Case Study: Amara 1
Case Study: Amara
School of Behavioral Sciences, Liberty University
COUC 546
May 25, 2025
Client Concerns
Symptoms Behaviors Stressors
Increased anxiety Uncontrollably anxious Caring for her 90-year-old
mother, who lives with her
Worrying Described as a helicopter
parent, and still worries about
everything
Husband’s death
Trouble sleeping/ fatigue Mind racing, now daily Stressing about what might
happen, even though it might
be unlikely
Irritable Snapping at her mother and
daughter
When confronted by family
about her high levels of worry
Increasing tension Shoulder and neck pain,
along with constant
headaches
Increased worry and anxiety
once she retired
Unable to sit still Excess worry makes her
anxious and causes her to
fidget
Lack of proper sleep,
worrying about anything
Case Study: Amara 2
Increased drinking The client has increased the
amount by drinking two
glasses of wine five times a
week (10 cups of wine)
Uses alcohol to “take some of
the edge off”
Assessment
The Beck’s Anxiety Inventory will be used to assess the severity of Amara’s anxiety and
presenting worries. The Beck Anxiety Inventory is a self-report rating inventory that consists of
twenty-one items (Muntingh et al., 2011). By using a four-point Likert Scale that ranges from
zero to three, zero represents no symptoms, and three represents severe symptoms, it describes
the most common symptoms of anxiety (Muntingh et al., 2011). The final score for this
assessment ranges anywhere from zero to sixty-three and is divided into three categories: scores
lower than twenty-one indicate low levels of anxiety, scores between twenty-two and thirty-five
indicate moderate levels of anxiety, and scores thirty-six or higher indicate high levels of anxiety.
This assessment was chosen because it will properly identify just how much worry and anxiety
Amara goes through and can determine the severity of it, which will then reflect how that is
affecting her within her daily life.
Diagnostic Impression
Amara’s symptoms, behaviors, and stressors meet the criteria for a primary diagnosis of
Generalized Anxiety Disorder, corresponding ICD-10 code F41.1. Amara meets six out of the six
diagnostic criteria for Generalized Anxiety Disorder (American Psychiatric Association, 2022).
Signs and Symptoms
DSM-5-TR Diagnostic Criteria: Generalized
Anxiety Disorder, F41.1
Client’s Signs/Reported Symptoms:
Criterion A: Excessive anxiety and worry that The client reported dealing with worry daily
Case Study: Amara 3
happens on more days than not for at least six
months.
for the last eighteen months.
Criterion B: Difficulty in controlling the
worry
The client reported worrying about everything
despite never experiencing those negative
events, which pop into her head, and she can’t
let them go.
Criterion C: A Minimum of three out of six
symptoms of anxiety and worry
The client reported the following symptoms:
Irritability, muscle tension, sleep disturbance,
restlessness, and fatigue.
Criterion D: The anxiety, worry, or physical
symptoms impact important functioning
areas.
The client has reported that her constant
worrying is causing havoc with her family,
health, such as proper sleep and alcohol
consumption, and anxiety about retiring and
finances.
Criterion E: The disturbance isn’t tied to the
use of a substance or a medical condition
The client has reported an increase in alcohol
consumption, but doesn’t attribute it to her
existing signs and symptoms.
Criterion F: The disturbance isn’t better
explained by another mental disorder.
The F41.1 diagnosis best explains the client's
current symptoms of increased anxiety and
worry.
Other DSM-5-TR Conditions Considered
Other diagnoses were considered for Amara, such as separation anxiety disorder,
obsessive-compulsive disorder, and adjustment disorder with anxiety. The client reported several
symptoms and behaviors that met some of the criteria for separation anxiety disorder, ICD-10
code F93.0. The criteria met included the persistent worry for major attachment figures that they
Case Study: Amara 4
may be harmed, injured, or die, recurring distress when away from major attachment figures, and
the disturbance of social, academic, occupational, or other areas of functioning. However, the
generalized anxiety disorder better explains the client’s disturbance than the separation anxiety
disorder. The obsessive-compulsive disorder criteria, ICD-10 code F42.2, aligned with some of
the symptoms that the client reported, such as recurrent and persistent thoughts and images that
cause anxiety and distress. Amara is constantly worrying that at any point, something could go
wrong for her and her family. This causes her to persistently call her children to ask if they’re
safe and proceeds to list off all possible situations that could go wrong. However, Amara doesn’t
report any existing compulsions such as repetitive or excessive hand washing or counting that is
a response to the obsession. Lastly, the adjustment disorder with anxiety, ICD-10 code F43.22,
was also considered as a diagnosis for Amara. Amara reported several symptoms, such as
increased worry, irritability, and anxiety that increased after her husband passed away, she
retired, and is caring for her ninety-year-old mother full-time. However, some years have passed,
and the client is still dealing with the symptoms and can be better defined by the generalized
anxiety diagnosis.
