Danerys Psychology Case Study (ANSWERED)

Each student will be presented with a pre-selected case study and be asked to select a theoretical orientation to use as the basis for the following:

• The student will imagine a first meeting with their patient, make an initial observation about the person presented and create a DAP formatted note documenting the initial meeting. This note will be incorporated into a 8-10 page paper that

1. a) defines and describes the therapeutic orientation,
2. b) describes the uses and application of its interventions,
3. c) discusses strengths and weaknesses of the theory and
4. d) discusses how the selected theoretical orientation supports or conflicts with their personal belief system.

• The paper should demonstrate a familiarity with the professional language used in the field. It should also identify key elements used in formulating a biopsychosocial assessment, which is necessary in developing an aftercare plan suitable for the patient.

A minimum of 4 sources is required. Paper must be written in APA format.

To clarify….

Cover

Page  1-2: introduction to your patient via the case study and the background story you have created

Page 3-4: DAP Notes of the initial meeting and follow- up interactions you have had with you patient.

Page 5-7 Biopsychosocial information following the template distributed in class.

Page 8-9 : Case conceptualization, interpreted diagnosis (can be primary & secondary, depending on the case), recommended treatment ( therapies, medication, etc…) & follow up.

*****Be sure to identify which therapy modality you have selected and why, medications ( if any) you have selected and why, and answer the above 1-4 a-d statements

Last page: References

*Any appendices you would like to add, should follow the reference page and please remember to apply APA format to the whole paper.

Please note that the templates for DAP note, Biopsychosocial and APA format are uploaded as a resource for you.

CASE STUDY

Danerys, a 15‐year‐old Puerto Rican living with both her parents and a younger sibling. Her parents have had been separated several times and were discussing divorce. Her mother reported having a history of psychiatric treatment for depression and anxiety and indicated that the patient’s father suffered from bipolar disorder and had been receiving psychiatric treatment. He was hospitalized on multiple occasions during previous years for serious psychiatric symptoms. Danerys was failing several classes in school, and her family was in the process of looking for a new school due to her failing grades and difficulties getting along with her classmates. She presented the following symptoms: frequent sadness and crying, increased appetite and overeating, guilt, low self‐concept, anxiety, irritability, insomnia, hopelessness, and difficulty concentrating. In addition, she presented difficulties in her interpersonal relationships, persistent negative thoughts about her appearance.

ANSWER

Danerys Case Study

Introduction

Danerys is a 15‐year‐old Puerto Rican living with both her parents and a younger sibling. Her parents have had been separated several times and were discussing divorce. Her mother reported having a history of psychiatric treatment for depression and anxiety and indicated that the patient’s father had bipolar disorder and received psychiatric treatment. He was hospitalized on multiple occasions during previous years for severe psychiatric symptoms. Danerys was failing several classes in school, and her family was looking for a new school due to her failing grades and difficulties getting along with her classmates. She presented the following symptoms: frequent sadness and crying, increased appetite and overeating, guilt, low self‐concept, anxiety, irritability, insomnia, hopelessness, and difficulty concentrating. In addition, she presented problems in her interpersonal relationships, persistent negative thoughts about her appearance.

The patient is suffering from depression. Depression is a mood disorder that often results in a person feeling sad and not interested in things they previously loved. In most cases, the disease affects how a person feels, behaves, and thinks (Van Rheenen et al., 2020). As a result, it may cause in a person different physical and emotional problems. For instance, a person suffering from depression may not complete their everyday activities. The most common symptoms a person suffering from depression may experience include the following;

• Sleep disturbances which may include but not limited to insomnia or excess sleep
• Lack of energy and tiredness
• Reduced or reduced appetite, which may result in weight loss or gain
• Agitation, restlessness, and anxiety
• Trouble concentrating, remembering things, or concentrating
• Suicidal thoughts

Danerys presented various symptoms that are related to depression. For instance, she had frequent sadness and crying, increased appetite and overeating, guilt, low self‐concept, anxiety, irritability, and insomnia, to mention a few. In addition to this, her mother has a history of psychiatric treatment for depression and anxiety. Because of her depression, she is unable to concentrate in class hence her failing courses. The therapeutic orientation for Danerys is the use of cognitive therapy, commonly known as cognitive behavior therapy. According to this theory, it is argued that a person’s behaviors and emotions come from their thoughts (Cohen et al., 2012). In simpler terms, if an individual undergoes depression, the individual has distortions and errors in a specific cognitive within them. As a result, the mistakes in cognition cause them to undergo these depressive episodes. A person experiencing depression may constantly think less of themselves and have thoughts like “I cannot handle this!” however, they can solve this by confronting and handling the cognitive error. They can do this by replacing the mental error with a thought more realistic to them. For instance, instead of a person stating that I cannot handle this, they can say, “this is not easy, but I can work something out.”

