Michael is a 20-year-old who was adopted at the age of 4.  Michael’s father was a Black male, and his mother was of Latin American descent. Michael was removed from the home at the age of 4 due to neglect and physical abuse and placed in a foster home. His foster parents were White, and he was later adopted by his foster parents.  Michael’s adoptive parents were living in an area of high socioeconomic status. Michael attended a private school throughout elementary-high school which consisted of primarily white students (over 85%) and the teachers were also white.  Michael always felt like he was “different” and later realized the teachers pointed out he attended the school and was “one of us.”  Michael remembered the students looked at him in a different way and he remembers one student touching his hair and felt it “looked cool.” Michael remembers chuckles from the other students.  He went home and cried in his bedroom as he felt like his parents would not understand since he also started to feel “different” in their home.

Michael began feeling like he “wasn’t good enough” and felt trapped in an environment where he thought others excluded him. Michael stood at 5’8″ in high school and remembers a student asking him if he was planning to try out for basketball. Michael realized in that moment that it wasn’t because of his height.  Michael began to isolate from his peers and his parents began to express concern.  His grades declined and he would spend many days in bed.  Michael also lost a significant amount of weight (8lbs.) in a two-week period and his parents found a journal where Michael expressed wanting to “end it all.”  Michael wrote about his feelings in his journal and described feeling hopeless, no pleasure in activities, and irritability.  Michael’s irritability increased and he had he was sent to the office three times within a two-week period for “defiant behavior.”  Michael often shuts down in class due to fear of embarrassment and the teachers spoke with Michael’s parents about being “defiant” in class.

Michael’s parents made an appointment with a local therapist when he was a senior in high school (age 17).  The therapist was a male in his late 20’s and was White. Michael immediately felt guarded as he entered the therapist’s office since he was in an environment again where he was “different.”  Michael met with the therapist a few times and developed courage to ask for a Black therapist.  The therapist expressed he was competent to deal with Michael’s “issues” and brushed off the request by stating there were no Black therapists in the area.  Michael again left feeling like he was “trapped” in a world of feeling “different” from everyone around him.  Using the Parent/Guardian-Rated Level 1 Cross-Cutting Symptom Measure for children between the ages of 6-17 produced the highest scores in the anxiety domain indicating moderate levels of symptom severity. The therapist diagnosed Michael with Attention Deficit Hyperactivity Disorder and Oppositional Defiant Disorder. and referred him to a psychiatrist who placed him on Methylphenidate (Ritalin).  After a few months of taking the medication, there was no difference in his symptoms and he continued to isolate, express irritability through defiant behavior and now felt labeled and even more “different.”  Michael began attempting to find members of his biological family thinking this would help to find his roots.  He discovered information about a cousin who was killed by gun violence in a nearby community. The discovery exacerbated Michael’s negative feelings and he reached his lowest point.

As time went on and Michael graduated high school, he attended a local community college. Michael was driving to class during the first month of school and was pulled over for going 35 MPH in a 32 MPH zone. Michael remembers the fear he experienced as the officer approached his vehicle.  He went into a panic as he thought about everything he has seen on the news and seeing the police officer’s gun triggered the news clips about his cousin.

Two months after being pulled over,  Michael began having flashbacks about his cousin and seeing news clips (almost nightly when watching the evening news).  Michael’s grades started to decline (B average to a C).  He is avoiding the area he was pulled over which has impacted his route to school.  He is now driving over 10 miles out of the way to avoid the area. Michael has intrusive memories daily, at least 4 nightmares of childhood per week (memories of abuse from his biological parents and the news clips about his cousin).  Michael is also experiencing nocturnal panic attacks three times per week. Michael is also becoming increasingly irritable and exhibiting episodes of anger (punching walls and verbally aggression toward peers).

Michael had been seeing the same therapist since high school and recognized the lack of progress and feeling “different” each time he entered the therapist’s office. Michael also realized he has been experiencing nightmares, flashbacks, fear of his future, and being startled when surprised to the point he panicked.  He realized in that moment that he needed to connect with resources and support. Since Michael turned 18 and is now in college, he felt empowered to see a new therapist (you) who provided insight into his experiences. You conducted a PTSD checklist (PCL) was conducted which indicated a score of 46 and conducted the Adult DSM-5 Cross-Cutting Symptom Measures which produced the highest scores in anxiety and indicated moderate scores in the anxiety and dissociation domains.