Developmental Theories and/or Systemic Factors
Human development and functioning require the consideration of all stages of life. The
human mind, behaviors, and daily functioning are dependent on which stage they are on from
Erikson’s stages of psychosocial development. Amara is placed in the later stages of adulthood,
specifically stage eight; old age period: Integrity vs. Despair (Orenstein & Lewis, 2022). A
common virtue in this stage is wisdom, wisdom gained from having experienced the earlier
stages of childhood and adolescence, which has formed who Amara is in the eighth stage. At the
same time, a maldevelopment is the disdain that can occur between Amara and her nuclear
Case Study: Amara 5
family (Orenstein & Lewis, 2022). In this stage, Amara is reflecting on her life, which includes
positive and negative reflections, such as past achievements or unresolved regrets. Amara’s
current state reflects her existing anxiety and worry. In this stage, she has gone through several
changes, the loss of her spouse, retirement, caring for her mother full time, and grown adult
children who no longer live at home, so much change could have led to role confusion because
everything that was a part of her routine has now vanished or changed.
Multicultural and/or Social Justice Considerations
Despite being born in America, Amara’s ethnic and racial identity as a South Asian
American plays a significant role in the decisions that she has taken and the traditions that form
her cultural identity. Ethnic racial identity and ethnic racial socialization are said to start in the
adolescent stage, where parental figures and extended family relay messages of their ethnic racial
group, providing a basis of understanding of what the culture consists of and what is or isn’t
acceptable (Wadhwa et al., 2025). Both of Amara’s cultural identities (Asian-American) begin to
clash, which causes worry and stress. From one perspective, Amara mentions the thought of
placing her mother in a nursing home, something that is common in the American culture, which
she grew up in. On the other hand, the South Asian part of her cultural identity defines the act of
placing her mother in a nursing home as cruel and shameful. This creates an understanding that,
on top of Amara’s existing worries, she also has to consider and abide by her and her parents’
culture due to the possibility of being shamed and disowned by her extended family in India.
This creates pressure and limited freedom to make decisions that could benefit Amara due to the
obligation to honor and abide by her cultural norms.
Treatment Recommendations
Case Study: Amara 6
Key Issues for Treatment
●Identity and role confusion resulting in excess worry and anxiety (Retirement,
Husband’s death, full-time caretaker)
●Strained relationships due to excess worry
●Trouble sleeping, constantly fatigued
Recommendations for Individual Counseling
Based on Amara’s key issue and symptoms, the first recommendation for treatment would
be to attend cognitive behavioral therapy (CBT). CBT has proven to be effective in treating both
depression and anxiety since some of the symptoms are similar (Yarwood et al., 2024). CBT
holds core theoretical principles that focus on the interrelationship of the thoughts, feelings, and
behavior of an individual (Yarwood et al., 2024). Acknowledging the focus of CBT creates a
recommendation for Amara to actively participate in CBT because it aims at identifying and
challenging the negative thoughts and beliefs that Amara has, which can, in return, begin to
affect her behavior and feelings, and transform them into more positive thinking and less
worrying. Flipping the initial negative thoughts and excessive worrying can affect Amara both
physically and emotionally by reducing the feelings of fatigue and diminishing the constant
negative thoughts that occur almost daily.
The second recommendation would be to attend Solution-Focused Brief Therapy (SFBT).
The SFBT stages consist of describing the issue, developing goals to address it, exploring any
exceptions, providing feedback at the end of a session, and consistently evaluating the progress
of the client (BoVee-Akyurek et al., 2019). Using this treatment recommendation takes into
account what Amara is struggling with, whether it be the existing worries, her cultural norms and
traditions, or her intimate relationship with her children and grandchildren that is being affected
Case Study: Amara 7
by her excessive concern. Ideally, if Amara were to take SFBT, the concept of using her needs,
solutions, and wants, can stimulate new awareness and possibilities that weren’t noted before
(BoVee-Akyurek et al., 2019). When noticing these new possibilities, she can steer away from
the compulsive negative thinking and instead embrace the positive aspects of her life, such as
spending time with her children and grandchildren, whom she expressed a lot of love and care
for.
