This is a Case Formulation dated 22/7/2017
I. Diagnosis:
Luisa is diagnosed with several mental disorders as a result of sexual abuse. These disorders are PTSD (Posttraumatic Stress Disorder), depressive disorder, and anxiety disorder.
II. Background/History
Luisa, 25 years old, housewife, illiterate, married, five living children, one dead (two pairs of twins), one granddaughter. Derived from the Unit of Psychiatry from Primary Care with diagnosis of chronic depression of 11 years of evolution, initiated in the last postpartum and associated by the patient to a surgical sterilization.
The five stages, denial, anger, bargaining, depression and acceptance are a part of the framework that makes up our learning to live with the one we lost. They are tools to help us frame and identify what we may be feeling. But they are not stops on some linear timeline in grief.
This is a Case Formulation dated 22/7/2017
I. Diagnosis:
Luisa is diagnosed with several mental disorders as a result of sexual abuse. These disorders are PTSD (Posttraumatic Stress Disorder), depressive disorder, and anxiety disorder.
II. Background/History
Luisa, 25 years old, housewife, illiterate, married, five living children, one dead (two pairs of twins), one granddaughter. Derived from the Unit of Psychiatry from Primary Care with diagnosis of chronic depression of 11 years of evolution, initiated in the last postpartum and associated by the patient to a surgical sterilization.
The five stages, denial, anger, bargaining, depression and acceptance are a part of the framework that makes up our learning to live with the one we lost. They are tools to help us frame and identify what we may be feeling. But they are not stops on some linear timeline in grief.
Complete your treatment plan template ( I WILL COMPLETE THIS)for Eli.docxskevin488
Complete your treatment plan template ( I WILL COMPLETE THIS)for Eliza based on LAST WEEKS assignments findings. Additionally, write and submit a 700-1,050-word essay that includes the following:
The treatment theory you would use and why.
A description of how you would address any mental health, medical, legal, and substance use issues that the client exhibits in the case study through the lens of your counseling theory of choice.
Include at least three scholarly sources in your paper.
Submit the paper and the treatment plan to your instructor.(I WILL COMPLETE THE ATTACHED TREATMENT PLAN) I JUST WANTED YOU TO HAVE IT FOR REFERENCE, PLUS THE PAPER YOU WROTE LAST WEEK.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful
CLASS TEXTBOOK REFERENCE:
Schwitzer, A. M., & Rubin, L. C. (2014).
Diagnosis and treatment planning skills: A popular culture approach
(2nd ed.). Los Angeles, CA: Sage Publications. ISBN-13: 9781483349763
Here is the example BPS for eliza
PCN-610 Eliza D Psychosocial Example
Name: Eliza Doolittle Date: ********* DOB: ********
Age: 18 Start Time: 1:15p End Time: 2:00p
Identifying Information:
The client is a Caucasian female with average height and slender build. The client stated that she is currently a freshman in college, majoring in engineering. The client also stated that her family resides in a small town approximately two hours away.
Presenting Problem:
At the onset of the session, the client stated that she had come to counseling as a result of being caught in a campus dorm with alcohol (it is an alcohol-free campus). Concerning the incident, the client stated “the RAs were called because my friends were being too loud in my dorm. When they arrived, they saw us with alcohol, and we got in trouble.” The client stated that her friends in the dorm were intoxicated but she was not, adding, “I was just buzzed” and adding that she was drinking “because they were” and “it’s just something to do.”
Life Stressors:
The client identified school as a life stressor, adding “things came easy to me in high school, I just figured it would be the same in college”. The client went on to state that, in addition to the difficulty in increased study requirements, she had struggles in making friends, stating, “a lot of my friends from high school have either gone to college somewhere else or are doing other things,” although the client denied feeling lonely.
Substance Use:
Yes
No
The client denied having a drug or alcohol problem, adding that she tried marijuana once in high school but “I didn’t like how it made me feel” and had not taken it since. The client stated that she was introduced to alcohol in HS when “friends asked me to drink it with them.” The client .
