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College of Social and Behavioral Sciences

School of Counseling

Counseling Masters’ Programs

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CLINICAL MENTAL HEALTH COUNSELING

MARRIAGE, COUPLES, FAMILY COUNSELING

CASE CONCEPTUALIZATION FORM

This Case Conceptualization & Reflection Form will be used in conjunction with your recording assignment to analyze your skills demonstration. For these assignments, you will complete the case conceptualization on the client you have chosen for your skills demonstration. Ideally, this will be the same client for both Week 4 and Week 8.

FOR THE WEEK 4 CASE CONCEPTUALIZATION

PART I

FOR THE WEEK 8 CASE CONCEPTUALIZATION

PART II

PART I

(Due
Day 7 of
Week 4)

Presenting Problem

To understand the presenting problem, describe the client’s past and present. Be sure to address each of the following elements:

· Demographic information:

· Employment history:

· Relevant legal problems:

· History of counseling:

· Reason for seeking counseling, according to the client:

· Onset and duration of concern:

· Frequency and intensity of symptoms:

· What the client wants to improve:

IH is a 12-year-old Hispanic female who lives with her parents and two siblings, an 8-year-old brother and a 19-year-old sister. She is seeking counseling to address her depressive-related symptoms. IH self-reported sadness, hypersomnia, fatigue, lacks to do pleasurable activities she once found to be interesting, difficulty concentrating, and excessive guilt . IH remembers about a year ago she began to feel this way as a result of some of her father’s harsh criticisms of her academic performance and lack thereof contributions in the home. IH also reported feeling guilt and blames herself for her parent’s frequent arguments. IH has heard her parents arguing about her father’s infidelity that she acknowledges has impacted her relationship with her father. IH denies SI, but has reported a history of self-mutilation (cutting) to cope with her feelings of guilt. Her symptoms were self-reported to vary in intensity, but in general occurs most days. IH wishes to improve her mood, socialize, and have a better relationship with her father.

Family Structure

Clients and their concerns are shaped by their family structure and stage of development. Be sure to address each of the following elements and their impact:

· Family of origin and role within

· Family of choice if different and role within

· Significant relationships/relationship patterns

· Children, marriages, divorces

· Current living arrangements

· Major losses, family traumas

· Family mental health history: No reported history

· Family substance abuse history: Denied

· Family violence or abuse history: Denied

· Stage of development impacts:

· Developmental challenges:

IH lives with all members of her family. She is the middle child of three and is in the early years of her adolescence. IH could face developmental obstacles to include identity formation, independence, and emotional destress tolerance. The clinician noted her relationships with her parents and siblings are important to her. Her father’s adultery and harshness makes her feel mistrust, thus developing feelings of resentment. The urge for her to protect her mother’s feelings demonstrates the closeness she may have with her mother. No other major family traumas were noted to clinician. No family history of family drug misuse or family violence was reported at this time.

Multicultural Considerations

Clients and their concerns are shaped by a multitude of multicultural considerations and their intersectionality. Be sure to address each of the following elements and their impact:

· Race or ethnicity

· Religion

· Ability/disability

· Sexuality

· Socioeconomic status

· Military:

· Criminal justice system:

· Geographic influences:

· Environmental factors:

· Experiences of oppression or marginalization:

Multicultural influences cross to form IH’s issues and problems. The El Salvadorian society values patriarchy, with the father as the main earner and authoritative figure. This cultural norm may make IH feel powerless and responsible to her mother. Given the traditional norm of male control, IH may feel a greater obligation to assist her mother emotionally when her father is authoritarian and unfaithful. This may increase her shame and impotence in the family since she may feel like she’s not meeting cultural norms.

El Salvadorian Hispanic households generally emphasize religion. This may greatly affect coping and guilt/forgiveness. IH’s religious background may shape her morality, making her feel guilty when her parents fight. Religious teachings on forgiveness may also impact her capacity to cope with her father’s adultery and self-blame. Depending on her religious principles, her religion may console and strengthen her or contribute to her inner turmoil.

