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· Application: Integrative Therapy—Case Conceptualization

Integrative therapy mindfully combines aspects of several theories and therapies to create a unique treatment plan for a client. A psychologist must be well versed in the theories he or she chooses from and have a solid rationale for integrating particular interventions. This week, you will revisit one of the case studies that you examined earlier in the course, Sam, Kyle, or Joanne. However, in this week's Application, you will conceptualize the client's presenting issues using an integrative approach. To prepare for this assignment:

· Select and review case study Sam , Kyle , or Joanne for use with this assignment.

· Re-conceptualize your selected case study by using concepts and considerations from integrative theory.

· Conduct a brief (2–3 articles) literature review, searching for empirically supported treatments that would support the particular integrative techniques and interventions that you are using.

· Review this week's Web sites for empirically supported treatments related to integrative therapy.

The assignment: (The completed template should be 2–3 pages)

· Complete the Case Conceptualization Template for your selected case study using an integrative therapy approach.

· Provide specific empirically supported treatments and evidence-based practice interventions.

· Include ethical and cultural considerations in your case conceptualization.

Case Study: Sam

Name: Sam Gender: Male Age: 32 Ethnicity: Greek American

Religion: Eastern Orthodox Christian Relationship Status: Divorced

Description of Presenting Issue:

Sam was referred to you by a colleague at work who was concerned about Sam’s recent poor performance at work, marked by bouts of angry outbursts, moodiness, and sarcasm towards coworkers.

Sam appears to be a relatively bright, articulate individual who is employed as a photographic editor at a large marketing firm. Sam’s major concern is the stress that he is feeling at his current job. He is concerned that his supervisor does not recognize his efforts, and is trying to “keep him on the back burner” and prevent future advancement in the organization. Sam is very frustrated by this, as he reports that when he first started working at the company, his supervisor “was an amazing mentor who literally took me under his wing.” Sam reports that he has done “everything that he could” to win back the approval of his supervisor.

Sam says he feels “empty and bored” lately. He is considering making a career change but is not certain what he would like to do next. He reports that he has an active social life, going out several times per week to clubs and bars. Although Sam does not use recreational drugs, he does note that he sometimes “drinks too much when he is out partying.” Recently, he was involved in a physical fight with another man at a bar.

Although currently single, Sam was married twice previously (for 2 and 5 years, respectively). He described his second divorce as particularly painful, during which he was briefly hospitalized for a failed suicide attempt. He is very eager to be in a relationship now, and believes that he just has not found “the right woman.”

Occupational History: Sam has had frequent changes in type and place of employment. He has worked in a variety of settings.

Educational History: Sam attended college, but left midway through his senior year.

Medical History: Hospitalization at age 26 for suicide attempt, and at age 30 for gall bladder surgery. No current medications or treatment.

Family History: Sam has one older (age 34) and one younger (age 28) sister. Both are married and live in the same town as Sam. Sam’s parents are still married, but when Sam was a young boy, his father suffered a “nervous breakdown” and left the family for 6 months. His parents are both retired, and travel frequently. He describes his father as a “serious, distant, hard-working man” and his mother as a “soft, warm, saint who put up with too much from everyone.”

Alcohol/Substance Use: During adolescence, Sam experimented with a wide range of illegal drugs and prescription medications. Since his mid-20s, he has restricted his substance use to alcohol to 3–6 drinks per night, 2–3 nights per week.

Case Study: Kyle

Name: Kyle Gender: Male Age: 40 Ethnicity: Caucasian

Religion: Lutheran Relationship Status: Married

Description of Presenting Issue:

Kyle’s wife urged him to contact you because she was concerned about radical changes in his behavior. As a reservist in the U.S. Marines, Kyle has been deployed twice to serve in Iraq. During his first deployment, he was stationed in Kuwait and had an uneventful service. However, his second deployment was marked by a significant tragic event. During a weekend leave, Kyle was exploring a rural marketplace with several military colleagues. A bomb detonated at the market, killing several dozen local civilians, and one of Kyle’s colleagues. Kyle, who was not hurt in the blast, heroically assisted both his colleagues and many of the civilians who were critically wounded.

