Case Conceptualization

Claire Martin 1

CHD5053 Case Conceptualization

1. Clinic Data

a. Claire Martin, BS, QMHP-T, Therapy Intern b. First practicum site c. Skyline Mental Health d. 2 total sessions e. Individual sessions

2. Client Demographic Data

S is a middle-aged, transgender woman. She is divorced and has two children, ages four and six, with her ex-spouse. S currently lives alone in a rented apartment and sees her children on weekends.

3. SES Data

S currently works in online customer sales for an electronics store. Her current salary is $70,000/year. She works to support her ex-spouse and two children. S owns her own vehicle but does not have much savings or family support. Her economic stressors include monthly child and spousal support.

4. Cultural Influences and Impact on Career

S’s identity as a transgender woman has a significant impact on her career. She wishes to feel safe, stable, and supported in her workplace. Her family is her main influence for career. She works to provide for her family, more specifically her children. She wants to ensure that she is able to support her family financially and takes a lot of pride in her ability to do so.

5. Presenting Problem(s)

S’s current presenting problems are that she was recently transitioned out of her previous role and removed from the promotion list. This happened after she came out at work as a transgender woman. In addition to the issues with her role at work, she is also receiving anonymous threatening notes on her desk at work that make her feel unsafe. This has been going on for about six weeks.

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S has concern regarding job stability, new career opportunities due to her gender identity, and possible continued education/job training. In addition to this, she is most concerned about her ability to support her family financially.

6. Relevant History

● S was previously married. They divorced when she began her transition about three years ago. Her transition in gender identity impacted her marriage and changed the way in which their relationship functioned. She and her ex-spouse are very amicable and left things on good terms. They work well together to co- parent their two children.

● As a white person, S denies having had many issues with ethnicity/race. However, her identity as a transgender woman has caused some instability in her general identity.

● S received a bachelor’s degree in sales as an undergraduate. Following this, she obtained a role at the electronics company in sales, where she worked for about 15 years.

● S began as a sales representative in electronics. Eventually, she was promoted to sales manager with a new company, and was in the role for two years before being “transitioned” to online sales after coming out as a transgender woman about a year ago.

● S does not have any significant medical history, illness, or accidents/injuries. Her only medical history comes from her gender confirmation and related medical needs (hormones, etc.).

● S is a very health woman. She gets eight hours of sleep per night, eats a balanced diet, denies tobacco use, and only has one cup of coffee in the morning.

● S reported some general struggles with mild anxiety and depression that was much more present prior to her transition. She does not have any official diagnoses, has never had evaluations done, and has never taken any psychiatric medication. S reports that her parents have not shared any mental health difficulties with her.

● S denied any psychiatric medication use. Currently she takes estrogen, progesterone, and testosterone blockers to aid in her transition. She is very compliant and has never missed a dose.

● S denied a legal history, arrests, imprisonments, lawsuits, or pending legal actions.

● S denied use or abuse of drugs or alcohol. ● S reported that her parents are recreational drinkers but have never had any

issues with alcohol use.

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7. Interpersonal Factors

S presented as well-dressed, healthy physical appearance, with a great amount of self- confidence. S describes her typical relationship as submissive, which has changed significantly from her previously more dominant demeaner prior to her transition. She states that she has lost some confidence/dominance since her transition as she fears how others may treat her.

With the therapist, S was very engaged, honest, and cooperative. She appears to want help with her career path and is seeking advice and guidance.

8. Environmental Factors

S reported that she stays very busy with work, and often works long hours to ensure ether job is well done. This seems to cause her more stress than if she worked only what was expected of her. S states that she works harder than other employees because she feels she has to prove herself due to her gender identity. She appears to have appropriate and expected concerns/worries about her children and their well-being.

9. Personality Dynamics

S is incredibly intelligent and introspective. She has a great awareness of herself, her thoughts/emotions, and those around her. She did appear to show caution, due to stated uncertainty in how others may interact with her due to her gender identity. S appeared to have a healthy level of insight and a great capacity for judgement, although she is a bit hesitant/cautious for fear of losing her job and then being unable to support her family.

S has an expected amount of emotional stress due to her need to provide financial for her family. She was engaged, cooperative, and interested to explore and learn as much as possible in the counseling environment. She displays an appropriate range of emotions, from sadness and fear to happiness and pride.

S did not present with any concerning or notable behavioral factors. She does not have any significant psychosomatic symptoms other than some nausea and headaches from general anxiety.

