PRACTICE 5 Mental Health Diagnosis in Social Work: The Case of Miranda Miranda is a 35-year-old, Scottish female who sought counseling for increased feelings of depression and anxiety. Her symptoms include constant worry, difficulty sleeping, irritability, increased appetite, unexplained episodes of panic, feelings of guilt and worthlessness, and feelings of low self-esteem. She denied any suicidal/homicidal ideation but verbalized feelings of wanting to be dead. She maintained these thoughts were fleeting and inconsis- tent. She reported an increase in alcohol consumption, although clarified it was only when she felt anxious. She denied any black- outs or reckless/illegal behavior while drinking. She denied any other drug use. Miranda works in the fashion industry and reported that she is very well liked by her peers and clientele. She is regularly chosen to train other staff members and comanage the store. However, she is often given a heavier workload to compensate for coworkers who are unable to perform at the expected level of her employer. Miranda stated that she has trouble saying no and feels increas- ingly irritable and frustrated with her increased workload. Miranda has been married to her husband for 3 years, and they have no children. She reported that both her mother and father have a history of mental illness. Miranda’s parents are divorced, and when they separated, Miranda chose to live with her mother. Miranda’s mother remarried a man she described as “vicious and verbally abusive.” Miranda stated that her stepfather called her names and told her that she was worthless. She said he made her believe that she was sick with chronic health issues and many times forced her to take medicine that was either unnecessary or not prescribed by a doctor. Eventually he asked Miranda to leave her mother’s home. Miranda stated that her mother was well aware of her stepfather’s behavior but chose not to intervene, stating, “He is a sick man. Just do what he says.” She denied any physical or sexual abuse in the home. SOCIAL WORK CASE STUDIES: CONCENTRATION YEAR 6 In order to treat Miranda’s symptoms, we first addressed the need for medication, and I provided a referral to a psychiatrist. The psychiatrist diagnosed her with panic disorder and major depres- sive disorder and prescribed appropriate medications to assist her with her symptoms. Miranda and I began weekly sessions to focus on managing her boundaries both at work and with her family. We discussed her behavior around boundary setting as well as the possibility of enlisting her husband as a support person to encourage and promote healthy boundaries. We also discussed unresolved issues from her childhood. This approach enabled Miranda to gain insight into the self and how her maltreatment as a child affected her functioning in the present time. This insight enabled Miranda to validate her feelings of anger, frustration, and sadness abo.

1. PRACTICE
5
Mental Health Diagnosis in
Social Work: The Case
of Miranda
Miranda is a 35-year-old, Scottish female who sought
counseling
for increased feelings of depression and anxiety. Her symptoms
include constant worry, difficulty sleeping, irritability,
increased
appetite, unexplained episodes of panic, feelings of guilt and
worthlessness, and feelings of low self-esteem. She denied any
suicidal/homicidal ideation but verbalized feelings of wanting
to be
dead. She maintained these thoughts were fleeting and inconsis-
tent. She reported an increase in alcohol consumption, although
clarified it was only when she felt anxious. She denied any
black-
outs or reckless/illegal behavior while drinking. She denied any
other drug use.
Miranda works in the fashion industry and reported that she is
very well liked by her peers and clientele. She is regularly
chosen
to train other staff members and comanage the store. However,
she is often given a heavier workload to compensate for
coworkers
who are unable to perform at the expected level of her
employer.

2. Miranda stated that she has trouble saying no and feels increas-
ingly irritable and frustrated with her increased workload.
Miranda has been married to her husband for 3 years, and they
have no children. She reported that both her mother and father
have a history of mental illness. Miranda’s parents are divorced,
and when they separated, Miranda chose to live with her
mother.
Miranda’s mother remarried a man she described as “vicious
and
verbally abusive.” Miranda stated that her stepfather called her
names and told her that she was worthless. She said he made
her believe that she was sick with chronic health issues and
many
times forced her to take medicine that was either unnecessary
or not prescribed by a doctor. Eventually he asked Miranda to
leave her mother’s home. Miranda stated that her mother was
well aware of her stepfather’s behavior but chose not to
intervene,
stating, “He is a sick man. Just do what he says.” She denied
any
physical or sexual abuse in the home.
SOCIAL WORK CASE STUDIES: CONCENTRATION YEAR
6
In order to treat Miranda’s symptoms, we first addressed the
need for medication, and I provided a referral to a psychiatrist.
The
psychiatrist diagnosed her with panic disorder and major
depres-
sive disorder and prescribed appropriate medications to assist
her