As a clinical social worker it is important to understand group .docxssusera34210
As a clinical social worker it is important to understand group typology in order to choose the appropriate group method for a specific population or problem. Each type of group has its own approach and purpose. Two of the more frequently used types of groups are task groups and intervention groups.
For this Assignment, review the “Cortez Multimedia” case study, and identify a target behavior or issue that needs to be ameliorated, decreased, or increased. In a 2- to 4-page report, complete the following:
Choose either a treatment group or task group as your intervention for Paula Cortez.
Identify the model of treatment group (i.e., support, education, teams, or treatment conferences).
Using the typologies described in the Toseland & Rivas (2017) piece, describe the characteristics of your group. For instance, if you choose a treatment group that is a support group, what would be the purpose, leadership, focus, bond, composition, and communication?
Include the advantages and disadvantages of using this type of group as an intervention.
REQUIRED resource for assignment
A Meeting of an Interdisciplinary Team
Paula has just been involuntarily hospitalized and placed on the psychiatric unit, for a minimum of 72 hours, for observation. Paula was deemed a suicidal risk after an assessment was completed by the social worker. The social worker observed that Paula appeared to be rapidly decompensating, potentially placing herself and her pregnancy at risk.
Paula just recently announced to the social worker that she is pregnant. She has been unsure whether she wanted to continue the pregnancy or terminate. Paula also told the social worker she is fearful of the father of the baby, and she is convinced he will try to hurt her. He has started to harass, stalk, and threaten her at all hours of the day. Paula began to exhibit increased paranoia and reported she started smoking again to calm her nerves. She also stated she stopped taking her psychiatric medications and has been skipping some of her
HIV
medications.
The following is an interdisciplinary team meeting being held in a conference room at the hospital. Several members of Paula’s team (HIV doctor, psychiatrist, social worker, and OB nurse) have gathered to discuss the precipitating factors to this hospitalization. The intent is to craft a plan of action to address Paula's noncompliance with her medications, increased paranoia, and the pregnancy.
Click one the above images to begin the conversation.
Physician
Dialogue 1
Paula is a complicated patient, and she presents with a complicated situation. She is HIV positive, has Hepatitis C, and multiple foot ulcers that can be debilitating at times. Paula has always been inconsistent with her HIV meds—no matter how often I explain the need for consistent compliance in order to maintain her health. Paula has exhibited a lack of insight into her medical conditions and the need to follow instructions. Frankly, I was astonished an.
SOCW 6070-week 4 discussion 1 Looking Through Different Lenses.docxsamuel699872
SOCW 6070-week 4 discussion 1 Looking Through Different Lenses
I have provided the case study and all resources I work for hospice and my lens is meeting people where they are in their journey and trying to help the whole person and family
As a social worker, you bring your own lens—that is, your own set of assumptions, biases, beliefs, and interpretations—into your interactions with clients and the human services professionals with whom you collaborate. Human services organizations have their own cultures that influence their organizational lenses. An organizational lens reflects key assumptions about the individuals to whom the organization provides services. These assumptions influence the organization’s policies and procedures which, in turn, impact service delivery. For example, an organization that focuses on understanding the perspectives of the clients it serves may allow clients to provide feedback about their client experience through membership on advisory boards or boards of directors. The clients may have the power to make recommendations and decisions about the organization’s policies and procedures.
Understanding cultural lenses—your personal lens, as well as those of the organizations and other individuals with whom you work and interact—will enable you to better serve your clients.
Focus on the Paula Cortez case study
for this Discussion. In this case study, four professionals present their perspectives on the Paula Cortez case. These workers could view Paula’s case through a variety of cultural lenses, including socioeconomic, gender, ethnicity, and mental health. For this Discussion, you take the role of the social worker on the case and interpret Paula’s case using two of these lenses.
Post
how you, as a social worker, might interpret the needs of Paula Cortez, the client, through the two cultural lenses you selected.
Then, explain how, in general, you would incorporate multiple perspectives of a variety of stakeholders and/or human services professionals as you treat clients.
Support your post with specific references to the resources. Be sure to provide full APA citations for your references.
