Category: Psychology and counseling assignment

Assignment Preparation: Case Scenarios

Case Scenarios

For next week’s assignment, you will analyze one of the case scenarios. Review these scenarios and choose one that aligns with your specialization and professional interests:

• Connor and Yuan Case Scenario.
• John and Carmen Case Scenario.
• Sadie and Madeline Case Scenario.

Select a family therapy model that you would use with the case you chose and use that model to develop additional questions you would ask to gather more information. Discuss the presenting issue(s) and overarching treatment goals, as well as specific treatment objectives.

You will be interpreting the assessments that the clients took in the case that you chose. Another part of the Unit 6 assignment is to examine your own experience of, and reactions to, the two assessments administered for your selected case. To prepare to do these activities for the assignment, make sure to review the readings and familiarize yourself with the specific assessments administered in the case by viewing them and their scoring directions in the Couple and Family Assessment Resource Folder.

Then, administer the two assessment instruments to yourself (do not administer the assessment to another person or persons).

Resources

• Connor and Yuan Case Scenario [PDF].
• Sadie and Madeline Case Scenario [PDF].
• John and Carmen Case Scenario [PDF].
• Couple and Family Assessment Resource Folder [PDF].
• Marriage & Family Therapy Library Research Guide.

Juan D. Pedraza, M.D.Jeffrey H. Newcorn, M.D.

Kyle was a 12-year-old boy who reluctantly agreed to admission to a psychiatric unit after getting arrested for breaking into a grocery store. His mother said she was “exhausted,” adding that it was hard to raise a boy who “doesn’t know the rules.”

Beginning as a young child, Kyle was unusually aggressive, bullying other children and taking their things. When confronted by his mother, stepfather, or a teacher, he had long tended to curse, punch, and show no concern for possible punishment. Disruptive, impulsive, and “fidgety,” Kyle was diagnosed with attention-deficit/hyperactivity disorder (ADHD) and placed in a special education program by second grade. He began to see a psychiatrist in fourth grade for weekly psychotherapy and medications (quetiapine and dexmethylphenidate). He was adherent only sporadically with both the medication and the therapy. When asked, he said his psychiatrist was “stupid.”

During the year prior to the admission, he had been caught stealing from school lockers (a cell phone, a jacket, a laptop computer), disciplined after “mugging” a classmate for his wallet, and suspended after multiple physical fights with classmates. He had been arrested twice for these behaviors. His mother and teachers agreed that although he could be charming to strangers, people quickly caught on to the fact that he was a “con artist.” Kyle was consistently unremorseful, externalizing of blame, and uninterested in the feelings of others. He was disorganized, was inattentive and uninterested in instructions, and constantly lost his possessions. He generally did not do his homework, and when he did, his performance was erratic. When confronted about his poor performance, he tended to say, “And what are you going to do, shoot me?” Kyle, his mother, and his teachers agreed that he was a loner and not well liked by his peers.

Kyle lived with his mother, stepfather, and two younger half-siblings. His stepfather was unemployed, and his mother worked part-time as a cashier in a grocery store. His biological father was in prison for drug possession. Both biological grandfathers had a history of alcohol dependence.

Kyle’s early history was normal. The pregnancy was uneventful, and he reached all of his milestones on time. There was no history of sexual or physical abuse. Kyle had no known medical problems, alcohol or substance abuse, or participation in gang activities. He had not been caught with weapons, had not set fires, and had not been seen as particularly cruel to other children or animals. He had been regularly truant from school but had neither run away nor stayed away from home until late at night.

When interviewed on the psychiatric unit, Kyle was casually groomed and appeared his stated age of 12. He was fidgety and made sporadic eye contact with the interviewer. He said he was “mad” and insisted he would rather be in jail than on a psychiatric unit. His speech was loud but coherent, goal directed, and of normal rate. His affect was irritable and angry. He denied suicidal or homicidal ideation. He denied psychotic symptoms. He denied feeling depressed. He had no obvious cognitive deficits but declined more formal testing. His insight was limited, and his judgment was poor by history.

