For Ann Harris

CASE STUDY TREATMENT PLAN

BIOPSYCHOSOCIAL ASSESSMENT FORM

Cultural Background:

Name:

Anita

Age:

22

Gender:

female

Race:

Caucasian

Ethnicity:

Columbian

Religious Issues:

Catholic, but not currently practicing. Anita believes in God, but is unclear how to reconcile her

faith with her sexuality.

Sexual Orientation:

Bi-sexual. Anita reports that she has had 3 relationships with men and 2 relationships with

women. She has kept the relationships with women a secret. Anita admits that her desire to

keep the relationship a secret caused the breakup of her last relationship with a woman.

Relevant Cultural Norms:

Strong family bond, with belief in unity and loyalty and traditional Catholic religious values.

Other Relevant Cultural Norms:

Support traditional notions of heterosexual relationships. Untraditional cultural norm of the

mother assuming the dominant role in parenting.

Current Symptoms:

Reason for Visit Listed as DSM-5 Symptoms:

Anita reports many instances of worry and fear if her family and friends learn of her bi-sexual

preferences. She is fearful of being disowned, and abandoned by friends and family. She is

also fearful that revealing her bi-sexual preferences will cause her to be thrown out of the

sorority. She worries that she is a bi-sexual and will never be able to pick a side. Her sexuality

creates feelings of guilt as it contradicts her Catholic faith.

Symptoms appear most consistent with a generalized anxiety disorder(300.02). Criteria A, B,

E, F, are met as there is excessive worry and anxiety for more than a 6 month period over a

number of different events and activities (friends, family, sorority, religious faith, etc.), she finds

it difficult to control the worry, and symptoms do not appear to be related to the effects of a

substance or medication, and are not better explained by another disorder. More information

would be needed to establish whether she meets the physical symptoms of anxiety (criteria B),

as well as whether her feelings of fear and worry are causing a significant impact on her

activities of daily living.

She has also turned to alcohol and marijuana recently in order effort to cope with her sexual

identity struggles. It is unlikely that she meets the criteria for an alcohol use disorder (305.00),

or a cannabis use disorder (305.20), even a mild one. While she has increased her

consumption of alcohol and cannabis recently, the increase was intended as a means to cope.

She has not presented the indications of any cravings, unsuccessful efforts to quit or reduce,

skipping social events to consume, or symptoms of withdrawal. To be sure, more information

on these areas would be beneficial to rule out the diagnosis.

Family Background:

Family of Origin Issues:

Two parent home of moderate income and means.

Family Environment in Childhood/Adolescence:

Anita reports a stable family environment. Her mother was very controlling and dominated

many areas of her life. Her father was dismissive and allowed her mother to be in control of

the home. She has one older brother and one younger sister, and maintains a strong

relationship with each of them.

Family responses to a young person's sexual identity can either serve as a positive or negative

influence in the life of a young person who is a sexual minority (Schmitz, & Tyler, 2018). In

coming out to her family Anita faces many potential obstacles. Revealing her bi-sexual

preference could be viewed by her parents as oppositional to their faith, their cultural

background, their family upbringing and against their beliefs in the norms of society.

In addition, Anita has a great deal of fear, worry and shame over her sexual orientation. Those

parents who raise a child with great autonomy are more likely to raise sexual minority

individuals with lower internalized homophobia, anxiety, depression, and greater self-esteem

(Legate, Weinstein, Ryan, DeHaan, & Ryan, (2018). Unfortunately, this was not the case for

Anita. Anita also has a mother who is controlling and a father who is passive and allows her

mother to dominate. Anita is also financially dependent on her parents for her support during

college, at least until she graduates in the fall. If her parents were to remove their financial

support from her, in retaliation for her lifestyle choices, Anita could be homeless. Homeless

sexual minorities are at an increased risk of suicide, substance abuse, prostitution, and

discrimination in housing and other essential services (Schmitz, & Tyler, 2018).