CASE STUDY also read Culture and Leadership chapter 15 pages 383 to 421
Paula has just been involuntarily hospitalized and placed on the psychiatric unit, for a minimum of 72 hours, for observation. Paula was deemed a suicidal risk after an assessment was completed by the social worker. The social worker observed that Paula appeared to be rapidly decompensating, potentially placing herself and her pregnancy at risk.
Paula just recently announced to the social worker that she is pregnant. She has been unsure whether she wanted to continue the pregnancy or terminate. Paula also told the social worker she is fearful of the father of the baby, and she is convinced he will try to hurt her. He has started to harass, stalk, and threaten her at all hours of the day. Paula began to exhibit increased paranoia and reported she sta.
Week 5 Focused SOAP Note and Patient Case Presentation Cosamirapdcosden
Week 5: Focused SOAP Note and Patient Case Presentation
College of Nursing-PMHNP, Walden University
NRNP 6675: PMHNP Care Across the Lifespan 2 Practicum
Introduction
Psychosis is a mental condition in which a person's ideas and perceptions are disrupted,
and the individual may have difficulty distinguishing between what is real and what is not.
A health condition, medications, or drug usage can all contribute to psychosis. Delusions,
hallucinations, incomprehensible speech, and agitation are all possible signs; the patient has
incorrect beliefs and sees or hears things that others do not see or hear. The person suffering from
the disease is usually unaware of his or her actions. Medication, psychotherapy, peer support,
family support and education, and talk therapy are all options for treatment. More or less every
mental intervention is backed by evidence accumulated during the patient's initial interview; each
patient's therapy begins with a thorough medical and mental health evaluation, the incorporation
of trust, and a discussion of past mental health history, substance misuse history, family mental
health history, and so on. In this example, the patient's evaluation was documented, and a
diagnosis was made based on the information collected from the patient during the evaluation.
When the case was being developed, a therapeutic approach was designed. The patient is a 53-
year-old Caucasian male who was scheduled for an initial screening for a psychotic disorder after
his sister recommended a visit to the psychiatrist because patient's behavior changed since the
mother passed away.
Patient Initial: S.T Age: 53 Gender: Male
Subjective Data:
CC: "I was brought here by my sister because since my mother passed away, I was living on my
own and not bothering anyone. Those people outside my window they are after me. They just
want me dead".
HPI: When patient was asked " what people?". Patient said " the government sent them to get
me because my taxes are high". Suddenly patient asked the provider if she can see the birds or
hear any loud noise. The provider responded by redirecting the patient that she does not hear any
voice or see anything. When the provider how long he is been hearing the voices or seeing
things, patient said " for weeks, weeks and weeks". Patient also said the sister tapped her phone
with the government. When asked about sleep, patient said " I have not slept well because the
voices keep me up for days. I try to watch the TV, they poison my food on TV, I locked
everything down in the fridge". Suddenly patient asked " Can I smoke?". Provider said "no you
can't smoke here". Patient admit that he smokes all day about 3 packs a day. Drinks alcohol
which his sister purchased for him to last him for weeks. Patient denies use of drugs. Admit to
history of marijuana use 3 years ago before the m ...
1. Social Work Research Couples CounselingKathleen is a 37-year.docxbraycarissa250
1. Social Work Research: Couples Counseling
Kathleen is a 37-year-old, Caucasian female of Irish descent, and her partner, Lisa, is a 38-year-old, Caucasian female with a Hungarian ethnic background. Kathleen reports that she has a long family history of substance use but has never used alcohol or drugs herself. She does not have a criminal history and utilized counseling services 10 years ago for family issues regarding her father’s alcohol use. Kathleen works as a nurse in a local hospital on the cardiac floor where she has been employed for 8 years.
Lisa reports experimenting with substances during college. She currently drinks wine on occasion. Lisa does not have a criminal history. Lisa has had many jobs and stated that she was unable to find her niche until recently when she took out a loan and opened a small Hungarian restaurant serving her grandmother’s recipes. Her restaurant has been open 1 year. Lisa reports that while she enjoys the work and has found her niche, she must work constantly to be successful, and she is worried the business might fail.