Diagnoses

· Conduct disorder, childhood-onset type, severe, with limited prosocial emotions

· Attention-deficit/hyperactivity disorder

Discussion

Kyle is a 12-year-old boy who was brought to a psychiatric unit after getting caught breaking into a grocery store. He has a lengthy history of behaviors that violate the rights of others. These behaviors deviate significantly from age-appropriate societal norms and have caused social, academic, and functional impairment. He has a disorder of conduct.

In DSM-5, the criteria for conduct disorder (CD) are organized into four categories of behavior: aggression to people and animals, destruction of property, deceitfulness or theft, and serious violations of rules. A CD diagnosis requires three or more specific behaviors out of the 15 that are listed within these four categories. The behaviors must have been present in the last 12 months, with at least one criterion present in the prior 6 months. Kyle has at least seven of the 15: bullying, fighting, stealing (with and without confrontation), break-ins, lying, and truancy.

Kyle also has a history of comorbid DSM-5 ADHD, as evidenced by persistent symptoms of hyperactivity, restlessness, impulsivity, and inattention. ADHD is found in about 20% of youth with CD. The criteria for the two disorders are relatively distinct, although both entities present with pathological levels of impulsivity.

DSM-5 includes multiple specifiers that allow CD to be further subdivided. Kyle’s behavior began before age 10, which places him in the category of childhood-onset type as opposed to adolescent-onset type. There is also an unspecified-onset designation, used when information is inadequate to clarify whether the behaviors began before age 10. When trying to identify the age at onset, the clinician should seek multiple sources of information and recall that estimates are often 2 years later than actual onset. People with an early age at onset—like Kyle—are more likely to be male, to be aggressive, and to have impaired peer relationships. They are also more likely to have comorbid ADHD and to go on to have adulthoods marked by criminal behavior and substance use disorders. In contrast, CD that manifests between ages 10 and 16 (onset is rare after age 16) tends to be milder, and most individuals go on to achieve adequate social and occupational adjustment as adults. Both groups have an elevated risk, however, of many psychiatric disorders.

The second DSM-5 specifier for CD relates to the presence (or absence) of callous and unemotional traits. The “limited prosocial emotions” specifier requires the persistent presence of two or more of the following: lack of remorse or guilt; lack of empathy; lack of concern about performance; and shallow or deficient affect. Kyle has a history of disregard for the feelings of others, appears unconcerned about his performance (“What are you going to do, shoot me?”), and shows no remorse for his actions. This label applies to only a minority of people with CD and is associated with aggression and fearless thrill seeking.

A third specifier for CD relates to the severity of symptoms. Lying and staying out past a curfew might qualify a person for mild CD. Vandalism or stealing without confrontation might lead to a diagnosis of moderate CD. Kyle’s behaviors would qualify for the severe subtype.

Multiple other aspects of Kyle’s history are useful to understanding his situation. His father is in prison for substance use and/or dealing. Both of his biological grandfathers have histories of alcohol abuse. His mother and stepfather are underemployed, although details about the stepfather are unknown. In general, CD risk has been found to be increased in families with criminal records, conduct disorder, and substance abuse, as well as mood, anxiety, and schizophrenia spectrum disorders. Environment also contributes, both in regard to chaotic early child-rearing and, later, to living in a dangerous, threatening neighborhood.

Kyle’s diagnosis of conduct disorder is an example of how diagnoses can evolve over the course of a lifetime. His earlier behavior warranted a diagnosis of DSM-5 oppositional defiant disorder (ODD), which is characterized by a pattern of negative, hostile, and defiant behaviors that are usually directed at an authority figure (e.g., parent or teacher) and may cause significant distress in social or academic settings. However, ODD cannot be diagnosed if CD is present. As he enters adolescence, Kyle is at risk for many psychiatric disorders, including mood, anxiety, and substance abuse disorders. Of particular concern is the possibility that his aggression, theft, and rules violations will persist and his diagnosis of conduct disorder will shift in adulthood to antisocial personality disorder.

· What can be gleaned from the assessments that have already been performed (if applicable)? If this client came into your office, what assessments would you perform (perhaps ones from the text that were not mentioned in the case)?  

