social work case study and need the explanation and answer to help me learn.
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Case Study Assignment Instructions
This Case Study Assignment is designed to help you apply the course content to a counseling situation. In this Case Study Assignment, you will have the opportunity to think through a clinical case, identify and prioritize key issues involved, consider and clarify relevant diagnostic issues, provide one assessment to clarify the case, and formulate treatment recommendations that are most likely to be helpful to the client. This Case Study Assignment will directly apply to your work in COUC 667 and with clients when you begin practicum.
For this assignment you will read the case study then generate a report that uses the following outline. Each section should be separated by the appropriate APA headings (Level 1, Level 2…).
Client Concerns: Using a table as in the example above, identify and list the client’s symptoms and any other key issues/concerns noted. (Modify the chart size as needed.) For example, these may include biological, psychological, social, and/or spiritual problems. If symptoms/behaviors overlap, you only need to list them once.
Provide one assessment that will be used to clarify the diagnosis — a valid assessment that a counselor can use. Give a short (3-5 sentences) overview of the assessment, what it would help you learn about the client, and why you chose it over other assessments (for example: Beck Depression Inventory: identifies clinical depression, strong research base, short, easy to administer and score). Provide one peer-reviewed journal article reference to support the use of this assessment.
Provide the primary diagnostic impression based upon the DSM-5-TR. Include the ICD-10 code and full name of each diagnosis. Be sure to consider secondary disorders in addition to the primary disorder. Is there more than one diagnosis? Provide the following for all diagnoses.
Signs and Symptoms
List the signs (client’s report) and link them directly to the symptoms (criteria you find in the DSM-5-TR) in table form (example below) to make sure you have linked every client sign to every DSM-5-TR symptom you will use to support the diagnosis. Be sure to adjust the size of the table accordingly. If there are client reported signs that do not fall into the DSM-5-TR diagnosis, make note that you considered them, but they did not align with the DSM-5-TR.
Other DSM-5-TR Conditions Considered
List symptoms of other disorders and other DSM-5-TR diagnoses you considered and the process you went through to decide they were not the correct diagnosis. For example: “The client reported three symptoms of Major Depressive Disorder (insomnia, depressed mood, and trouble concentrating), but five symptoms are needed for this diagnosis, so the disorder was ruled out.”
Developmental Theories and/or Systemic Factors
Discuss theories of normal and abnormal development and/or systemic and environmental factors that affect human development, functioning, and behavior. For example, consider questions such as “What Erikson stage is the client in?” or “What is occurring within the client’s family system that may be influencing the client’s current functioning or behavior?” Provide one peer-reviewed journal article reference to support your discussion.
Multicultural and/or Social Justice Considerations
Using the RESPECTFUL model acronym (below), choose at least one of the client’s identities and discuss multicultural or social justice considerations that went into your diagnostic thought process. The case study may or may not explicitly discuss each of these; based on what is known about the client, explore how this identity may influence their lived experience. For example, what would the client say about their symptoms/situation from their cultural point of view? Is/Could the client be experiencing concerns related to discrimination, marginalization, oppression, etc.? Provide one peer-reviewed journal article reference to support your discussion.
Economic class background
Sexual (and/or gender) identity
Trauma/threats to well-being
Unique physical characteristics
Key Issues for Treatment
In bullet point form, identify the top 2-3 symptoms/issues you believe are involved in the case study, in order of importance.
The goal here is to clearly delineate what you believe will be of the most help to your client.
Recommendations for Individual Counseling
Individual counseling recommendations: Identify two treatment recommendations for individual counseling based on the 2-3 key issues you identified. You will need to cite these recommendations using one peer-reviewed journal article for each recommendation (at least two references for this section), focusing on the treatments a counselor would provide. Examples of these include but are not limited to dialectical behavior therapy, cognitive behavioral therapy, eye movement desensitization and reprocessing, etc. Referral to another type of therapy (e.g., group counseling, family therapy, inpatient) may be a recommendation, but since these are case management, they do not count towards the two required recommendations and should not be the primary recommendations listed. Consider recommendations that will be motivating to your client and reflect a collaborative approach. Be mindful of multicultural, ethical, and social justice considerations. Approach this part of the assignment as your exploration of what you would do with this type of client in individual counseling.