3. with her symptoms. Miranda and I began weekly sessions to
focus
on managing her boundaries both at work and with her family.
We discussed her behavior around boundary setting as well as
the possibility of enlisting her husband as a support person to
encourage and promote healthy boundaries. We also discussed
unresolved issues from her childhood. This approach enabled
Miranda to gain insight into the self and how her maltreatment
as
a child affected her functioning in the present time. This insight
enabled Miranda to validate her feelings of anger, frustration,
and
sadness about her upbringing and further give herself permis-
sion to set appropriate boundaries in her relationships. We also
discussed the need for relaxation and stress management.
Miranda
was able to identify that she used to enjoy cycling and running
but
had not been engaging in them because of the demands at work.
After discussing the importance of self-care, Miranda began to
exercise again and set a goal to enter local running and cycling
events to encourage herself to continue.
After 1 year of therapy, Miranda decided to taper down her
medication, which was monitored by her psychiatrist. She has
chosen to remain in therapy weekly to monitor her mood as she
decreases her medication. Miranda’s overall presentation has
improved greatly. With the use of medication, behavioral
therapy,
relaxation techniques, and psychodynamic therapy, Miranda’s
affect presents as stable and her symptoms of depression are
gone. Miranda is a client that is able to verbalize the benefits of
treatment in helping her gain insight and empower herself to
vali-
date her own emotional needs. She has been a highly motivated
patient who enjoys the safety of being able to express her

4. thoughts
and feelings without judgment.
APPENDIX
95
Reflection Questions
The social worker in each of the cases answered select addi-
tional questions as follows.
Practice
Mental Health Diagnosis in Social Work:
The Case of Miranda
1. What specific intervention strategies (skills, knowledge, etc.)
did you use to address this client situation?
I referred the client to a psychiatrist. I used behavioral therapy,
relaxation and stress management techniques, and psychody-
namic and structural family theories to address underlying
issues from childhood.
2. Which theory or theories did you use to guide your practice?
I used psychodynamic and structural family theories to address
adult survivors of child abuse in order to help Miranda connect
to the effects of her stepfather’s maltreatment, regain her sense
of self, and recognize the unhealthy functioning in her present
relationships and daily living.
3. What were the identified strengths of the client(s)?

5. Miranda was motivated, identified goals well, and had a
supportive
husband.
4. What were the identified challenges faced by the client(s)?
Miranda reported a mental health history.
5. What were the agreed-upon goals to be met to address the
concern?
The initial goal was to decrease symptoms of anxiety and
depression. As therapy progressed, the greater goal became
gaining insight into Miranda’s childhood to allow for more self-
care and stress management.
6. How can evidence-based practice be integrated into this
situation?
Miranda’s case is a great example of the benefit of a combina-
tion of medication and talk therapy for overall improvement of
emotional and mental health.
SOCIAL WORK CASE STUDIES: CONCENTRATION YEAR
96
7. Is there any additional information that is important to the
case?
It is important to note that prior to seeing me for treatment,
Miranda had been to several psychiatrists who misdiag-
nosed her with borderline personality disorder and bipolar
disorder specifically based on the fact that she was female
and had a history of abuse. She had been given a series of

