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AMARA’S CASE STUDY
Case Study Assignment: Amara
Mónica A. Lynn
Department of Counselor Education and Family Studies, Liberty University
Author Note
Mónica A. Lynn
Department of Counselor Education and Family Studies, Liberty University
I have no conflict of interest to disclose.
Correspondence concerning this article should be addressed to Mónica A. Lynn
Email: malynn1@liberty.edu
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Client Concerns
Symptoms Behaviors Stressors
Worry Trouble sleeping 90-year-old mother caretaker
Irritability Tiredness Finances
Anger Lack of Motivation Inexistent harm
Body Tension Difficulty sitting still Unfounded worries
Headaches Drinking
Non-stop Thinking Pattern Fatigue
Assessment
According to the gathered details about Amara’s present interview, as a therapist, I would
use the Beck Anxiety Inventory (BAI) to identify the severity of various symptoms related to the
Generalized Anxiety Disorder diagnosis. I would use this assessment since it would help me by
screening any anxiety disorder presented in the client. The Beck Anxiety Inventory is highly
known for its consistency, reliability and validity when measuring anxiety symptoms. Therefore,
I believe that BAI would be an efficient tool for Amara (Kagee et al., 2015).
Diagnostic Impression
DSM-5-TR Diagnostic Criteria:
Generalized Anxiety Disorder F41.1
Client’s Signs/Reported Symptoms
Criterion A: Excessive anxiety and worry
(apprehensive expectation), occurring more
days than not for at least 6 months
The client reports that in the past 18 months
worry has increased to daily for a majority of
the day.
Criterion B: The individual finds it difficult
to control the worry
The client reports that is aware about
unfounded worries and is unable to stop them
“popping” into her head.
Criterion C: The anxiety and worry are The client reports that in the 12 past months
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associated with three, or more, of the
following six symptoms:
Restlessness or feeling keyed-up or on
edge
struggled to sleep nightly, laying in bed
awake for 1-2 hours.
Being easily fatigued The client reports presenting fatigue for at
least a period of 12 months.
Difficulty concentrating or mind going
blank
The client reports difficulty sitting still when
starts to worry for the last 12 months.
Irritability The client reports that is irritable and will
snap at her daughter when confronted about
her worries.
Muscle Tension The client reports feeling of increased tension
in her body over the past 24 months.
Sleep disturbance The client reports that she started presenting
sleeping problems three years ago.
Criterion D: The anxiety, worry, or physical
symptoms cause clinically significant distress
or impairment in social, occupational, or other
important areas of functioning.
The client reports struggling completing tasks
and doing things around the house due to lack
of energy and having a hard time motivating
herself.
Criterion E: The disturbance is not
attributable to the physiological effects of a
substance or another medical condition.
The client reports no history of preexisting
medical condition and medication.
Criterion F: The disturbance is not better
explained by another mental disorder.
The client also reports no history of any other
mental disorder.
Other DSM-5-TR Conditions Considered
During the assessment, Amara’s oldest daughter confirmed that client was always
present, worried and attempting to protect her children from some sort of unseen harm. In
addition, the relationship with her other two children and daughter-in-law has been affected due
to constant phone calls about wondering and checking in, making sure they are okay and none of
the terrible things she was worried about happened to them. Therefore, Amara met two criteria
for the Separation Anxiety Disorder diagnosis (F93.0). Nonetheless, she needs to meet at least
three of its criteria to meet the diagnosis. Consequently, this diagnosis was ruled out. Besides this
additional diagnosis, Amara also presented with symptoms of the Major Depressive Disorder
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AMARA’S CASE STUDY
with anxious distress (F32.1). Besides the presented anxious symptoms, the client also presented
with lack of motivation in completing tasks, difficulty to sleep and fatigue. All of these are
symptoms as well for a diagnosis of Major Depressive Disorder; however, client must present at
least five, or more to meet official diagnosis. Therefore, this diagnosis was ruled out as well.
Developmental Theories and/or Systemic Factors
According to the Erikson’s stages of development theory, Amara is currently at the last
phase, Ego vs Despair. At this stage, the individual starts centering his/her life in whether it has
been meaningful and satisfying, and in which the individual finds in the position of noticing the
culmination of the development (Gilleard, 2020). According to Knight (2017), the ego/integrity
during this stage tends to grow realizing about the challenges and alternatives made in life.
Therefore, the individual reflects on the decisions, actions and behaviors lived to notice a
fulfilling and pleasing life at this stage. Nonetheless, Amara reports all the contrary during this
stage. She demonstrates the despair fact of this development theory’s stage. Although Amara is
becoming close to her children, she is damaging the relationships between them and also her
friend by her excessive anxious thoughts and worries.
Multicultural and/or Social Justice Considerations
Amara reported that she is from South Asia, specifically from India. She reported that she
takes care of her mother to avoid her entering a nursing home since it would be shameful for the
family such act. She stated that she would never be able to face her family back in India again if
she would have allowed her mother to go to a nursing home. In Asia, mental health disorders are
seen as consequence due to a failure and are culturally stigmatized. Therefore, the South Asian
community, especially women, can find it hard whenever they have to reach out for help, share
and validate their feelings and struggles pushing them to suffer in silence (Reda, 2023). Despite
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AMARA’S CASE STUDY
Amara is aware of, not only her symptoms, issues and how shameful might be to get help for her
mental health, she still decided to take the step, move forward and get the help she needs.
