AMARA: CASE STUDY 1
Amara: Case Study
Stacey R. Ferrell
Liberty University
COUC546: Psychopathology
Author Note
I have no known conflicts to disclose.
Correspondence concerning this paper should be addressed to
Stacey R. Ferrell
Email: [email protected]
AMARA: CASE STUDY 2
Client Concerns
Symptoms Behaviors Stressors
Anxiety Anxiousness -Taking care of elderly
mom
-Husband’s death
-Grandchildren not
wanting to be around her
-Retirement
Not Sleeping Constant worrying takes up
most of her time; she
frequently wakes up at
night
-worry about finances
-worries about what people
are thinking about her
-wants to know if she is
good at providing for her
family
-worries about how
children from her classes
are doing
Not Eating Worry consumes daily
activities, leaving her less
interested in eating
-finds things to worry
about outside of normal
daily occurrences
-taking care of her mother
-helping take care of her
grandchildren
Body Aches -Headaches
-body aches
-shoulder pain
-neck pain
-husband’s death
-retirement
-stress of taking care of
everyone else
Assessment
The first impression of Amara suggests that she may be suffering from General Anxiety
Disorder (GAD). The use of the General Anxiety Disorder Scale-7 (GAD-7) is a seven-question
diagnostic tool that is used by professionals to study a client’s symptoms to determine if they
meet the criteria for this diagnosis (Sapra et al. 2020). Many patients who present symptoms of
AMARA: CASE STUDY 3
anxiety often experience the same symptoms, such as elevated heart rate, sweating, and tremors,
to name a few (Sapra et al. 2020). However, the individual presenting with GAD often has
symptoms of excessive worry (Kring & Johnson, 2022). I chose this module to use for a
diagnosis tool because of its ease of use. The simple seven questions will help to determine how
excessive her anxiety symptoms are. Amara will have the option to answer the questions
truthfully about how often she experiences feelings of anxiety during a variety of time slots.
Diagnostic Impression
DSM-5-TR Diagnostic Criteria:
Generalized Anxiety Disorder F41.1
Client’s Signs/Reported Symptoms:
Criterion A: Excessive anxiety,
worry, and panic occurring more frequently
than not for at least six months.
Amara reported that she has worried
throughout the day more constantly within the
last 18 months.
Criterion B: Amara is unable to
control her constant worrisome thoughts.
Amara has no control over the
thoughts that are occurring and does not know
how to control them.
Criterion C: Anxiety contributing to
restlessness, fatigue, feeling on edge
Amara claims restlessness has
occurred multiple times during the week for
the past year. She has also experienced
extreme fatigue within the past year, as well
as being tense and experiencing more pain
within her body.
AMARA: CASE STUDY 4
Criterion D: Anxiety causing tension
within the body, especially muscles.
Amara has experienced tension within
her body that has increased within the last
year and has been present for two years. Her
neck and shoulder pain also causes headaches
that occur up to four times a week.
Other DSM-5-TR Conditions Considered
When listening to Amara speak about what has brought her to counseling, she brings up
one immediate thing that is a reminder of Major Depressive Disorder (MDD) (F23.9). DSM
criteria require a diagnosis of at least five symptoms to provide a diagnosis of MDD (Kring &
Johnson, 2022). Amara had three noticeably obvious symptoms: irritability, fatigue, and anxiety.
These symptoms mimic a host of other mental illnesses as well, which is why the DSM is
adamant about having at least five symptoms before making a diagnosis. Knowing that there is a
minimum of symptoms that need to be experienced, it was an easy decision not to diagnose
Amara with this disorder at this time. Her other symptoms overrule this illness because of the
effect that it is having on her lifestyle and her need for change.
Developmental Theories and/or Systemic Factors After taking the time to listen to
Amara and the events that are going on in her life, I began thinking to myself, “What is presently
occurring within her family system that is causing her to constantly worry about things she has
AMARA: CASE STUDY 5
no control over?” For starters, Amara grew up in a traditional Asian household, one that stood on
values where family took care of family. Amara feels that to stay true to her family values, she
must continue to take care of her mother and not place her in a nursing home. Although this
would make things a little easier for her, she just cannot bring herself to do it. The goal Amara is
trying to obtain by taking care of her mother is that her children will care for her too when she
becomes older and needs more assistance. Amara has expressed her constant worry about
whether she is doing the right thing, or if her children notice how hard this task is becoming for
her. She worries about her decision to keep her mother out of a nursing home and loses sleep
about her decision-making process.
