Discussion Question

2

Treatment Plan and Progress Monitoring: Eliza

Onediouth L. Hutto-James

College of Science, Grand Canyon University

CNL-610 Clinical Assessment, Diagnosis, and Treatment

Dr. White

July 7, 2021

Eliza is a second semester freshmen majoring in Engineering. Eliza comes from a rather successful background of Engineers being that her father and her two older brothers completed a degree in engineering and currently working in that field. Though she doesn’t necessarily want to be an engineer she feels pressured and obligated to do so. Due to Eliza’s hometown being located two hours away from her college, she is unable to spend a lot of time back home with her family and friends. Eliza is having a hard time wrapping her mind around the fact that she is struggling with her schoolwork, especially since she hardly had to study or apply herself in high school. Eliza is currently attending tutorial sessions to try and stay on top of her schoolwork, but is feeling overwhelmed with having to do so. Eliza participates heavily in drinking and partying but denies that it is in excess. However, she uses alcohol to cope with the stressors of maintain her GPA and not having any friends she feels she can trust or talk too. Eliza has also admitted to cutting behaviors and admits to engaging in online video games for hours at a time. Despite undergoing counseling previously after being caught on campus by her Resident Assistant with alcohol, Eliza has had a relapse. After receiving two grades of a C in her engineering core classes, Eliza became very upset, got heavily intoxicated, and attempted suicide.

Problem Identification and Diagnostic Decision Making

Cross-cutting symptom measures refers to self-or-informant rated measure that evaluates mental health domains which are significant for the diagnostic process. These measures are meant to empower mental health professionals establish additional areas of inquiry that may prove relevant to the clients’ treatment as well as prognosis. Moreover, these measures may also prove useful in helping monitor the progress of the client over time after the treatment intervention is introduced (Corey, 2017; Murphy, 2017). I would use the Level 01 Cross-Cutting Measure to get a more accurate view of exactly how often has Eliza been bothered by things or experienced the feelings withing the last two weeks. Using the questionnaire will help me to gauge other areas deeper that maybe having an impact Eliza’s treatment and prognosis. It can also be used later on to measure or track any changes over the course of treatment.

Diagnosis is a descriptive tool. It provides an agreed-upon language for characterizing a client’s behavior, thoughts, feelings, and other aspects of distress, impairment, or risk (Schwitzer, 2015). Based on the DSM-5 and ICD-10 Eliza meets the criteria for Major Depressive Disorder, Single Episode, Moderate. Eliza has symptoms of insomnia, loss of interest in daily activity, loss of esteem and confidence. The symptoms have been present for more than two weeks. These symptoms have affected her daily functioning, specifically her studies. According to the DSM-5 the areas that show concern include domains I and II that included depressed mood and low-self-esteem/confidence. The functional domains affected include her peer relationships, academics, family relationships, life stressors, anxiety, and self-harm. The initial diagnosis is Depression. The criteria met are: depressed mood, interest loss, diminished ability to concentrate, fatigue, and worthlessness. (APA, 2013).

Eliza also shows signs and symptoms of anxiety. Anxiety is an emotion characterized by feelings of tension, worried thoughts and physical changes such as increased blood pressure (APA, 2013) Eliza is worried about failing at engineering and disappointing her father who is an engineer as well as her mother who she describes as controlling. This worrying and anxiety has caused her not to be able to control her emotions therefore acting out and attempting to take her life stating, “she can’t take it anymore.”

Theoretical Approach

Despite having been in a counseling program Eliza depression and stress has increased causing a relapse and a suicide attempt. With the diagnosis of Major Depressive Mood the best method of therapy would be Cognitive Behavioral Therapy (CBT). Cognitive Behavioral Therapy is a set number of sessions that are designed to help a person change any negative ways of thinking and mindset about a particular situation. The objective of CBT is to cultivate skills that will help one to respond to life stressors more effectively. CBT can be useful to prevent any relapse of depression, manage the symptoms of depression, help to resolve relationship conflicts, learn more effective communication techniques, and identify ways to manage emotions (Mayo, 2019). The goal is to help Eliza overcome her suicidal thoughts and consider her life’s worth and importance. The objective is to get Eliza connected to a licensed counselor or psychologist that would commence a new treatment program that is applicable. This program should begin immediately, and I recommend inpatient services. The second objective is to inform Eliza’s parents, so they can be a part of her treatment plan. It is important to engage Eliza in the presence of her parents while ensuring that her parents are supportive in her treatment. The support of her family is going to be essential in her recovery. This will be bi-weekly sessions and the modality would be family.

Another goal is to help Eliza manage her emotions especially when things do not go her way. The objective is for one-on-one engagement in order to establish and maintain a positive relationship that would make a positive impact. Providing Eliza with support and tools to help her cope with her stress will be vital for her recovery. I believe Eliza going to Alcohol Anonymous meetings will also help with the excessive drinking. The group support will help her cope and not feel like she is battling this alone.

Throughout the Cognitive Behavior Therapy, it is my ultimate goal for Eliza to see her self-worth and help her cope with her stress. It is important for me to be genuine yet transparent with Eliza about her choices to drink underage and against her school’s policy. She has to understand that the consequences of this being her second time caught could result in legal actions as well as being expelled from school, which in turn will bring on more stress.

Progress Monitoring

In the weeks following the initial evaluation and diagnosis, I will use the Level 02 Cross-Cutting Measure to assess depression, anxiety, and substance use within the last seven days. Some measurement tools are PROMIS Emotional Distress Anxiety Short Form and PROMIS Emotional Distress Depression Short Form. These assessments allows for the client to report as well as counselor to evaluate if they have eliminated negative self-talk and negative thinking, and now engaging in more positive self-talk. We must continue to assess Eliza’s goals and be sure they are achievable goals, in accordance to how she prioritizes her concerns. The goal is to strengthen her overall competence to make the best decisions for her life.

Reference

American Psychological Association (2013) Anxiety Retrieved from https://www.apa.org/topics/anxiety/

Corey, G. (2017). Theory and Practice of Counselling and Psychotherapy. Cengage Learning.

Mayo Clinic (2019) Cognitive behavioral therapy

Retrieved from https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610

MediLexicon International. (n.d.). Emotional distress: What are the causes and symptoms? Medical News Today. https://www.medicalnewstoday.com/articles/emotional-distress#symptoms.

Murphy, D. (2017). Counselling Psychology: A Textbook for Study and Practice. John Wiley & Sons.

Schwitzer, A. & Rubin, L. (2015). Diagnosis & treatment planning skills: A popular culture casebook approach (2nd ed.). Los Angeles, CA: Sage