Kathleen and Lisa have been together for over 15 years. They have a close group of friends and see their families on major holidays. They came to outpatient counseling at a nonprofit agency to examine the possibility of starting a family together. They were both feeling ambivalent about it, and it had been the source of more than a few arguments, so they decided to come to counseling to address their concerns in a more productive way. They said they chose this agency because it was recognized as lesbian, gay, bisexual, and transgender (LGBT) friendly. They asked about my sexual orientation and my history because they were concerned about my level of experience working with the issues they were presenting.
I thanked Kathleen and Lisa for sharing this concern, and I informed them of various programs I had worked in within the agency, including supportive services for LGBT youth in schools and in the community. I also shared our agency philosophy and mission, which includes outcome measures and engaging clients in feedback to evaluate practice.
I explained the tools we used to measure outcomes. The first form measures how each of them are feeling with regard to their life and current circumstances. There are four different scales to measure aspects of their lives, such as social, family, emotional health, etc. I also provided the chart on which I score the scales and track progress. I explained that the purpose was to see where they began to demonstrate progress with the work we were doing.
The second form measures how well I am providing treatment. I demonstrated the four scales that measure if the client feels heard and understood and if we addressed in session what they wanted to. I explained that this should address their concern about my ability to assist them. Because we would be evaluating both how they felt and how the sessions were going each week, we could make adjustments on.
1. Social Work Research Couples CounselingKathleen is a 37-year.docxjeremylockett77
1. Social Work Research: Couples Counseling
Kathleen is a 37-year-old, Caucasian female of Irish descent, and her partner, Lisa, is a 38-year-old, Caucasian female with a Hungarian ethnic background. Kathleen reports that she has a long family history of substance use but has never used alcohol or drugs herself. She does not have a criminal history and utilized counseling services 10 years ago for family issues regarding her father’s alcohol use. Kathleen works as a nurse in a local hospital on the cardiac floor where she has been employed for 8 years.
Lisa reports experimenting with substances during college. She currently drinks wine on occasion. Lisa does not have a criminal history. Lisa has had many jobs and stated that she was unable to find her niche until recently when she took out a loan and opened a small Hungarian restaurant serving her grandmother’s recipes. Her restaurant has been open 1 year. Lisa reports that while she enjoys the work and has found her niche, she must work constantly to be successful, and she is worried the business might fail.
Kathleen and Lisa have been together for over 15 years. They have a close group of friends and see their families on major holidays. They came to outpatient counseling at a nonprofit agency to examine the possibility of starting a family together. They were both feeling ambivalent about it, and it had been the source of more than a few arguments, so they decided to come to counseling to address their concerns in a more productive way. They said they chose this agency because it was recognized as lesbian, gay, bisexual, and transgender (LGBT) friendly. They asked about my sexual orientation and my history because they were concerned about my level of experience working with the issues they were presenting.
I thanked Kathleen and Lisa for sharing this concern, and I informed them of various programs I had worked in within the agency, including supportive services for LGBT youth in schools and in the community. I also shared our agency philosophy and mission, which includes outcome measures and engaging clients in feedback to evaluate practice.
I explained the tools we used to measure outcomes. The first form measures how each of them are feeling with regard to their life and current circumstances. There are four different scales to measure aspects of their lives, such as social, family, emotional health, etc. I also provided the chart on which I score the scales and track progress. I explained that the purpose was to see where they began to demonstrate progress with the work we were doing.
The second form measures how well I am providing treatment. I demonstrated the four scales that measure if the client feels heard and understood and if we addressed in session what they wanted to. I explained that this should address their concern about my ability to assist them. Because we would be evaluating both how they felt and how the sessions were going each week, we could make adjustments on ...
1. For this discussion, Lila Miller Goldberg is a 45-year-old diabe.docxAlyciaGold776
1. For this discussion, Lila Miller Goldberg is a 45-year-old diabetic. She had difficulty losing weight since her pregnancy years ago and has started experiencing symptoms related to her condition. She has insulin-dependent diabetes mellitus (IDDM), and has been symptomatic for more than 10 years. She has been resistant about changing her diet and has been inconsistent with treatment, despite her health. She always hated her mother Ella’s fixation on nutrition while she was growing up, the different diets she tried, and the “weird meals” she prepared. She prefers quick and easy convenience foods, fast food, and what tastes good. After all, she is a busy working mom! She has never liked to exercise and, with the pain that has developed in her feet, it is physically too difficult.
