the past few months Mikayla has also experienced symptoms of fatigue and is finding even the smallest of tasks a challenge. At school she has been experiencing concentration difficulties and has been taking longer than usual to complete assigned activities in class. In order to support Mikayla, her teachers have been granting her extensions for most of her assignments. Despite being given extra time Mikayla still finds it difficult to meet these deadlines and generally feels disheartened about her academic progress. Mikayla has also become more and more withdrawn at school and has given up many of her extracurricular activities. She now spends most of her free time either sleeping, or watching TV at home. Mikayla complains of always feeling tired and has been sleeping up to 11 hours per night on weeknights. On weekends and days home from school, Mikayla sleeps up to 18 hours per day. As a result, her mother has started to do most of Mikayla’s daily activities, such as chores, for her. Prior to the onset of her seizures, Mikayla was a straight “A” student with plans to eventually study medicine at university. She has won many awards throughout high school and was thought to be on track to obtain a top overall position score at school. As a result of her recent school difficulties, Mikayla has started to feel increasingly disappointed in herself. She stated that “bad things seem to just happen to me” and “there is nothing I can do about it”. Mikayla generally finds it difficult to cope with stress. Mikayla also feels disheartened because the doctors could not find a medical cause for her seizures.
Background
Mikayla is an only child. Her parents moved from the USA to Australia before Mikayla was born. As a result the family have little extended family in Australia.
Mikayla disclosed to the paediatrician that she had been sexually abused five years ago by her maternal uncle, but denied being affected by this today. She was unable to recall many details of this experience other than that the abuse lasted three months before she had the courage to tell her mother what had happened. As her family generally do not openly express problems or feelings, Mikayla found this whole experience extremely stressful. In response to her confession, Mikayla’s mother blamed herself for not protecting her daughter and not being able to foresee the possibility of this happening to her. Mikayla’s uncle committed suicide not long after she told her mother about the abuse. Since this time her mother has struggled with depression. As she blamed herself for what happened to Mikayla, her mother became overly protective of Mikayla and placed strict rules on where and when her daughter could be away from home. As Mikayla matured, her mother was unable to relax these rules because of fears for her daughter’s safety. In response to her mother’s depression, Mikayla and her father try not to express unpleasant emotions, or discuss personal problems, for fear of making her depression worse. Mikayla reports she feels as though she must be strong and not show any feelings of stress or sadness. She was observed to find it difficult to identify her emotions. The sexual abuse has never been spoken of within the family since Mikayla’s uncle committed suicide.
As a result of her mother’s over-protectiveness, Mikayla has come to rely on her mother for making important decisions, including which subjects to study at school, who to be friends with, and whether she should start dating. Although Mikayla has demonstrated exceptional academic abilities, she admits that her mother has pushed to do well at school and takes pride in telling other parents that Mikayla will be a doctor one day. Mikayla is unsure whether she really does want to do medicine, but stated she probably will in order to keep her mother happy and make her proud. Mikayla’s father reported that although they want the best for Mikayla, his wife places a lot of pressure on her to perform well academically. Her father feels as though Mikayla has been finding year 12 and the academic pressure challenging this year. He stated, “I think this has been a really hard year for Mikayla, as it is also the 5th anniversary of her uncle’s death”. Mikayla failed to mention these details when interviewed.