It will be important to work with Anita and advise her on the potential obstacles, and the timing

of her disclosure. Anita must be prepared for the adjustment period that may be needed with

her family and friends. She must also be prepared for the possibility of rejection, both from her

family and her heterosexual friends. It will be important for Anita to foster the network of

friends she already has in the LGBT community. The positive influences of peer groups and

the support of friends in the LGBT community can help to counter the negative impacts of

family rejection (Higa, Hoppe, Lindhorst, Mincer, Beadnell, et. al., 2014).

References:

Higa,D., Hoppe,M. J., Lindhorst, T., Mincer, S., Beadnell,B.,Morrison, D. M.,…Mountz, S.

(2014).Negative and positive factors associated with the well-being of lesbian, gay, bisexual,

transgender, queer, and questioning (LGBTQ) youth. Youth & Society, 46, 663–687.

Legate, N., Weinstein, N., Ryan, W. S., DeHaan, C. R., & Ryan, R. M. (2018). Parental

autonomy support predicts lower internalized homophobia and better psychological health

indirectly through lower shame in lesbian, gay and bisexual adults. Stigma and Health,

doi:10.1037/sah0000150

Schmitz, R. M., & Tyler, K. A. (2018). The complexity of family reactions to identity among

homeless and college lesbian, gay, bisexual, transgender, and queer young adults. Archives

of Sexual Behavior, 47(4), 1195-1207. doi:http://dx.doi.org.library.

capella.edu/10.1007/s10508-017-1014-5

Marital/Partnership History:

Single.

Children Issues/Concerns:

No children.

Social/Community Background:

Connections to Community Support (Church, AA Group):

She belongs to the sorority group at her college.

Support Network:

Anita has a best friend who she has not told that she is bi-sexual. She also has friends who

are gay and lesbian.

Hobbies or Volunteer Activities:

She enjoys playing the violin.

Personal Background:

Developmental History:

She had a normal developmental history, but now faces the developmental crisis of Individual

identity vs. Identity confusion.

Disability:

No physical or mental disabilities.

Educational:

Anita is majoring in Environmental Sciences and will be graduating from college in the fall.

Military:

No military background.

History of Trauma:

No history of trauma.

Employment Status:

Anita is working part-time on campus in the Dean's office.

Legal Status:

She has reached majority, and is a United States citizen.

Financial Status:

She is currently earning little income and is primarily supported by her parents.

Other Circumstances, Such as Transportation, Housing, et cetera:

She lives in a house off campus with friends, and drives to college in a car provided by her

parents.

Medical Background:

Medical History:

No past or present history of any medical problems.

Use of Medication:

Not using any medications.

Current Medications:

No current medications.

Substance Use Background:

No background of any drug or alcohol use until recently. Initially, it was reported that there was

no drug use, and only some limited alcohol use primarily when she is at parties with her

sorority sisters. However, in another interview she reports that she has been drinking and

smoking marijuana more frequently over the past several months to help her cope with the

fears of disclosure that she is experiencing. Memory recall is a complex process that is

impacted by many factors, and a flaw in the process cannot be assumed to be resistance or

fabrication (Arbuthnott, & Arbuthnott, 1999). Craney, Watson, Brownfield, & Flores (2018)

report that individuals in the LGBT community are at an increased risk of turning to substances

in an attempt to escape or cope with the stressors associated with being a sexual minority.

References:

Arbuthnott, K., & Arbuthnott, D. (1999). The best intentions: Prospective remembering in

psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 36(3), 247-256.

doi:10.1037/h0087673

Craney, R. S., Watson, L. B., Brownfield, J., & Flores, M. J. (2018). Bisexual women’s

discriminatory experiences and psychological distress: Exploring the roles of coping and

LGBTQ community connectedness. Psychology of Sexual Orientation and Gender Diversity,

5(3), 324-337. doi:10.1037/sgd0000276

Mental Health Background:

Previous Psychological Issues (Depression, Anxiety, et cetera):

For the past 4-5 years, Anita has been experiencing fear, worry, guilt and conflict over her

sexual identity and whether to reveal her bi-sexual orientation.

