Conceptualization and Diagnosis of Laura and James
# 3 Discussion 1 due 10/19/2019 – $15.00
Conceptualization and Diagnosis of Laura and James
You reviewed the cases of Laura and James in the study activities for this unit. Select one of these cases and respond to each of the questions below. Your initial post must be at least 250 words in length and include at least two references to a current article in the professional literature to support your ideas.
Start by considering the broad category of the client’s presenting issues. What words would you use to describe the client’s presenting concerns and the types of thoughts, feelings, and behaviors the client is experiencing? What broad categories in the DSM-5 do these words relate to (i.e., depression, anxiety, trauma, et cetera).
Next, look at the case study and review the specific symptoms the client is reporting. Compare these symptoms to those listed in the broad categories you have considered. In what area of the DSM do the client’s symptoms seem to fit best?
Select the DSM-5 diagnosis that you believe is the best match for the symptoms that the client is presenting and be sure to include the numeric ICD 10 code along with the name of the disorder.
Support your choice of diagnosis by listing the diagnostic criteria in the DSM-5 and noting for each one how the client has expressed this. Does the client meet all criteria for this diagnosis or are there some areas that you are not fully sure about?
If you do not have enough information about some symptoms that are required criteria for the diagnosis you have selected, what additional questions would you need to ask the client, or what other information would you need to obtain from other sources so that you could support an accurate diagnosis?
· Read Wilkinson’s 2015 article, “The Orientation Model: A Dual-Process Approach to Case Conceptualization,” from The Journal of Humanistic Counseling, volume 54, issue 1, pages 23–40.
· Read Kenofer’s 2015 article, “Developing Gestalt Case Conceptualization,” from Gestalt Review, volume 19, issue 2, pages 110–132.
· Read Scott and Cervone’s 2016 article, “Social Cognitive Personality Assessment: A Case Conceptualization Procedure and Illustration,” from Cognitive and Behavioral Practice, volume 23, issue 1, pages 79–98.
· Read Ellis, Hutman, and Deihl’s 2013 article, “Chalkboard Case Conceptualization: A Method for Integrating Clinical Data,” from Training and Education in Professional Psychology, volume 7, issue 4, pages 246–256.
· Review Christon, McLeod, and Jensen-Doss’s 2015 article, “Evidence-Based Assessment Meets Evidence-Based Treatment: An Approach to Science-Informed Case Conceptualization,” from Cognitive and Behavioral Practice, volume 22, issue 1, pages 36–48.
image2.png COUN6332 – Clinical Internship 2
image1.png COUN6332 – Clinical Internship 2
Unit 3 Case Studies
Laura
Laura is a 55-year-old Latina who is a former nurse. She has been married for 35 years to Raymond, who is 63. Raymond, who is also Latino, is a practicing physician who is nearing retirement. Laura met Raymond at a hospital when both were in training for their medical careers. They dated for less than a year and married when Laura was 20 years old. She continued to work as a nurse after graduation until their first child, a daughter, was born and Laura and Raymond agreed she should stay home to care for their child. Their son was born two years later. Laura did not return to her career as a nurse, and remained a homemaker and stay-at-home mother. Throughout the years, Laura and Raymond frequently socialized with other couples, although Laura did not form individual friendships with other women, stating she “just isn’t comfortable” with most women. Laura was an avid reader and an artist, and tended to enjoy quiet, solitary pursuits rather than joining group activities, so she resisted Raymond’s suggestions that she join women’s philanthropic groups or participate in volunteer activities. Laura and Raymond spent weekends with their children when Raymond was not working, and they always took family summer vacations and spent time on family activities. Laura’s parents live nearby and were very involved in the family activities as well. Laura is an only child. The family always considered themselves to be closely knit. Laura is in generally good health. Although she smoked cigarettes for 30 years, she quit seven years ago. She consumes alcohol daily and does not take any regular medications. She is sedentary and has gained 30 pounds over the past 15 years. Raymond does not smoke but he joins Laura in a nightly cocktail after work. He does not formally exercise but is on his feet most of the day at work. His weight is the same as it was when he was 25 years old. Raymond had prostate cancer five years ago; surgery and radiation treatments seem to have cured his cancer.
Laura’s children are now adults. Both completed college, found successful careers, and married. Laura’s daughter has recently given birth to her first child, a son.
In the past year, Laura has started to worry about her loved ones’ safety and well-being. She frequently becomes preoccupied with thoughts of injury or illness that could harm Raymond, her daughter or son, and now her infant grandson. Laura is unable to calm these fears or put them out of her mind. She often has trouble falling asleep because she “can’t shut down” her mind, and she wakes up in the middle of the night fearing something has happened to one of her loved ones. She is often fatigued during the day and is notably irritable. Lately, Laura has been calling her husband, daughter, and son several times a day, including when they are at work and cannot take her calls. She implores them to “be safe.” She has asked them not to drive or participate in social activities because they might have an accident or be infected with a disease by someone with whom they socialize. She is especially concerned that her infant grandson might contract a disease and die. She insists that her daughter not take the baby out or allow visitors. She has been known to drive to her daughter’s house at night to check whether the family is home, and if they have guests. Laura’s family members are beginning to be annoyed with her “meddling” behaviors and no amount of logical discussion seems to convince her that her fears are ungrounded. For this reason, her family is becoming upset with her and starting to avoid her.
James
James is a 43-year-old Caucasian male who has made his first appointment with you for counseling, saying he “just feels awful” about himself lately and he has “no energy to do anything,” although he does not know why. James has been married for 18 years and reports that his relationship with his wife is generally satisfactory, although their sexual relationship has significantly declined in terms of frequency and satisfaction over the past two years. James and his wife have two teenaged children who are reportedly healthy, active in school and other activities, and earning good grades.
James has a BA in business and has worked in a middle-management positon at a bank for 15 years. He reports that he earns a good salary but is bored with his job and does not foresee any ability to move up to a more interesting position without an MBA. He’s thought about going back to school for another degree but he can’t get himself motivated to start this process.
James reports he is in generally good health and takes no medications. He stopped running and going to the gym to lift weights about a year ago, although he can’t say why. Exercise used to give him a lot of pleasure but he has lost interest in it. Although he has always been slim and fit, James has gained 25 pounds in the last year or two. James states that his appetite has increased dramatically, which partially explains the weight gain. He also reports that he is experiencing insomnia. It is very difficult for him to fall asleep most nights and he tends to wake up in the middle of the night or very early in the morning, so he averages about five hours of sleep per night.
James has been in the habit of consuming one or two beers each evening when he comes home from work. His wife has always joined him with a glass of wine before dinner. In the past six months, James reports he has increased the number of beers he drinks to an average of four after work and before dinner. He says this helps him relax and fall asleep, although his wife has commented that his drinking concerns her.
Although James expresses his unhappiness with himself, he denies that he has had thoughts about suicide. He says that he sometimes thinks it would be nice to “not wake up tomorrow morning,” but he is not actively contemplating taking his life.
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