Taking into consideration Erikson’s psychosocial development theory, Amara would be
classified as dealing with integrity v. despair. She is a 68-year-old woman who is expressing
feelings that are relative to those of someone who is in the later stages of this development. This
stage is the 8th and final stage of Erikson’s psychosocial development theory. During this stage,
the individual often looks back on their life and thinks about the decisions they have made and
how they have controlled the outcome of their lives (Cherry, 2024). Although Amara has not
stated that she is unhappy with how her life has played out, she has expressed how worried she is
that some of her decisions may have left her alone. For example, she worries that if by continues
to care for her elderly mother, her family will hold it against her that she is not around as
frequently as they would like. She worries about the effect that taking care of her mother is
having on her life and her mental state.
Multicultural and/or Social Justice Considerations
Using the RESPECTFUL model acronym when considering a diagnosis for Amara, I
considered how her Ethnic/Racial Identity may play a role in the treatment she is willing to
AMARA: CASE STUDY 6
accept. With Amara having an Asian background, her desire to seek help can be seen as a
weakness in the eyes of her family members. Members of the Asian heritage do not typically
seek guidance from professionals for their mental health (Kim & Lee, 2021). Many members of
the Asian community rely on aide and advice from their close social network (Kim & Lee,
2021). Amara could have been waiting for so long to seek treatment after the loss of her husband
because she did not want to seem weak to her family. She may have been waiting for them to
offer their support to her since they have seen the steady decline in her mental state. She may
have also wanted to take her time and hope to resolve her own issues that way she did not
become a burden to anyone she was around. The feelings that she is experiencing may not have
triggered anything within her mind that there was something wrong with her mental health.
Treatment Recommendations
Key Issues for Treatment
Worry/Anxiety
Fatigue
Tension
Recommendations of Individual Counseling
Perhaps the most used and accepted form of treatment for Amara and her Asian culture
would be Cognitive Behavioral Therapy (CBT). According to a study conducted by Bhattacharya
et al. (2022), CBT is the gold standard of evidence-based intervention for use on individuals
diagnosed with GAD. However, with Amara being of Asian descent, this treatment could prove
to be difficult based on her heritage. Many Asians and Asian Americans are relatively private
people; they want to keep their feelings to themselves. Knowing this may make it harder to use
CBT treatment because of the need to express one’s feelings and the effects it has on oneself,
AMARA: CASE STUDY 7
rather than those with whom they live (Kwon, 2023). Using this type of therapy will be
beneficial with Amara because it can target the anxiety that is plaguing her mind. The excessive
anxiety is related to the tension and fatigue she is experiencing. This is because her mind is
constantly on the go. The negative thoughts and pondering questions are continuously running
throughout her mind, making it difficult for her to function. By using CBT treatment, I can work
with Amara to develop skills that she can use to alter her thought process. Whenever she begins
to feel herself beginning to worry, she will have a plan in place on how she can overcome those
thoughts.
I would also like to recommend that Amara and her daughter participate in Group
Therapy. Since Amara has agreed to attend counseling sessions at the recommendation of her
family doctor, this shows that she is not afraid of losing face, which could make group
counseling an effective part of treatment (Iwamasa, n.d.). Perhaps by talking in a group with
other individuals who are suffering from anxiety, Amara will find ways to cope with her current
situation. Hearing other individuals discuss what they are experiencing and how they handle it
will give her encouragement to want to do those things as well. This will help get her life back to
a normalcy that will allow her to function with her children while still taking care of her elderly
mother.