Previous Counseling, Hospitalizations:

No previous counseling or hospitalizations.

Family Fistory of Mental/Psychological Issues:

No family history of any mental or psychological issues.

Ethical/Legal Background:

Anita has identified as a bi-sexual. She is also a Hispanic-American of Columbian decent. This

raises multi-cultural considerations, related to race, ethnicity, gender, and sexual orientation.

Multi-cultural/diversity considerations will be an extremely important ethical consideration in

Anita’s case.

The ACA Code of Ethics requires that counselors understand the client’s unique culture, and

also engage in a self-evaluative process of their own cultural beliefs and attitudes, along with

their biases and prejudices, and how it may impact the counseling relationship. The ethical

importance of cultural considerations is apparent in the Preamble of the code, which mandates

a commitment for the counselor to honor diversity and embrace a multi-cultural approach in

support of the worth, dignity, potential and uniqueness of people within their social and cultural

contexts (ACA, 2014). Counselors must work to instill cultural sensitivity by communicating

information in a manner that is culturally responsible (ACA, 2014, A.2.c.).

In order for Anita to benefit from counseling, it is imperative in the counseling process to

demonstrate knowledge and awareness of her unique cultural background and values, which

includes consideration of her race, ethnicity, gender and sexual orientation (Sue & Sue, 2016.)

For example, many Hispanic clients come from a more collectivist orientation, preferring

lifestyle choices that benefit the family over their own individual needs and desires (Sue &

Sue, 2016). The counselor must be sensitive to this cultural value as it may increase the

struggle Anita suffers over revealing her sexual identity to her family and friends.

On the other hand, it cannot be assumed that all Hispanic clients are the same. This is evident

in Anita’s case since, since Hispanic families tend to reflect a patriarchal presence, with a

preference for male machismo (Sue & Sue, 2016). Yet, in Anita’s family, her mother is the

dominating force, and her father is more passive parent. Therefore it is important to learn the

Anita’s unique cultural and family experience, and also to determine her level of acculturation

(Sue & Sue, 2016). In addition it will be important to incorporate culturally appropriate

assessments (ACA, 2014, E.8; Sue & Sue, 2016). In counseling, it will also be very important

to chose a treatment method that is culturally appropriate and will help to build resilience and

empower Anita by promoting her self-efficacy as a means of sexual identity development.

Finally, ethical and legal considerations include informing Anita of her confidentiality rights,

and the limits on confidentiality, which may defer from state to state, as the Federal and state

laws that prohibit discrimination on the basis of sexual orientation in areas such as housing,

education, and employment (Croteau, J. M., Bieschke, Fassinger, & Manning, 2008).

References:

American Counseling Association (2014). ACA code of ethics. Alexandria, VA: Author.

Croteau, J. M., Bieschke, K. J., Fassinger, R. E., & Manning, J. L. (2008). Counseling

psychology and sexual orientation: History, selective trends, and future directions. (pp. 194-

211). Hoboken, NJ, US: John Wiley & Sons Inc.

Sue, D.W., & Sue, D. (2016). Counseling the culturally diverse: Theory and practice

Consultations/Referrals Needed:

Referral to Catholic church supportive of LGBT lifestyle and LGBT support group. Another

referral would be for bi-sexual group therapy. Group therapy for young adults who are bi-

sexual has been found to be a successful method because it allows the participants to

collectively share and grow from the similar challenges and triumphs of others in the group

(Aronson, 2002). When (or if) the time is appropriate, referral to family therapy should also be

considered. Family can the most important source of support, empowerment and resilience for

the young adult sexual minority (Schmitz, & Tyler, 2018). Research has led to the conclusion

that those benefits can best be harnessed through family therapy (LaSala, 2013). Further

Anita comes from a Hispanic background and Hispanic families place great emphasis on

family unity, loyalty and support (Sue & Sue, 2016).