Medication considerations: Discuss whether you would refer the client for a medication evaluation and discuss why or why not. If you would refer, provide a brief discussion of the research regarding the use of medication for this diagnosis. For example: which symptoms would be the most likely to benefit from the use of medication? What broad classification of medications might be prescribed (e.g., anti-anxiety, anti-psychotic, mood stabilizers, etc.)? Be sure to provide at least one scholarly reference to support your discussion.
For each case study you will have one specific consideration. You will need to provide one paragraph responding to the questions that correspond with each case study. In your response to these questions, address how these considerations affected your diagnostic impression and your treatment recommendations. Provide one peer-reviewed journal article reference to support your discussion.
Amara – Case Study 1: How important of a role does cultural background play in this case? What additional information would you need about her culture? What kinds of values conflicts might you experience due to the client’s culture? How would you manage your personal values while working with this client?
Sam – Case Study 2: How does a client being in crisis change the focus of your assessment and treatment planning? How might a client being in crisis affect a diagnosis?
Jeff – Case Study 3: How do multiple diagnoses affect the decision-making process for diagnostic impressions and treatment planning? How do you decide what disorder you might address first, or do you address both simultaneously? How does a substance use disorder affect the process of diagnostic impressions and the order you make treatment recommendations?
Theo – Case Study 4: How might you use a trauma-informed treatment approach with this client? How important is it to collaborate with the client when treatment planning? What are some barriers you might encounter treatment planning with this client and how might you address those barriers?
Victor – Case Study 5: How might the client’s age affect diagnosis and treatment recommendations? What kind of consideration must be made for the family system?
Each Case Study Assignment is to be 6-8 pages in length. This excludes the title page and reference page. Use current APA format. The Case Study Assignment does not require an abstract. The Case Study Assignment requires a minimum of 7 resources from peer-reviewed journals. This includes the use of the DSM-5-TR textbook as a reference. All resources need to be less than 10 years old.
Be sure to review the Case Study Grading Rubric before beginning this Case Study Assignment.
Note: Your assignment will be checked for originality via the Turnitin plagiarism tool.
Amara Case Study
Amara is a 68-year-old widowed Asian American. She lives in a condominium she and her husband purchased prior to his death 4 years ago. Amara has three adult children who live outside her home. Her oldest daughter lives in the same suburban community, while her middle son and youngest daughter both live in adjoining states. Amara is the primary caretaker of her 90-year-old mother who lives in the home with her. Her father died of natural causes ten years ago. Amara stated that she took on the care of her mother to keep her from entering a nursing home, which would be shameful for her to allow. Amara’s parents immigrated to the United States from India two years prior to Amara’s birth and she holds to many of her parents’ South Asian traditions, including the need to prevent her mother from entering a nursing home. Amara reported that the primary reason she is seeking counseling is due to her increasing anxiety. Her oldest daughter, who also provides care for Amara’s mother, has threatened to stop coming to the home if Amara does not do something to get her anxiety under control. Amara saw her family doctor and requested medication to help with the anxiety. She was prescribed Paxil and has been taking the medication for four weeks. Her doctor referred Amara to you for an assessment and treatment.
Amara reported that she has always been “high strung” according to family and friends. Amara’s oldest daughter confirmed that “Mom has always been somewhat anxious. When I was growing up she would have been classified as somewhat of a helicopter parent. Not really pushing us to succeed, but always being present, worried, and attempting to protect us from some sort of unseen harm that she always believed was on the horizon. Ever since her retirement she has gone from being high strung to absolutely uncontrollably anxious about everything.” Amara stated that her mother was very anxious until she went into menopause and has relaxed a lot in the last 30 years. Amara reported that three years ago she began having some trouble sleeping but attributed it to her life changing so much in such a short time. She reported that she started noticing that her mind would race with various worries for part of the day 2-3 days a week about 2 years ago. In the past 18 months the worry has increased to daily for a majority of the day. Amara stated that she worries about “Are the kids safe? Do I have enough money for the rest of my life? Is the condominium building I am living in going to fall into a sink hole? Do people like me? Did I say something stupid when I was talking to someone? Do my grandchildren like me? Will my children take care of me when I am 90? Am I allergic to milk? I love milk and would be so sad if I developed an allergy. Is the chicken I just bought safe or does it have salmonella? Do I look OK or do people see me in public and think I am crazy? Do I have body odor? How are the kids in my classes doing? Are they successful or did I do something to lead them down the path to being criminals? Is my neighbors dog going to bite me and if he does, will my neighbor yell at me? Will I get rabies? Am I taking good care of my mother? Would my father and husband approve of the care I am giving her?” Amara continued for at least 5 minutes with a wide variety of worries. She stated several times that she has never experienced any of the events she is worried about. She has never had food poisoning, any traumatic injury, any family member harmed, or any friend/ neighbor express dislike for her. She stated she rationally knows that her worries are unfounded, but she is unable to stop them from popping into her head. “Once they are in my head, I cannot seem to let them go. They roll around and around until another worry pops in and takes over. I try to tell myself to stop worrying… to just stop. It never works.”
