Casey Psychology Case Study (ANSWERED)

QUESTION

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

Casey is a 26-year-old doctoral candidate in English literature at the local university. She is in good standing in her program and has plans to enter the job market in the fall. In your intake, she tells you she thinks she is “fat” and has been self-conscious about her body since the sixth grade, at which time she began menstruating and developing breasts earlier than the other girls in her class. She was teased for needing a bra and remembers feeling “chubby, too big, and just wanting to be small like [her] younger sister.” She started dieting in the seventh grade, following strict rules for weeks (e.g., she recalls the grapefruit only diet), then transitioning into what she called “bad” weeks.  During these times, she would stock up on candy bars and other snack foods and eat them, often in her bedroom late at night. This behavior has continued.

ANSWER

Case-Study: Casey

Casey, a 26-year-old female, is referred to the outpatient facility with suspected self-esteem issues. She is an English literature doctoral candidate planning to start working during the fall. The client has been struggling with body image issues since the sixth grade. Casey does not meet the national guidelines for overweight or obesity but still believes she is fat. She started a “grapefruit only diet” when she was in seventh grade for being chubby. She wants to be like her sister, and her primary goal is to improve her appearance to become happy and fulfilled in life. The client reveals she eats snacks and candy late at night to cope with bad times.

She experienced bullying, which was characterized by teasing and body-shaming from her peers. Casey’s perceptions of body image have behavioral consequences. The client’s mental and behavioral problems stem from her childhood experiences. The client discloses that she is not satisfied with her current condition and desires to change some aspects of her appearance

DAP Notes

Data

The counselor meets Casey for a 30-minute session designed to improve her body image acceptance. Casey is provided with a media critique exercise where she is required to examine a skinny model’s picture. Through controlled guidance, she is expected to identify the bias of perpetuating the model’s body type as the ideal type. She is also asked to identify and appreciate the appearances of people from different cultural backgrounds. By doing so, Casey should be able to discredit the notion that being skinny is beautiful and appreciate the beauty in diversity.

At the end of the session, Casey can identify why it is unfair to demand every woman to assume the model’s body shape. However, she discloses that she would still be happy if she had that kind of body. After discussing the body ideals, Casey seems to be less dispassionate towards “bigger women.” When I asked her if she thought one woman being attractive discredited another woman’s beauty, she responded optimistically. Her response is a first step towards analyzing maladaptive thinking.

Assessment

The session’s goal was to teach Casey to improve body image literacy by recognizing the irrationality of the media’s ideal body size. Her ability to recognize the unfairness in expecting women to have the model’s body size is a positive outcome. She is at the pre-contemplation stage because she is not ready to take the required steps towards achieving accepting her body. Her unpreparedness is evidenced by the desire to have the model’s body type.

Plan

For the next session, the counselor will help Casey understand the impact of long-term internalization of such beauty ideals. During the next session, Casey will be taught how to identify the irrational and automatic thoughts that support the concept that skinny is beautiful. The counselor will use the psychoeducation strategy to help Casey identify the causes and consequences of irrational thoughts on body image.  According to Alleva et al. (2015), this technique can significantly improve a patient’s body type. The counselor will develop exercises to help Casey identify such irrational schemas between now and the next session.

Biopsychosocial Assessment

Patient

Casey, a 29-year old African American female, comes to the facility alone. She appears to be in good health and claims she takes an annual medical examination. Her chief complaints are eating disorders and how she feels about her body. The patient reports that she has enrolled in weight-loss programs a few times. She states that she lost weight while still enrolled in the programs but would gain all of it a few weeks or months after quitting them. She also reveals that she has purchased over-the-counter medications such as Orlistat or Alli to help cut weight.

Casey revealed that she had not received any psychological help before this appointment.

She never felt that her issues needed any professional help until she heard one of her colleagues talk about them. She denies having any known acute or chronic diseases. She does not recall having any unusual events that occurred during her childhood. She believes she achieved her developmental milestones with ease. She denies sustaining any significant injuries and surgical history.

