CASE PRESENTATION 1
Case Presentation
Rhonda Wright
School of Behavioral Sciences, Liberty University
CASE PRESENTATION 2
Case Presentation
Part 1 – Assessment and Diagnosis Identifying Information
Identifying Data
Date of Initial Assessment: 3/6/2023
Name: Kameka S.
Age: 35
Gender: Female
Sexual Orientation: Heterosexual
Race/Ethnicity: African American
Marital Status: Married
Employment Status Licensed Vocational
Nurse
Reason for Referral/Presenting Problem
Kameka is being self-referred to Birth Choice for counseling. She states she is
experiencing anxiety, sadness, and is hearing voices. This has been going on for the last year. She
explains that she has been medically discharged from the military and has been feeling as if she
struggles with not fitting into her community. Her family has invited her to attend functions and
events that she used to enjoy and participated in. She states that her and her husband have been
arguing over things that they use to be able to work through such as how to discipline the
children, what vacation they are going to plan, and how to save and spend money. She states that
she feels as if she is not able to manage her emotions and often times does not want to get out of
bed. She also states that loud noises cause her to jump and panic. “On the 4 of July is when I
th
have very high anxiety because of the fireworks. It brings me back to when I was in combat
during my deployment to Iraq.” I was able to review the confidentiality with Kameka and was
able to obtain verbal, and written permission to video tape one of our sessions for individual and
group supervision and faculty group supervision.
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Source of Information: The information provided was collected during the intake and initial
diagnostic evaluation with the client. The client completed William W.K. Zung “Zung self-rating
depression scale, and Beck depression inventory BDI-II.
Background, Family Information, and Relevant History
Kameka is a 43-year-old African American female who is currently married with two
male children and is three months pregnant whose sex is unknown at this time. She is originally
from Louisiana and currently lives in Forney, Texas. Kameka and her husband are both retired
from the military where they met. She has been married for 20 years. She was raised by both of
her parents who were also in the military. She describes her father as someone she looks up to
although she thinks he suffers from post-traumatic stress syndrome. Kameka shared that her
relationship with her mother is difficult because she feels that her mother is not satisfied with any
of the decisions Kameka makes, such as leaving an abusive relationship and marrying her current
husband.
Kameka attended chartered private school during her elementary years (K-12) and she
has received her Master’s in nursing from the University of Louisiana. She describes herself as a
very smart black women who has worked very hard to obtain all she has achieved. She graduated
with a 4.0 from the University of LSUA and is now working as a Director of Nurses at a very
prestige hospital. She prides herself on teaching her children to be academically successful by
home schooling them. Her oldest son who is 8 years is very knowledgeable and wants to one day
study geography. She shared “I am amazed that my oldest son has the knowledge of
understanding such a complex topic. He already knows what is involved in becoming a
geometrician.” Her other child who is 2 years old only interested in playing. Kameka was
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observed as smiling while speaking about her children. She shared having her children brings her
pleasure and peace. “I really enjoy being a mother and raising my boys and I look forward to the
newest addition whom I hope is a girl.” Kameka does not have a history of substance abuse and
has not acknowledged any mental health issues before her retirement from the military. She
spoke of her grandparents and an uncle who has substance abuse issues. She shared “I only knew
about him and have not had a relationship with him. My mother and father kept my siblings and I
away from him.” She has shared that her uncle caused her father’s side of the family continued
grief and hurt that she was not exposed to.
Problem and Counseling History
Kameka has not had counseling in the past. She recently has come to the conclusion that
she may need to seek professional help due to her extreme sadness, panic attacks that cause her
heart to race. She states that she feels as if her nerves are out of control. Kameka has noticed that
she shakes uncontrollably, she is unable to catch her breath when she is having a panic attack.
She also notices that she jumps at loud noises, such as when the door slams, thunderstorms, and
when people are talking very loudly. Kameka expresses that she has intrusive and distressing
memories of when she was deployed to Syria during the war. She states “there were times when I
had to make very hard decisions about killing a child who was holding a rifle at one of my
officers or myself. I needed to kill the child in order to save myself and those who were under
my command.” She shares memories of having nightmares that seem as if she is reliving the
experience all over again. Kameka shares sometime she feels as if she is not in her body and is
on the outside of herself as an observer.
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Kameka expresses that she struggles with reality not knowing if what she is experiencing
is real or a dream. She shares that having these experiences make her not want to be involved
with others. “I feel weird, and out of place most of the time. My husband is always asking me if I
am alright? And I tell him I am fine when almost all of the time I am not fine.” Kameka shares
she struggles with sleeping and is always tired and lacks energy to things such as doing the
dishes, washing clothes, and even going to work. She states that she has a hard time
concentrating and is indecisive when it comes to making choices about herself and her family.