Amara reported, and her daughter confirmed, that she has been very difficult to get along with since the worry increased 18 months ago. She is irritable and will “snap” at her daughter and mother if they confront her about her worry. She will also get angry when her other two children tell her to stop calling to check on everyone. “About a year ago I started calling my son and younger daughter daily to make sure that everyone in the family was safe and that none of my worries had come true. My daughter will always answer the phone but in the last several months she is started telling me that she’s going to start letting my calls go to voicemail because I spend 30 minutes listing off all the terrible things that could happen to her family. My son’s wife tends to answer the phone when I call and but she has started letting my calls go to voicemail. She and my son will call me about every other week to make sure I’m OK. But outside of that, they have no contact with me right now. This makes things very difficult as I used to have a very good relationship with my son and daughter-in-law and their children. I miss interacting with them about things besides my worry, but I just can’t help the worries spilling out when I talk to them.” Her older daughter reported that she and Amara have gotten into multiple fights over the last 12 months because of Amara’s irritability and constant reports of worries. Amara reported this strained relationship also makes her very sad as she had a very positive relationship with her older daughter until about two years ago. Amara stated that even though she is sad over the strain in her relationships, the emotion she feels most of the time is worry and anxiety.
Amara reported that over the past 24 months she has felt increasing tension in her body. “I used to get a headache 1-2 times a year. I now have a headache 3-4 times a week. The doctor and my daughter call them my worry headaches. My shoulders and neck hurt all the time and I feel like a rubber band that has been overwound.” Amara stated that for the last 12 months she has difficult sitting still when she starts to worry and will often get up and walk around due to feeling like she might “jump out of my skin at times.” She went on to report, “You would think because I feel wound up all the time that I would have a lot of energy and I would get a lot of things done. But I don’t! I feel tired all the time and I have a really hard time motivating myself to do anything around the house that doesn’t absolutely have to be done.” She reported her fatigue has been present for at least 12 months. Amara has been struggling to sleep for the past 18 months. She stated that in the past 12 months she has struggled to get to sleep nightly, laying in bed awake worrying for at least 1-2 hours every night and waking up worrying after 5-6 hours of sleep. Prior to her retirement, Amara slept 7-8 hours a night. Amara reported all of these difficulties have occurred daily for the past 12 months. She stated that prior to a year ago, “Some of these things like sleep and being fatigued happened two to three days a week. And then two to three days a week I would feel really wound up and tense. It’s like they would trade off with each other, two of them visiting me and then going away and then two others coming to visit and then going away. These past 12 months I feel like they all have moved in with me forever. “
When Amara discussed her husband, she smiled at the memory of their relationship and then appeared sad as she recounted his death. Amara stated that she and her husband were married when she was 30 years old. She stated they had a very positive relationship and she had always been happy in the marriage. She reported that her husband was diagnosed with cancer two years prior to his death. “For the entirety of that two years, I juggled working full time, taking care of my mother who had just moved in with us, and caring for my husband. And I never felt overwhelmed like I do now. Even when I knew that he was not going to live much longer, I didn’t worry like I do now.” Amara stated that she felt very sad and cried a lot the year after her husband died. She stated, “Every day I will think of him and miss him and some days I still feel sad. Now I think more about the good times I had with him and laugh with others when we tell funny stories about him. He had a great sense of humor and kept everyone around him laughing!”