Analyze and discuss the relationship between Lila’s environment growing up, her physiology, and her attitudes and behaviors. Use the following questions to guide your explanation, and be certain to apply basic medical terminology as appropriate.
How might Lila’s condition affect her thinking, her relationships, and social situations? In what ways might these factors worsen her condition?
How has Lila’s aversion to her mother’s dietary fanaticism while she was growing up affected her choices and, as a result, her health?
How might Lila’s condition of being overweight impact her relationships?
How might others in Lila’s family and community view her, and how might this affect how she views herself?
What do you believe are Lila’s options at this time? Cite research that supports your reasoning.
If you were Lila’s close friend, how might you counsel her based upon your understanding of the biopsychosocial aspects related to her position? Provide evidence from the available resources.
2. Analyze the new research indicating that heart disease may affect females more than males and comment upon how gender impacts our behaviors related to disease. How has the fact that most prior research has studied heart disease in males changed the ways in which women perceive the risks of heart disease and heart attacks? Do sociocultural experiences affect how an individual reacts to symptoms of disease? For instance, do men and women handle disease differently? Does it depend upon the type of disease? How do we see disease in others based upon gender? For example, do we see some diseases as unfortunate and others as possibly avoidable by the individual? Do we judge ourselves or others differently when disease or chronic conditions are present? Be sure to provide evidence from your resources to back up your statements.
Need back within 4 hours.
.
2. CASE STUDY
!2
The Mental Health Division of the Public Defender Service of the District of Columbia
takes on clients that are emergency or involuntary patients at psychiatric wards in the district and
want to fight their status. As a social work intern, I assist my supervisor in meeting the clients’
case mangement needs, ensuring the client is efficiently equipped to be discharged into the
community.
Client 3 is a 50-year-old female who is currently at a psychiatric ward in D.C. She has
described herself as having had a “hard life”: she was hit by a car at age nine, has survived sev-
eral rapes, some of which impregnated her, and has a history of illicit drug usage. Client 3 has
never aborted her multiple pregancies from rape, believing that the babies do not deserve to be
punished for an event that is not their fault. As a result, she has ten children, all of whom are ei-
ther in prison, estranged, or do not have their own housing. She is not married. Her mother occa-
sionally visits her, but has not visited in months and has a disconnected phone number. Client 3’s
sister has visited, seemingly as per the request of the mother, but has not returned since being
implored as Client 3’s caretaker. Various children sporadically visit, most with the desire to be
their mother’s caretaker; however, their irregular pattern of visitation and lack of resources prove
they are unreliable and unfit potential caretakers.
Aside from the mental health issue at hand, Client 3 is debilitated by a muscle atrophy
disease. She is in a wheelchair, and is described by the nurses as “total care” – she requires as-
sistance with all hygiene, grooming, and is considered at risk for falls and medication/treatment
refusal. She requires acute fifteen-minute checks, as she has a history of attempting to move in-
3. CASE STUDY
!3
dependently and injuring herself as a result. She cannot transfer independently, as she is inca-
pable of moving her own wheelchair and has minimal dexterity.
Client 3’s official psychiatric diagnosis is major depressive disorder and schizophrenia:
paranoid type. She is considered “hyperreligious”, and has various eccentric beliefs that have led
health professionals to believe she is delusional. Client 3 has a history of not eating for religious
reasons, citing Jesus’ thirty day fast and Deuteronomy 14, occasionally claiming the devil poi-
soned the food, wants her to eat and gain weight, and wants to steal her body and soul, as she
claims God is her body and soul. As she is a diabetic, this often complicates her medication
treatment, as the nurses must withhold insulin when she does not eat. Recently she has been
more compliant in her eating pattern, only skipping one or two meals when she does resist.
Client 3 has had two involuntary psychiatric admissions, in 2009 and 2013 respectively.