References:

Aronson, S. (2002). Group work with special populations. In S. Aronson, & S. Scheidlinger

(Eds.), (pp. 55-74). Madison, CT: International Universities Press, Inc. Retrieved from

http://library.capella.edu/login?url=http://search.ebscohost.com/login.

aspx?direct=true&db=psyh&AN=2003-00610-004&site=ehost-live&scope=site

LaSala, M. C. (2013). Out of the darkness: Three waves of family research and the emergence

of family therapy for lesbian and gay people. Clinical Social Work Journal, 41(3), 267-276.

doi:10.1007/s10615-012-0434-x

Schmitz, R. M., & Tyler, K. A. (2018). The complexity of family reactions to identity among

homeless and college lesbian, gay, bisexual, transgender, and queer young adults. Archives

of Sexual Behavior, 47(4), 1195-1207. doi:http://dx.doi.org.library.

capella.edu/10.1007/s10508-017-1014-5

Sue, D.W., & Sue, D. (2016). Counseling the culturally diverse: Theory and practice

Strategies to Address Presenting Problems:

1:

Anita wants to find the strength and confidence to disclose her bi-sexual orientation with

friends and family. She is not coming out to them for fear of being disowned, and this has

already occurred with some of the friends she has already told. She is also not maintaining

intimate relationships with women because she is not willing or able to be open about her

relationship with others. She is also not disclosing her sexual identity with the social

organizations she enjoys, such as her sorority, for fear that they will kick her out. She believes

in god, but doesn't practice her Catholic faith out of guilt. She can't seem to reconcile her own

sexual feelings and beliefs, which she believes differ from her Catholic faith.

At present, Anita is not achieving well-being because she has not learned how to be in

connection with her friends, family, social community, or her religion. It will be important to

recognize the kind of conflicted roles and challenges Anita is experiencing, not only personally,

but through a social, cultural and religious sense, and work to promote relational competence

(Comstock, Hammer, Strentzsch, Cannon, Parsons, et. al., 2008; Duffey, Haberstroh, &

Trepal, 2009; Frey, 2013).

For Anita to achieve relational competence, the strategies will involve: (1) working with her to

develop an understanding of her own needs, desires and preferences; (2) developing the skills

for her to be effective in taking personal responsibility to discover the strategies necessary for

her to meet her own needs and desires; and (3) bringing awareness to Anita that others

(friends, family, community, social and religious institutions) may have different desires,

preferences and needs (Comstock, Hammer, Strentzsch, Cannon, Parsons, et. al., 2008;

Duffey, Haberstroh, & Trepal, 2009; Frey, 2013).

Developing Anita's own acceptance will be very important in the event that her friends, family,

or sorority do not wish to accept her bi-sexual lifestyle. It will be important to use an approach

that will work to empower Anita, and help her achieve authenticity and honesty (Comstock,

Hammer, Strentzsch, Cannon, Parsons, et. al., 2008; Duffey, Haberstroh, & Trepal, 2009;

Frey, 2013). This will allow her to stand on her own (without worry and fear or the need to use

substances to cope) and without forfeiting her own needs and desires in the midst of non-

acceptance (Comstock, Hammer, Strentzsch, Cannon, Parsons, et. al., 2008; Duffey,

Haberstroh, & Trepal, 2009; Frey, 2013). Just as important as helping Anita to learn

acceptance of her own needs and desires will be to work on strategies that allow this to occur,

while also showing her strategies that will allow her to refrain from disregarding the needs of

others (Comstock, Hammer, Strentzsch, Cannon, Parsons, et. al., 2008; Duffey, Haberstroh, &

Trepal, 2009; Frey, 2013). Examples of some of the strategies to show Anita in dealing with

heterosexists individuals or encounters include: learning ways to set boundaries, using

situation modification strategies to by-pass the topic of sexual orientation, learning to keep a

low profile in heterosexist situations, and deconstructing heterosexist assumptions to see the

truth of the situation (McDavitt, Iverson, Kubicek, Weiss, Wong, et. al., 2008). For example,

religious views on the sinfulness of being bi-sexual can be met through the recognition that

god created everyone in his or her own image, so a part of her must be like god (McDavitt,

Iverson, Kubicek, Weiss, Wong, et. al., 2008).