DISCUSSION 1:

 

The Aging Process

 

As individuals grow older, they experience biological changes, but how they experience these changes varies considerably. Senescence, or the process of aging, “affects different people, and various parts of the body, at different rates” (Zastrow & Kirst-Ashman, 2016, p. 658).

 

What factors affect the aging process? Why do some individuals appear to age faster than others? In this Discussion you address these questions and consider how, you, as a social worker, might apply your understanding of the aging process to your work with older clients.

 

To prepare for this Discussion, read “Working With the Aging: The Case of Francine” in Social Work Case Studies: Foundation Year.

 

Post a Discussion in which you:

 

o   Apply your understanding of the aging process to Francine’s case. How might Francine’s environment have influenced her aging process? How might you, as Francine’s social worker, apply your knowledge of the aging process to her case?

 

o   Identify an additional strategy you might use to apply your knowledge of the aging process to social work practice with older clients in general. Explain why you would use the strategy.

 

 

Be sure to support your posts with specific references to the resources. If you are using additional articles, be sure to provide full APA-formatted citations for your references

 

References

 

Plummer, S. -B., Makris, S., & Brocksen, S. M. (Eds.). (2014). Social work case studies: Foundation year. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].

 

Zastrow, C. H., & Kirst-Ashman, K. K. (2016). Understanding human behavior and the social environment (10th ed.). Boston, MA:  Cengage Learning.

 

 

 

Working With the Aging: The Case of Francine

Francine is a 70-year-old, Irish Catholic female. She worked for 40 years as a librarian in an institution of higher education and retired at age 65. Francine has lived alone for the past year, after her partner, Joan, died of cancer. Joan and Francine had been together for 30 years, and while Francine personally identifies as a lesbian, she never came out to her family or to her colleagues. When speaking to all but her closest confidantes, Francine referred to Joan as her “best friend” or her “roommate.” Francine’s bereavement was therefore complicated because she did not feel she could discuss the true nature of her partnership with Joan. She felt that there was little recognition from her family, and even some of her close associates, of the impact and meaning of Joan’s death to Francine. There is a history of alcohol abuse in Francine’s family, and Francine abused alcohol from late adolescence into her mid-30s. However, Francine has been in recovery for several decades. Francine has no known sexual abuse history and no criminal history.

Francine sought counseling with me for several reasons, including an ongoing depressed mood, a lack of pleasure or enjoyment in her life, and loneliness and isolation since Joan’s death. She also reported that she had begun to drink again and that while her drinking was not yet at the level it had been earlier in her life, she was concerned that she could return to a dependence upon alcohol. Francine came to counseling with several considerable strengths, including a capacity to form intimate relationships, a successful work history, a history of having maintained her sobriety in the past for many years, as well as insight into the factors that had contributed to her current difficulties.

During our initial meetings, Francine stated that her goals were to feel less depressed, to reduce or stop drinking, and to feel less isolated. In order to ensure that no medical issues were contributing to her depression symptoms, I referred Francine to her primary care physician for an evaluation. Francine’s physician did not find any medical cause of her symptoms, diagnosing Francine with moderate clinical depression and recommending that Francine begin a course of antidepressant medication. Francine was reluctant to take medication and first wanted to try a course of counseling.

In order to help Francine meet her goal of reducing her depression symptoms, I employed a technique called behavioral activation (BA), which is drawn from principles of cognitive behavioral therapy and helps to reengage people in pleasant physical, social, and recreational activities. We began with a small initial goal of having Francine dedicate at least 5 minutes of each day to an activity she found pleasant or rewarding. Over the following weeks, we increased the time. Francine’s treatment progress was monitored through weekly completion of the Patient Health Questionnaire (PHQ-9) in order to determine whether or not her depressive symptoms were improving.

I helped Francine address her drinking by reconnecting her with effective coping strategies she had used in the past to achieve and maintain her sobriety. These included identifying triggers for the urge to drink and exploring her motivations for both continuing to drink and for stopping her use of alcohol. Francine began attending regular meetings of Alcoholics Anonymous^™ (AA) and found several meetings that were specifically for older women and for lesbians. In addition, Francine spoke regularly with a sponsor who helped her to remain abstinent during particularly stressful moments during her reengagement in sobriety.