Amara stated that she retired 3 years ago. She worked full time as an elementary school teacher in various grades and school districts since she was 24 years old. She stated that she decided to stay at work an extra year after her husband died. She reported, “It gave me a sense of normalcy and a reason to get up in the mornings.” Her school district has a mandatory retirement age, and Amara stayed until she was forced to retire. She considered applying for another job in a different school district, but that would have resulted in her having to move. Because she depends on her daughters help with her elderly mother, she did not feel like she had the freedom to move.
Amara stated that after she retired from her job, she did feel sad for about six months. She stated that she worried what she would do with her time and had moments where she felt like her usefulness might be over. She reported that currently she doesn’t feel sad about leaving her job but worries about things like finances. When questioned about her financial situation, Amara stated that her husband left a significant amount of money when he died, and she has a substantial retirement account. She stated that she makes more money per month now than she ever did while working. Amara acknowledged that her worries about money are completely unfounded, but she will find herself consumed with worrying about finances several times per week.
Amara stated that she does miss her coworkers and that was the hardest part of leaving her job. A lot of her social network was formed from coworkers. She stated that after she retired, she kept in touch with some of them but over the last 18 months has lost touch with everyone but two friends. Her friends have confronted her about her constant worry and have expressed that they enjoyed spending time with her much more prior to her increase in worry. Currently Amara spends most of her time caring for her elderly mother and helping her oldest daughter with her children. Amara reported that she enjoys being with her family but worries about them all the time. Amara’s daughter reported that she desires to have a good relationship with Amara and that she wants her children to have a close relationship with her grandmother. She stated that this has become harder and harder recently due to all the worry. She reported that her children have started to notice how difficult it is to be around their grandmother and have started asking to be excused from family gatherings that involve their grandmother. Her daughter has informed her of this situation. Amara stated that it made her cry for several days when her daughter said her grandchildren did not want to be around her. “I am now worried that no one would ever want to be around me again and that I will die alone in the streets, forgotten and rejected by my friends and family.”
Amara reported that prior to her husband’s death they would have a 1 glass of wine 2-3 days per week. She stated that for a year after her husband died she stopped drinking altogether. “I already felt really sad and I had read that alcohol is a depressant, so I figured if I wanted to start feeling better I should not drink.“ About six months after her retirement Amara began to drink wine again, approximating that she drank 5 to 6 glasses per week. In the past 12 months Amara stated that her wine consumption has increased to having two glasses of wine five days per week. She stated that the wine does “help take the edge off of me a little bit and makes me feel somewhat relaxed. A little bit! But I know what happens when people start to self-medicate… and I am not going there! Too many in service training about alcoholism and teachers.” Amara stated that she does not feel like her alcohol consumption has not gotten out of control and that the same amount of alcohol has the same effect on her. Amara’s older daughter reported no concerns about Amara’s alcohol use and stated “Sometimes I wish she would drink more so she would just calm down. Not really, but you know, anything to get her to stop being so anxious.”
Amara reported no preexisting medical conditions and no medication prior to the doctor prescribing her Paxil four weeks ago. She stated she entered menopause around 60 but did not notice the decrease in anxiety like was observed in her mother. She stated that she has taken the Paxil daily and has not started feeling any less anxiety. She stated the doctor did explain to her that it could take multiple weeks for the Paxil to work and she could need an increase in the dosage in the next 6 to 8 weeks. She also reported an understanding that Paxil may not be the medication that works for her and she may have to go through several trials to find an effective medication. “I really hope this one works because I don’t want to damage my relationships any more than they have been. But if the doctor tells me to try something different because my worry doesn’t decrease, I’ll do it! I don’t want to live like this anymore!” Amara reported no history of any other mental health diagnosis and has never been to a counselor before. Her daughter stated, “There are many times I wished my mom would get help, but she never did. Counseling was not an option in her family growing up and you always kept family problems in the family. I am so glad she is taking this step now.”
Amara reported that she is Hindu and would be interested in integrating the teachings of her religion into counseling.
When asked about her motivation for counseling, Amara stated that she has to continue to care for her mother. “It would be so much shame on my family. Both my mother and father still have lots of family in India and I would never be able to face any of them again if I allowed mother to go to a nursing home. And I need my daughter’s help to care for my mother. I also deeply value my relationships including my children, grandchildren, extended family and friends. I think my daughter telling me that her children didn’t want to be around me anymore was a bit of a wakeup call for me.”