Between these admissions, she resided at a nursing home, but was returned to the ward after re-
sisting meals and medication, submitting an array of grievances to the home, and reportedly hav-
ing paranoid delusions. In general, she is resistant to everyday hygiene and self-care. She will not
even minimally assist when nurses are bathing her, brushing her teeth, brushing her hair, etc. She
typically resists showers. Since back at the ward, she has been more compliant with eating, phys-
ical therapy, taking medication/vitamins, and getting her finger stuck (although she still resists
getting her blood drawn). It is important to note that while her compliance has improved, her
compliance is not consistent. It is also important to note that there has never been evidence of
hallucinations while at the psychiatric ward.
Client 3 is socially withdrawn – she will engage when engaged, but does not interact with
the other patients. She says they are all “sick” and “swear too much”. She claims a desire to
4. CASE STUDY
!4
spread God’s word and help them repent, but she has never proselytized. She gets credit for par-
ticipating in groups, but in reality the groups simply happen around her. Client 3 appears lethar-
gic in social situations, but upon inquiry reports being “bored”. She repeatedly shows awareness
of her surroundings, and reports interest in certain gospel/pop music, reading her Bible, and puz-
zles. She always has a pillow on her stomach, which she lays her head upon when she is bored;
she sits straight up and makes eye contact when she wants to engage.
Client 3 reports feelings of sadness because people are not following God. When asked,
she says she will resolve this by spreading the word of God, but never does. Client 3 repeatedly
says she would prefer to be in the kingdom of God. However, she emphatically denies suicidal
ideation and has otherwise never shown any suicidal tendency.
Client 3 has a blatant interest in the Bible and God, but does not seem able to pontificate.
By Fowler’s stages of faith development, she does not appear to be past stage 2: mythical-literal
faith (simplified by M. Scott Peck as the chaotic-antisocial stage). This stage, usually occuring in
middle childhood but sometimes lasting into adulthood, involves self-centeredness, a basic ac-
ceptance of stories provided by a faith community/text, and an extremely literal application. This
often leads to unprincipled living, which can present obstacles. All transitions from this stage, if
they do occur, are dramatic.
Client 3 is currently an involuntary patient at a psychiatric ward because nowhere else
can take her, and she is unwilling to go anywhere other than an apartment by herself, living with
her kids, or in God’s kingdom. Nursing homes will not take her because of her psychiatric needs
and her history at past nursing homes as being a difficult patient. My supervisor therefore turned
to Little Sisters of the Poor, Mother Theresa’s order in the district, as they seem best suited for
5. CASE STUDY
!5
Client 3: they are an all-women environment that adheres better to Client 3’s high religious stan-
dards. Unfortunately, upon meeting her, Little Sisters of the Poor determined they cannot ac-
commodate Client 3’s physical needs. The client has thus far refused a case worker from the De-
partment of Behavioral Health, who can connect her to a housing agency. The client is unable to
live by herself and has no responsible family to speak of. There used to be a psychiatric nursing
home, but it was closed for fiscal reasons. The psychiatric ward is currently keeping her, simply
because there is nowhere else to put her. Her treatment team is working to find a more suitable
living situation, as she does not thrive on the ward. In the mean time, her treatment plan is fo-
cused on increasing social engagement through one conversation with staff per day, three groups
per week for at least ten minutes, and at least three interactions with patients weekly; continue
maintenance of her physical needs; better fill her time with leisure activities; and have bed baths
daily and at least one shower weekly. Upon finding a suitable discharge facility and receiving her
consent, Client 3 will be discharged.