Finally, in order to address Francine’s goal of feeling less lonely and isolated, we explored potential avenues to increase her social networks. In addition to spending time with her family, friends, and her AA sponsor, Francine began to visit the local lesbian, gay, bisexual, and transgender (LGBT), center for the first time in her life and attended a support group for women who had lost their partners. Francine also began spending time at her local senior center and went there at least three times a week for exercise classes, other recreational activities, and lunch. She also began to do volunteer work at her local library once a week.

Over several months of counseling, Francine stopped drinking; significantly increased her daily involvement in pleasant and rewarding activities, including social and recreational activities; and reported feeling less lonely, despite still missing her partner a great deal. Francine’s scores on the PHQ-9 gradually decreased over time, and after 16 weeks of counseling, Francine reported that she no longer felt she needed the session to move on with her life. In addition, Francine visited her primary care physician, who found upon evaluation that her depression had lifted considerably and that an antidepressant was no longer indicated. By the end of counseling, Francine’s focused work on identifying her depression symptoms and her triggers for drinking equipped her to better recognize when she might need support in the future and to whom she could reach out for help if she needed it.

 

 

 

 

 

Discussion 2: Mental Health Care

 

Mental health care is a primary concern to social workers, who are the main providers of care to populations with mental health diagnoses. The system that provides services to individuals with mental health issues is often criticized for being reactive and only responding when individuals are in crisis. Crisis response is not designed to provide on-going care and is frequently very expensive, especially if hospitalization is involved.

 

Critics suggest a comprehensive plan, which involves preventive services, as well as a continuum of care. However, there are few, if any, effective and efficient program models. Social work expertise and input are vital to implementing effective services. Targeting services to individuals with a diagnosis of mental illness is one strategy. Another approach includes providing an array of services that are also preventative in nature. How might these suggestions address potential policy gaps in caring for individuals such as the family members in the Parker Family case?

 

For this Discussion, review this week’s resources, including the Parker Family video. Then consider the specific challenges or gaps in caring for individuals with a chronic mental illness might present for the mental health system based on the Parker case. Finally, think about how environmental stressors, such as poverty, can aggravate mental illness and make treatment more challenging.

 

·      Post an explanation of the specific challenges or gaps in the mental health care system for the care of individuals with chronic mental illnesses.

 

·      Base your response on the Parker case.

 

·      Then, describe how environmental stressors, such as poverty, can aggravate mental illness and make treatment more challenging.

 

Support your post with specific references to the resources. Be sure to provide full APA citations for your references.

 

 

References

 

Popple, P. R., & Leighninger, L. (2015). The policy-based profession: An introduction to social welfare policy analysis for social workers. (6th ed.). Upper Saddle River, NJ: Pearson Education.

World Health Organization. (2004). Mental health policy and service guidance package: Mental health policy, plans and programmes. Retrieved from http://www.who.int/mental_health/policy/en/policy_plans_revision.pdf

 

Plummer, S. -B., Makris, S., & Brocksen, S. (Eds.). (2014). Sessions: Case histories. Baltimore: MD: Laureate International Universities Publishing. [Vital Source e-reader].

 

 

Parker Family Episode 5 Program Transcript

 

COUNSELOR: So you’ve been hospitalized, let’s see, four times altogether.

 

FEMALE CLIENT: Well actually, I should have only been in the hospital three times.

 

COUNSELOR: Why do you say that?

 

FEMALE SPEAKER: Well, on the third hospital visit they kicked me out before I was ready to leave. They said I was just in there to get away from my mom, but I told them they were wrong. My sister even backed me up on this. But they didn’t care. They just checked me out, and home sweet home I went. I was barely gone like a month and I was back in their monkey house. So technically, for me, hospital visits three and four are the same. I remember going back to that hospital seeing the same docs and nurses, and I just smiled and waved and said, see, I told you so. I mean, we picked up right where we left off.

 

COUNSELOR: What do you mean your sister backed you up?