Since returning home 10 months ago, Kyle has been unusually withdrawn. He will not discuss his time in Iraq with his wife or family, and becomes quickly irritable when asked by friends about his deployment. Kyle’s wife reports that he frequently has nightmares in which he calls out or cries in his sleep. Kyle, himself, has not mentioned these nightmares. She has also noticed that Kyle seems unable to sit though a movie, a pastime that they both used to enjoy regularly.

Last month, a rash of nighttime burglaries occurred in Kyle’s neighborhood. Kyle became fixated on protecting his house and family, often staying up through the night and walking around the house repeatedly.

Kyle reports that although he cares about his family, he cannot seem to “connect” with them anymore. He can see that the change in his behavior is taking a toll on his marriage, but he does not believe that he can do anything about it.

Occupational History: Kyle is a software programmer. He has held various positions in the technology field, including management, but he prefers to write code.

Educational History: Kyle received his bachelor’s degree in computer science.

Medical History: Kyle is being treated for gastroesophageal reflux disease. His physician is treating the condition with Tagamet and dietary change.

Family History: Kyle is an only child. His parents adopted him when he was 9 months old; he has no contact or knowledge about his birth mother. He describes his father as “very caring, but very strict.” On the contrary, Kyle’s mother tended to spoil him and she refrained from disciplining him when he was growing up. Kyle’s father was an alcoholic and he would occasionally erupt in a drunken outburst. On rare occasions, he would lash out physically against Kyle or his mother.

Alcohol/Substance Use: Due to his father’s history, Kyle does not use alcohol. He occasionally takes prescription painkillers given to him by a friend to help him “chill out.”

Case Study: Joanne

Name: Joanne Gender: Female Age: 64 Ethnicity: African American

Religion: Methodist Relationship Status: Widowed

Description of Presenting Issue:

Joanne was referred to you from the pastor at her church who was concerned about her welfare. Six weeks previously, Joanne’s long-time partner, Anne, died of unexpected heart failure. Having been together for 31 years, Joanne reported that she was having significant difficulty “moving on, and taking care of basic things.” She has not returned to her part-time position at the local library, and generally avoids contact with friends and family. She has two adult sons from an early marriage, but says that she does not want to “burden” them with her problems. She has avoided dealing with much of the legal issues and paperwork resulting from her partner’s death.

Joanne reports that she ruminates about her relationship with Anne, focusing on feelings about not having appreciated her enough during their time together. She feels “lost” and is unable to find purpose or meaning in her life. She has strong feelings of worthlessness, and spends hours thinking about how she “should” have lived her life.

Once an avid hiker and golfer, Joanne has not participated in either since Anne’s death. Joanne reports that she now wakes up late, “putters around the house” and takes a nap in the afternoon. She is eating poorly, relying on take-out food and sweets for meals.

Occupational History: After a fulfilling full-time career with the county library, Joanne transitioned to part-time work at age 60 to travel more with Anne.

Educational History: Joanne earned a master’s degree in library science. She also took several continuing education courses in creative writing.

Medical History: Joanne is being treated for hypertension and diabetes. She is moderately overweight, but was generally fit up through her late 50s. Both pregnancies were normal and uncomplicated.

Family History: Joanne is the eldest of six siblings. Her father (deceased) was an officer in the military and the family moved frequently throughout her youth. Joanne is very close to her mother, who now lives in an assisted living home in a town several hours away. Joanne has good relationships with her siblings except for her youngest brother, Roger, who does not “accept her lifestyle.” She and Roger have not spoken for nearly 15 years.

Alcohol/Substance Use: Joanne reports drinking occasionally (3–4 times per month). She does not smoke or use recreational drugs. She has been prescribed Ambien by her physician to help her fall asleep and reports that she needs the Ambien “most nights.”