Case Conceptualization Paper

Client demographics:

1. 24 years old 2. Female (cisgender), heterosexual 3. Single, never married; currently lives with her boyfriend of 8 years 4. Identifies as catholic but says she is not “very religious” 5. 2 children (father is her boyfriend)

Clinical problems/symptoms and diagnoses of the client:

*PLEASE REFER TO The Diagnosis and Treatment of Generalized Anxiety Disorder ARTICLE TO SUPPORT THE DIAGNOSIS*

● The client explains that her worry occurs more often than not and has persisted for at least six months (not specific)

● The client also expressed feeling anxious when things do not go her way, or when there is a last minute change in existing plans (ex:boyfriend was supposed to pick up kids from school, he got stuck later than he anticipated so she had to pick them up and gets anxious about being late)

● The client expressed feelings of worthlessness, along with low energy levels as well as a significant difference in sleeping/eating patterns recently.

● Her main struggle is anxiety, which sometimes leads to other issues such as depression or difficulty managing her anger

● She expressed concerns that her anxiety and inability to control it has affected her relationships with her boyfriend and children. She did not recognize it as being a big issue until her oldest son expressed that she “stresses him out” about everything.

● General Presenting Concerns: anxiety, depression and anger ● Generalized Anxiety Disorder 300.02 (F41.1) : The client meets the Diagnostic Criteria

(ex: Excessive anxiety and worry, occurring more days than not for at least 6 months, concerning a number of events, Restlessness, feeling keyed up or on edge, The individual finds it difficult to control the worry etc.)

Pertinent clinical issues:

*PLEASE REFER TO Mental Health Stigma ARTICLE FOR THIS SECTION.*

● Client describes mental health as being a “taboo” subject in her family growing up therefore she had no formal Psychiatric history to report.

● She said that her boyfriend and some of her friends mocked her when she confessed to them that she was seeking treatment.

● The client is initially hesitant to share her reasons for seeking treatment.

● She pretends that everything is fine on the exterior appearance to others to avoid being made fun of, but on the inside she is experiencing a wide range of what are often negative emotions that she does not know how to handle in a healthy way.

Cognitive Behavioral Case Formulation and Treatment Plan:

The client demonstrated many symptoms of anxiety including difficulty concentrating, muscle tension,shaking, etc.She has never experienced a successful work history or marriage. She had always aspired to be successful and independent and a person who was competent and reliable and helpful to others but feels as if her getting pregnant at a young age “stoof in the way” of those aspirations.. She strongly values hard work but feels she is not achieving this. Her held values led to behavioral patterns related to depression and anxiety of holding high, and somewhat unrealistic, expectations for herself to “be completely independent.”. Her corresponding intermediate/schemas beliefs were: “I am worthless because I am not good at anything”, “I am not going to get through this rough period of my life”, “I worry about everything and am told that I overthink a lot” and “I have to hide my feeling aso people don’t say that I think too much.”

My client’s biggest struggle is her anxiety, which often leads to other problems such as depression or difficulty managing her anger. “Often chronic in nature, anxiety disorders are associated with severe impairments across interpersonal and occupational domains.” (Antony, M. M., & Stein, M. B. 2009, p. 4). She communicated worries that her anxiety and inability to control it have significantly affected her relationships with her boyfriend and children.

The client reports that she was a good student in High School, describing her grades as “A’s and B’s most of the time.” She graduated from High School, but has not yet attended college despite aspirations to do so. She explained that it has always been her dream to attend college and pursue a successful career but she reports that time restraints due to her having children at such a young age as well as financial problems are the main reasons for not attending college

The main aspects of “being put down” that the client reported from stemming from her relationship with her boyfriend and her friends..She reported factors such as name calling, aggression such as yelling and various forms of emotional abuse such as name calling and gas lighting. The client reports that she never felt “good enough” for her boyfriend, and as a result was always fearful of criticism.

The plan is to reduce The client's anxiety which would reduce the clients symptoms of depression and inability to control her anger as well as, improve her functioning and social interactions, and increase positive affect.

1). Unemployment/Get a job: Examined advantages and disadvantages of looking for a job in order for the client to feel a sense of independence. The client and the therapist evaluated and responded to hopeless automatic thoughts, “I am worthless because i do not have a job,” problem-solved how to update resume and look for a job; roleplayed job interview.

2). Avoidance/Re-engage in avoided activities: The client and the therapist came up with specific tasks around the house to do at specific times; did behavioral experiments to test his automatic thoughts (“I am not good at anything”) The therapist and the client evaluated and responded to automatic thoughts. These scheduled activities along with other activities that could help to bring a sense of pleasure. The therapist encouraged the client to give herself credit and appreciation for any task that she completed.

3).Communication skills with boyfriend/Investigate whether improved communication skills can help being “open” with a partner about anxiety. The client and the therapist practice communication skills such as assertion and performed behavioral experiments to test thoughts

4). Help the client cope with her depression and anxiety with interventions involving goal setting, self monitoring, and behavior modification.

5). Set up specific goals, with defined steps, to aid her in reaching the quality of life that she wants.

6). We also practiced the art of being present. This process involves the practice of mindfulness. The client is encouraged to soak everything in, down to every single detail. For example, when the client leaves for work in the morning, she is encouraged to slow down and take the time to observe things such as the weather, the sound of leaves or neighbor’s cars starting, etc.

7). Help the client learn how to accept accountability for her actions and decisions with positive and negative reinforcement, and reframing her negative automatic thoughts

Treatment depicted, therapeutic progress, and proposed interventions

The client and the therapist meet weekly for twelve weeks, then every other week for four weeks, then once a month for four months, for a total of 18 sessions over 8 months. We had standard 45-minute CBT sessions.

The Therapist and the client agreed that together, they work first on the following: (1) encouraging the client to get out of her house almost every day, even if it is to complete a small task (2) spending more time trying to communicate effectively to her partner what she is experiencing/going through (3) cleaning up her house because completing any task increased her sense of worthiness .(Later the client and the therapist worked on spending more time practicing self-awareness in order to help reduce the clients anxiety.. Once the client is functioning at a higher level and practicing coping skills for anxiety effectively, the client and the

therapist will work on finding employment for the client to feel more independent and accomplished.

The therapist will continue to monitor progress in the coming sessions.

Overall, the client showed a positive clinical response to CBT treatments. Further to that, she has shown a reduction in anxiety and depression. .She has responded positively and quickly to interventions