 

FEMALE CLIENT: Jane, that’s my sister. Jane, she knew how crazy my mom is, so she took pictures of all that mess and all that junk my mom hoards, and she showed them to the social worker in the hospital.

 

COUNSELOR: What happened?

 

FEMALE CLIENT: You know what the social worker said? She said that there was nothing that she can do about it, that her job was to only make sure that patients have a place to go when they leave the hospital. Translation, when you’re out the door, good riddance and good luck. Some policy, huh?

 

 

 

 

 

 

 

Discussion 3: Emerging Issues in Mental Health Care

 

Like so many areas of practice in social work, mental health is dynamic and ever-evolving. Research continues to provide new information about how the brain functions, the role of genetics in mental health, and evidence to support new possibilities for treatment. Keeping up with these developments might seem impossible. However, being aware of and responsive to these developments and incorporating them into both your practice and social policy is essential to changing the lives of individuals and families who live with a mental health diagnosis and the impact it brings to their daily lives.

 

For this Discussion, review this week’s resources. Search the Library and other reputable online sources for emerging issues in the mental health care arena. Think about the issues that are being addressed by social policy and those that are in need of policy advocacy and why that might be the case. Then, consider what social workers can do to ensure that clients/populations receive necessary mental health services. Also, think about the ethical responsibility related to mental health care social workers must uphold in host settings when they encounter conflicts in administration and home values. Finally, search your state government sites for the mental health commitment standards in your state and reflect on the mental health services covered under your state’s Medicaid program.

 

·      Post an explanation of those emerging issues in the mental health care arena that the policymakers address and those that are in need of policy advocacy and why.

 

·      Then, explain what strategies social workers might use to ensure that clients/populations receive necessary mental health services.

 

·      Finally, explain the mental health commitment standards and mental health services in your state. In your explanation, refer to the services covered under your state’s Medicaid program.

 

Support your post with specific references to the resources. Be sure to provide full APA citations for your references.

 

References

 

Popple, P. R., & Leighninger, L. (2015). The policy-based profession: An introduction to social welfare policy analysis for social workers. (6th ed.). Upper Saddle River, NJ: Pearson Education.

World Health Organization. (2004). Mental health policy and service guidance package: Mental health policy, plans and programmes. Retrieved from http://www.who.int/mental_health/policy/en/policy_plans_revision.pdf

 

Plummer, S. -B., Makris, S., & Brocksen, S. (Eds.). (2014). Sessions: Case histories. Baltimore: MD: Laureate International Universities Publishing. [Vital Source e-reader].

 

 

Mental Health America. (n.d.). Retrieved October 10, 2013, from www.mentalhealthamerica.net

Topic: Brief Therapy Counseling

Brief therapy counseling is accomplished in 3–10 sessions and has become the norm in nearly every field of counseling endeavor. According to the course text, what are the process and the key techniques that make up this model as it applies to Christian counseling and pastoral care? Describe an effective technique using support from the course material and journal articles. Use the Jerry Falwell library to access an article https://www.liberty.edu/library/.

250 WORDS

TEXTBOOK: COMPETENT CHRISTIAN COUNSELING VOLUME 1 BY CLINTON AND OHLSCHLAGER

Review the Topic 2: Vargas Family Case Study. Write a 750-1,000-word paper in which you demonstrate how therapists apply psychoanalytic and cognitive-behavioral theories to analyze the presenting problem(s) and choose appropriate interventions.

Be sure to answer the following questions in your paper:

1. What are the two main presenting problems for the Vargas family?

2. How are the problems maintained?

From the psychoanalytic perspective

From the cognitive-behavioral perspective

3. What interventions would you plan to use in your next session?

From the psychoanalytic perspective (identify and describe your plan for two interventions)

From the cognitive-behavioral perspective (identify and describe your plan for two interventions)

4. What is the role of the counselor in the change process?

From the psychoanalytic perspective

From the cognitive-behavioral perspective

Cite at least three academic sources (peer-reviewed journal articles, books, etc.).

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the directions in the Student Success Center.

