Catherine is a 45 years old woman of Asian American descent and works as a marketing manager. She is heterosexual, married and has been with her husband for over 20 years, and they have two children. Catherine and her husband are the parents of two sons, ages 12 and 15. She and her husband are currently residing in their home in the US. Catherine grew up as the only child in a two-parent household with her mother and father. Her father is still alive, but her mother passed away in 2017 due to high blood pressure. Catherine stated that she was very close to both parents and was devastated when her mother passed away a few years ago. She had an accident and was hospitalized for more than six months. She reported increased stress during the period because she was the only breadwinner of the family because her husband had previously lost his job due to the outbreak of the COVID-19 pandemic. She reported no previous or current substance abuse.
Catherine reported having a healthy social relationship with relatives and friends. Every weakened, she must have a friend visiting or them being invited by another family. Catherine also stays with the husband’s three sisters, studying in college. They also live with a friend’s daughter because she traveled to the UK for studies. She reported a positive relationship with the in-laws, who also live in the US. They occasionally visit the in-laws, but they often talk through the phone. She likes reading books during her free time and spending with friends. In addition, as a family, they usually go for a vacation once a month to strengthen the ties. However, she likes staying alone and going for prayers at the local church when under stress.
Catherine expressed dissatisfaction with their relationship because the husband changed after the accident. She reported that the relationship deteriorates because her husband has started drinking, being abusive, and seeking a divorce. Catherine stated that her life had been squandered because she was filled with rage and resentment. Home is no longer a conducive environment for her because she frequently feels frustrated and demeaned. Catherine and her husband began having communication issues in their marriage. She recalls that he was not pleased with the turn of events and felt frustrated. As a result, Catherine believes the stress of worrying about their financial situation, the kids, and deteriorating marriage is having an adverse effect on her life.
Assessment of Client
A Mental State Examination (MSE)
Mental State Examination (MSE) is an essential part of the clinical assessment process. In this method, patients are observed and described according to their behavior, appearance, thought process, mood and affect, and thought content, all while being assessed on various domains (Black, 2018). To help therapists make accurate diagnoses and treatment, MSE aims to obtain a comprehensive description of the mental state and history of the patient. This information is combined with the historical and biographical information of the psychiatric history.
|Appearance||Catherine was dressed appropriately in a knee-length dress that appeared ironed and cleaned. She was well-groomed with well-kept hair. There was no neglect observed on Catherine’s appearance.|
|Behavior||Catherine was calm, collected, and cooperative. She responded to every question to the best of her ability. However, Catherine’s behavior may have appeared inappropriate, especially when I asked questions regarding her mother and the accident. Before responding, she would stare side away for a while.|
|Mood||The mood was low, evidenced by her negative sentence structure and sparse responses to questions. She also exhibited poor body posture, with her arms folded and her gaze fixed on the floor. In addition, her body language was negative, and she lacked enthusiasm in response to some questions.|
|Affect||Catherine’s affect was limited, and she lacked the ability to express a full range of appropriate emotions. As a result, she was reticent to respond to questions and lacked enthusiasm for any future-focused goals.|
|Speech||Catherine’s tone and volume were low, and she took an unusually long time answering questions. However, she exhibited no signs of elevation or anger when responding to questions.|
|Thought form||When she was asked questions, she struggled to respond instantly on a number of occasions, showing thought blocking. At time, she would took some time to recall the question.|
Differential Diagnosis (DDX) is used to distinguish between two or more ailments that share similar symptoms with elimination. Based on the symptoms from Catherine, she might have post-traumatic stress disorder or anxiety disorder. Post-traumatic stress disorder happens to individuals have experienced or witnessed a traumatic event (Black, 2018). In this case, Catherine’s traumatic events include the death of the mother and getting involved in an accident, and the husband losing his job. In addition, she tries to avoid talking about things that remind her of the traumatic events. For example, she takes a lot of time to respond to some personal questions. On the other hand, anxiety disorder is where an individual respond to certain things with fear. Catherine expressed minimal fear of responding to some situations. She was confident throughout the session and answered the questions effectively. Therefore, Catherine appears to have post-traumatic stress disorder and not an anxiety disorder.
Catherine meets the DSM-5 criteria for Post-Traumatic Stress Disorder diagnosis. The code for this condition is 309.81 because it influences the criteria applied (Flatt et al., 2018). She first encountered a traumatic event when she lost her mother. She was too close to the mother as the only child of her parents. Catherine believed she would suffer because there would be no one to confide in when she has an issue. She has been exposed to a lot of devastation in her marriage for a long time. The first subsection says that the person must have seen the traumatic experience firsthand. On the other hand, the second subsection wants the person to have a lot of exposure to the details of the traumatic event. There was a lot of damage caused by accidents around her for two years.
Assess for Risks, Trauma, Identification, and Management
Post-traumatic stress disorder individuals are prone to various risk factors. The factors make an individual more likely to develop post-traumatic stress disorder. These risks can be assessed by asking the client about their social life and how they feel when they witness an accident. Some of the risk factors Catherine is exposed to are having little or no social support, living through harmful events and traumas, and losing a job. However, Catherine has adopted an effective coping strategy to manage the situation. For example, she seeks support from relatives and family friends. She also has hope and believes that it will be well with everything. She has also learned how to get through stressful events. Therefore, although Catherine can be exposed to a number of risk factors, she applies effective coping strategies to lower the impact of the risk factors.