Treatment Recommendations
Key Issues for Treatment
Worry
Irritability
Body tension
Recommendations for Individual Counseling
As Amara’s therapist, I would strongly recommend the Cognitive-Behavioral therapy
(CBT). Studies have shown the effectiveness for multiples issues presented in a person including
depression, eating disorders, anxiety among others. This type of therapy would focus on
changing and replacing the thinking and behavioral patterns (American Psychological
Association, 2017). Kaczkurkin & Foa (2015) discussed that this short-term and skill-focused
treatment focus on shifting the maladaptive emotional responses by switching the behaviors and
thoughts. Likewise, such treatment has been associated with the improvement of life quality of
individuals that suffer from anxiety. As Amara’s therapist, I believe that cognitive-behavioral
therapy would be a great start for her treatment. I strongly believe that working and replacing
any negative thinking pattern an individual has should be identified, challenged and replaced
with healthier and positive thoughts so behaviors in the individual’s life can optimistically
change.
In addition, besides the cognitive behavioral therapy as primary recommendation for
Amara’s treatment, as her therapist, I would also recommend mindfulness. Studies have
demonstrated that, specifically, the mindfulness-based cognitive therapy is efficient in reducing,
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AMARA’S CASE STUDY
not only depressed symptoms, but also anxious symptoms (Hofmann & Gómez, 2017).
Mindfulness is an exercise that invites the individual to accept and be aware of the present and
reality along with being able to manage and redirect the individual’s attention on a beneficial
way (Fallah et at., 2023). Amara reported being aware of her anxious symptoms and how these
have affected other aspects of her life. Therefore, being able to guide her during this process with
the mindfulness exercise will benefit her on how to calm and relax the pattern of anxious
thoughts.
Specific Considerations
Medication Considerations
As Amara’s therapist, I would not recommend the client for a medication evaluation for
this first-period of treatment before trying the recommendations for individual counseling. One
of the reasons would be to avoid dependency on the medication. Heitler (2017) shared that even
though doctors try to avoid addiction to certain and specific anxiety medications and prescribe
antidepressant drugs to relieve anxiety, these medications can make you drug dependent.
Unique Client Considerations
The cultural aspect is vital when working with any client. In the presented case study,
Amara reported from the beginning her origins and cultural background. As a therapist, receiving
this type of information when starting the treatment process is extremely helpful since it will
allow me to identify the values and how much important is for the client. According to the ACA
Code of Ethics A.4.b (2014), counselors are aware of their own values, attitudes, beliefs and
behaviors. In addition, they respect the diversity of the clients. They also try to research more in
areas in which they are not expert, so they don’t impose their own values onto the client.
Therefore, besides researching more information about Amara’s cultural background, I would
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mostly make her the first and principal source of information. I would gather and retrieve as
much information I can from her to, not only be aware and knowledgeable, but also receptive
and accepting of my client. In addition, it would support the process of building a rapport and
prevent me as a therapist to impose my personal values and beliefs onto the client’s progress.
References
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American Counseling Association. (2014).IACA Code of Ethics. American Counseling
Association | A professional home for
counselors.Ihttps://www.counseling.org/resources/aca-code-of-ethics.pdf
American Psychiatric Association. (2022).IDiagnostic and statistical manual of mental
disorders (5thIed.). American Psychiatric Association Publishing.I
American Psychological Association. (2017, July 31).IWhat is cognitive behavioral therapy?
https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
Fallah,IN., Abdolahzadeh,IF., & Yaaghobi,IM. (2023). Mindfulness and anxiety among foreign
language teachers: The role of cognitive reappraisal and self-
efficacy.IMindfulness,I14(12), 3020-3032.Ihttps://doi.org/10.1007/s12671-023-02259-5
Gilleard,IC. (2020). The final stage of human development? Erikson's view of integrity and old
age.IInternational Journal of Ageing and Later Life,I14(2), 1-
24.Ihttps://doi.org/10.3384/ijal.1652-8670.1471
Heitler,IS. (2017, January 20).IAnxiety treatment: Should you be wary of anxiety
medication?IPsychology Today.Ihttps://www.psychologytoday.com/intl/blog/resolution-
not-conflict/201701/anxiety-treatment-should-you-be-wary-anxiety-medication
Hofmann,IS.IG., & Gómez,IA.IF. (2017). Mindfulness-based interventions for anxiety and
depression.IPsychiatric Clinics of North America,I40(4), 739-
749.Ihttps://doi.org/10.1016/j.psc.2017.08.008
Kaczkurkin,IA.IN., & Foa,IE.IB. (2015). Cognitive-behavioral therapy for anxiety disorders: An
update on the empirical evidence.IDialogues in Clinical Neuroscience,I17(3), 337-
346.Ihttps://doi.org/10.31887/dcns.2015.17.3/akaczkurkin
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Kagee,IA., Coetzee,IB., Saal,IW., & Nel,IA. (2015). Using the Beck Anxiety Inventory among
south Africans living with HIV.IMeasurement and Evaluation in Counseling and
Development,I48(3), 204-213.Ihttps://doi.org/10.1177/0748175615578734
Knight,IZ.IG. (2017). A proposed model of psychodynamic psychotherapy linked to Erik
Erikson's eight stages of psychosocial development.IClinical Psychology &
Psychotherapy,I24(5), 1047-1058.Ihttps://doi.org/10.1002/cpp.2066
Reda,IQ. (2023). Cultural barriers for South Asian American women in substance abuse and
mental health treatment retention.IClinical Social Work Journal,I51(3), 273-
282.Ihttps://doi.org/10.1007/s10615-023-00869-z