DAP Notes of the Initial Meeting

On our first meeting, the patient was not comfortable, and she was shy. She was well-groomed, and as much as she did not smile much often, she was cooperative in the session. It was clear that she wanted to be there as she knew that she needed help. Therefore, to improve on her school work, she had to have a better relationship with herself. She understood that her parents trying to get her to another school would not help improve her academic performances, but the sessions we were having would be helpful. Generally, the session went well, and as much as the patient was not cooperative and hardly answered all my questions, it was evident that she could progress. We talked about her life and what she felt was making her not perform in school and why she had difficulty making friends and building relationships. In addition to this, we talked about how her parent’s separation and divorce impacted her life and that of her siblings. When asked about her parent’s separation affecting her life, Danerys did not give much information. She stated that she wished she had stability at home. According to the patient, her parents were more focused on their fights and constant separations. As a result, they hardly paid attention to anything that she and her sibling were going through. Since her parents have been having continuous separation episodes and now discussing a divorce, Danerys explained that this lack of stability in a home was the main reason she found it hard to build interpersonal relationships. She was afraid if she ever got close to anyone, they would not stay forever and leave her when she needed them the most. As a result, she chose to remain alone and not build any relationships with anybody.

The overall goal of the planned sessions with the patient is to help her overcome her depression and become better. Overcoming depression and episodes the patient keeps having will be essential in her life and may help improve her school performance. The session relates to the goal because the patient is opening up, and she is willing to participate to get better. Due to the depression the patient has been going through, and she has had insomnia. Also, she has been overeating to get over everything going on around her. As a result, the patient has gained a lot of weight. Accumulating too many pounds has led to her hating herself hence having negative thoughts about her. The client has gained weight, and for a 15-year old girl, she is overweight, and that might be why she has negative thoughts about herself. From this first session we had, it was evident that the client was in the contemplation stage. The contemplation stage is the stage where people intend to start healthy behavior. At this stage, individuals realize that their behavior is problematic and may have significant impacts on their lives if they do not change their ways.

Uses and Application of CBT 

CBT is a combination of theories on how individuals can learn with different approaches. CBT is mainly used in the treatment of mood and anxiety disorders (Thoma, Pilecki & McKay, 2015). In counseling, CBT is especially applicable, and it is a talking therapy. The therapy is essential as it allows an individual to manage their problems by recognizing how their thoughts and what is on their minds affect their behaviors and feelings. During this therapy method, the patient and counselor work together to identify and take note of unhelpful behavioral and thinking patterns. The therapy mainly believes that if one changes the way they think or behave in a given situation, they can change how they feel. Therefore, the treatment focuses more on the behaviors one learns their habits and the negative thought patterns to transform them into positive ones. For patients like Danerys who suffer from depression, the therapy will start with the patient receiving education regarding depression. In addition to this, the education process will help the patient understand the symptoms they possess and what they can do about them.

Biopsychosocial Information

The patient is Danerys, and she is of 15-year old Puerto Rican origin. She speaks Spanish and English, but she is more fluent in English compared to Spanish. She is single and is still in high school. The patient has been having depressive episodes, and these have impacted her performance in school. Considering her parents have had constant separations and are currently discussing divorce, this has impacted her life, and as a result, she is incapable of having interpersonal relationships. Fortunately for the patient, she has not had any past psychiatric history that needed medical attention before the last three months. However, she has experienced cases of anxiety, and since they were not severe, she never sought any medical help. Her parents have sought psychiatric help, but she has been lucky enough not to be a victim. Her current state has been ongoing for the last three months. It started with a few symptoms, but with time, the signs have continuously multiplied, and her eating habits have increased as well, leading to her having excessive weight gain. She has not undergone any surgeries and has no records of allergies.

The patient is not using any substances. She has never tasted any drug, and even though she has been in a position to do so, she has never done that before. In addition to this, she is not under any medications currently. However, for the selected intervention to work, it will be necessary to give her a prescription. The patient mentioned that since the fights between her parents increased over the last month, she has thought of hurting herself, but she has never acted upon it. She is neither dangerous to herself nor to others around her. She has no recurrent thoughts of harming herself. Therefore, harm is not on the table for discussion. Even though her parents fight a lot and have previously separated a couple of times, they have never been abusive towards their children. She has not been forced to have sexual contact with anyone, and she has never been abused or experienced abuse of any kind.

