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Application: Case Conceptualization

When a client comes into your office, this person has certain expectations, some idea of what his or her problem is, and hopes of getting some answers, making changes, and/or obtaining relief. This week, you learned about the importance of developing a case conceptualization to help formulate successful treatment planning.

Developing a case conceptualization includes defining the problem, identifying and evaluating outcome goals, and planning a treatment. This process follows the sequence of scientific thinking: problem definition, hypothesis formulation, hypothesis testing, data collection, results, and recommendations. Keep this sequence in mind as you prepare to complete this week's Application Assignment.

The assignment: (2–3pages)

· Describe major components necessary to develop an investigation of evidence-based practice and analyze how EBP resembles the scientific method.

· Explain the value and importance of case conceptualization.

· Analyze each section of the Case Conceptualization Exemplar.

· Explain how each section of the Case Conceptualization Exemplar relates to each other.

Student Name: Case Name/#: Case Study Example: Linda

1. Problem identification and definition: [1–2 paragraphs]

[Primary and contributing concerns for the client]

· Client concerns: Cognitive abilities

· Client concerns: Feeling “anxious,” associated with being accepted by others

· Clinical concerns: Interpersonal isolation

· Clinical concerns: Self-devaluation, adequacy

· Clinical concerns: Depressive symptoms

2. Contextual considerations: [1–2 paragraphs]

[What ethical, legal, cultural, or other key considerations need to be considered with this client when creating a treatment plan?]

· Given no family, friends, or beliefs were identified as a support base, it would seem there are no resources on which Linda might rely.

· Given her sustained employment, attempts at effecting change, and self-referral, it seems as Linda may have the capacity for insight, ability to sustain, and motivation for change.

3. Diagnosis

Axis I: [Be sure to provide full title and code]

300.04 Dysthymic Disorder

Axis II:

V71.09 No diagnosis on Axis II

Axis III:

None

Axis IV:

Reccurring headaches within last 6 months

AXIS V: GAF =

45–55 Severe symptoms of impaired social and interpersonal relationships

Moderate symptoms of flat affect

Diagnostic comments: [1 paragraph]

[Provide a brief comment (no more than 1 paragraph) on the justification for your diagnosis]

1) Disturbance of mood: Exaggerated feelings of self-depreciation, self-doubt, lack of energy, problems with sleep, “headaches,” impaired decision making.

2) Dysthymic Disorder: Prolonged duration of “low self-esteem,” “feeling of hopelessness,” “depressed mood, most of day.”

4. Theoretical conceptualization: [1–2 paragraphs]

[How would your selected theoretical orientation explain the primary issues for this client, and thus which interventions/treatments would be best suited for this client?]

1) Long-standing concerns of self-worth and acceptance may be rooted in unconscious wish to be nurtured.

2) Given this, the mother/child bonding and attachment may have been impaired, early impairment may have led to “stunted” personality development and associated limited defenses, blunted libidinal energy, being self-absorbed, unmet dependency.

3) Given the long-standing and deep-rooted nature of the impairment that appears to have impacted most domains of this individual’s life, major personality change would seem the most appropriate goal for this client.

4) Given the lack of external supporting relationships, the client/patient relationship may be viewed as a source of “working out” the early parent/child relationships.

A psychodynamic orientation may best meet these two issues.

5. Treatment plan

Presenting Issue #1: Questions and concerns over cognitive abilities, interpersonal relationships, and self-worth.

Strengths: Sustained employment exemplifying “reality” and ego strength. Through intermittent and unsuccessful attempts at looking outside of self for “remedies,” client may show desire and recognized need for change.

Barriers: School-academic history, birth order, “teasing” from male siblings, genetic influences, anxiety over intellectual functioning—all of which suggests early and long-standing issues resulting in a sustained personality structure.

Goals: While symptom reduction is an obvious end, to uncover unconscious motivations and to develop successful “attachment” are basic to effect their being change.

Interventions: Note: Though cognitive testing may be an obvious intervention, given the conceptualization, this would support the client’s need to look outside herself for “answers,” therefore, this option is rejected.

Modality/Duration:

Use long-term psychotherapy focusing on the psychotherapeutic relationship and exploration of self.

Three weekly 50-minute sessions for up to 2 years

Measure of Progress:

Monitor progression of therapy sessions assessing transference and “uncovering.”

Empirically Supported References:

Name: Linda Gender: Female Age: 29 Ethnicity: Third-generation European

Religion: Non-practicing Christian Relationship Status: Single

Description of Presenting Issue:

Linda referred herself to learn about her cognitive ability and for help with being “anxious” over how she presents herself to others. She reported a history of marginal academic success, a brother who received school support for a diagnosed learning disability, and stated, “I’m always self-conscious about my not being smart,” and, “…thinking people are laughing at me for being stupid.”

She is considering applying to a nursing program at a local college, but is not sure she will be successful. This is because of “…how I feel about myself, I don’t have many friends, I don’t date, and am always feeling like I don’t count.” “I tried joining a reading group and would study the book, but I couldn’t remember anything, so I didn’t go to the first meeting.”

She described her daily routine as “putting on my usual outfit, going to work, coming home, maybe eating supper, watching TV, and then trying to go to sleep… because I am always tired.” She stated, “See what a loser I am?” as she began to tear up.

Occupational History: Linda works as an office worker at a local insurance agency. She has worked at the agency since she was placed there in the 11th grade as a vocational education student. She continued to work at the agency after her high school graduation.

Educational History: Linda graduated from her local high school and enrolled in two adult education classes, which were unsuccessful.

Medical History: Apart from childhood colds and a “bout of headaches” during 9th grade, Linda shared no medical concerns. She reported that her headaches, for which she takes aspirin, had become frequent again in the last six months.

Family History: Linda is the fourth born after three male siblings. She described her relationship with them and their families as “OK” and to her surviving and retired parents as “odd.” She described her father as being a hard-working accountant who owned his own business and her mother as “helping him out.” Linda noted her childhood and adolescence as being “OK,” that she did not have many friends but that was “OK,” and her brothers “…teased me a lot.” “My mother told me to ignore them and they’d stop, but they didn’t.”

Alcohol/Substance Use: Linda reported having no alcohol or drug use history, but “I did try a marijuana cigarette once—I got sick.”