Salvadoran cultural standards might affect how IH views her sexuality and relationships. She may base her romantic partnership expectations on conservative sexuality ideals. If she feels her experiences or desires contradict societal standards, this may lead to isolation and difficulty making friends. She should examine how these societal expectations affect her self-esteem, body image, and identity as she reaches adolescence.

As a 12-year-old with self-reported sadness and self-harm, her age and ability status may alter how she views her capacities and resilience. Her Hispanic cultural norms about gender and sexuality may impact her sexuality. Socioeconomic status affects assistance and resources. Her geographic influence as an El Salvadorian may provide distinct cultural characteristics. While there are no explicit accusations of discrimination or marginalization, her multicultural background and family relationships should be examined to understand their complex involvement in her presenting difficulties and treatment planning.

Narrative Summary

Take a step back and, through the lens of your education to this point, work to conceptualize the big picture. Consider the influence of all the information in Part I. Consider how it has all culminated and impacted who your client is and their world view. Within that context, consider the problem they presented with for counseling and address each of the following elements:

· Describe your understanding of the problem.

· Describe your observations of the client.

· Describe your impressions of the client.

· Describe any factors contributing to or reinforcing the problem.

· Describe the purpose of the client’s behaviors.

· Describe themes and patterns that emerge or connect.

· Describe barriers to growth and coping. Not wanting to socialize

· Describe strengths, assets, protective factors, signs of resilience. Likes to journal, dance, play sports to cope.

My understanding of IH’s issue is complex and anchored in her family, culture, and developmental stage, according to the facts in Part I. IH often described herself as melancholy and feels guilty about her parents’ fights, troubled connection with her father, and a desire to enhance her self-confidence and self-image. Observations of the client indicate a 12-year-old Hispanic girl who seems to be in emotional anguish and internal struggle. Identity formation and self-esteem are crucial when she enters adolescence. My impressions of IH are that she is a strong and kind little girl who may have absorbed family problems and tried to protect her mother. Her history of self-harm may suggest a maladaptive coping method for emotional anguish and guilt.

Several factors exacerbate IH’s issues. Due to her father’s adultery and apparent harshness, she may have lost faith in the family. Depression and social withdrawal stem from her shame about her parents’ conflicts and her feeling that she is to blame. Her age and growth expose her to adolescent issues like identity discovery and independence, which might worsen her isolation and poor self-esteem. Self-harm and avoidance of socialization are two of IH’s behaviors. Self-harm may provide her a temporary release from emotional anguish or control. Her avoidance of socialization may be an effort to insulate herself from judgment or rejection and to avoid seeing her parents’ fights.

Themes and patterns in IH’s case include a strong feeling of family obligation, a desire to protect her mother, and a fight between independence and family. The theme of guilt is also strong, as she blames herself for her parents’ fights. Her unwillingness to socialize restricts her prospects for peer support and good social contacts, which are barriers to growth and management with IH. She also struggles with self-harm, which has to be replaced with healthy coping mechanisms. Her connection with her father may be another obstacle to her emotional well-being and family dynamics.

IH possesses several strengths and safeguards despite these obstacles. Journaling, dance, and athletics show her adaptability. She may express herself and empower herself via these activities. Her desire to seek therapy at her age shows self-awareness and drive for good change.

DSM–5 Diagnosis

It is of utmost importance to diagnose ethically and responsibly. You must consider all elements covered thus far not only in your understanding of the problem but in rendering a diagnosis. With this in mind, address each of the following elements:

· DSM–5 diagnosis:

· Rationale for how diagnosis was determined

· Two other diagnoses considered, but not given

· Explanation for ruling out diagnoses not given

· Mental health assessments or scales used:

· Other assessments or scales that could be used:

DSM–5 Diagnosis

The most suitable DSM-5 diagnosis for IH is Major Depressive Disorder, Recurrent, Moderate (F33.1) which is based on the information supplied and a comprehensive examination. This diagnosis is based on her self-reported depressive symptoms including sadness, loss of interest, hypersomnia, excessive guilt, fatigue, and difficulty concentrating. These symptoms somewhat disrupt her everyday life and are not better explained by other causes.