She is currently on Tylenol 325mgX2 PO PRN and Ibuprofen 200mgX2 PO PRN. She states that she only takes these medications occasionally to deal with menstrual pains. The drugs are self-medicated. Past medication is Orlistat, which was also self-medicated.  She claims she took one capsule three times a day during or at least one hour after the meal. Orlistat is indicated to prevent weight gain after loss and is approved as an over-the-counter medication in the U.S (Bansal & Al Khalili, 2020). She stopped using the medication because of its adverse effects; she claims she experienced diarrhea and abdominal pains and discontinued use.

Casey denies any drug or substance use. However, she states she occasionally drinks wine when she is alone watching movies. She acknowledges that food brings her comfort.  Casey denies having any suicidal/homicidal ideations. The client claims she has never attempted, planned, or thought of suicide. Casey has never had the thoughts of harming others. She admits to bulimia: she reveals she has had cyclical binge eating and would induce vomiting after the binge eating to prevent weight gain. However, she claims that she did this when she was younger and has not experienced this in adulthood. She does not have any other high-risk behaviors.

Casey has endured verbal and emotional abuse from her parents and peers. She claims her mother was obsessed with appearance, and at the age of 11, she put her on a grapefruit diet to help her keep in shape. The World Health Organization defines child adversity as any action or words that hurt a child’s wellbeing. These include, but are not limited to, verbal and physical abuse, bullying, neglect, emotional abuse, etc. (Pearce et al., 2019). Casey recalls her mother blamed her for the bullying because she failed in losing weight. Her mother constantly abused and berated her, demanding she becomes like her little sister.

She says her father never intervened or said anything in her defense. However, she indicates that none of her parents ever struck her. Any imposed punishments involved losing privileges. She recalls that her mother once caught her illegally eating snacks and was put on a strict vegetable-only diet for a month. She was not allowed to have any ice-creams, candies, or treats even when they went to the amusement park. She has never experienced any inappropriate sexual incidence.

Family/Social History

Casey was raised by her parents, whom she lives with, together with her 22-year old younger sister. She is currently single, has never been married, or had any significant relationships. Her social life and support systems are close to inexistent. Casey disclosed that she has always felt alone and unloved. She never really connected with her mother because of their constant fights over her body weight. Casey reveals that she never shared or talked to anyone about her feelings because she feared they would judge her. She is currently unemployed but is looking forward to having her first job. She has never had legal problems. The significant life event is that she is thinking of entering the job market after graduating from her doctorate program. She does not recall having any relatives with mental illness. However, she claims she has paternal relatives with the same weight issues as hers.

Developmental History

She claims that nobody ever wanted to be her friend in school because she was the “fat kid.” As illustrated from her social/family history, she did not have any close relationships or support, including from her primary care providers. Casey reveals that she was teased for developing breasts and needing a bra earlier than her counterparts. She also started her periods earlier, signaling possible isolation or loneliness for being different. Her traumatic experiences began at the age of 11.

The patient identifies as a straight woman and an atheist primary because her family was never really religious. Casey does not have an income range; however, she plans to start working soon. She uses food as a coping strategy and primary source of comfort.

Casey describes herself as an introvert; she loves reading books, watching movies, hiking, picnics, etc. Casey hates social gatherings, including her family’s, because they make her anxious.

Mental Status Assessment

Appearance: poor eye contact

Behavior/Motor Activity: Normal

Mood/Affect: Anxious

Speech: Pressured/Incoherent

Attitude: Feelings of inadequacy

Thought Process: Racing, word salad

Thought Content: Phobia (social), obsessive preoccupation with minor deformations on her body

Delusions: None

Hallucinations: None

Impulse Control: Normal

Judgment: Normal

Cognition/Knowledge

Orientation: Person

Attention: Can the patient spell W-O-R-L-D backward? Yes

Memory: Immediate recall of 3 objects _Yes; Recall after 5 minutes Yes___/3

Naming: Point out three objects. How many can the patient name? __Yes_/3

Visual-spatial: Can the patient copy intersecting pentagons? _ Yes

Praxis: Can the patient follow a three step command? _Yes

Calculations: Serial 7’s (how many times can the patient correctly subtract 7 from 100): __Fourteen times

Abstractions:  Comprehends

Insight- Normal

Is the patient able to meet their basic needs? –Yes

Functional Ability

Areas of concern: Family relationships, social skills, and social relationships.