She states that she is concerned about making the wrong choice and will carry the guilt and
shame of having made a decision that is going to impact the lives of others. “I feel guilty not
being able to help the men in my company while in the Army. I was right there when those
soldiers died, and I could not do anything.”
Kameka has noticed that she is gaining weight and feels as if she is eating her emotions.
Her husband and a few of her close friends are concerned about her physical and mental health.
Her husband is always watching her and doing his best to help her manage the house. She feels
as if he is getting tired because this is a different type of battle. She expressed her experience as a
new enemy an unfamiliar enemy and she is seeking counseling to learn how to fight this battle
and win the war of the mind. “Miss Rhonda, I need weapons from you to know how to fight in
this war. I know how to use natural weapons, but the weapons I need are unknown, and I am
hoping you can provide me with the training I need to overcome this spiritual and mental battle I
am experiencing.”
Observations made during the initial intake were how restless Kameka was during the
session. The evidence behind this was her inability to sit still, fidgeting with her finger, shaking
her leg, and unable to maintain eye contact. Kameka was oriented to person, place, time and
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situation. She was dressed appropriately in her work clothes a nurse’s uniform. Her speech was
pressured evidence by her rapid rate of communication and jumping from one subject to another.
There are some barriers to treatment she may struggle with such as not wanting to leave the
house when she is experiencing severe panic attack, or having a major depressive episode.
Kameka will be very successful by her willingness to process information and learning how to
cope with the memories from her experience while in the Army.
Diagnostic Impression
Principal diagnosis:
F43.10 Posttraumatic-Stress-Disorder, with anxiety, panic attacks, reliving traumatic
events such as the death of those while in combat. Being frighten by loud noises.
F41.1 Generalized Anxiety Disorder, restlessness, Constance worry, struggles with
concentration, irritability, and sleep disturbances. (Provisional)
Z56.82 Problem related to current military deployment status
Z63.0 Relationship distress with spouse or intimate partner
Differential Diagnosis: F33.1 Major Depressive Disorder
Discussion of Diagnostic Impression
Kameka reports having severe nightmares relating back to when she was in the army and
deployed to Iraq. She shares that she witnessed seeing people die, having to kill children, and
being a shield for one of her commanding officers. This commanding officer was a very close
friend of Kaneka’s. She also reports that she had to carry several people who were a part of her
platoon back to where she was stationed. Kameka meets the Criteria for F43.10 posttraumatic
stress disorder A, 1, 2, and 3. Criteria B, 1,2, 3, 4, and 5. Criteria C, 1, and 2. Criteria D, 2, 3, 4,
5, 6, and 7. She does not meet the criteria for episode 1. She does not meet the criteria for E, but
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does meet criteria for F. The duration of the disturbance (Criteria B, C, and D) she may meet the
criteria for G, and does not meet the criteria for H (American Association, 2022). Kameka meets
the criteria for Z56.82 she reports that she is caring for her children alone although she is married
and living with her husband. Her husband is disabled and struggles with supporting her within
the home. Criteria Z63.0 her relationship with her husband is in distressed she reports that they
do not sleep in the same room, and finds that her sons are always in bed with her and this also
interferes with her sleep.
Kameka reports symptoms of weight gain, lack of concertation, panic attacks, and is
having sleep issues. She states she goes to bed and falls asleep then wakes up for about an hour,
and falls back to sleep to wake up again within a couple of hours. She has shared that she is not
resting due to her over active mind. Kameka symptoms are consistent with Criteria A, B, C, and
D of generalized anxiety disorder (provisional) as described in the DSM-5 TR. Her symptoms do
not meet the diagnostic criteria of E and F due to substance abuse or mental disorder
(Association, 2022).
Part 2 – Case Conceptualization: Inverted Pyramid Model (IPM)
STEP 1: IDENTIFY AND LIST CLIENT CONCERNS AND ANY OTHER PROBLEM
AREAS
Sadness
Weight gain
Lack of concertation
Panic attacks
Irritability
Restlessness
Lack of energy
Experience detachment from her body
Guilt/shame
Nightmares and flashbacks
STEP 2: ORGANIZE CONCERNS INTO LOGICAL THEMATIC GROUPINGS
A psychological exam was given to Kameka to determine the level of depression she is
experiencing. According to Schwitzer and Rubin (2014) “We have found four different ways
CASE PRESENTATION 8
counseling professional often go about the task of forming this type of clinically valuable
intuitive-logical groupings.” It is recommended that more than one theme be applied for Kameka
over a period of time.
