Factitious Disorder is certainly a possibility here, but each day I work with my patient, it seems a little less realistic. She's been talking about something in the past that cannot be resolved and if brought into the open, would do nothing but hurt more people. She'd rather be the one hurting then seeing the others hurt, she says. She told me that when she's in therapy she learns to let go of a little of the 'guilt.' (Unclear what the guilt is at this point) It makes her start to feel better, she ends therapy to be "normal" and slowly, the guilt returns and starts dragging her down again. The situation has to do with the family member that committed suicide and the patients need to "not ruin how everyone felt about him. He was the funniest, the friendliest- my dad's brother and his very best friend." I'm working to explain to her that if she is no longer in danger, the things we talk about do not have to be explained to her parents unless she wants them to be. Seems the confidentiality has been broken in the past. My case is starting to move slowly forward, which really pleases me. Maybe it honestly was just taking her a long time to get comfortable. She glances up from the floor every once in awhile, seems a little more relaxed. She even asked if I could sit in a chair next to her instead of across from her. It seems to help her comfort level. Slowly but surely, we're making a beginning. It has been very helpful to post here about it.
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