Non-suicidal Self-Harm: IH’s history of self-cutting suggests a maladaptive coping strategy linked to emotional discomfort. While not suicidal, self-harming activities are disturbing and may reflect an effort to manage overwhelming emotions or seek assistance.

Alternative Diagnoses and Reasoning for Ruling Out:

Conduct Disorder (CD) and ODD: Conduct Disorder (CD) is a pediatric mental health illness that causes chronic aggression, antisocial conduct, and social norm breaches (Wu et al., 2022). Oppositional Defiant Disorder (ODD) is similar to CD but lacks significant antisocial behaviors. It involves frequent disobedience, irritation, and antagonism toward authority authorities (Aggarwal et al., 2020). While IH displays some verbal rudeness and hostility, her behaviors are better explained by her emotional anguish and family relationships, not oppositional or conduct-related behaviors.

Mental Health Assessments or Scales Used

The Patient Health Questionnaire for Adolescents (PHQ-A) is a nine-item self-reported tool that measure that assesses the severity of depressive disorders and episodes in children from ages 11-17. An additional tool that can be used to detect depression in IH is the Children’s Depression Rating Scale-Revised (CDRS-R). The CDRS-R measures depressive symptomology in minors aged 6-12, but is also used in adolescents. The clinician typically administers the CDRS-R in a semi-structured interview with the child, parent, and teacher.

PART II

(Due
Day 7 of
Week 8)

Theoretical Orientation and Application

Your theoretical orientation influences your counseling approach. While you are likely still in the very early stages of considering and trying on different theoretical orientations, you have likely noticed that some seem to resonate with you more than others. While you have been trained in Person-Centered Theory, consider another orientation that most closely aligns with your understanding of human behavior and your approach to it. In doing so, respond to the following:

· State your preferred theoretical orientation and the original theorist. CBT

· Describe what elements of this preferred theoretical orientation resonate with you.

· Explain how this preferred theoretical orientation approaches client problems.

· Explain how this preferred theoretical orientation approaches positive change.

· Describe how this preferred theoretical orientation would make sense of your client’s presenting problem.

· Now select another counseling theory and contrast how it would make sense of your client’s presenting problem differently.

Treatment Planning

The nature of the treatment plan and evidence-based interventions should coincide with the needs of the client and the theoretical orientation utilized. Additionally, treatment goals should be SMART (specific, measurable, attainable, realistic, and timely). Using your theoretical foundation of Person-Centered Theory coupled with your preferred theoretical orientation described in Part II, respond to the following elements:

· Short-term SMART goal for treatment

· Interventions, approaches, and techniques to work toward this goal

· Mid-range SMART goal for treatment

· Interventions, approaches, and techniques to work toward this goal

· Long-term SMART goal for treatment

· Interventions, approaches, and techniques to work toward this goal

Ethical and Legal Considerations

Nearly all clients and every situation present the possibility for ethical concerns and dilemmas. It is important to be proactive and intentional in our consideration of what those might be. Ethical challenges can arise in a number of ways, including transference/countertransference, court-ordered counseling, informed consent, boundary violations, poor self-care, limits of confidentiality, and mandated reporting. Using the ACA
Code of Ethics, reflect on your work with the client and respond to the following:

· Describe ethical dilemmas present or potentially present.

· Identify your own barriers or challenges that may complicate the ethical dilemma.

· Explain the steps you should take to be intentional and proactive in your ethical approach.

Social Change Implications

The end of your work with a client should not be the end of your work. Each client impacts us as we impact them. Reflect on your client and their circumstances. Consider their efforts in relation to their successes and failures. Keeping in mind all of the information you have considered for this case and all of the insight you have gained, respond to the following elements:

· Address the systems and barriers the client experiences that impacted the current situation and outcomes.

· If changed or removed, identify what systems and barriers could impact positively upon this individual in the future.

· Discuss how your work with this client has informed your understanding of a larger social challenge or barrier.

· Identify steps you could take to effect positive social change in relation to this social challenge or barrier.

Rev: June 2020

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