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ASSESSMENT REPORT:
Name:
Address:
Date of birth:
Age at assessment:
Date of report:
Dates of assessment:
Case manager:
Lizzie Smith
007 Rocky Road Greensland
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23/12/23
August-November 2023
Tim Doyle
Assessments employed: Clinical interviews with Lizzie, Betty and her family; Interview with Wendy
and Jocelyn from Greensland Community Health Centre; Phone Interviews with Michael Weeding
(Greensland) and Brendan (SWC, Greensland Secondary College).
REFERRAL INFORMATION
Lizzie was referred by her GP, Dr Peter O’Toole, on the 18.12.22
PRESENTING PROBLEMS
 Aggressive behaviour
Lizzie has a history of verbally and physically abusive behaviour at home. The onset of this
behaviour occurred in May-June, 2022. Lizzie was in Year 7. Lizzie is reported to be verbally
abusive to various members of the family several times a day. Lizzie would be physically
aggressive 4-5 times a week. The physical aggression takes the form of punching, kicking,
scratching and pushing. There was one reported incident of Lizzie hitting a family member with
a chair. Lizzie has also chased family members – particularly her brother Christian- with a
knife. Although Lizzie says that she would stab a family member, the other members of the
family communicated that they do not believe that she is likely to do so. Lizzie has also
destroyed property – smashing windows and her mother’s car windscreen.
Although the Department of Health and Safety has been contacted regarding Lizzie’s violent
behaviour by KITS RECONNECT workers twice in the last 3 months, DHS have decided to
not intervene due to the minor nature of the behaviour.
Lizzie has been verbally aggressive towards peers at school. This appears to be reactive or
retaliatory in nature rather than Lizzie seeking to bully particular students. Finally, Lizzie is
reported to have been verbally abusive and degrading to teachers at both her previous and
current high schools. This behaviour is episodic.

School Refusal
As of the referral, Lizzie was school refusing. Lizzie had been expelled from Eltham High
School last year and had not attended school until June of 2023. Jocelyn Courtney, of KITS
Reconnect had successfully facilitated Lizzie’s re-integration at Greensland High School, into
year 8. However, Michael Weeding, year 8 co-ordinator stated that Lizzie has not produced any
schoolwork since joining Greensland and has not attended regularly since the resumption of
school for Term 4. As of this report Lizzie is not attending school. She is, in part, school
refusing and in part kept home by her mother because of Lizzie absconding from school to meet
a 19-year old male.

Oppositional Defiant behaviour
Lizzie is behaving in a demanding and manipulative manner within her family. For example,
Lizzie will refuse to eat unless her choice of meal is prepared or refuse to attend school unless
she is given a new mobile phone. At school, Lizzie refuses teachers requests to comply with
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standards of behaviour (i.e., ceasing swearing at teachers) and will not obey some instructions.
As indicated, Lizzie’s oppositional behaviour is inconsistent

Threats of Suicide
Lizzie has made two threats of suicide in the past. Lizzie has threatened Betty that she will
jump in front of a train or cut her wrists. On one occasion, Lizzie has taken a mouthful of her
mother’s thyroid medication but spat it out immediately. Such incidents have taken place in the
context of increased conflict with Betty.
PAST ASSESSMENTS/INTERVENTIONS
2023 – Secondary consultation provided to ECHC by Emily and Sheryl (CCOT – Austin CAMHS)
Late 2022 and 2023 – Involvement with Jocelyn & Wendy, ECHC
Late 2022- early 2023 Distance Education
FAMLY ASSESSMENT - genogram
Chris sep. ‘79
Dion
Carissa
Betty
Samantha Kate
Steve
Lizzie
Christian
Jackson
PARENT’S FAMILY OF ORIGIN
Lizzie is the only child to Betty and Steven. It should be stated from the outset that Steven has seen
Lizzie on only two occasions and has no ongoing relationship with either Betty or Lizzie. Steven has
not been involved in this assessment.
Betty is the only child to her parents, whom Betty never named. After spending the first three months of
her life in the care of her biological mother, Betty was raised by her father’s parents, Alexander and
Gladys. Betty never met her mother again. Betty’s father was a transient figure in her life. He
occasionally lived with Betty and her grandparents. His identity as her father was not revealed to her
until the age of 8 or 9. Betty stated that she had no relationship with her father.
Betty grew up with Alexander and Gladys in Mt Evelyn. Betty described feeling safe and loved while
growing up with her grandparents. She stated that they ‘spoilt her rotten’, but that she learnt at an early
age that ‘no meant no’. When considering the parenting style of Alexander and Gladys, Betty stated that
the parents seemed to work together and were consistent with rules and consequences. Betty felt that
their parenting was ‘always fair’.
Betty described attending a local primary school with a number of friends in her street. She stated that
the small group of girls and boys remained friends throughout primary school and high school. She
added that there is still contact between members of the group. Betty recalled that she enjoyed primary
school. She stated that she did not struggle with any particular or general aspect of the academic
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requirements. As explained previously, Betty had a group of close friends throughout primary school
She described herself as a ‘bit of a tomboy’ and spoke of enjoying climbing trees and roughhousing
with the boys.