The Descriptive-Diagnostic
This approach will show Kameka the larger clinical problems that are characterized by
criteria of F43.10 posttraumatic stress disorder, (Association, 2022)
Areas of Function and Dysfunction
This approach focuses on one’s ability to deal with life and the stresses that come along with
it this approach also may help with emotional regulation techniques. Also associated with
F43.10 (Association, 2022)
Clinical Targets Approach
This approach focuses on the four aspects of Schwiter and Rubin. Kaneka’s feelings, experience,
thoughts, and behavior. will be addressed. According to the criteria as a provisional diagnosis
related to F41.1 generalized anxiety disorder (Association, 2022)
STEP 3: THEORETICAL INFERENCES:
ATTACH THEMATIC GROUPINGS TO INFERRED AREAS OF DIFFICULTY
Maladaptive thoughts and behaviors/Psychotherapy (CPT)
Maladaptive thinking in the following areas: flashbacks of witnessing human remains, guilt for
having to take another human’s life, feeing like she is the only one who needs to get things done.
Unable to ask for help.
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Psychotherapy used with cognitive processing therapy is a form of cognitive behavioral
therapy that teaches and help s individuals to change unwanted thoughts and memories it is use
for those suffer from PSTD.
STEP 4: NARROWED INFERENCES AND DEEPER DIFFICULTIES
Deepest core issues (CPT)
Guilt, shame, regret a deep core issue for re-occuring thoughts and memories. “I had to
kill children who were my son’s age.”
Narrative of the Case Conceptualization
The Narrative through the cognitive processing lens, Kameka core beliefs of feeling like
a worthless individual brings her to a place of despair. Which results in her having to experience
her time in Iraq. Kameka has shared that she spends her time over caring for those around her
which leaves her little time for herself. Kameka has taken the Zung self-rating depression scale
and has scored a 65 which means she is on the severe according to Breteler et al., “although
anxiety and depression are considered comorbid disorders it remains unclear how a concurrent
depression affects the outcome of anxiety treatment. When using CPT to help clients learn how
to process their trauma and accept the understanding as to why certain experienced had to
happen such as witnessing the death of a loved one, or being involved in behaviors where self-
defense was warranted the client will better understand the reason behind the experience and
learn to grow from it instead of using self-defeating thoughts” (2021). Kameka is a veteran and
she has experienced life on a different level than most Americans. She has gone to another
country to protect those who live in her homeland. According to (Shorer et al.,) many veterans
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coping with combat-post-traumatic stress disorder (PTSD) refrain from seeking psychological
treatment. The reason for this avoidance is due to what is perceived by their peers” (2021).
Kameka did express that she did not want anyone to know that she was seeking
counseling because she did not want to seem as if she was weak. “During my training in boot
camp they told us that we had to have a strong mind because if we were captured by an enemy
that is the first thing they will try and break.” Kameka was able to describe certain signs while
they were not very apparent the counselor did notice soft signs. According to García-Blanco et
al. (2018) “The determination of soft signs can be a conducive practice to understand the
differential etiology between depression and anxiety.” Kameka expresses sadness, lack of
concertation, lack of sleep, and panic attacks. She also reports she has gained weight over the
past year. Her avoidance of family functions and loss of interest of things she once enjoyed is
leading her to isolate herself from her loved ones. She expressed that she is constantly cleaning,
organizing her home and preparing herself and the children for the next day. She has also stated
that when she gets home from work that she takes a nap that last for about four to six hours.
Part 3 – Treatment Planning/Integration/Counseling Theory
Treatment Plan
Problems
F43.10 Posttraumatic-Stress-Disorder, with anxiety, panic attacks, reliving traumatic
events such as the death of those while in combat. Being frighten by loud noises.
F41.1 Generalized Anxiety Disorder, restlessness, Constance worry, struggles with
concentration, irritability, and sleep disturbances. (Provisional)
Goals for Change
Understand unhealthy thinking patterns
Recognize triggers for prompting thoughts
Use coping skills to process thoughts and change them
Engage in activities that bring her enjoyment
2. F41.1 Generalized Anxiety Disorder, restlessness, Constance worry, struggles with
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concentration, irritability, and sleep disturbances. (Provisional)
Develop grounding techniques such as deep breathing, counting from 1to 10
Find a support group that involves other veterans
Use journaling to deal with distressing emotions and discuss during sessions.
