Case Study of Angela Counseling 621 Kelli Cofer November 11, 2011
Client Description• Angela• 44 year old African American female• School teacher & guidance counselor• Morbid obese – Recommendation for gastric by-pass surgery• Uses food to copy with stress• Additional health problems
Purpose of Assessments• Initial intake assessment – Determine adequate support system – Clarify purpose of evaluation• Mental status examination (MSE) – Statement of how client looks, feels, and behaves during initial examination• Minnesota Multiphasic Personality Inventory – Second Edition (MMPI-2) – Highlights red flags in profile – Assess patterns of personality and emotion disorders• Million Clinical Multiaxial Inventory – Third Edition (MCMI-III) – Identifies predominant personality traits
Assessment Proceduresand Protocol• Initial intake interview – Performed during initial visit – Notice of Privacy Practices (HIPAA form) – Consent of treatment – Release of information• Mental Status Examination (MSE) – Performed during initial visit – Series of questions• Minnesota Multiphasic Personality Inventory – Second Edition (MMPI-2) – 567 items – True, False, Cannot Say answers – Results evaluated using computer software• Million Clinical multiaxial inventory – Third Edition (MCMI-III) – Distinguish psychiatric disorders – Complex scoring done by computer
Medical/Developmental History• Weight condition evident, age 16• Morbid obese, age 25• Fourth of six children• Family history of obesity• Two sons• Divorced twice• Marital history of abuse and infidelity• Mother died of heart attack seven years ago
Familial Psychiatric History• Family history of drug and alcohol abuse
Work History• Elementary school teacher• Guidance counselor• No record of reported work absences• Weight affects occupation
Home Behavior/Social• Family of origin – Fourth of six children – Mother died about seven years ago – Father still living• No reference to family closeness• No reference to social activities• Divorced, two sons
Assessments Used & Appropriate Interpretations• Initial intake assessment – Determine support system• Mental Status Examination (MSE) – Organize client information• Minnesota Multiphasic Personality Inventory – Second Edition (MMPI-2) – Personality characteristics• Million Clinical multiaxial inventory – Third Edition (MCMI-III) – Assist in diagnostic process – Differentiate psychiatric disorders
Summary of Findings• Intake assessment – Mentally alert – Poor support system• MCE – Functions well in occupation – History of binge eating – Food used as stress management• MMPI-2 – Elevated L Scale – No Cannot Say responses – Defensiveness• MCMI-III – Evidence of panic disorder with agoraphobia – No sense of hopelessness – No cyncicism – Unevaluated mental health disorders
DSM DiagnosisAxis I: 300.00 – Anxiety disorder NOSAxis II: V79.01 – No diagnosisAxis III – High blood pressure, diabetes, orthopedic problems, obesityAxis IV: None reportedAxis V: Current GAF - 60
Treatment Plan & RecommendationsAngela reports symptoms of anxiety, but she seems to bemildly or moderately defensive in her test responses. Anongoing counseling relationship is recommended to help herwith her panic attacks, and will be helpful in dealing withanxiety following surgery. Angela will benefit fromparticipation in a support group with people experiencingsimilar medical concerns after gastric by-pass surgery. Familycounseling services can help with addressing issues involvingher bad relationships, eating behaviors, nutritionalguidance, and transition in self-image.
References• Whiston, Susan C. (2008). Principles and applications of assessment in counseling (3rd ed.). Thomson Brooks/Cole: Belmont, CA.• American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV TR. Washington, DC: American Psychiatric Association.