CLINICAL REPORT. Presenting Symptoms

Transcription

1 CLINICAL REPORT Presenting Symptoms Cheng is an Asian-American male who was referred to the Community Mental Health Center by the Academic Counseling Office of the Darin County Community College. Cheng has been placed on academic probation for failure to maintain the minimum grade point average. He shared that he is failing all of his courses. Cheng believes that he is capable of passing, but believes his instructors are unfair. He reported engaging in an argument with his math instructor that led to his being kicked out of class. Cheng also expressed that he did not want to attend community college or college. He stated that his mother had forced him to attend because she believes that without higher education, he will not be successful. Cheng expressed on several occasions that he has tried to share his feelings with his mother, but reports she will not listen. He shared that his mother has put the responsibility for taking care of the family on him. Cheng added that he feels a lack of control over his life. He reports a decrease in appetite, energy, socializing with friends, poor concentration, and interrupted sleep. Cheng stated that his life was perfect prior to entering the local community college. Mental Status Exam Cheng was appropriate in dress and appearance but he did not make eye contact. His head and eyes remained down, looking at the floor. He was oriented to time, place, and person. Cheng presented with low mood and depressed affect. The interview was paused on two occasions due to his crying. There were no apparent delusions or hallucinations. Cheng appeared to be a personable young man, exhibiting few difficulties in talking about his feelings regarding community college and his family. Present Situation and Relevant History Cheng was born in Los Angeles, CA. He has a twin sister and an older brother. Cheng and his siblings were raised by their mother, who emigrated from the Philippines. She currently works as a retailer. He has never met his father. Cheng s twin sister has been in legal troubles resulting in juvenile probation as a result of participation in adolescent female gang activities. His older brother is married with one child and is successful employed in the television industry. As long as Cheng can recall, his mother has struggled to make ends meet. He reported that she constantly expressed to her children the role education plays in landing a good paying job and in success in life. Cheng describes his past performance in K-12 schooling as above average. He reports that in high school he rarely had to study. Cheng shared that he and his mother have had many disagreements, often stemming from disagreements over how he should conduct himself as an adult. He stated that his mother expects him to behave as if he were raised in her home country. He wishes his mother would allow him to make decisions about his future without making statements that cause him to feel guilty. Prior Treatment Cheng has received no prior counseling. He is physically healthy. Diagnostic Impressions 1

2 Axis I Adjustment Disorder With Depressed Mood, Acute Axis II No Diagnosis Axis III. Axis IV Axis V None Problems with primary support group: discord with mother; Educational problems/academic problems GAF = 61 (Current) 2

3 DEVELOPING AN INVERTED PYRAMID FORMULATION STEP 1. PROBLEM IDENTIFICATION Lack of control over his life; academic failure; decrease in appetite, energy, and socializing; feels forced to pursue higher education; perceives instructors as unfair; interrupted sleep; difficulty concentrating; conflictual relationship with mother STEP 2. THEMATIC GROUPINGS (1) Depression (2) Adjustment Issues (3)Feelings of Powerlessness STEP 3. THEORETICAL INFERENCES (Cognitive) Arbitrary Inferences (Catastrophizing) STEP 4. NARROWED INFERENCES Irrational belief that he lacks personal power 3

4 INVERTED PYRAMID CONCEPTUALIZATION NARRATIVE EXPLANATION Step One In step one, I gathered information based on the client s behavior, thoughts, feelings, and physiology. Next, I looked for abnormalities in adjustment, transition, and/or development. Step Two Cheng is experiencing depression as evidenced by his low energy, decreased in appetite, and difficulty in concentrating. He also reports a decrease in socializing with his friends. Cheng stated that his life was perfect prior to entering community college. He reports being forced by his mother to attend college. Cheng shared that he is currently on academic probation. The theme appears to be adjustment issues. Based on Cheng s belief that he lacks control over his life, and his belief that his instructors are responsible for his academic failures, he appears to be experiencing feelings of powerlessness. Step Three Using the Cognitive theoretical approach, Cheng feels his situation is hopeless, and in turn, he is catastrophizing. Step Four Cheng has irrational beliefs that he lacks personal power. He believes the course of his life is being controlled by external forces. 4

5 CHENG S TREATMENT PLAN: SOLUTION-FOCUSED APPROACH Target Problem Depressed Mood Behavioral Problem Definition Low mood associated with feelings of hopelessness in response to life situation Global Goal Development 1. Recognize, accept, and cope with feeling of depression 2. Develop healthy cognitive patterns and beliefs about self and world that lead to alleviation of depression symptoms. 3. Alleviate depressed mood and return to previous level of effective functioning Behaviorally Measurable Objectives 1. Identify and replace cognitive self-talk that is engaged in to support depression. 2. Verbalize hopeful and positive statements regarding self and future. 3. Increase frequency of assertive behaviors to express needs, desires, and expectations. 4. Use positive conflict resolution skills to resolve interpersonal discord and to make his needs and expectations known. 5. Implement a regular exercise regimen as a depression reduction technique. Interventions 1. Ask the client to make a list of what he is depressed about; process the list s contents. 2. Identify a connection between previously unexpressed (repressed) feelings of anger (and helplessness) and current state of depression. 3. Assist the client in developing an awareness of his cognitive messages that reinforce hopelessness and helplessness. 4. In conjoint sessions, help the client resolve interpersonal conflicts. Outcome Measures 1. Client s self-reported decrease in presenting depressive symptoms over the course of counseling. 2. Increase in mood, decrease in anxiety, and increase in motivation and energy observed by clinician in progressive sessions. 3. Overall reduction in depressive symptoms and increase in functioning observed by clinician reflected in positive change in GAF to at least GAF = 71 (at termination) 5

6 CHENG S TREATMENT PLAN: THEORETICALLY-DRIVEN APPROACH Explore and learn about Cognitive Therapy and attempt to prepare your own treatment plan for Cheng. Then, consider ways in which the solution-focused and cognitive therapy plans appear to overlap and to differ! 6