Expert answer:The cast study of john
Expert answer:The DSM-5 supports consideration of the effects of cultural variables on the diagnostic process. In this assignment, you will identify and describe potential cross-cultural issues affecting diagnosis and provide culturally sensitive treatment recommendations and risk assessment. In addition, in your response, you will provide an accurate diagnostic profile, which includes your diagnostic rationale.Tasks:Review the following case:The Case of JohnOn the basis of your review, provide a summary of the relevant diagnostic information that could be included in the cultural formulation interview (CFI). Within your summary, do the following:Explain why you, as a counselor, should consider cultural variables as part of the intake process.Describe how culture can influence diagnosis and treatment.Explain how you would address the issue of not understanding aspects of a client’s culture during the intake assessment.Finally, create a comprehensive diagnostic profile with treatment recommendations. Be sure to also address any ethical considerations pertaining to risk assessment.You can find a copy of the cultural formulation interview (CFI) questions in Section III of your DSM-5.Your final product should be a 3- to 4-page paper written in APA format. Utilize a minimum of three scholarly sources. Your paper should be written in a clear, concise, and organized manner. Demonstrate ethical scholarship in the accurate representation and attribution of sources and display accurate spelling, grammar, punctuation, and references.Submission Details:By the due date assigned, save your document as M6_A2_LastName_FirstInitial.doc and submit it to the Submissions Area.
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The Case of John
© 2015 Argosy University
The Case of John
John is a 42-year-old Hispanic male who has been referred to you by his psychiatrist for counseling.
During the initial session, John reports that he experiences overwhelming anxiety. He currently takes the
following psychotropic medications: Tegretol, Wellbutrin, Vistaril, and Elavil. According to John, he was
diagnosed with Type I diabetes 2 years ago, for which he takes medication. John says gender identity is
an important topic for him because he feels he is a female although he is a male biologically. He reports
becoming aware of his feelings approximately 15 years ago but states he has not begun hormone
replacement therapy due to his family’s negative response to his feeling he is female. There is no
discussion of this topic in the family, or with others in the community, leaving John feeling like an
“outcast.”
John also reports feeling uncomfortable around others, particularly in one-to-one situations. He describes
himself as feeling “pretty good” in small groups of people. When he feels anxious, he feels his heart
pounding, sweats, and believes others are watching him because they can tell he is anxious. His mind
races, he cannot organize his thoughts, and he perceives events as occurring “in a dream.” He is afraid he
may have one of these “attacks.” Therefore, he tries to avoid going to places without a family member or
a very close friend. He tends to spend much of his time at home because of his symptoms, the family’s
limited financial resources, and lack of transportation. He relies on public transportation or church
members to go to appointments and complete necessary shopping. However, he often becomes very
anxious when using public transportation. The only way he has found to alleviate his anxiety in these
types of situations is to listen to music he has downloaded on his cell phone.
In addition, John spends 6–10 hours a day on the computer. Most of this time is spent in science fiction
role play with others. John becomes very verbal and enthusiastic when he discusses this aspect of his life.
He explains he is a “captain” on one of the spaceships and enjoys creating various scenarios and
challenges for him and other “crews” to resolve. He communicates with a number of people in the U.S.
and other countries who have similar interests, and this is the way he met his fiancée.
John denies current suicidal intent but reports experiencing intermittent suicidal ideation. He does not
believe he could harm himself because of his parents and his religious beliefs but states that, sometimes,
he wishes he would die so that he does not have to “live a lie.”
Relevant Psychosocial History
John has always lived in the same town where he was born and where his father is a minister. Due to
financial difficulties, John had to move in with his parents 2 years ago. John and his parents are very
active in their small church. John reports he is in charge of the technical aspects of the services, where he
spends Sunday morning, Sunday evening, and Wednesday evening each week.
John reports he got married when he was 20 years old and in the military. His wife was unable to
accompany him overseas, and he reports becoming “severely depressed” because of this and
experiencing suicidal ideation. He received an honorable discharge from the military due to his
depression. After 2 years of marriage, he and his wife divorced. John is currently engaged to a woman
who lives in Germany. They met face-to-face one time when he visited her, but they talk every day by
phone. She is aware and reportedly accepting of his gender identity. She plans on visiting the United
States next year, when they will marry. After the marriage, John plans to move overseas and live with her.
John is concerned his parents will not approve of his marriage; therefore, he has not shared his plans with
his parents. John reports he does not have any children or plan on having children in the future.
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Diagnosis and Treatment of Behavioral and Emotional Disorders
©2015 Argosy University
2
The Case of John
After his discharge from the military, John was employed in a number of different jobs, including longdistance truck driving. At the time of his intake, John reports he has been unemployed for 3 years. His last
job was in telephone customer service for a large electronics company where he had worked for 9 years.
He believes he was fired from this job because he sometimes wore women’s clothing to work. He also
reports he became increasingly anxious at work, to the point where he would “freeze” when talking to
customers even though he had the knowledge to assist them. He reports this anxiety was not new,
stating this “freezing” behavior first began at the age of 13 years, when he had to speak in front of the
class, and then later, during performance-based evaluations, when he was in the military.
He denies a history or current use of alcohol or other substances. He would like to find a job where he can
work out of his home on his computer. He believes he has the technical ability to do this and that he will
be able to continue this type of work after he marries his fiancée and moves oversees. However, he is
fearful he may be unable to complete any type of job where he has to interact with the public or be
monitored for quality control.
Page 3 of 3
Diagnosis and Treatment of Behavioral and Emotional Disorders
©2015 Argosy University
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