Question

Part 1: 

What is a diagnostically driven treatment plan for this case being sure to have a long-term goal and three short term goals. These need to be clearly related to the diagnosis/signs and symptoms (not about attendance at therapy, etc.)  Then provide your clinical rationale for these.  These need to be SMART which means they are measurable and time framed.  Be sure that your short-term goals are connected to your long-term goal.   Ideally, these would be for the principle diagnosis.  If you choose to write them on a secondary diagnosis be sure to explain why.

Note: Goals which are focused on attendance at counseling, at meetings, at groups are not symptoms focused goals.

Long term goal:

Short term goal #1:

Short term goal #1:

Short term goal #3:

Part 2 :

Review the literature for an evidenced based/evidence supported treatment of the client diagnosis. Briefly describe the model/intervention. There needs to be enough here to show you have a clear idea of the focus of the model and how that is done.

• Would you use this approach with this client (Assuming the client is in agreement with the modality)?  Why or why not?

Part 3:

From a large systems’ (macro) perspective identify three issues (such as community and environmental issues, bias and stigma, socioeconomic issues, laws, policies, agency services and policies, resource availability, societal beliefs) which have impacted the onset, severity, maintenance of, and/or response to the mental health diagnosis, signs and symptoms for this client and/or others like them and provide rational.

Identify two different specific focuses for advocacy which could impact the mental health status of this client and others like them. Demonstrate a commitment to social justice and an understanding of how complex systemic issues impact the development, maintenance and/or treatment of mental illness. and provide rational

Please provide references. Thank you!

ANSWER

Case Analysis and Treatment Plan for Michael: PTSD Diagnosis

Part 1: Diagnostically Driven Treatment Plan

Long-term Goal

Michael will achieve a significant reduction in PTSD symptoms and related impairments to improve overall mental health and well-being.

Short-term Goals

Michael will learn effective coping strategies to manage intrusive memories and nightmares. He will demonstrate a 30% reduction in the frequency of intrusive symptoms within three months.

Clinical Rationale: Intrusive symptoms significantly impact Michael’s daily life and functioning. Reducing these symptoms is crucial for his well-being.

Michael will engage in exposure therapy to confront and process the fear associated with his traumatic experiences. He will complete at least six exposure sessions within two months.

Clinical Rationale: Exposure therapy is an evidence-based treatment for PTSD. By addressing fear and avoidance, Michael can work through traumatic memories.

Michael will develop anger management skills to reduce aggressive outbursts. He will demonstrate a 50% reduction in aggressive incidents within four months.

Clinical Rationale: Michael’s anger outbursts are negatively affecting his interpersonal relationships and mental health. Reducing aggression is essential for his recovery.

Part 2: Evidence-Based Treatment

One evidence-based treatment for PTSD is Cognitive-Behavioral Therapy (CBT), specifically Prolonged Exposure (PE) therapy. PE involves revisiting the traumatic memory repeatedly until it becomes less distressing. It includes in vivo exposure (confronting avoided situations) and imaginal exposure (revisiting traumatic memories through discussion). PE aims to reduce avoidance behavior and alleviate emotional distress linked to traumatic memories.

I would recommend using PE with Michael, as it has a strong evidence base and addresses his intrusive memories, nightmares, and avoidance behavior. However, it’s important to tailor the approach to Michael’s specific needs and cultural background, ensuring that he feels safe and empowered during therapy.

Part 3: Systemic Factors Impacting Mental Health

Issues

Bias and Stigma: Michael’s experiences of feeling “different” and isolated due to his racial and cultural background, along with negative stereotypes and biases, may have exacerbated his mental health struggles.

Socioeconomic Issues: Michael’s socioeconomic status may have limited his access to mental health resources, quality education, and support services.

Advocacy Focus

Anti-Stigma Campaigns: Advocate for anti-stigma campaigns that raise awareness about the impact of biases and stereotypes on mental health. These campaigns can promote acceptance and understanding of diverse cultural backgrounds.

Mental Health Access: Advocate for increased access to affordable mental health services and educational resources in underserved communities, ensuring that individuals like Michael can receive timely and culturally sensitive support.