6. medications that were ineffective due to misdiagnosis. When
Miranda came in for the first session she was very distrusting
of psychotherapy as well as medication. My ability to create
a safe and trusting environment was of the upmost impor-
tance in order for Miranda to get well and work with her
underlying issues.
8. Describe any additional personal reflections about this case.
Miranda’s case is a great example of the need for a thorough
mental health history, mental status exam, as well as family
history of mental health issues and relationships. With individ-
uals, it is important to ask critical questions that reflect mood
and affect presentation as well as history of drug and alcohol
use,
family dynamics, and any past history of abuse. There is almost
always a reason for a patient’s mood deregulation. A proper
eval-
uation session allows for accurate diagnosis and treatment plan-
ning as well as letting you, the social worker, know if this is a
case
that will fit within your practice.
Social Work Supervision: Trauma Within Agencies
1. What specific intervention strategies (skills, knowledge,
etc.) did you use to address this client situation?
This was a difficult tragedy to deal with, and it was difficult
to know how to proceed. I had contacted the county (who
funded the agency) for help. The people I contacted at
the county did not know what to do and were of little help
because, as they stated, they had never dealt with death of a
staff member. I turned to my senior staff, and we as a group
came up with a plan to notify each client in the most sensitive
way possible. In addition, the use of another agency and our

7. Purpose of Assignment
Students should be able to calculate time value of money
problems including solving for; present value, future value, rate
and payment, determine the value and yield of corporate bonds,
and use the dividend discount model to calculate the value and
expected return of a common stock.
Assignment Steps
Resources: Tutorial help on Excel® and Word functions can be
found on the Microsoft®Office website. There are also
additional tutorials via the web that offer support for office
products.
Complete the following Questions and Problems from each
chapter as indicated.
Show all work and analysis.
Prepare in Microsoft® Excel® or Word.
· Ch. 5: Questions 3 & 4 (Question and Problems section):
Microsoft® Excel® templates provided for Problems 3 and 4
· Ch. 6: Questions 2 & 20 (Questions and Problems section)
· Ch. 7: Questions 3 &11 (Questions and Problems section)
· Ch. 8: Questions 1 & 6 (Questions and Problems section):
Microsoft® Excel® template provided for Problem 6
Format your assignment consistent with APA guidelines if
submitting in Microsoft® Word.
Ch 5 notes
3. Calculating Present Values [LO2] For each of the following,
compute the present value:

8. 4. Calculating Interest Rates [LO3] Solve for the unknown
interest rate in each of the following:
CH6 notes
2. Present Value and Multiple Cash Flows [LO1] Investment X
offers to pay you $4,700 per year for eight years, whereas
Investment Y offers to pay you $6,700 per year for five years.
Which of these cash flow streams has the higher present value if
the discount rate is 5 percent? If the discount rate is 15 percent?
20. Calculating Loan Payments [LO2, 4] You want to buy a
new sports coupe for $79,500, and the finance office at the
dealership has quoted you an APR of 5.8 percent for a 60-month
loan to buy the car. What will your monthly payments be? What
is the effective annual rate on this loan?
Ch7 notes
3. Valuing Bonds [LO2] Even though most corporate bonds in
the United States make coupon payments semiannually, bonds
issued elsewhere often have annual coupon payments. Suppose a
German company issues a bond with a par value of €1,000, 23
years to maturity, and a coupon rate of 5.8 percent paid
annually. If the yield to maturity is 4.7 percent, what is the
current price of the bond?
11. Valuing Bonds [LO2] Union Local School District has a
bond outstanding with a coupon rate of 3.7 percent paid
semiannually and 16 years to maturity. The yield to maturity on
this bond is 3.9 percent, and the bond has a par value of $5,000.
What is the price of the bond?
Ch8 notes
1.Stock Values [LO1] The Jackson–Timberlake Wardrobe Co.
just paid a dividend of $1.95 per share on its stock. The
dividends are expected to grow at a constant rate of 4 percent
per year indefinitely. If investors require a return of 10.5
percent on The Jackson–Timberlake Wardrobe Co. stock, what

9. is the current price? What will the price be in three years? In 15
years?
6. Stock Valuation [LO1] Suppose you know that a company’s
stock currently sells for $63 per share and the required return on
the stock is 10.5 percent. You also know that the total return on
the stock is evenly divided between a capital gains yield and a
dividend yield. If it’s the company’s policy to always maintain
a constant growth rate in its dividends, what is the current
dividend per share?