Wk8 Assignment Discussion Paper
Wk8 Assignment Discussion Paper
Please no plagiarism and make sure you are able to access all resources on your own before you bid. The main references come from the American Psychiatric Association. (2013) and/or Kress, V. E., & Paylo, M. J. (2019). You need to have scholarly support for any claim of fact or recommendation regarding treatment. Grammar, Writing, and APA Format: I expect you to write professionally, which means APA format, complete sentences, proper paragraphs, and well-organized and well-documented presentation of ideas. Remember to use scholarly research from peer-reviewed articles that are current. Sources such as Wikipedia, Ask.com, PsychCentral, and similar sites are never acceptable. Please remember that resources used must be from peer-reviewed resources such as academic journals. The assigned textbook and the DSM-5 are required for all assignments (i.e., cite and reference the textbook and DSM-5 in every assignment). As a general rule, web sites are not peer-reviewed except those which are online journal articles. Therefore, it is advisable for you to avoid using these websites as resources. Walden Library offers many peer-reviewed articles that pertain to the topics covered. While not required to use these articles, you should select a couple that you find interesting and which supports your critical thinking and analysis. Wk8 Assignment Discussion Paper
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Please follow the instructions to get full credit for the discussion. Please look at all the attachments.
Assignment – Week 8
Assessing and Diagnosing Devon
The process of diagnosis is complex. Clients may come to their first counseling session needing to vent about multiple areas in their lives, and they may not necessarily know what they need to share with a counselor to get a diagnosis. Counselors must listen to the client to understand a full picture of what may be going on. If a client says that they are having a hard time dealing with family, difficulty in relationships, not eating regularly, or not sleeping, counselors must know how to listen and ask questions that can pull more information needed for an accurate diagnosis.
This week, you put your skills to practice by conceptualizing a client’s presenting concerns and rendering a diagnosis. You will review the case of Devon, found in this week’s Learning Resources. Based on the case information, along with the DSM-5 resources, you will evaluate Devon based on possible symptoms he presents to diagnose potential disorders. Wk8 Assignment Discussion Paper
To prepare for the Assignment:
- Review this week’s Learning Resources.
- Review the Case of Devon in this week’s Learning Resources.
- Download the Diagnostic Conceptualization Template from the media.
- Review the handout, Jane: Diagnostic Conceptualization Example, provided in Week 3 to review the appropriate information to include in each section of the Diagnostic Conceptualization Template.
- Review the expectations in the Rubric.
By Day 7
Complete the Diagnostic Conceptualization Template you downloaded in the Learning Resource, Completing a diagnostic conceptualization: The case of Devon.
Be sure to support your postings and responses with specific references to the Learning Resources.
Required Resources
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
· Section II, “Feeding and Eating Disorders”
· Section II, “Sexual Dysfunctions”
· Section II, “Gender Dysphoria”
· Section II, “Paraphilic Disorders”
· Section II, “Sleep-Wake Disorders”
Kress, V. E., & Paylo, M. J. (2019). Treating those with mental disorders: A comprehensive approach to case conceptualization and treatment (2nd ed.). New York, NY: Pearson.
· Chapter 11, “Feeding and Eating Disorders”
· Chapter 15, “Sleep-Wake Disorders, Sexual Dysfunctions, Paraphilic Disorders, and Gender Dysphoria”
Required Media
Completing a diagnostic conceptualization: The case of Devon [Transcript]
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Week3JaneDiagnosticConceptualizationExample.docxDiagnostic Conceptualization Template
Client Name Jane* Case Conceptualization ( Note: Include specific information about client symptoms and presenting concerns Jane is a 35-year-old Caucasian female who self-referred for treatment. Jane reports experiencing feelings of withdrawal, sadness, and hopelessness. She stated that she has struggled to maintain relationships and has lived with her mother her entire life. Jane’s relationships are often volatile and characterized by others viewing her as “needy”, “dramatic”, “emotional” and “crazy. ” Jane declines any current religious involvement but noted some interest in exploring Buddhism and spirituality.
Jane has a history significant for sexual abuse by her older brother and her brother’s best friend. Jane reported that the abuse took place from the ages of 4 to 14 and stopped only when her brother left home. Jane reported that she has never disclosed the abuse to her mother. Jane has experienced instability in relationships with friends, and reported no support system beyond her mother. Jane struggles with individuation and often internalizes the interests of her others.
Jane tends to think very concretely and she struggles with a general negative outlook. She has a past history significant for severe self-injury (i.e., self-cutting). She’s also had periods of suicidal thoughts but she reports no current suicidal ideation at the time of session. Jane also has a history of disordered eating but she reports that she has not engaged in any binge/purge behavior for approximately the past several years.
Jane’s medical history includes previous diagnoses of Major Depressive Disorder and Posttraumatic Stress Disorder. She has been diagnosed with asthma. Jane reports that she has the ability to induce an asthma attack and she admitted to doing so at least twice weekly over the course of the past year in an effort to seek medical care. Jane reported that she enjoyed the attention associated with medical care.
Jane has a history of inappropriate boundaries with her previous counselor and she acknowledged going to great lengths to obtain her previous counselor’s home address so that she could drive by her house.
Jane has previously attended college but is not currently enrolled. She was the first individual in her family to attend college and she reports that her mother was not supportive of her education. Jane reported that she would like to eventually return to school but she fears that she will be able to complete her studies until her medical care is addressed.
Diagnostic Impressions (Note: Be sure to use the ICD-10 code, name of the disorder, and all of the specifiers) F60.3 Borderline Personality Disorder (Reason for Visit)
F33.1 Major Depressive Disorder, Recurrent, Moderate, Provisional
F43.1 Posttraumatic Stress Disorder, Provisional
Rationale for Diagnostic Impressions (Note: Use the DSM-5 to explain how the client’s symptoms are reflected in the diagnostic criteria for each diagnosis that you render. If you do not render a diagnosis, you still must use the DSM-5 to explain why you chose not to render a diagnosis.) Jane’s medical history includes past diagnoses of F33.1 Major Depressive Disorder, Recurrent, Moderate and F43.1 Posttraumatic Stress Disorder, Provisional. Based on her current presentation, it appears that reason visit is related to symptoms of F60.3 Borderline Personality Disorder.
Consistent with the symptoms of Borderline Personality Disorder, Jane demonstrates a pervasive pattern of instability in multiple facets of her life that appears to have begun in late adolescence. Jane reports that those with whom she has had relationships have called her “needy” and she indicated that her relationships tend to vacillate between ideation and devaluation (Criterion 2). Jane reported that she doesn’t feel connected to a particular identity and she often takes on the identity of those in her life (Criterion 3). Jane has recurrent suicidal thoughts and self-injurious behavior (Criterion 5). She also experiences affective instability and her mood appears reactive to those around her (Criterion 6). Jane reports feeling empty and she often struggles to find meaning in her life (Criterion 7). Jane is prone to bouts of anger, especially in response to situations in which she feels out of control – for example, slashing a friend’s tires after a fight (Criterion 8).
In order to qualify for a diagnosis of a personality disorder, an individual first must meet the General Criteria for a Personality Disorder. Jane’s symptoms have been evident since at least age 20, which suggests that her symptoms represent an enduring pattern of behavior that have impacted her thoughts (“If there were a God, he wouldn’t have let my life turn out this way”; Criterion A1), her affect (characterized by overwhelming feelings of sadness and hopelessness; Criterion A2), her interpersonal functioning (volatile relationships with friends; Criterion A3), her impulse control (a history of self-injury and bulimia; Criterion A4). Jane’s symptoms have been evidenced in numerous situations (e.g., work, school, home; Criteria B) and the symptoms cause clinically significant distress across numerous areas of her life (e.g., home, relationships, work, school; Criteria C). Jane’s symptoms appear to have begun in late adolescence (Criteria D). Although the client has asthma, there are no other medical conditions that are responsible for her current symptoms (Criteria E). The client is prescribed Paxil but there is no evidence of substance use and thus, no evidence that substance are causing her symptoms (Criteria F).
The client reports that she has previously been diagnosed with F33.1 Major Depressive Disorder, Recurrent, Moderate and F43.1 Posttraumatic Stress Disorder. The client’s current presentation does not provide enough evidence to support rendering either diagnosis at this time. However, based on the client’s past trauma history and her self-reported “dark times”, both disorders warrant further exploration.
Cultural and Ethical Considerations (Note: Include information that may be pertinent to the diagnosis). The client does not have any current religious involvement but she reported some interest in pursuing Buddhism. The client is a first generation college student and she reports limited support for pursuing her education from her friends and family. The client has a limited social support system and spends the majority of her time with her mother.
Jane is not currently sexually active and she reports discomfort with the idea of intimacy. She appears to feel more comfortable with females; however, she is not currently in a relationship and does not appear to be actively seeking out romantic partners.
The client has a history of inappropriate boundaries in relationships. The client previously engaged in stalking-type behavior toward her previous therapist. Thus, it is important that boundaries are enforced for the duration of the counseling relationships. Wk8 Assignment Discussion Paper
Student Name and credentials (e.g., Frida Kahlo, B.A.) *Note: Case Available in Chapter 9 of Kress, V.E., & Paylo, M.J. (2018). Treating those with mental disorders: A comprehensive approach to case conceptualization and treatment (2nd ed.) New York, NY: Pearson
Date COUN 6720 DIAGNOSTIC CONCEPTUALIZATION TEMPLATE Page 2 of 2
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Week8COUN_6720_DiagnosticConceptualizationTemplate.doc
Diagnostic Conceptualization Template
Client Name Case Conceptualization ( Note: Include specific information about client symptoms and presenting concerns Diagnostic Impressions (Note: Be sure to use the ICD-10 code, name of the disorder, and all of the specifiers) Rationale for Diagnostic Impressions (Note: Use the DSM-5 to explain how the client’s symptoms are reflected in the diagnostic criteria for each diagnosis that you render. If you do not render a diagnosis, you still must use the DSM-5 to explain why you chose not to render a diagnosis.) Cultural and Ethical Considerations (Note: Include information that may be pertinent to the diagnosis). Student Name and credentials (e.g., Frida Kahlo, B.A.) Date COUN 6720 DIAGNOSTIC CONCEPTUALIZATION TEMPLATE Page 2 of 2
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Week8CaseofDevon.pdf
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“Completing a Diagnostic Conceptualization: The Case of Devon” , Program Transcript ,
This is your very first session with Devon. Devon is a 24-year-old biracial, gay, male who self-referred for counseling. When Devon called your office to schedule his session, he stated that he recently broke up with his boyfriend of 3 years, Marcus, after he discovered that Marcus was being unfaithful to him. He stated that he was feeling really anxious and sad and needed someone to talk to about his feelings. Wk8 Assignment Discussion Paper
COUNSELOR: Hi, Devon! Thanks for coming in today. I’m sorry to hear that you and your boyfriend broke up, that can be a really painful thing to go through. I’m happy you’re here so we can through what you’re feeling. To get us started, I have your intake here and I just wanted to follow up on some of what you shared.
Walden Counseling Intake:
• Client Name: Devon • Today’s Date: January 18 • Legal Name: Devon • Address 16 Birch Dr • Cell Number: 555-555-1111 • Is it okay to leave a voicemail: Yes • Age: 24 • Preferred Pronoun (example: She, he ze, they): He • Self-identified Gender: Male • Primary Language: English • E-mail address: devon15@gomail.com • Secondary Language: None • Relationship Status: Single • Children: None • School / Employment: Software Engineer for Network Solutions. • Previous history of counseling: Yes, about two years ago • Other health conditions: heartburn and migraines • Medications: over the counter heartburn medications, Relpax for migraines • What brings you in to the counseling at this time? Breakup with boyfriend
COUNSELOR: In reviewing your intake, I noticed that you’ve had some previous counseling. Can you tell me a bit more about that experience? What brought you into counseling in the past?
DEVON: Yeah, I went to see a counselor about 2 years ago for some issues related to my eating. I was basically out of control.
COUNSELOR: You were eating more than you wanted?
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“Completing a Diagnostic Conceptualization: The Case of Devon” , Program Transcript ,
DEVON: Yeah, I was eating my feelings. I would binge constantly and then do whatever I could to try to get rid of all of the calories.
COUNSELOR: During those binges, did you feel like you were out of control once you started eating?
DEVON: Yeah, for sure. Once I started, I couldn’t stop, even if I started to feel sick. I can easily eat like three boxes of cookies, couple bags of chips, a box of doughnuts, and two cheeseburgers within like the span of 40 minutes. It’s disgusting but once I get going I can’t stop. Like in my brain, I’m like “Devon, stop this you’re not hungry don’t eat” but my body takes over and I just feel like it can’t stop it.
COUNSELOR: I noticed that you said “I can eat and I can’t stop” – is this something that’s still happening now?
DEVON: Yeah, good catch, I didn’t even realize I said that. It’s definitely something that I’ve been doing more since Marcus and I broke up. I mean, it’s definitely something that’s been off and on for like the past eight years but when I get upset or stressed, I definitely turn to food.
COUNSELOR: Would you say it’s something that you do weekly? Or perhaps more or less often than that?
DEVON: Yeah, a couple times a week would probably be more accurate, especially since the breakup. I’ve really been hating on myself since I found out that Marcus had been cheating and that’s made me eat more which then sort of leads to me hating myself even more and needing to get rid of the calories because I don’t want to become fat and unlovable.
COUNSELOR: It sounds like this breakup with Marcus has really exacerbated some of those feelings of self-hate?
DEVON: Yeah, definitely. Not even so much the breakup as the finding out that he was cheating on me part.
COUNSELOR: Learning that your partner has been unfaithful can be pretty traumatic; I’m sorry you’re going through this. You mentioned that you try to compensate for overeating by getting rid of the calories. Can you tell me a bit more about what sorts of things you’ll do to get rid of the calories?
DEVON: Yeah, I throw up mostly. Usually, it’s pretty easy to do because I feel so sick after I eat all that food. Sometimes I’ll also exercise a lot more than usual to try to get rid of all the crap I’ve eaten but that’s more of a next day sort of thing. Most often, it’s me eating all that crap and then immediately trying to get it out of my body. Wk8 Assignment Discussion Paper
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“Completing a Diagnostic Conceptualization: The Case of Devon” , Program Transcript ,
COUNSELOR: Would you say that trying to get all that food out of your body is related to a desire to maintain a certain appearance.
DEVON: For sure. If I gain weight I feel like a failure. Like if I’m fat my life is over. No one will love me. I will die alone. I know that’s a pretty insane thing to think but that’s where I am.
COUNSELOR: These eating issues that you’ve shared with me here, is that something that you’ve shared with others too?
DEVON: Not really. I suspect Marcus knew something was up when he would go into the kitchen and find that I had plowed through like four boxes of Girl Scout cookies, but he never said anything about it.
COUNSELOR: So, it’s fair to say this is something you’ve struggled with on your own?
DEVON: It is, yes. I wanted to be more honest with Marcus about it but I’m glad that I wasn’t because he obviously wasn’t honest with me.
COUNSELOR: You’ve said you’ve been feeling pretty overwhelmed since the breakup, can you describe to me what you’ve been experiencing?
DEVON: I’m just sad all the time. I cry about what could have been. I’m mad that he would do this; that he would lie right to my face. I really pictured us having this good relationship and it was all built on a lie.
COUNSELOR: Have you had any problems at work?
DEVON: I took a couple sick days at work right after we broke up. I know that sounds stupid, but my job requires concentration and I had zero ability to do so. I’m back to work now. But honestly, I continue to struggle to feel fully invested in anything. I sort of feel like a zombie going through the motions. We weren’t even living together but I stayed at his house most nights and to now be back at my apartment, by myself, I just feel so alone. I haven’t even been spending much time with friends because they are friends of Marcus too and I just find it hard to believe that they didn’t know that he was cheating on me. And if they did know, then I feel like a fool. Like everyone knew something I didn’t. Every time I think about it that way, I feel so disgusted. Thinking about that stuff like that definitely starts the cycle of self- hate which then leads to the overeating and which then leads to even more self-hate. Wk8 Assignment Discussion Paper
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