Accredited by the Higher Learning Commission of the North Central Association of Colleges and Schools

100 Washington Avenue South, Suite 900, Minneapolis, MN 55401

www.waldenu.edu

College of Social and Behavioral Sciences

School of Counseling

Counseling Masters’ Programs

[email protected]

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)

Counselor name:	Client age:
Client initials:	Client race or ethnicity:
Number of sessions with client:	Self-identified gender:

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

     

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

· Family substance abuse history

· Family violence or abuse history

· Stage of development impacts

· Developmental challenges

     

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

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.

· Describe strengths, assets, protective factors, signs of resilience.

     

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

     

PART II

(Due
Day 7 of
Week 8)

Counselor name:	Client age:
Client initials:	Client race or ethnicity:
Number of sessions with client:	Self-identified gender:

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.

· 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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Accredited by the Higher Learning Commission of the North Central Association of Colleges and Schools

100 Washington Avenue South, Suite 900, Minneapolis, MN 55401

www.waldenu.edu

College of Social and Behavioral Sciences

School of Counseling

Counseling Masters’ Programs

[email protected]

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)

Counselor name:	Client age: 10
Client initials: CH	Client race or ethnicity: African-American
Number of sessions with client: Assumed to be the initial assessment	Self-identified gender: Male

Presenting Problem

Christian, a 10-year-old African-American boy, is the smallest among all his siblings and lives with his mother and his elder brother in Washington, D.C. No legal problems with Christian are reported, and he has no previous experience with counseling, psychiatric treatment, or inpatient hospitalization. Christian’s referral to an evaluation came from the report of his intending to harm himself, which he further explained was his wish to become an animal and communicate with God upon reincarnating. Furthermore, at school, he is bullied by two girls, and the emotional neglect and academic difficulties eventually push him away from his peers. Christian exhibits depression with all the symptoms of the disorder, like feeling sad, very tired, and having negative feelings towards things that he used to like.

Reports from students (Christian’s peers) revealed in the past suicidal ideation and bullying. He goes through a cyclic pattern of his moods, which results in melancholia, apathy, and the idea of leaving his human body and becoming an animal. Although he is slightly contemplating suicide, he has never acted upon it. However, the symptoms manifest themselves differently (in terms of frequency and severity), yet they have been greatly distressing to the victim and his family. Christian feels depressed due to having no friends, his poor academic performance, and bullying by classmates, which greatly hinder his concentration on school work. This desire for emotional support prompts him to question his feelings and wonder what different emotions mean to him as a person.

Family Structure

Christian’s family setup is instrumental in establishing the nature of his struggles and worries. Within the family of his origin, he lives with his mother and brother, being the youngest child. Serving as both a listener and a family member, Christian may become accustomed to receiving advice and support from senior family members, but he may also encounter several challenges as the youngest member of the family. Despite the absence of his father, his sister not coming to the home since December 2021, and his mother filing for divorce, Christian still has a solid household setting. Nevertheless, as patients experience the break in their visit schedules and their families disintegrate, it is possible that they will develop feelings of instability and emotional distress (Monk et al., 2022).

To describe the important relationship patterns in Christian’s life, he is loyal to his mother and brother. Nevertheless, the lack of ample time with his nonresidential father and/or disturbance in visitation patterns could impact Christian’s emotional growth and feelings of stability within the family. Besides, the bullying in school that Christian has to face in addition to his relationships with his fellow students may worsen these social isolation and loneliness problems.

At present, Christian lives with his mother and brother in Washington, D.C. Their dwelling encourages stability and a sense of familiarity from his nostalgic beginnings. Besides no major loss or family trauma, the fact that he does not see his father which may have a long-term effect on his feelings. There as no information about the family’s mental health history, treatment, or hospitalization. While it is conceivable that, as a result of this, Christian will not have to grapple with mental health problems, this may in turn contribute to their overall well-being by offering a family that is supportive and caring. Another thing is that there is no record of substance abuse or violence in the family background, and that`s also one of the factors that obviously gives a good arena for Christian.

At the age of 10, the way Christian would stage the escalation of family circumstances could affect Christian’s family dynamics as well as external stressors. His developmental tasks may comprise learning about his place in society, dealing with his emotions, and managing different academic and social stresses. Careful consideration of Christian’s stage of development is vital to the intervention and a support system that is more helpful to his requirements for growth and development (Anastasia et al., 2022).