2:

Anita is also not fully in connection with her gay and lesbian friends because she believes they

view her as a person who hasn't picked a side yet. Another strategy to use in this regard will

be to help Anita develop and strengthen new connections through relational development in

the bi-sexual community, political advocacy, and spiritual or religious affiliation with groups

supporting the bi-sexual lifestyle (Comstock, Hammer, Strentzsch, Cannon, Parsons, et. al.,

2008; Duffey, Haberstroh, & Trepal, 2009).

Sexuality Research to Support Strategies:

1:

References:

Comstock, D. L., Hammer, T. R., Strentzsch, J., Cannon, K., Parsons, J., & Salazar, G.,II.

(2008). Relational-cultural theory: A framework for bridging relational, multicultural, and social

justice competencies. Journal of Counseling & Development, 86(3), 279-287.

doi:10.1002/j.1556-6678.2008.tb00510.x

Duffey, T., Haberstroh, S., & Trepal, H. (2009). A grounded theory of relational competencies

and creativity in counseling: Beginning the dialogue. Journal of Creativity in Mental Health,

4(2), 89-112. doi:10.1080/15401380902951911

Frey, L. L. (2013). Relational-cultural therapy: Theory, research, and application to counseling

competencies. Professional Psychology: Research and Practice, 44(3), 177-185. doi:10.1037

/a0033121

McDavitt, B., Iverson, E., Kubicek, K., Weiss, G., Wong, C. F., & Kipke, M. D. (2008; 2007).

Strategies used by gay and bisexual young men to cope with heterosexism. Journal of Gay &

Lesbian Social Services, 20(4), 354-380. doi:10.1080/10538720 802310741

2:

References:

Comstock, D. L., Hammer, T. R., Strentzsch, J., Cannon, K., Parsons, J., & Salazar, G.,II.

(2008). Relational-cultural theory: A framework for bridging relational, multicultural, and social

justice competencies. Journal of Counseling & Development, 86(3), 279-287.

doi:10.1002/j.1556-6678.2008.tb00510.x

Duffey, T., Haberstroh, S., & Trepal, H. (2009). A grounded theory of relational competencies

and creativity in counseling: Beginning the dialogue. Journal of Creativity in Mental Health,

4(2), 89-112. doi:10.1080/15401380902951911

TREATMENT PLAN

Instruments/Screens to Facilitate Diagnosis

Instruments and Screens:

N/A

DSM-5 Diagnosis

DSM-5 Diagnosis:

N/A

Differential Diagnosis

Differential Diagnosis:

N/A

Ethical/Legal Consideration of the Diagnosis

Ethical/Legal Consideration of the Diagnosis:

N/A

Short-Term Goals to Address the Diagnosis

Short-Term Goals to Address the Diagnosis:

N/A

Long-Term Goals to Address the Diagnosis

Long-Term Goals to Address the Diagnosis:

N/A

Strategies to Promote Optimal Sexual Functioning

1:

N/A

2:

N/A

3:

N/A

Evidence-Based Treatment Interventions to Support Strategies

1:

N/A

2:

N/A

3:

N/A

Treatment Plan Interventions Annotated Bibliography

Based on your diagnostic impression, develop an annotated bibliography of resources describing suggested interventions for the client. You should describe each source in your own words, not simply use the provided abstract. You will utilize a minimum of five current articles from peer-reviewed journals in the counseling or related professions from the Capella Library. Cite and reference the resources using APA 6th edition guidelines. You may utilize your textbook, but it does not count as one of your five scholarly resources. You are also encouraged to utilize more than five resources if they aid in developing a comprehensive treatment plan.

N/A