PCN-521 Topic 2: Vargas Case Study

Elizabeth arrives on time with Frank and Heidi for the second session. Elizabeth appears somewhat frazzled and tells you that she had just heard from Bob who said he would be “a little late” because he “lost track of time.” You note Elizabeth’s frustration which she confirms by saying this is “typical.” She proceeds to share that she feels “completely disregarded,” especially after having shared with Bob the night before how important these sessions are to her. You notice that Heidi seems upset as well and looks as if she has been crying. You ask her how her day is going and she tearfully tells you that Frankie tore up her school paper with the gold star on it. Elizabeth elaborates that Frank had become angry and ripped up the picture that Heidi was proudly sharing with her. Frank, who had gone directly to the Legos, appears oblivious to the others in the room. When you ask him about his sister’s sadness, he replies, “Who cares? She always gets gold stars!”

As you were about to further explore these feelings, Bob arrives stating, “She probably told you I’m always late, but hey, at least I’m consistent.” You notice Elizabeth’s eye rolling and direct your attention to the children, asking them about what brought them to your office. Heidi says, “I’m good but Frankie’s bad at school, and it makes Mommy and Daddy fight.” Frank, who had helped himself to one of your books to use as a car ramp argues, “I hate school. It’s boring and my teacher is mean.” Bob attributes Frank’s boredom to being “too smart for the second grade…what do they expect?” Elizabeth responds that they, like her, expect him to follow rules and be respectful, and suggests that Bob should share those same expectations. Bob dismisses Elizabeth’s concerns by saying, “He’s a normal boy, not like all your friends from work who you say are ‘creative.’”

You notice Elizabeth’s reaction and decide to redirect your attention to Frank. You ask him what bothers him most about school, to which he replies, “I get in trouble, then I don’t get to have all the recess time, then I can’t play soccer because they already started and they won’t let me play.” You notice Frank’s interest in sports and probe for more information. You learn that he is quite athletic and has been asked to join a competitive youth soccer team that plays on Saturdays and Sundays. You discover another source of discord when Elizabeth shares that Bob “feels strongly” that Sundays are to be spent only at church and with family. Bob confirms that after church on Sundays, they spend the rest of the day with his parents, siblings, nieces, and nephews. Elizabeth says that Sunday mornings are the only time she gets to be by herself and that she typically joins the family around 1:00 p.m. Bob adds, “Apparently Liz needs time to herself more than she needs God and her family,” and suggests she should appreciate his family more because “it’s the only family she has.”

As the session comes to a close, you share your observations of the family by noting their common goal of wanting to enjoy family time together. You also suggest that while Frank’s behavior challenges are concerning, perhaps you could focus next week on learning more about each parent’s family of origin in hopes of gaining a better understanding of the couple’s relationship.

Required Text Books:

Entwistle, D. N. (2015).  Integrative approaches to psychology and Christianity (3rd ed.).  Eugene, OR: Wipf and Stock.  ISBN: 9781498223485.

McMinn, M. R. (2011).  Psychology, theology, and spirituality in Christian counseling (Rev. ed.).  Carol Stream, IL: Tyndale House.  ISBN: 9780842352529.

In 500 words, consider how to counsel suffering clients: The class lectures, Entwistle, and McMinn text books all discuss the concept of suffering and factors guiding how we counsel those who are suffering.  In fact, a careful reading of the Reading & Study materials indicates numerous concepts and principles that we could apply as we counsel those who are hurting.

1. Considering the numerous points that were made, make a list of at least 5 concepts (“questions to ask myself as I counsel those who are suffering. . .  “) that you found particularly helpful, insightful, unique, or had not thought about before.  What guidelines would you particularly emphasize as you counsel hurting people?
2. Then consider this client’s statement: Client: “Dr. Counselor, I have been coming to you now for six weeks.  I am not sure that counseling is working.  I don’t feel any better now than when we started talking.  Why are you not helping to remove this pain that I am feeling?”  If your client expects that you help to remove the suffering, how would you respond, based on what you learned from your study for the week?

Make sure to integrate appropriate concepts from the class sources, and cite correctly, per current APA format.