Multicultural Considerations

In considering Christian’s position, it is necessary to look into some multicultural factors that may influence his perceptions. In contrast to the unadulterated innocence of childhood, Christian, as a black boy, may face special issues, centered around racial identity and discriminatory behaviors. According to Blawert & Wurm (2021), historical and societal issues may impact his self-perceptions of value, and he holds on to those perceptions strongly, especially when in predominantly white environments. Likewise, Christian never has direct mentions of his religion, but his perception of concepts like rebirth and talking with God is possibly influenced by religion or cultural practices that are popular within his community.

The symptoms of Christian, as per report is, depression and difficulty concentrating, point to the possibility that he has issues with emotional navigation and paying attention. The challenges he is facing must be identified and met with the provision of suitable support programs to make sure his welfare is secured. The environment in which Christian is, permeates his identity as a pivotal condition for his development.

Christian’s upbringing features a family background that is possibly of a lower socioeconomic rank, and it may impair the availability of resources and access to support systems. Financial stressors will not lead to easy solutions, and they will other heighten other problems, like bullying or academic problems, thus making a strong support system a necessity. There were no reports of criminal histories with Christian or his family.

Christian’s residence in Washington, D.C., will possibly create the influence for him to grow through various cultural and social experiences that are found within urbanized settlements. Understanding these factors can be a source of new knowledge concerning his experiences and thus a basis for the development of specific interventions. Ecological factors, like, the types of neighborhoods, the access to recreational facilities, and the presence of environmental hazards that can cause pollution or have long-term effects on a human’s well-being and overall development, play a role in Christian’s well-being (Schaafsma, 2021). As a black teenage boy in a situation of being victimized by bashing and emotional struggles, Christian could possibly suffer from overt feelings of oppression or more. Recognizing and supporting him, which will give him validation of his experiences and increase his resilience, is what I consider a significant part of the promotion of his psychological well-being.

Narrative Summary

Christian’s situation is complex and multi-dimensional, with different forces such as the family structure, culture, and experience having an influence on it. The first priority of this patient is intentional self-harm, which, from his own point of view, is imagined as a way to communicate with God and prove reincarnation. This stance holds true because of the misinterpretation of events. Christian’s pain, surrounded by the problems of bullying at school and social exclusion, gives him no choice except to try to find meaning in life. As we see it, Christian’s adolescence is not easy, and it is definitely heavier for him than for an ordinary teenager. This is where he comes out as a deep thinker and a child who is well beyond his age when it comes to feelings and concepts. In spite of a strong facade, he is a very sensitive person in reality, which is shown in his manner, providing clues about his doubts about self-worth and identity.

My opinion of Christian is that he is a reflective and creative boy, keenly observing little details in his thoughts, which help him come to conclusions. He has a tremendous desire to figure out the meaning of life by doing scientific research and answering life’s philosophical questions. Nevertheless, the sheer magnitude of bullying and social seclusion has undoubtedly contributed to his emotional deterioration—a state of complete disconnection and loneliness from all his peers.

More than one factor is in the pattern of the issues presented by Christian: bullying, family affairs, and internal conflict with the issue of his identity and belonging. Christian’s fatherless upbringing with inconsistent visitation may have easily made him feel unloved, and he may have also longed for fatherly care and support. This lack of fatherly affection and guidance not only made it worse but also intensified his loneliness and low self-esteem (Krauss et al., 2020). Christian undertakes acts such as disclosing suicidal tendencies and believing in rebirth to cultivate a sense of significance and well-being in a sometimes crime-ridden and daunting environment. That is to say, these rituals assist him in handling even the most extreme hardships by replacing the destructive behaviors of the character and building the emotional world of the story.

In Christian’s tale, concepts of loneliness, nostalgia, and the process of self-identity can be seen. He attempts to find the solutions to the existental questions of life and death, reinforcing his grievance as the purpose of the world. He relies on spirituality and the idea of reincarnation. As a result of being bullied or socially marginalized, this aspect of the personality is full of impressions of failure and self-worth problems that stem from bullying or social isolation. The stigma surrounding mental health, which is not widely accepted as a real health issue, the lack of support facilities, and not having a role model who can help be an example are the things that Christian struggles with as he tries to find a way of growing and coping. Such obstacles force him to act alone and seek nothing but solutions to his problems in anger, which in turn leads to self-isolation. It is not just the cold, hunger, and uncertainty of life that make Christian’s very existence a problem; it is his unwavering spirit and unblinking courage that make him indispensable. The fact that he opens up about his emotions and confides in members of the school staff and his family radically exposes his inclination to face his plight and seek recovery. Beyond that, Christian’s imaginative mind and spiritual outlook, even though they were a result of the circumstances he was put in, can be viewed as a source of solace and hope, giving him a renewed sense of direction and purpose in hard times.