As for medication recommendation, Amara is currently taking an anxiety medication
called Paxil, which she has been consistently taking for the past four weeks. During those four
weeks, she expressed that there hadn’t been any change in her existing symptoms. Amara stated
that the medication could take anywhere from six to eight weeks to have an effect, and she might
even need a higher dosage. While the current medication that she is taking is fine for the next
couple of weeks, if there isn’t a notable difference I would then recommend for her to instead of
taking prescriptions and diagnosis from a regular family doctor (PCP), she should instead see a
board certified psychiatric mental health nurse practitioner that is licensed to specifically provide
medication management for disorders and symptoms of anxiety, stress, depression, etc. and can
properly bill sessions for mental health, meaning that the client is thoroughly assessed before
being diagnosed and prescribed any medication at all (Turi et al., 2023). This way, she has a
bigger opportunity to find a medication and dosage that best meets her needs.
Specific Considerations
Cultural Background plays an important part in the case of Amara. Despite being born in
the States, Amara has expressed a deep connection with her parents’ culture and identifies as
Asian American. Amara’s culture consists of following the Hindu religion and other customs that
are deemed appropriate. Other necessary information that needs to be considered is how she
Case Study: Amara 8
views mental health and the use of medication. From the case study, it is noted that this is the
first time that Amara seeks out any counseling service due to her cultural beliefs that don’t
believe in seeking professional mental health services and maintaining any problems within the
family. Because I am not as informed about the South Asian culture, I’d need more information
on what the cultural norms look like, gender roles, and more detailed family history. Differences
in cultures between the counselor and the client can create conflicting values for the counselor.
Malott et al. (2023) state that even the most highly educated individuals can still be reluctant to
integrate new learning. When early beliefs are threatened by new information that contradicts
their own beliefs, it can fortify those early beliefs, making it even more difficult to work with the
client (Malott et al., 2023). As a future counselor, the foundation of a professional identity
consists of abiding by the American Counseling Association's code of ethics. These ethics
provide a guideline and understanding of what must be followed and what must be done to
ensure that any counseling session is benefiting a client rather than causing harm. Specifically,
section C.2.f Continuing Education and E.5.b Cultural Sensitivity discuss the need to
consistently grow and seek further education in general, but specifically for multicultural
understanding (American Counseling Association, 2014). It also acknowledges the need to be
sensitive to other cultures because the way they identify and define problems could be different
than how the counselor views it.
Case Study: Amara 9
References
American Counseling Association. ACA Code of Ethics. 2014,
www.counseling.org/resources/aca-code-of-ethics.pdf.
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental
Disorders: DSM-5 TR (5th ed. Text Revision). American Psychiatric Press, Inc.
BoVee-Akyurek, A., Chenail, R. J., & Erolin, K. (2019). Exploring Relationships between Needs
and Solutions in Solution Focused Brief Therapy: A Recursive Frame Analysis. The
Qualitative Report, 24(7), 1618-1635. https://go.openathens.net/redirector/liberty.edu?
url=https://www.proquest.com/scholarly-j ournals/exploring-relationships-between-
needs-solutions/docview/2258087462/se-2
Liberty University. Amara Case Study. [Case Study Assignment: Amara]. School of Behavioral
Sciences, Liberty University, Canvas. https://canvas.liberty.edu/
Orenstein, G. A., Lewis, L. Erikson's Stages of Psychosocial Development. [Updated 2022 Nov
7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.
Available from: https://www.ncbi.nlm.nih.gov/books/NBK556096/
Malott, K. M., Yee, T., & Barraclough, S. (2023). Overcoming Barriers to Social Justice
Learning in Multicultural Counselor Education. International Journal for the
Advancement of Counselling, 45(2), 356-369. https://doi.org/10.1007/s10447-023-
09506-3
Muntingh, A. D., van der Feltz-Cornelis, C. M., van Marwijk, H. W., Spinhoven, P., Penninx, B.
W., & van Balkom, A. J. (2011). Is the Beck Anxiety Inventory a good tool to assess the
severity of anxiety? A primary care study in the Netherlands Study of Depression and
Anxiety (NESDA). BMC family practice, 12, 66. https://doi.org/10.1186/1471-2296-12-66
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Turi, E., McMenamin, A., Kueakomoldej, S., Kurtzman, E., & Poghosyan, L. (2023). The
effectiveness of nurse practitioner care for patients with mental health conditions in
primary care settings: A systematic review. Nursing outlook, 71(4), 101995.
https://doi.org/10.1016/j.outlook.2023.101995
Wadhwa, H., Daulat, N., & O'Brien, C. (2025). Masala and Misogyny: A Qualitative Study of
South Asian American Women's Ethnic-Racial Identity. Journal of Ethnic and Cultural
Studies, 12(1), 86-106. https://doi.org/10.29333/ejecs/2202
Yarwood, B., Taylor, R., & Angelakis, I. (2024). User Experiences of CBT for Anxiety and
Depression: A Qualitative Systematic Review and Meta-synthesis. Community Mental
Health Journal, 60(4), 662-671. https://doi.org/10.1007/s10597-023-01196-w
