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Dr. Balis:
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Ms. Schultz?
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Ms. Schultz:
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Yes?
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Dr. Balis:
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This is Dr. Balis, returning your call.
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Ms. Schultz:
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Oh, yes. I wanted to speak with you about my granddaughter, Rachel. I think she may need your help.
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Dr. Balis:
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I am taking new patients. What age is Rachel? Are you her guardian?
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Ms. Schultz:
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She's twenty one. I have cared for her since her mother died three years ago. Doctor, it has been a long time since I've had to raise a child. I don't know what to expect from a young adult these days. I'm afraid I succeeded in driving her older brother right out of the house. I don't want that to happen to Rachel. She seems more fragile, more needy somehow.
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Dr. Balis:
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I see. Can you describe the behavior that caused you to seek a therapist?
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Ms. Schultz:
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Where to start. Rachel seems to be stuck in her teens as far as her interest in her appearance. She has nervous habits that take up a lot of her time. She over grooms, shall I say?
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Dr. Balis:
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Please explain, Ms. Schultz.
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Ms. Schultz:
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Her hair is falling out in handfuls. I see clumps of it in the wastebasket every day. She brushes and brushes. Her hair used to be so silky and thick. Dr. Holcomb, our family doctor, says it doesn't seem to be a nutrition issue. And she has a good appetite--that's the German in her.
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Dr. Balis:
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Is there anything else she does to an unnatural degree? By that, I mean going beyond the amount of time it would take most people to perform the same function.
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Ms. Schultz:
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Oh yes. She's a manicurist so she's always fussing with her nails. She seems overly concerned about getting them shaped and painted perfectly. Her nails look better now that she has stopped biting them. One habit replaced another, I'm afraid. She used to take tremendously long showers but I put an end to that.
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Dr. Balis:
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How so?
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Ms. Schultz:
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The water bill was almost double one month. That's when I began to notice the time Rachel spent in the bathroom. The water would run for thirty or forty minutes sometimes. What did the girl do in there for that long? It worried me. I replaced the door handle so she can't lock herself in there. What if something happened to her?
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Dr. Balis:
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You are wise to be concerned. Is there anything else that seems unusual or obsessive to you?
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Ms. Schultz:
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The other day I came into her room and she had her head drooped over her desk and was scratching her hair madly. Then she traced her finger in the dandruff left behind. I surprised her but she didn't seem alarmed. Then I noticed she had been working over the Bible. She seems preoccupied with her hair. Does that seem odd to you?
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Dr. Balis:
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Ms. Schultz, I don't mean to be evasive. Human behavior is so variable from person to person, situation to situation. It sometimes takes several sessions to determine the extent to which behavior interferes with a patient's life. Tell me, Ms. Schultz, is Rachel able to work, drive, go to school, socialize in spite of these things you observe at home?
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Ms. Schultz:
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So it seems. Why do you ask?
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Dr. Balis:
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Well, I'd like to see Rachel. Does she know that you contacted me?
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Ms. Schultz:
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No. I wasn't sure if my concerns were legitimate. It seems that they are.
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Dr. Balis:
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I'll be able to tell better after I've had an opportunity to talk with Rachel. Do you think Rachel will resist coming to see me?
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Ms. Schultz:
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We have discussed her habits. We've had to since we live together. It wasn't easy to take in two children when I'd been living alone for fifteen years. Rachel does have a stubborn streak. I'm afraid she got that from her mother. Doctor, Rachel is a very determined and bright girl. When she puts her mind to something, she doesn't usually let up. The only exception I can recall is when she dropped out of school when her mother died. She has made us very proud with her good grades and always wanting to do the right thing. Not at all like her brother, I might add. If you are as careful and patient with her as you have been with me, I don't think there will be a problem in treating her.
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Dr. Balis:
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Let's set up her first session for the week beginning September 22nd. Is one day better than another as far as her schedule goes?
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Ms. Schultz:
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I'm her transportation, but both our schedules are open in the afternoons, the earlier the better. I'll probably drop her off, then go to the market during the time you meet with each other. How long are the sessions?
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Dr. Balis:
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We will meet for an hour each time.
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Ms. Schultz:
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Thank you, Doctor. I'll discuss this with Rachel, of course.
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Dr. Balis:
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Good. Then let's make an appointment on Tuesday, September 23rd at 1 pm. If you can come a little early, you can complete some paperwork that I'll need. We will use it for billing purposes as well. You are aware of my fees?
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Ms. Schultz:
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Yes. It's not a problem. I just want Rachel to get the help she needs.
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Dr. Balis:
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I'm looking forward to meeting her. I must explain that if I begin treating Rachel, that she will be the patient. I'll seek information from you and I'll listen to what you have to tell me, but I won't be able to talk to you about Rachel's condition or progress unless she gives me permission to do so.
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Ms. Schultz:
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Oh, I understand, Doctor.
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Dr. Balis:
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But especially in the beginning, I would value having a chance to discuss Rachel in more detail after I've had a chance to meet here. We can arrange for an appointment or we can just do a phone conference. Which would be your preference?
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Ms. Schultz:
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It might be nice to see your office, Doctor. Do I have to make a decision today?
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Dr. Balis:
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Not at all. I'll look forward to meeting you both on Tuesday, September 23rd at 1 pm.
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Ms. Schultz:
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Sounds good. Thanks again.
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Dr. Balis:
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You're very welcome. Goodbye.
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Doctor Balis' Notes on this Telephone Call
Transcripts of Rachel Tanner's Communications