DSM–5 Diagnosis

According to specific features and based on the presented information, the most likely diagnosis for Christian by the DSM-5 would be adjustment disorder with mood depression (F43.21). Such a diagnosis is especially valid considering the major distress and limitations in social activity, performance in studies, and ability to feel and express emotions that Christian is going through as a result of his schooling experiences, sad feelings, and thoughts of becoming an animal. In the given case, adjustment disorder with depressed mood becomes the right diagnosis after observing depression-like symptoms, such as sadness, lack of energy, and loss of interest in activities (Schulz, 2020). The reason this diagnosis is made is because of the clear relationship between the bullying at school and the onset of Christian’s symptoms (the temporal relationship between these two factors). His symptoms of the criteria set forth in the DSM-5 for adjustment disorder include impaired normal reactions and distortion, which is beyond the measure of the stressor’s intensity.

In addition, MDD (major depressive disorder) and anxiety disorder were the other diagnoses that the mental health professional could have considered. Nevertheless, Christian’s experience necessitates the minimum five symptoms observed in MDD for a two-week period, which may not totally correspond with his condition. Anxiety disorder might be suggested, too, through the statements about fear and dread; however, the foremost of Christian‘s symptoms is the occurrence of mood disorder rather than anxiety. It is imperative to exclude diagnoses like bipolar disorder or psychotic disorders, given that hallucinations or psychotic traits are not present in Christian’s clinic (Perrotta, 2020). No clinical findings of disorganized thoughts, hallucinations, or delusions, which are the hallmark findings of these disorders, were found.

The diagnosis was determined through clinical interviews and observations of himself, as well as data provided by his family and his school. Although the given information did not mention any specific mental health scales, we could use standardized scales such as the Children’s Depression Inventory (CDI) of the Beck Youth Inventories (BYI) to analyze and evaluate Christian’s symptoms and monitor the progress of his treatment. Some other measurements that could be used additionally are the anxiety scales, for example, the Screen for Child Anxiety Related Disorders (SCARED), as it has been reported that Christian has experienced bouts of distress and worry. Also, taking into account incidents of Christopher’s bullying and employing tools that assess the intensity and severity of bullying, such as the BVSC (Bullying and Victimization Scale for Children), could be a powerful source for gathering information on his experiences that could be used for intervention.

References

Anastasia, O., Cattan, S., & Meghir, C. (2022). Early childhood development, human capital, and poverty.
Annual Review of Economics, 14, 853-892.
https://www.annualreviews.org/content/journals/10.1146/annurev-economics-092821-053234

Blawert, A., & Wurm, S. (2021). Shifting self-perceptions of ageing: differential effects of value priorities on self-perceptions of ageing beyond age stereotypes.
European Journal of Ageing, 18(2), 257-267.
https://link.springer.com/article/10.1007/s10433-020-00578-3

Krauss, S., Orth, U., & Robins, R. W. (2020). Family environment and self-esteem development: A longitudinal study from age 10 to 16.
Journal of personality and social psychology, 119(2), 457.
https://psycnet.apa.org/record/2019-55801-001

Monk, J. K., Kanter, J. B., & Ogan, M. A. (2022). Prior on–off relationship instability and distress in the separation and divorce transition.
Family process, 61(1), 246-258.
https://onlinelibrary.wiley.com/doi/abs/10.1111/famp.12653

Perrotta, G. (2020). Psychotic spectrum disorders: definitions, classifications, neural correlates and clinical profiles.
Ann Psychiatry Treatm, 4(1), 070-084.
https://www.researchgate.net/profile/Giulio-Perrotta/publication/349002054_Psychotic_spectrum_disorders_Definitions_classifications_neural_correlates_and_clinical_profiles/links/60218db2a6fdcc37a8126ff3/Psychotic-spectrum-disorders-

Schaafsma, M. (2021). Natural environment and human well-Being.
Life on Land, 688-699.
https://link.springer.com/referenceworkentry/10.1007/978-3-319-95981-8_104

Schulz, D. (2020). Depression development: From lifestyle changes to motivational deficits.
Behavioural brain research, 395, 112845.
https://www.sciencedirect.com/science/article/abs/pii/S0166432820305441

Rev: June 2020

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