Betty stated that she did not enjoy the transition to high school, but was unable to highlight those
particular aspects of high school that she did not enjoy. Betty did state that she maintained her friends
and did not find the academic work difficult. Betty thought that she was not like ‘the good girls’ in high
school. However, she was adamant that she never missed a day of school because of the trouble it
would bring her grandparents.
In 1969, Betty moved to Kalgoorlie with her grandparents. They were persuaded to move by their son –
Betty’s father. Betty was 14 and in form 3 (Year 9). Betty explained that she spent a fairly miserable six
months in Kalgoorlie, and then moved back to Melbourne to live with her aunt and uncle – father’s
sister. She worked at ACA in Lilydale as a secretary. After 12 months she returned to her grandparents
because she missed them. She gained employment at a medical supplier again as a secretary. She left
this and went into nursing.
In 1971 she met Chris. He was 19 and working as a butcher. Betty described that she and Chris dated
for approximately 18 months before moving in together and becoming engaged. They were married in
1973. Betty stated that Chris was ‘lovely’ before they were married, but that “as soon as that wedding
band was ‘round my finger, he changed!” Betty explained that he began drinking far more heavily than
in the past and in turn became physically abusive. She stated that Chris’s family were similarly inclined
to drink and fight. She describes being terrified for most nights of the week for 6 years (’73-’79), at
which time she left and returned to Melbourne. Her son Dion stayed with Chris in Kalgoorlie while her
daughter Carrisa lived with Betty.
Betty moved to Geelong where she again acquired clerical work. Betty had a series of short-term
relationships within which her children Samantha, Kate, Lizzie, Christian and Jackson were conceived
to four different fathers.
DEVELOPMENTAL HISTORY
While in a relationship with ‘Steve’ in 1989, Betty became pregnant with Lizzie. It was an unplanned
pregnancy. When Steve was informed of the pregnancy, he threatened to kill Betty and the baby. Steve
then stated a wish to have no involvement with the baby or Betty. He has had nothing to do with Lizzie
since this time.
Betty stated that the pregnancy was ‘easy’ – without complications. She stated that she did not feel
pressured by having three children aged 14, 5 and 4 while also being pregnant. Betty did not use any
medication over the pregnancy. She smoked throughout her pregnancy, but did not consume alcohol or
any other recreational drug. Betty stated that Lizzie was 16 days overdue. Betty stated that her two-hour
labour with Lizzie was relatively quick, not traumatic and free of complications. Betty stated that she
did not suffer from post-natal depression, and has never done so.
Betty stated that Lizzie was an easy baby, who slept and fed well. Betty breastfed Lizzie for three
months. She ceased breastfeeding due to her experiencing extreme fatigue. Medical examinations
identified that Betty was suffering Grave’s disease. Betty started a course of medication but due to
concerns about its effects on Lizzie, did not recommence breastfeeding. However, she thought that
Lizzie did not struggle with the move to being bottle-fed.
Betty described baby Lizzie as having an easy-going temperament. Betty stated that she was adored by
her older siblings. As a toddler, Betty reported that Lizzie was a ‘lovely and agreeable kid’.
Betty thought that Lizzie’s transition into kindergarten was without any problems – Lizzie left her
mother without reluctance and rejoined her easily. Betty remembered that Lizzie seemed to interact
well with the other children and loved the activities. Considering the transition to primary school, Betty
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recalled that Lizzie was young for her year, and underwent a series of assessments to establish whether
she was suitable to enter prep. She had Lizzie ‘checked out for ADHD – the whole bit’. Betty explained
that Lizzie was moody and non-compliant for approximately six months in prep. However she settled
and then ‘sailed through’ primary school. Betty said that Lizzie appeared academically quite capable
and always had a group of friends.
Regarding family relations, Betty stated that Lizzie had a good relationship with all her siblings – older
and younger. She never appeared jealous or upset about her siblings, did not ask questions about her
father, and enthusiastically celebrated birthdays and Christmas with the family.
Betty did not expect that the transition to High School would be difficult – it has not been so for any of
her children previously. However, Lizzie seemed unsettled during her first few weeks at High School,
and which point her aggressive and abusive behaviour towards the family and oppositional behaviour
towards the school began, and subsequently escalated dramatically. According to Brendan (SWC) of
Greensland High School, Lizzie started to abuse teachers early in Term 1. She began abusing students
throughout the following terms and her repeated poor behaviour led to her expulsion at the end of the
year.
CURRENT FAMILY FUNCTIONING
Regarding current family functioning, I include the following observations:
1) The family could be characterised as a ‘High EE’ family – they say what they are thinking and
edit very little. Criticism is common and frequent. Point-scoring, moralising and sniping at each
other is typical of the family communication I witnessed.
2) Lizzie is isolated, not unexpectedly, within the household. She had no obvious allies during the
interview I has with the family.