Objectives & Therapeutic Interventions
The client will engage in a 12-week psychoeducational session that involves CPT.
Psychoeducation on changing unhealthy thinking patterns
Gain education on developing healthy sleeping patterns
Engage in activity that involves self-care (e.g., going on a trip, taking relaxing baths,
spending time with her husband alone.)
Become involved in her community
Outcome Measures of Change
Develop a sense of oneness with self through engagement with family, making friends, and
attending functions outside of the home.
Self-report the decrease in her sadness.
Counselor will observe change in mood though communication about those areas that
were once negative, and are now positive.
Discuss accomplishments achieved and set new goals that are attainable to be reached.
Integration
I am a Christian counselor who believes in the Father, Son, and the Holy Spirit. When I
became a new Christian, I was not taught to integrate science and religion. I was taught science
is a hypothesis that leaves room for change, while the Word of God was factual and true that
originate from an unchanging God. As a Christian counselor I have learned that I do not need to
integrate science with the word of God. I need to allow God’s word to work through me without
being intrusive.
This come with meeting people where they are and accepting them for who they are
regardless of their beliefs. I have learned and understand I am not better than the person I am
helping become whole. It is no up to me to change anyone or change their hearts only God can
do that. I am to be a willing vessel ready to be used by the Lord Jesus Christ as He sees fit. I
have worked with all populations of people starting with adolescents’, toddlers, adults, and the
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elderly. I have been available to work with those who have intellectual disabilities, mental
illness, physical disabilities, and substance abuse. I have been on the other side in a couple of the
above areas and I understand the pain that comes along with needing someone to help me reach
my goals.
As a counselor it is not about integrating therapies, or operating from a text book it is
about loving the unlovable, and showing up for those who are lost and need someone to guide
them to the light of life. The Lord has delivered me from darkness and now has allowed me to
return to the darkness to show others how to find their way out. I pray for my clients, my staff,
and those who are in my community. I pray that God would allow me to make a difference in the
lives of those with whom I come into contact with.
I have been commissioned by Jesus Christ to go and teach about this new way of life. The
Book of Acts 5:21 reads “But during the night an angel of the Lord opened the doors of the jail
and brought them out. Go stand in the temple courts, he said and tell the people all about this
new life. At daybreak they entered the temple courts, as they had been told and began to teach
the people.” If I can help one person understand that they are loved and wanted I have done
what I have been called to do.
Personal Model of Counseling
I do not have one model of counseling that I am working towards and if I had to choose, I
would have to say it is CBT. I have learned from my own experience everything begins with our
thoughts which in turn affect all areas of our lives. Once I learned to change the way I think I
noticed that my behaviors began to change along with the way I lived, and behaved. I also like
and would like to learn more about DBT which deals with those who struggle with personality
disorders and irrational beliefs. Once I became a Christian, I learned that the World lied to me,
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and told me things that were not true. Once I became friends with Jesus Christ, I found life and
the truth about what my life is supposed to be. Attending Liberty University and being mentored
by the professors has develop me into a strong biblical based woman of God. Dr. Ed Henson was
my first professor who I have admired for the duration of his teaching. I will use everything that
I have learned from Liberty and pass it on to those I counsel.
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References
Association, A. P. (2022). Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR.
Breteler, J. K., Ikani, N., Becker, E. S., Spijker, J., & Hendriks, G. (2021). Comorbid depression
and treatment of anxiety disorders, OCD, and PTSD: Diagnosis versus severity. Journal
of Affective Disorders, 295, 1005–1011. https://doi.org/10.1016/j.jad.2021.08.146
García-Blanco, A., González-Valls, P. I., Iranzo-Tatay, C., Rojo-Moreno, L., Sierra, P., &
Livianos, L. (2018c). Hypoesthesia in generalized anxiety disorder and major depression
disorder. International Journal of Psychiatry in Clinical
Practice. https://doi.org/10.1080/13651501.2017.1417441
Schwitzer, A. M., & Rubin, L. C. (2014). Diagnosis and Treatment Planning Skills: A popular
culture casebook approach (DSM-5 Update). SAGE Publications.
Shorer, S., Caspi, Y., Goldblatt, H., & Azaiza, F. (2021). Acknowledging Post-Traumatic Stress
Disorder: Treatment Utilization Amongst Israeli Bedouin and Jewish Combat
Veterans. . British journal of social work https://doi.org/10.1093/bjsw/bcaa152