Based on my education thus far from Liberty University’s School of Psychology, I would
not agree with the diagnosis of schizophrenia: paranoid type or Major Depressive Disorder. With
clients like Client 3, the gray area in abnormal psychology is highlighted: after all, her erratic
religious beliefs pose a danger to herself and are not based in reality. But before such heavy di-
agnoses can be made, I feel one must look deeper, and in this case I feel no one examined the
context properly. In an objective evaluation of Client 3’s history and the DSM-V, alongside my
observation of her behavior, I found no evidence of Major Depressive Disorder or schizophrenia:
paranoid type. In fact, I found no evidence for a diagnosis anywhere on the schizophrenia spec-
trum. Her beliefs are stated in passing and are inconsistently acted upon. For these beliefs to be
6. CASE STUDY
!6
delusional, they would have to be consistently acted upon for two months straight. As this is not
the case, she cannot have delusional disorder. She cannot have schizotypal personality disorder,
as she shows no discomfort with interpersonal relationships. Upon meeting her, I found her en-
gaging; she inquired about my hometown and my education, and showed appropriate affect,
laughing and smiling at times. Her lack of a convoy is due to frequent hospitalization, living
among a group of older people she cannot relate to, and perhaps her religious standards and lim-
ited ability to morally reason beyond herself and her own ideas. She shows no evidence of hallu-
cinations, disorganized speech, or catatonic behavior, and is not delusional. She is emotionally
normative, if socially reclusive, and therefore cannot have schizophreniform or schizophrenia. In
order to fit either diagnosis she would need to meet at least two of the criteria, and she meets
none. Therefore, while she has eccentric beliefs and sometimes presents paranoia, it is not
enough to suffice a schizophrenia diagnosis.
Furthermore, while she might present lethargic and catotonic, Client 3 is actually just
bored. She lives with people she cannot relate to, and has a limited range of activities or foods
she will partake in due to her religious standards. Therefore, she is not provided sufficient stimu-
lation or engagement. Otherwise, she is alert, is open when engaged, likes to read her Bible, em-
phatically denies suicide ideation, and enjoys various activities like listening to gospel music and
deciphering puzzles. She reports feelings of sadness, but links them to sadness for the sinners
around her who will not repent. She does not present week-long episodes of depression – her
mood changes like everyone else. Client 3 does not have much to be jovial about – until today,
she did not have her preferred Bible (the Devotional Bible by Max Lucado, which my supervisor
bought for her over the weekend), she has no convoy, she has no opportunity to create a mean-
7. CASE STUDY
!7
ingful convoy, she suffers from a debilitating disease, she is institutionalized, she is often forced
to be dependent due to her limitations, and she is surrounded by swearing “sinners”. Client 3
merely experiences normal sadness, an emotive state anyone might wrestle with in her shoes.
As for Client 3’s resistance to certain foods, medications, social interactions, and hygiene,
I feel they are all spirited attempts to claim control. She cannot walk, cannot move herself, can-
not perform ADL’s independently, is stuck in a broken mental health care system where she has
little say, is estranged from her family, and currently has nowhere to go. There is little she can
control, so I feel she exercises independence and control whenever she can, and does so abra-
sively. With so many restrictions in her life, this does not surprise me, nor does it gravely con-
cern me. I feel she is just trying to fight back, and this sometimes gets her into trouble, which is
the unfortunate reality.
My preferred treatment plan would be to discharge Client 3 to the Little Sisters of the
Poor. She engaged positively with the Sisters and seemed impressed with their environment
(Bible study, gospel music, playing puzzles, no television, no swearing, and no men). Unfortu-
nately, it seems she will not be able to go to the Sisters until she can transfer herself from a bed
to the chair, which has been deemed an unlikely possibility. I would enforce strict, intensive
physical therapy in an attempt to give her the ability to do the minimal amount needed to effec-
tively transfer so that she can be discharged immediately. I would give her a tour of the Sisters’
home, have the Sisters regularly visit her, and even post some of their paraphenilia in her room
so that she can have constant motivation. If this is not a medical possibility, I would discharge
her to a family nursing home that is open-minded to psychiatric patients. I would hopefully dis-
prove the ward’s diagnosis with a second opinion to make this easier. A family nursing home
8. CASE STUDY
!8
would be best for Client 3 as it is like an apartment (which she wants) with only a small number
of people to live with, who can hopefully be matched to her based on personality tests. I would
attempt music therapy, animal-assisted therapy, and perhaps even family therapy. I would pro-
vide as many opportunities as possible for her to exercise control, an advantage found in music
and animal-assisted therapy. She can also exercise control by providing a list of meals she will
eat and give input for her itinerary. I would also move forward with the ward’s aforementioned
treatment plan in its entirety. Finally, I would attempt to construct an incentive system for Client
3 if she partakes in the different aspects of her treatment plan, which might boost subjective well-
being and allow her to exercise control.