Client’s Perspective and Strength
A client’s perspective and strength are important in managing a health condition. Catherine is optimistic and believes that all will be well and they will be a happy family. She is ready to get any help to solve the problem. She also believes that therapy effectively solves mental issues and restores situations in a family. Catherine draws her strength from prayers and reading the scriptures based on strength. She usually attends church services together with her family. Catherine has social support coming from friends and close family members. She has a close friend whom she frequently talks with through the phone even though she is out of the country for studies. She also has loving in-laws who inform her that everything will turn in their favor.
A cultural formulation is an important tool that assists professionals in collecting and organizing culturally-relevant health information. For example, Catherine stated that Chinese women are always reluctant to seek help because it is a sign of weakness. As a result, they remain quiet to avoid being stigmatized by the community. She claims that she experienced the problem during her first few years in the US. However, she overcomes the problem and is now often ready to ask for help from people close to her, especially family members.
Clinical biases manifest themselves when a psychiatrist attempts to diagnose and label a patient’s behavior. Their development due to life experience can result in a misdiagnosis if possible reasons for the behavior are excluded. This is an example of confirmation bias, in which symptoms are interpreted to corroborate the therapist’s initial, rapid diagnosis. When a professional interpret the extremely vague signs, it is proven true.
Adlerian theory helps a therapist to acknowledge how a person works in their environment. Adler used this to make a person’s mental state and connection to the world more human (Johnson-Migalski & Drout, 2018). Adler studies how people grow by looking at their birth order, lifestyle, family constellations, and how they remember their early memories. During that time, new things that an individual learns are thought of in their current way of life, not as a way to start a new one. An individual’s way of life is formed when they are born because of the things they have done in their family. Values and morals are taught in the family structure and become a permanent part of the family’s way of life.
When the client and therapist show each other respect and treat each other the same, they form a therapeutic relationship. There are no winners or losers in therapy because both the client and the therapist work together, and the client is supposed to play an active role in the process of change (Sperry & Binensztok, 2018). The main goal of Adlerian counseling is to help the client find and understand any false and untrue beliefs. In addition, it helps the client get used to living in a new place and contributing more to society. Catherine talked about how society thinks about women her age and what is normal for a forty-year-old woman.
Treatment planning is an essential component of the therapy process. It should be individualized, detailed, and meet all clients’ needs. The therapist concentrates on the client’s presenting issue and discusses it with them; goals should be collaborative. The treatment plan should also be consistent with the therapist’s theoretical model, reflect current research, and address any ethical or legal issues. The first goal is to stabilize the level of stress and increase confidence as well as self-esteem. The main objective is to ensure that the client gains confidence. This involves talking about the client’s strengths, such as having a caring family and friends and a supportive society. A therapist can also bring scriptures to encourage the client and ensure that their self-esteem is high and stress is reduced.
The second goal is to improve on coping strategies and develop problem-solving skills. Although Catherine has demonstrated some coping strategies, learning others to increase their safety is important. Therefore, the client should acquire appropriate skills to manage stressful situations effectively. For example, how can Catherine control her feelings when she encounters or sees a person who had an accident. In addition, the client should learn how to solve problems within the family. She should develop effective communication skills to avoid conflicts with the husband and other family members. This will eliminate the misunderstanding that comes with ineffective communication. Therefore, the goal will help Catherine create a positive relationship with the husband, family members, friends, and others within the society.
The third goal is to determine appropriate responses to feelings. Catherine should know how to manage her emotions. This involves choosing how and when to express the emotions an individual feel. The objective is to increase Catherine’s emotional awareness. This ability is all about being able to notice and identify the emotions we are experiencing at any given time. It is the most fundamental of Catherine’s abilities to cope with the situation. She should be able to identify the emotions they are experiencing because it will make her feel more in control of her emotions. In addition, Catherine should understand and accept the emotions by knowing why she feels the way she does when in some situations. As a result, she should be able to know how to respond to her feelings effectively.
Family-based therapy should be adopted to help solve the situation. This strategy involves bringing together family members, namely, husband, children, and other close friends, to assist with the situation. A therapist should also consider quoting some scriptures in the Bible to bring hope. In addition, the core of the intervention should be emotional awareness to make sure that they understand each other. The therapy will ensure that the client develops a good relationship with family members. The relationship is important during the therapy due to the support factor. Catherine’s self-esteem will increase if she sees the husband and other family members involved in the process.
Black, D. W. (2018). Pocket Guide to Psychiatric Practice (6th ed.). American Psychiatric Pub.
Flatt, J. D., Gilsanz, P., Quesenberry Jr, C. P., Albers, K. B., & Whitmer, R. A. (2018). Post-traumatic stress disorder and risk of dementia among members of a health care delivery system. Alzheimer’s & Dementia, 14(1), 28-34. Web.
Johnson-Migalski, L., & Drout, M. O. C. (2018). Using the international classification of functioning, disability, and health (ICF) in Adlerian approaches. The Journal of Individual Psychology, 74(1), 38-54. Web.
Sperry, L., & Binensztok, V. (2018). Adlerian pattern-focused therapy: A treatment manual. The Journal of Individual Psychology, 74(3), 309-348. Web.