âApplication: Cognitive-Behavioral OrientationâCase Conceptualization
Case Conceptualization Exemplar (cont.)
Student Name: Case Name/#: Case Study Exemplar: Linda
Problem identification and definition: [1–2 paragraphs]
[Primary and contributing concerns for the client]
Client concerns: Cognitive abilities
Client concerns: Feeling “anxious,” associated with being accepted by others
Clinical concerns: Interpersonal isolation
Clinical concerns: Self-devaluation, adequacy
Clinical concerns: Depressive symptoms
Contextual considerations: [1–2 paragraphs]
[What ethical, legal, cultural, or other key considerations need to be considered with this client when creating a treatment plan?]
Given no family, friends, or beliefs were identified as a support base, it would seem there are no resources on which Linda might rely.
Given her sustained employment, attempts at effecting change, and self-referral, it seems as Linda may have the capacity for insight, ability to sustain, and motivation for change.
Diagnosis
Axis I: [Be sure to provide full title and code]
300.04 Dysthymic Disorder
Axis II:
V71.09 No diagnosis on Axis II
Axis III:
None
Axis IV:
Reccurring headaches within last 6 months
AXIS V: GAF =
45–55 Severe symptoms of impaired social and interpersonal relationships
Moderate symptoms of flat affect
Diagnostic comments: [1 paragraph]
[Provide a brief comment (no more than 1 paragraph) on the justification for your diagnosis]
1) Disturbance of mood: Exaggerated feelings of self-depreciation, self-doubt, lack of energy, problems with sleep, “headaches,” impaired decision making.
2) Dysthymic Disorder: Prolonged duration of “low self-esteem,” “feeling of hopelessness,” “depressed mood, most of day.”
Theoretical conceptualization: [1–2 paragraphs]
[How would your selected theoretical orientation explain the primary issues for this client, and thus which interventions/treatments would be best suited for this client?]
Long-standing concerns of self-worth and acceptance may be rooted in unconscious wish to be nurtured.
2) Given this, the mother/child bonding and attachment may have been impaired, early impairment may have led to “stunted” personality development and associated limited defenses, blunted libidinal energy, being self-absorbed, unmet dependency.
3) Given the long-standing and deep-rooted nature of the impairment that appears to have impacted most domains of this individual’s life, major personality change would seem the most appropriate goal for this client.
4) Given the lack of external supporting relationships, the client/patient relationship may be viewed as a source of “working out” the early parent/child relationships.
A psychodynamic orientation may best meet these two issues.
Treatment plan
Presenting Issue #1: Questions and concerns over cognitive abilities, interpersonal relationships, and self-worth.
Strengths: Sustained employment exemplifying “reality” and ego strength. Through intermittent and unsuccessful attempts at looking outside of self for “remedies,” client may show desire and recognized need for change.
Barriers: School-academic history, birth order, “teasing” from male siblings, genetic influences, anxiety over intellectual functioning—all of which suggests early and long-standing issues resulting in a sustained personality structure.
Goals: While symptom reduction is an obvious end, to uncover unconscious motivations and to develop successful “attachment” are basic to effect their being change.
Interventions: Note: Though cognitive testing may be an obvious intervention, given the conceptualization, this would support the client’s need to look outside herself for “answers,” therefore, this option is rejected.
Modality/Duration:
Use long-term psychotherapy focusing on the psychotherapeutic relationship and exploration of self.
Three weekly 50-minute sessions for up to 2 years
Measure of Progress:
Monitor progression of therapy sessions assessing transference and “uncovering.”
Empirically Supported References: