Case conceptualization and self-assessment Essay

Case conceptualization and self-assessment

Clinical Information

A thirty five year old guard nurse, Kate recently returned home from deployment only to find that her husband had left and moved with her children to another region.In addition, even though she initially thought that the hospital that had employed her would retain her, only to realize that they would replace her especially considering the fact that her deployment was a voluntary extension of her original tour. In the auditorium, she had not been offered the choice of lengthening, leading her to presume that her earlier position would remain secure. Despite her determination in searching for z new job, Kate has been unsuccessful and her situation has been exacerbated by the fact that her spouse has not been cooperative in planning for visitation of the children. All these factors have heightened her despair causing her to spend the better part of the past month in bed. During her first meeting with her counselor, Kate stated that she had experienced visiblesigns of apprehension, in addition to suffering                                                                                                                   four dreadspasms within the previous week. As aMexican American woman, Kate’s cultural practices is essentially based on the values of feminism, respect and congeniality, folk healing, as well as the significance of language and spirituality. Being a feminine, she is expected to exercise a powerful sense of family care and responsibility, because this is a significant aspect of the Mexican American culture(Addis,2004). Cultural standards can in some instances build uppressures for Mexican Americans in the appearance of challengingcompressions which may encompass unsatisfiedbacking or humiliation.In this culture, people believe that the family support is sufficient and very essential at any point of need. Due to the significance that is placed on strong reliance on family, where there is weak or unreliable family support, the needs of the family member can at times be left unmet.In addition, more ethnographic interviews reveal that individuals who fail to get the support of the family they desire tend to experience emotional imbalances or depression and physical complaints just like in the case of Kate. Accordingly, the cultural customs and practices of the  Mexican Americans can have an effect on the use of health care, despite the complexity of the relationship.

One interesting aspect that is still practiced among the Mexican American populace is folk-healing which has remained a vital feature of this community. It is very common for Mexican Americanstomix cultural methods with convention health approaches within their day to day life, hence implying that they do not view the traditional and modern medicine as incompatible. There are many innovative culturally competent approaches that are aimed at improving access to health and healthcare in this populace have been established in a manner that reflects the complex ways that Mexican American families combine the cultural practiceswithin their social setting. Such approaches have worked on the basis of re-conceptualizing culture as a strength as opposed to obstacle, a factor that stimulates community-level outreach methods, and enhances healthcare availability by handling system blockades.As such, these cultural customs and practices are likely to influence the choice of assessment tools and /or interventions methods to be used in dealing with Kate.It is important to use femilism as a tool of evaluation because it can be very vital in Kate’scase, in terms of appropriately influence Kate to make behavior changes that benefits her health. This technique entails the counselor inspiring the client to upkeep  herself for the benefit of the family.

Case conceptualization

Diagnosis: a multi-axial (Axis I-V) diagnosis for Kate

In axis I, based on the information that the counselor obtained from Kate, it was realized that she was suffering from major depressive disorder, recurring, severe, and also provisional panic disorder.For example, during the first counseling session, the counselor realized that Kate was unable to cope with harsh conditions or harsh times and therefore most of her activities permitted other people to make difficult decisions on her behalf and she did this to avoid conflict with others at all costs.Her own perceptions or beliefs that she cannot deal with adversity causes her to face constant rejection because people tend to get bored with her character and this makes her get depressed. As such, her husband’s move to another state with the children  only exacerbated things for Katebecause she increased her thought that she was unlovable and this caused the husband to become hesitant in arrangingvisitation process.

In axis II, it was noticed that Kate also had issues or signsof reliantbehavior disorder. Kate explained that growing up as a middle child in a family of six children, three of whom had special requirements, her parents and elder siblings paid little attention to her. Even though she desperately desired to fit in with her peers during her school-going years, she was more of a homely child who was frequently rejected. She took the opportunity to become friends with most of the new students in school. However, with time these kinds of friendships would break off when her friends expanded their social circles with other peers whom they viewed as more exciting. This led Kate to believe that she was unloved and made her go to the extreme to please other people in her workplace and within other social settings. Some of the things she did included accepting to engage in whatever activities and obliging to different requests as well as avoiding to speak up even when other people mistreated her. She did all these things in order to make other people love her. Even though such attributes would satisfy other people for a short while, in the long run, most people perceived her to have little to offer in the relationship and therefore distanced themselves from her.In Axis III diagnosis, Kate was found to have severedepression that led to panic attacks, which was a general medical condition that was diagnosed in Kate during the first session of the counseling process.In axis IV, Kate was diagnosed of having problems in accessing health care services because her culture heavily relied on the support of the family during the healing process of a person. Accordingly, this escalated her issues with regards to her social environment because she perceived herself as a failure and felt that nobody loved her hence she would go out of her way to please her workmates and those around her so as to avoid being rejected.Finally, in axis V, it was revealed that Kate’s behavior was significantly affected by misconceptions or illusions, which resulted in seriously weakened communication as well as judgment. For example, on some occasions, she would be incoherent and behave unsuitably or even be incapable of functioning in almost all areas hence remaining in bed all day, with no job, family or friends.

Since Kate perceived herself as a failure, it was not easy to detect her strengths in terms of both intra and interpersonal skills hence she preferred not to communicate her issues with anyone because she thought that they would reject her.

With regards to the theoretical approach, the counselor decided to employ the cognitive model in order to solve Kate`s problem. In any form of psychotherapy, it is important to first understand the underlying theory in order tointegrate the symptoms of the patient into a coherent conceptualization and also identify the best treatment strategies that can logically follow afterwards. In effect, cognitive behaviorsmodel is not an exception in this case(Heimberg, 2002).From the perspective of the cognitive behavioral theory, emotional experiences are often influenced by people’s thoughts and behaviors.Psychologicalhealth issues result from the exhibition oflife-threateningvarieties of thought patterns and action by individuals which frequently interact with each other to increase the indications and complications of a patient. Even though two individuals can encounter similar situations, their perceptions can cause them to react differently. For example, Kate perceives her life to have no meaning and sees herself as a horrible person who cannot do what she wants to. This causes her to respond by crying and remaining in bed for the better part of the day.

Cognitive theory refers to the automatic thoughts that an individual may have concerning specific circumstances that they have and the occasions that they encounter. This means that such thoughts happen automatically and too fast for the patients to notice hence even their significant impact on the patient’s behavioral and emotional reactions also goes unnoticed as well. Nevertheless, even though such feelings occur very fast, more often than not they have a very deep impact on the attitude of the people because they provide a kind of evaluation or perception of the present circumstances that a person is currently facing. There are those clients who indicate that certain happenings trigger vivid images and pictures. In Kate’s case, she stated that she experienced this and had vivid images of her husband with another woman putting their children to bed and this image portended the worst for the future. When faced with such images, Kate’s distress escalates and she retreats to bed(Emery, 2005).The cognitive theoretical approach was selected because it helps to comprehend the diverse manifestations of depression and anxiety that counselors perceive in their clients. As such, it helps to learn the behaviors of the clients and hence help in learning how to handle her and also come up with strong solution and also dictate the appropriate recovery process.

Treatment plan

The treatment organization is composed of three key stages namely: primary stage, midstage, and the advancedstage. In the primary phase, the counselor places more emphasis on the clinical assessment, motivational improvement, as well as the socialization to the cognitive behavioral theory approach. After the primary phase of treatment, the creation of the case conceptualization takes place and specific goals developed. Based on the situation conceptualization, there us a selection of specificmental and behavioral plans and later on the execution of the midstage of treatment. During the advancedstage of treatment, the counselor focused more on stopping deterioration and collaborated with the client to create a plan for closure.The counselor preferred the use of  mood check and bridging from the previous sessions as the best ways of conducting a prevention and educational activity throughout the process.

The counselor is responsible for evaluating the mood of the client at the beginning of each session so as to track how the client progresses over time. This way the progress and results become more explicit therefore instilling hope and creating momentum.By being careful and monitoring the progress of the client, the counselor can identify the indications that require fast consideration within the session. In order to achieve the practice of monitoring, it is necessary for the client to get to the health care center at least five to ten minutes before the beginning of the session and complete a standardized self-report inventory.  Therefore, the counselors use this information from the clients and make follow-up inquiries with regards to the symptoms that show improvements or decline on the the patient’s health. For the case of Kate, would be  to encourage her to socialize more frequently and avoid any misconceptions of self-pity and negative thoughts of feeling unloved and perceiving herself as a failure. She can change her misconceptions by visiting recreational centers and mingling freely with different people as opposed to staying in bed the entire day.  In addition to this, Kate should be encouraged to visit physical fitness centers or gyms in order for her to engage in physical activity and release some of the tension that she may be feeling currently hence reduce her depression levels in the process.  Working out at the gym can help Kate to develop more positive feelings about herself and gain determination as well as self belief that will be useful in the future. These strategies can help Kate and other clients in her situation to comprehend and access varied community resources that can help her to progress.


Agenda development is one of the best intervention methods that can be used with this particular client to achieve Proofreading-Editingtheir goals. This will be a collaborative procedure between the client and the counselor during which there is mutual recognition of the topics that will be dealt with during the therapy sessions. Such an intervention can help to prioritize the most pressing matters that are linked to the goals of treatment. Additionally, the efficient use of time and also helps the client to gain goal setting skills, hence giving the client a systematic approach of how to organize the problems she is facing(Basco, 2006).

Reviewing the previous session courseworks or assignments  by the counselor can also form another important intervention. If the counselor fails to do this, the patients might actually think that the assignments given are not so important. A review of the previous session can help the client to consolidate what he or she learnt in the previous session and also reinforce the application of what he or she has learnt in their day-to-day life. The client can also use the skills that were practiced during the review process. The discussion of agenda items of the central activities that occur within the behavioral theory session. Another intervention includes discussion if agenda items, which the central activity that happens in a cognitive behavioral theory session. Agenda matters ought to be handled in a mutually agreed upon direction chosenby the client and the counselor(Beck, 2007). Each item is discussed and the counselor is expected to remain aware of the cognitive behavioral principles that are layered beneath the main issue in order to develop the best case conceptualization or skill building technique. The fourth intervention entails periodic summaries that happen through developing the session and ascertainment of mutual understanding between the client and the counselor concerning the difficulty of  the matter being discussed  and also the resolutions made concerning it.Summaries can also be done periodically and in a tactful manner whenever the counselor notices that the session is not going as intended.


Transcription Clinical competencies(Assessment questions) Analysis of clinical thinking Evaluation of Response
CO That sounds very difficult; what did you next?Did you try calling your husband or the kids on the cellular phone?

What do you believe or think would happen if you called them?

What made reach that conclusion?

Is that why you believe they left? Do you believe that you do not contribute anything meaningful to their lives?

When did you find out about the loss of your job?

What happened then?

I tend to imagine that this was quite shocking for you.

Do you have a new job lined up?

Might it be useful for us to put together a game plan for addressing some of these stressors that are piling up?





In basic terms, Kate`s problems have pilled dup because of the fact she has been ignoring stresses by finding alternative destructors. She has never understood or learnt how to pull off herself from stressful events.In essence, this seems more of a learned behavior. This is because her predisposition to ignore  serious matters that work her out of balance; including her weakness to generally assume that she is useless or a distant parent made issues to be far worse. She became a passive mother, and it contributed to her problems even when she realized that she had been replaced at work.

Furthermore, based on the scale of 1to10, I had ranged between eight and nine. This implies that the goals that I had previously set were almost met a hundred percent.


Pointing out Kate`s absurdity is vital, in this regard, I am talking about how ignorant she was in dealing with stresses and other related matters. The other important thing is that, She failed to maintain control of herself. This is manifested in how she failed to explain her case before her hospital boss. On one hand this is also manifest in how she failed to position herself as a mother and influence her family positively. To this end, I do believe that, by understanding her complex situation easily, I may handle matters more speedy. A responsive reaction made it possible to get the interview going, and she was more open and friendly to talk about her issues openly. This is tied on the fact that she shared her real issues about not being able to find a job and not being able to control her feelings or stresses.
CL When I came home, my mother met me from the ground floor and told me that my husband had moved with the kids out of state.I went home and did nothing but slept for three days after pulling down the blinds.

For what use? Since they had left, probably they do not want to talk to me.

They would say it straight they do not need me.

This is because everybody is better off without me being around them. I think am so uninteresting to them.

Yes. I was just trying hard not to make any bad moves, believing that they would not leave me if I did not cause them problems.

After realizing, that I would not stay in bed forever and that the hospital needed me. This prompted me to go the hospital since I thought they would be expecting me. After visiting the hospital administrator’s office, to inform, her that I was back and wanted to start taking shifts.

She was surprised by my visit and she said they had filled up my position six months ago.

No I cannot find one. I cannot deal with this, already bills are piling up and I cannot pay for them.

For what use? I have never been capable tohandle anxiety





From Kate’s case, the counselor, the counselor displayed intermediate level counseling skillin general. It is necessary to foster a powerful collaborative therapeutic relationship in order to successfully employ the cognitive behavioral theory with a client. A counselor should allow a client to make the most meaningful changes by conducting psychotherapy when they are in a conducive and accepting environment in which there is a comfortable feeling that enables them to clearly articulate otherwise painful thoughts and beliefs while attempting to use diverse strategies to improve her life.

Therefore, as a cognitive behavioral counselor, I tried my best to exercise empathetic understanding, validation, warmth and genuineness with my client in order to make her feel comfortable.   Empathetic understanding is one of the most essential skills in cognitive behavioral theory which are usually used for therapeutic purposes and are developed through acknowledgement of the suffering of the patient as well as communicating an understanding of their problems from a cognitive behavioral structure(American Psychiatric Association, 2003).Different steps were taken so as to maintain a therapeutic relationship and these include honesty, listening and patience as well as giving room for the client to open up concerning their issues without being interrupted. In addition, we also created the agenda items together. To develop a good rapport, we had to go through the assignment together and also summarize the lessons learnt so as to identify any key areas that needed to be addressed urgently or improved. This fostered a very strong relationship because my client felt like she was loved and cared for. As a result, all these measures helped to ease the interactions between my client and I, an achievement that I would not have attained had I stuck to the theoretical approach.

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American Psychiatric Association. (2003). Practice guideline for the assessment and treatment of patients with suicidal behaviors. Arlington, VA: Author.

Basco, M. (2006). Cognitive-behavioral therapy for bipolar disorder. New York, NY: Guilford Press.

Beck, A. T. (2007). Depression: Causes and treatment. Philadelphia, PA: University ofPennsylvania Press.

Emery, G. (2005). Anxiety disorders and phobias: A cognitive perspective.New York, NY: Basic Books.

Heimberg, R. G.(2002). Cognitive-behavioral group therapy for social phobia: Basic mechanisms and clinical strategies. New York, NY: Guilford Press.