10. Psychological Testing

S reported receiving psychological testing with diagnosed her with gender dysphoria. She stated this was necessary to get insurance to assist with her transition and hormone

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therapy. This testing/assessment was done about three years ago at Region Ten, her local community services board, when she wanted to begin her transition.

11. Life Transition/Adaptation Skills

S presented with fantastic coping skills. She has a wonderful affect and persona despite the challenges she has faces as a transgender woman. Despite her hardships, she is incredibly adaptive, optimistic, and motivated as evidenced by her introspection and general positivity.

12. Theoretical Conceptualization of the Case

In my work with S, I have utilized the Person-in-Environment perspective. This theory focuses primarily on interactions throughout one’s life span. Through the career counseling process, S’s environments are examined to learn more about the roles they play and the things that may influence them (Zunker, 2016). While her internal pathology is considered, I also looked for other experiences, relationships, and situations that have impacted S and influenced her career perspectives/goals.

S's environments consist of her family and her workplace, the two places she spends most of her time. This means that her career must be a place where she feels safe, secure, and confident so that she can continue to be an amazing and supportive parent to her children.

13. Recommendations

My recommendations for S are to continue career counseling. I believe that with guidance and exploration, she will be able to figure out what career would be best for her and her goals. Her prognosis is good, and I believe that she will be able to reach her career goals relatively quickly. I believe that Person-in-Environment is an appropriate therapeutic orientation to be used with this client, with the addition of client-focused care.

It would be appropriate and beneficial for S to pursue individual counseling to work through life’s stressors and adjustment in her new identity. I also would like to recommend a transgender support group. I believe that being able to converse and relate to others experiencing the same hardships as her in relation to her gender identity would be extremely beneficial in continuing to build her confidence and assume her new identity. I do not believe she will need counseling for very long due to her

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resilience, motivation, and general personality that make it easy for her to self-reflect and improve.

14. Treatment Plan

Based on S’s concerns, there are a few goals we will work towards in counseling. The first is personal and career exploration. I want to ensure that she has the opportunity and space to safely explore her personal and career goals. This will take place through a variety of career exploration activities and assessments. Using Person-in-Environment perspective, I will explore her environments, how they have affected her, and what she hopes for future environments to be like. The next goal is confidence-building and anxiety symptom management. While her anxiety appears to be under control currently, I would like for S to get to a place where she is easily able to manage these symptoms, especially during a stressful time like career change.

I suggest a minimum for five career counseling sessions. This will give a good baseline of information, recommendations, and skills to take into her career development. I suggest biweekly or monthly individual counseling sessions to work on personal development and anxiety symptom management. I also believe that biweekly or monthly group therapy/support group sessions for transgender individuals would be extremely beneficial.

15. Mock Session and Interpretation Critique

Treatment Goals for the Session:

My goals for this session were to identify the traits/areas that were most important to S in her career and personal life. In addition, I hoped to gain a better understanding of S’s background, personal life, and personal development, as well as current concerns, difficulties, and accomplishments. Another goal was for S to feel comfortable and to develop a therapeutic alliance with the counselor (myself). This is incredibly important due to the lack of safety and support S feels in her current career.

Interpretation Critique:

● The Values Card Sort was my chosen assessment for S during this session.

● I chose this assessment because I felt it was a great way to figure out what her values are, as well as for her to explore these values as well. Once values have been identified, it will be easier to begin exploring careers that match these values to ensure a better fit.

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● S was able to identify five top values through the Values Card Sort. These values are as follows: Fairness, placing importance in justice, decency, and equality. Safety, a concern for the security and well-being on one’s self and/or others. Family, connection to immediate or extended relations. Security, the feelings of being protected or safeguarded from danger, a sense of comfort. Diversity, appreciates and respects individual differences.

● Based off of S’s intake (case conceptualization), I feel that there values well-matched her career goals. I also felt that these values made sense in relation to her gender identity. It makes sense for a transgender woman, that often faces discrimination and intimidation to seek safety and security in her career. This also matched her desire to support her family. This is very important and exciting to see as a career counselor, as there are some times that one’s assessed values do not match their career or personal goals, making it difficult to align these aspects of the client’s life.

● S was able to match the connection/identification between her career goals and identified/chosen values. She felt confident in her decision to seek career counseling following this, and is now looking forward to continued career counseling sessions/work.

● If I had to do the session over again, I would add the goal of having the client seek to better understand the impact her anxiety has on her well-being and performance in the workplace.

References Zunker, V. G. (2016). Career Counseling: A Holistic Approach (9th ed.). Cengage Learning.

Think2Perform. (2022, October 7). Values Cards Exercise. Think2Perform. https://www.think2perform.com/values