intervention and plan

Client Case Assessment Scenario

MFCC 537

The client, 32-year old Jack, is a single male. He was adopted by his mother Betty, currently 68, when she was 36 and Jack was only 8 weeks old. Jack is currently not in a relationship and does not have any close friends since the ones that he had in college left him due to his untidiness and his negative habits during his manic episodes. Jack struggled academically in school and was additionally bullied because of his size but he always proved to be friendly and outgoing. He further participated in wrestling and drama during high school and was even chosen as a youth leader. His symptoms started developing when he was in college and worsened to the point where he had to drop out of school (Carter, 2018).

The main presenting problem is Jack’s Bipolar Disorder. The first signs of mental illness developed when Jack was in college. The disorder causes him to shift between manic and depressive episodes. During manic episodes, Jack reportedly feels like he is on top of the world which causes him to engage in various destructive inappropriate habits. Some of the times he engages in “dining and dashing” where he orders a large meal in a restaurant and walks away without paying. He managed to do this a number of times without getting caught although he was eventually apprehended and taken to jail. During this incident, his mother required him to agree to counseling before she could pay his bail, a fact that made him very upset with her. Other times during his manic episodes he got his friend to give him money to get a bargain that he knew he could not acquire. Another effect of his manic episodes is his attraction to bars where he spends most of the time fantasizing, drinking heavily, spending money and getting into trouble. On the other hand, his depressive episodes bring along feelings of hopelessness and helplessness. These feelings often lead him to stay in bed, isolate himself in his room, refuse to bathe and rely on his mother for support and comfort.

Alcohol abuse is another presenting problem, although related to the Bipolar Disorder. Jack has been observed to engage in high amounts of alcohol intake. One of the factors contributing to his alcohol intake is self-medication, in situations when he does not have the proper medication for his symptoms. Furthermore, his various moods, particularly the manic episodes, are also a contributing factor to the alcohol abuse.

The developmental needs for Jack mainly concern his emotional and cognitive delay. The primary result of this delay was his lack of responsibility for his actions as a grown man. There are numerous instances when Jack acted in a highly irresponsible manner that should have been reserved for someone younger than him. One of these involves the lack of bathing. As noted from the case study, one of the main reasons Jack split from his roommates in college was due to the fact that he did not bath nor clean after himself. This led to a situation where Jack and his surrounding were quite untidy and dirty, a fact that his roommates could not tolerate.

There are limited cultural considerations for the case since neither Jack nor his mother seems to hail from a unique culture that would require particular attention when addressing his possible treatment regime.

One effective therapeutic approach to take in maintaining alliance with the patient involves interpersonal and social rhythm therapy. This for of therapy comprises two components. The first part is the interpersonal therapy which focuses on how the patient relates with other people in their life. This is a vital component since Jack has shown to be friendless and to have problems in social engagement. Interpersonal therapy will therefore help Jack in stress reduction, hence mitigating the effect that stress has on his disorder as a trigger. The second component is the social rhythm therapy which aims at stabilizing Jack’s social rhythms so as to maintain stability in his moods. Social rhythms include activities such as eating, sleeping and exercising. Disruptions in these daily activities may have negative effects on an individual’s circadian rhythms, and consequently, their mood states.

The method used to assess Jack’s cognitive, psychosocial and moral development was the Sixteen Personality Factor Questionnaire. This assessment has been found to be effective in circumstances requiring in-depth evaluation of the individual. The sixteen factors tested include: tension, perfectionism, self-reliance, openness to change, apprehension, privateness, abstractedness, vigilance, sensitivity, social boldness, rule-consciousness, liveliness, dominance, emotional stability, reasoning, and warmth.

The primary interview questions to ask are one concerning the history of the presenting illness. Therefore, the questions will try to establish from both the mother and the patient the onset of the illness, its symptoms, consequences and possible stressors. As for the latter, although some disorders appear to commence spontaneously, there are events that often cause, precipitate, or worsen a patient’s mental issues. Consequences help in establishing the severity of the illness. Consequences range from those regarding marital and love relationships and interpersonal friendships to employment and legal issues.

An evaluation of suicide potential is also a significant part of the interview since all mental patients require such evaluation. As an interviewer, one should not worry about the risk of suggesting suicide to a patient since anyone with such thoughts will have already considered it and hence, the real risk lies in asking too late. The interview should also ask questions concerning the patient’s substance misuse due to the high rate of correlation between psychiatric illness and substance misuse. Substance abuse affects a large area of the patients life and hence the questions will have to focus on the medical, financial, interpersonal, legal and employment effects of the substance misuse problem.

An important initial diagnostic technique is the Structured Clinical Interview for DSM (SCID). This tool consists of a semi-structured interview that provides symptom thresholds, interview probes, and exclusion criteria information. The SCID has different modules designed to capture the core information regarding specific diagnoses. In this regard, there is a bipolar disorder SCID module which is quite reliable in diagnosing bipolar disease as compared to other similar tools. The Schedule for Affective Disorder and Schizophrenia (SADS) is another semi-structured interview tool with a high degree of reliability for both diagnoses and symptoms of bipolar. The tool has demonstrated particular effectiveness with regards to manic versions of bipolar disease, which Jack seems to mainly suffer from.

References

Carter, D. J. (2018). Case Study: A Transactional Analysis Model for a Single Mother and her Adult Child with Bipolar Disorder. Clinical Case Studies, 17(5), 796. doi:10.1177/1534650118790811