Family History

Danerys was born in Puerto Rico, but they moved to the United States when she was five. She is the firstborn in a family of two children; the younger one is a boy. She was raised by both her parents despite their constant separations. Her parents have a history of mental illness where her father is bipolar and has struggled with the disease since the patient can remember. He was hospitalized on multiple occasions during previous years for severe psychiatric symptoms. Her mother, on the other hand, has undergone depression and anxiety but has sought psychiatric help. She is in high school, and she has had a traumatic childhood where all she remembers of her parents is their fights and separations. At school, she is poorly performing and has not successfully built any interpersonal relationships with anyone. She has no friends whatsoever and is always spending most of her time alone. Even though she believes in God, the patient does not attend religious services. As a Puerto Rican person living in the United States, Danerys has experienced her share of discrimination. She remembers a particular time when at the local store, one of the cashiers refused to serve her, and her mum telling them that they should go back to Puerto Rico and stop stealing American citizens’ jobs. The patient loves swimming, and that is what she does well at. Spending time at the pool gives her pleasure, and she often feels refreshed after a good swim.

Mental Assessment

The patient’s orientation is sleepy and confused. Even though she is well-groomed, the patient hardly made eye contact in our session. She was restless, and her facial expressions were every day. However, it was evident that they were tired, and the patient had been crying from her eyes. She looked depressed, and her speech was softer than usual. Her attitude was guarded, and she seemed afraid to let anyone in her thoughts. She is attentive, and her memory seemed fine, and her insight was regular. Apart from attending her classes, she often heads home to look after her younger brother as her parents are never there. In case they are, they repeatedly shouting at one another, neglecting their parental responsibilities. Apart from school and home, the only other place the patient ever visits is the swimming pool, where she spends most of her days. According to her, the waters are her happy place.

Strengths and Weaknesses of CBT

In most cases, CBT is as effective as the use of medicine. However, it may fail to work in some patient’s mental health problems (Lagerveld et al., 2012). The most common advantages of CBT include

• It helps patients in cases where the prescribed drugs could not work alone.
• One can complete the therapy in a short while compared to other treatments where patients talk.
• The therapy method can be offered to patients in different strategies that include group therapy.
• The therapy method teaches a patient the practical strategies they can apply in their daily lives. These approaches may help them if they undergo attacks.

Disadvantages of CBT

Despite the various advantages associated with the theory, it is accompanied by multiple disadvantages, and they may include;

• First, for CBT to work effectively, one needs to commit to the process. The therapist can advise a patient, but the patient needs to cooperate for the intervention to work.
• The approach may not work for individuals with more complex mental health needs. It is so because it needs more structured sessions.
• Lastly, it may result in emotional discomfort. This is so because the process involves confrontation of both anxieties and emotions.

The patient is suffering from depression, and it is significant from the prescribed symptoms. She has every sign that shows her depression is severe, and if not treated, she might become worse. Due to the stresses, she has gone through, the patient has developed poor eating habits and has gained weight. In addition to this, her mental problem has affected her performance, and she has been failing her classes terribly. Therefore, the most recommended treatment for Danerys is cognitive behavioral therapy and SSRIs. These two will help the patient control her symptoms at the same time, allowing her to revisit her anxieties and what may be causing them. The selected theory CBT may interfere with her personal beliefs as it will force her to rethink her fears and concerns that may result in the patient becoming emotionally uncomfortable.

References

Cohen, J. A., Mannarino, A. P., Kliethermes, M., & Murray, L. A. (2012). Trauma-focused CBT for youth with complex trauma. Child abuse & neglect, 36(6), 528-541. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3721141/

Lagerveld, S. E., Blonk, R. W., Brenninkmeijer, V., Wijngaards-de Meij, L., & Schaufeli, W. B. (2012). Work-focused treatment of common mental disorders and return to work: a comparative outcome study. Journal of occupational health psychology, 17(2), 220. https://pubmed.ncbi.nlm.nih.gov/22308965/

Thoma, N., Pilecki, B., & McKay, D. (2015). Contemporary cognitive behavior therapy: A review of theory, history, and evidence. Psychodynamic Psychiatry, 43(3), 423-461. https://pubmed.ncbi.nlm.nih.gov/26301761/

Van Rheenen, T. E., Meyer, D., Neill, E., Phillipou, A., Tan, E. J., Toh, W. L., & Rossell, S. L. (2020). Mental health status of individuals with a mood-disorder during the COVID-19 pandemic in Australia: Initial results from the COLLATE project. Journal of affective disorders, 275, 69-77. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7331562/

To get your original copy of this completed paper, please Order Now