3) Betty described that the seemingly permissive parenting she demonstrates with Lizzie is unlike
the parenting she employed with the other children. Lizzie stays out at night until 12.00-3.00
am. She spends her time with large groups of boys aged between 13 and mid 20’s. Betty states
that she is unable to control Lizzie and is ‘at the end of her tether’.
INDIVIDUAL ASSESSMENT
Appearance
Lizzie Smith is a thin, slight and short 13 year-old Caucasian girl. She has light brown, shoulder length
hair and fine facial features. Lizzie has dressed neatly and wore a small amount of makeup to all the
assessment appointments. Lizzie was co-operative throughout the assessment process and her manner is
best described as one of slightly uncertain bravado.
Affect/Mood
Lizzie’s affect was euthymic. She spoke about significant issues in her life such as health concerns,
school attendance and familial conflict with bravado or indifference. Her affect was reactive, responsive
and appropriate. Mood appears consistent in that Lizzie reported being reliably reactive and violent
towards her family.
Orientation and Perception
Lizzie appeared oriented to time, place and person across all appointments. She demonstrated some
perceptual disturbance. Further investigation revealed a pattern of responses indicative of a sense of
social isolation, difference and a preference for thoughts and fantasies over interpersonal interactions,
such that internal experience may be confused with external reality. Furthermore this is indicative of a
personality style rather than psychosis or ‘breaks’ from reality. Finally, Lizzie appeared to struggle to
maintain her concentration throughout each session, becoming distracted and losing the topic of
conversation. This did not appear part of a psychotic process.
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Coping Mechanisms
Lizzie used a number of defence mechanisms: denial, minimisation, avoidance, but most often
projection. When asked why she did what she did, her response was that they (brother, mother sister
etc) was “a stupid moron”, “a faggot”, “a loser”. Only the most recent session was it revealed that
Lizzie thinks of herself as “a dumbass” and believes that she may be unable to complete her schooling.
Thought Processes and Verbalisations
Lizzie appears to have some trouble expressing herself, and frequently uses phrases such as “like
that…you know….oh I just can’t think of the word…it just is that way…”to express her ideas. A
cognitive assessment placed Lizzie’s Verbal IQ in the Borderline range, which means that Lizzie will
struggle to understand increasingly complex information and also find expressing ideas difficult.
Supporting this is that she refused to complete the open-ended Thematic Apperception Test (TAT), but
not an intelligence or memory assessment. Otherwise, Lizzie’s rate, tone and volume of speech was
appropriate and there was no evidence of Formal Thought Disorder.
Themes/Fantasy
Lizzie refused to complete open-ended projective tasks concerning fantasies such as three-wishes or the
desert island task. In the clinical interview, the themes evident in Lizzie’s conversation were: (a) casual
attitude towards violence and consequences for herself and family; (b) blasé attitude concerning school
and family; (c) no evidence of feelings of responsibility for her actions or attributions of blame. Put
differently, Lizzie’s attributional style is external.
Superego
Lizzie’s superego development appears limited at best. Lizzie appears indifferent to causing harm and
demonstrates no sense of responsibility. This is supported by the results of the Junior Eysenck
Personality Questionnaire - Revised (JEPQR). Lizzie’s predisposition to experience positive and
negative affective states is comparable to the majority of her peers: she does not demonstrate a neurotic
disposition. However, her extremely high Psychoticism score represents an impulsive, aggressive and
cold/egocentric aspect to Lizzie’s personality. When considering moral development, such results
indicate that Lizzie’s internal behaviour control is limited and not well informed by societal norms. In
the instances where Lizzie does demonstrate inhibitory self-control it is in response to direct threat from
Betty – either of physical violence or loss of privileges.
Concept of Self
Lizzie left the impression of an ill-defined sense of self. Lizzie was extremely reluctant to discuss her
self, position in her family, relationship to friends, future, life, school etc. One might hypothesise that
Lizzie, given her egocentricity, is painfully aware of her sense of self and her reluctance to talk about
such may be indicative of a sense of failure, inadequacy, lack of future etc. In the family session, Lizzie
responded to accusations of violence by saying that “you guys said I’d be raped and dead by 15…”
When questioned further about this, Lizzie flippantly stated that this was ‘probable’.
Lizzie struggled to identify vocational goals. She struggled to name a consistent group of friends. Lizzie
stated that she did not want a boyfriend but frequently spoke about the boys she spent time with and
how ‘ugly’ or ‘hot’ they were. She avoided or was unable to name her hopes, dreams, goals or
ambitions. Betty reported that Lizzie has been known to cut up baby photos of herself and the other
children and hide them under her bed. Lizzie has also asked about her absent father and has appeared
jealous towards the father and step-siblings of Christian.
Regarding her ability to make and sustain friendships, Lizzie’s PIY results indicate the Lizzie dos not
perceive any problems in this domain. She reports having a consistent group of friends she sees on
school nights and weekends. Although Lizzie was reported to be close to her sisters in primary school,
the relationship between the girls – particularly Samantha, Kate and Lizzie – is ambiguous at best and
highly conflictual.
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FORMULATION
DIAGNOSIS
Relevant negative findings –
RECOMMENDATIONS