Case Conceptualization

Differential  Diagnosis

Casey has body image disturbance characterized by impaired psychosocial functioning and behavioral issues. She is dissatisfied with her body and thinks she is too big. According to Hosseini and Padhy (2019), the behaviors and perceptions displayed by Casey are characteristic of body image distortion. This condition occurs when patients have thoughts, feelings, behaviors, and self-evaluations that misperceive their body size and shape. Casey does not meet the national guidelines of an overweight or obese woman, yet she thinks she is too big. Another critical feature of body image disturbance that Casey displays is bulimia. Patients with body image disturbance commonly experience anorexia, bulimia nervosa, and body dysmorphic disorder (Hosseini & Padhy, 2019). According to Hosseini and Padhy (2019), patients with this disorder are also likely to have occupational and social functioning limitations. This finding is evidenced by Casey’s inexistent social life and inability to have social relationships.

Counselors need to understand the etiology of mental health issues to implement effective counseling strategies. The etiology of Casey’s condition can be prescribed by cognitive-behavioral therapies (CBT) theory. CBT is a structured, goal-oriented therapy where the therapist and patient collaboratively work to change the client’s thinking patterns and behaviors to improve their life (Chand et al., 2019). CBT has been extensively used to treat eating disorders, depression, substance use, personality disorders, anxiety, and body image disturbances (Chand et al., 2019). Additionally, it has proved effective as an adjunct therapy treatment to medications for mental disorders such as schizophrenia and bipolar disorder (Chand et al., 2019). The theory focuses on the relationship between a client’s cognition (automatic thoughts, underlying beliefs, and cognitive distortions), emotion, and behaviors. According to the theory, a client’s automatic thoughts and underlying beliefs will influence their interpretations of events which, in turn, will influence their behaviors and emotions.

The strength of CBT is that it has been proven to be effective in treating mental health issues, including the ones experienced by Casey. Additionally, if treatment is successful, a patient can acquire effective life skills and strategies to cope with stress and adversities. The key weakness of this therapy is that it largely depends on the patient’s cooperation to be effective. Unless the patient is willing to open up, share their intimate thoughts, and cooperate with the counselor, the therapy cannot work.

This theory was selected because it supports Casey’s case. As prescribed by the CBT theory, Casey’s belief system influences her behaviors and emotions. Her underlying schema about self is that she needs to lose weight to become happy. It explains why Casey wants to improve her appearance to achieve satisfaction and fulfillment in life. The role of a counselor in CBT is to help the patient replace the irrational and negative automatic thoughts associated with her self-image. The counselor evaluates situational stressors that activate the patient’s unpremeditated thoughts. The knowledge is built throughout the counseling and shared with the client at an appropriate time when they are emotionally prepared.

The counselor’s goal is to improve Casey’s quality of life by instilling healthy and positive thinking patterns and behaviors. The counselor’s job is not to change the circumstances in Casey’s life but to help her control her perceptions and interpretations of those circumstances. On the other hand, Casey’s goal is to lose weight and her eating habits to improve her appearance. Both Casey and the counselor will work collaboratively to ensure that their shared goals are achieved by the end of the session.

References

Alleva, J. M., Sheeran, P., Webb, T. L., Martijn, C., & Miles, E. (2015). A Meta-Analytic Review of Stand-Alone Interventions to Improve Body Image. PloS One, 10(9), e0139177. https://doi.org/10.1371/journal.pone.0139177

Bansal, A. B., & Al Khalili, Y. (2020). Orlistat. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK542202/

Chand, S. P., Kuckel, D. P., & Huecker, M. R. (2019, April 29). Cognitive Behavior Therapy (CBT). Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470241/

Hosseini, S. A., & Padhy, R. K. (2019, September 9). Body Image Distortion. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK546582/

Pearce, J., Murray, C., & Larkin, W. (2019). Childhood adversity and trauma: experiences of professionals trained to routinely enquire about childhood adversity. Heliyon, 5(7), e01900. https://doi.org/10.1016/j.heliyon.2019.e01900

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