Phil_Case_Study.docx.pdf.pdf

Case Study: Phil

Phil Case Study

Rocio Vega Arriaga

School of Behavioral Science, Liberty University

Author Note

Rocio Arriaga

Symptoms Behaviors Stressors

sadnessCried a lot & begged father toParents separation

come back

angerAnger outburstsdivorce

HopelessnessRefused to attend the his Remarriage of father

father’s wedding

ArgumentativeArgues with mother 3-5 timesRemarriage of father

per week & daily with

siblings and at school.

Sleep DeprivedHard time getting to sleepRemarriage of father

Struggling academicallyHard time concentratingDivorce

Social life affected negativelyChange in moodsRefusal to engage with others

(cousins & friends)

GuiltUnsure about faith being the Moms feelings about her

center of his life.faith

Assessment

In Phils case the most appropriate assessment is the Adjustment Disorder–New Module

20 (ADNM-20). The ADNM-20 is a self-report assessment composed of two lists: a stressor list

and an item list (Lorenz et. al., 2016). The stressor list focuses on stressful events in the past two

high (Lorenz et. al., 2016).

Diagnostic Impression

Signs and Symptoms

All of the following information was taken from the Diagnostic and Statistical Manual 5th

Edition, Text Revision (American Psychiatric Association, 2022) unless otherwise noted. Based

on Phil’s symptoms and behaviors Phil is struggling with Adjustment Disorder with Mixed

disturbance of emotions and conduct (F43.25).

DSM-5-TR Diagnostic Criteria: Adjustment Client’s Signs/Reported Symptoms: Both

Disorder with mixed disturbance of emotions emotional symptoms & a disturbance of

and conduct (F43.25)conduct.

Criterion B: These symptoms or behaviors 1.Phil feels that they are the first broken

are clinically significant, as evidenced by one home in the family & he feels as if he

or both of the following: is different from everyone else and no

1.Marked distress that is out of one will understand. Mom reported

proportion to the severity or intensity that Phil’s reaction is so much bigger

of the stressor, taking into account the than his sisters.

external context and cultural factors 2.Phil is refusing to engage with others

that might influence symptom severity and mom is worried that he might not

Criterion E: Once the stressor or its

consequences have terminated, the symptoms

principal and has been reprimanded

for the last four months for fighting

and speaking disrespectfully to

teachers. Mom & Phil agreed that his

social life has been negatively affected

by his change in mood.

Criterion C: The stress related disturbance

Phil reported that he has never been

does not meet the criteria for another mental diagnosed with an illness & only takes

disorder and is not merely an exacerbation of avitamins.

preexisting mental disorder.

four months ago when his stressor occurred.

(ODD). Mom reported a verbally aggressive behavior at school and has been reprimanded at

school weekly for fighting and speaking disrespectfully to teachers. Since his dad remarried he

has also been more argumentative with his mother 3-5 times per week and daily with his sisters

and has refused to speak to his father. Phil reported that he has swings from sad to being angry,

he is having a hard time getting to sleep, and he refuses to engage with others. Phil met many of

the criteria for this disorder. However, I had to rule it out because his symptoms have not lasted

for at least six months as evidence of this disorder.

broken home in the family. Research also states that belonging to what is considered “normal” to

a group is what adolescents seek in this stage (Ragelienė, 2016). Phil's idea of a family system

has been disrupted and he feels as if no one understands what it's like to be different.

Multicultural and/or Social Justice Considerations

DSM-5-TR states that response to stressors under the Adjustment Disorder with mixed

disturbance of emotions and conduct may vary across cultures. Phil is a 15-year-old hispanic

male who lives with his sisters and mother. Phil reported that they are the first broken home in

the family. Based on this we can conclude that divorce is not common among his culture and

marriage is important to them. He may not feel understood or part of their culture anymore

because of what his family is going through. Phil refuses contact with his father since his

described.

Recommendations for Individual Counseling

For Phil I would recommend individual counseling using Cognitive Behavioral Therapy.

Since Phil’s disruptive and aggressive behaviors developed in the past four months, behavior

activation-focused CBT would be the most appropriate therapy for him. This therapy targets

maladaptive beliefs and thoughts associated with the stressor and helps clients with problem-

home in the family and he doesn’t believe his family is able to understand.

Since Phil is struggling to sleep, I would recommend Temazepam. This medication is a

short-term treatment that he can benefit from. If he starts getting enough rest at night it might

help with the aggressive behavior at school since he seems less tolerant of others.

Specific Considerations

Phil is a 15-year-old hispanic male. He is a teenager and for that reason any treatment

given to Phil needs the approval of the parent or guardian. This may be a challenge to the

counselor since the parents did not agree on their parenting styles. Mom reported that they had

very different ideas about how to raise children and what a family looked like.

Since his brain hasn't fully developed this can also impact the diagnoses because his

hormones may also be affecting his emotions, reactions, and symptoms. When using techniques

and skills, the counselor will need to make sure she keeps in mind the age of the client and builds

an excellent rapport with Phil and the parents if family counseling will be explored.