Medication Considerations
Since Amara has been prescribed Paxil by her family doctor, I would recommend that she
continue taking the medication and follow up with her PCP for evaluation on the effectiveness of
the treatment. If Amara is reluctant and does not want to continue taking the medication, I would
be acceptive of her following a more holistic approach. Anti-anxiety medications are good for
covering up the chemical problem within the brain; however, they do not address what is causing
AMARA: CASE STUDY 8
the person to experience anxiety (Buchwald, 2023). By taking on a more holistic approach,
Amara and I can establish treatments that would focus on her religion as a stepping stone to
conquering the problem that is causing her to be overly anxious. This type of treatment may be
more acceptable to those within her Asian heritage as well, because she can remain focused on
herself instead of relying on the assistance of others to help her.
Specific Considerations
As previously discussed, culture plays a remarkable role in providing treatment for
Amara. Although it is not mentioned in the case study, Asian Americans are relatively private
people. They do not like to discuss issues regarding their mental health with others. To
effectively ensure that I am respectful of her culture, I would like to know what her religious
preferences are. As a Christian counselor, I am to treat my clients on a faith-based module;
therefore, knowing Amara’s religion would be beneficial. Since many Asians in Western
countries rely on their religious preferences rather than those of a mental health professional, it is
important to know and study these things to make treatment more effective (Sahai-Siddiqui,
2025). When working with Amara, values between me and Amara may be challenged in simple
ways. For example, my values tell me that if there is someone available to help me, I am going to
reach out to them willingly, whereas Amara will be more reluctant to express her need for help.
By being a professional counselor, it is my duty to remain professional and meet the client where
they are and to respect their decisions for treatment without letting my biased opinions get in the
way of their treatment.
AMARA: CASE STUDY 9
References
Bhattacharya, S., Goicoechea, C., Heshmati, S., Carpenter, J. K., & Hofmann, S. G. (2023).
Efficacy of Cognitive Behavioral Therapy for Anxiety-Related Disorders: A Meta-
Analysis of Recent Literature.ICurrent psychiatry reports,I25(1), 19–30.
https://doi.org/10.1007/s11920-022-01402-8
Buchwald, N. (2025, February 10). Holistic Healing: Exploring Alternatives to anxiety
medication. Manhattan Mental Health Counseling. Retrieved May 24, 2025, from
https://manhattanmentalhealthcounseling.com/holistic-healing-exploring-alternatives-to-
anxiety-medication/
Cherry, K. (2024, May 2). Erikson’s stages of development. Verywell Mind. Retrieved May 24,
2025, from https://www.verywellmind.com/erik-eriksons-stages-of-psychosocial-
development-2795740
Iwamasa, G. & Asian American Psychological Association. (n.d.). Recommendations for the
treatment of Asian-American/Pacific Islander populations. Psychological Treatment of
Ethnic Minority Populations, 2.
https://www.apa.org/pi/oema/resources/ethnicity-health/asian-american/psychological-
treatment
Kim, S. B., & Lee, Y. J. (2022). Factors Associated with Mental Health Help-Seeking Among
Asian Americans: a Systematic Review.IJournal of racial and ethnic health
disparities,I9(4), 1276–1297. https://doi.org/10.1007/s40615-021-01068-7
Kring, A. M., & Johnson, S. L. (2022). Abnormal Psychology: The Science and Treatment of
Psychological Disorders.
AMARA: CASE STUDY 10
Kwon, D. (n.d.). Better therapy for Asian Americans. https://www.brainfacts.org/diseases-and-
disorders/mental-health/2023/better-therapy-for-asian-americans-092123
Sahai-Siddiqui, V., MD. (2025, March 21). Spirituality versus psychiatry: Why many South
Asians turn to religion before therapy or psychiatric medication. Behavioral Health
News. Retrieved May 24, 2025, from https://behavioralhealthnews.org/spirituality-
versus-psychiatry-why-many-south-asians-turn-to-religion-before-therapy-or-psychiatric-
medication/
Sapra, A., Bhandari, P., Sharma, S., Chanpura, T., & Lopp, L. (2020). Using Generalized
Anxiety Disorder-2 (GAD-2) and GAD-7 in a Primary Care Setting.ICureus,I12(5),
e8224. https://doi.org/10.7759/cureus.8224
Spiritual and religious competencies. (2024). Association for Spiritual, Ethical, and Religious
Values in Counseling. Retrieved May 23, 2025, from https://aservic.org/spiritual-and-
religious-competencies/
