Expert answer:You have been hired as the counseling intern for M
Expert answer:You have been hired as the counseling intern for Maeve.Click here to read the case of Maeve and information provided after the completion of an initial biopsychosocial assessment.Tasks:Your differential diagnosis paper will include the following:Introduction: Include a brief description of the client and an overview of the client’s presenting issues.Differential Diagnosis: On the basis of the information presented in this vignette, develop an appropriately coded and recorded diagnostic profile. Be sure to include all appropriate specifiers. In addition, provide your rationale to support your choice of diagnoses and use of specifiers, as well as documented support as to why other diagnoses were ruled out or are still under consideration. A discussion of differential and co-occurring diagnoses should also be provided.Cultural Considerations: Describe cross-cultural factors that may influence the diagnoses that you are recommending, and identify cultural issues that may require additional exploration in treatment.Health Conditions: Describe potential health conditions and consider the potential impact on the client’s diagnoses (e.g., primary, secondary, and so forth) and treatment.Other Mental Health Conditions: Describe any psychosocial and environmental problems and consider the potential impact on the client, primary diagnoses and subdiagnoses, and treatment.Treatment Considerations and Recommendations: Provide a summary of the counseling problem statement, long-term goals, therapist interventions, medications and side effects, modalities, level of care/placement (i.e., outpatient, inpatient, etc.), and adjunct treatment recommendations based on the diagnostic profile. Be sure to clearly outline how you will manage client risk factors in treatment. Provide an explanation of how you considered the risks and benefits of the diagnostic labels you assigned.Conclusion: Provide a comprehensive summary of your case findings. Be sure to include a review of the diagnosis and any specific factors that influenced your diagnostic determination, treatment recommendations, etc.Your final product should be a 12- to 15-page Microsoft Word document utilizing a minimum of 12 scholarly sources. Your paper should be written in a clear, concise, and organized manner. It should demonstrate ethical scholarship in accurate representation and attribution of sources and display accurate spelling, grammar, punctuation, and references. Please note that:Only minimal direct quotes are allowed for this assignment, and only primary citations are accepted. This means you must directly read the article instead of referencing it with “as cited in” another article, and you should not simply copy the DSMdiagnostic criteria.The DSM and a minimum of 4–5 peer-reviewed journal articles must be cited in the paper, with the total number of references not less than 12. Only scholarly references will be accepted.The applied differential diagnosis paper must follow APA format (6th edition) (e.g., margins, page numbers and headers, abstract, text and final references, 12-point font, double spacing, unbiased language, etc.).Submission Details:By the due date assigned, save your document as M7_A2_LastName_FirstInitial.doc and submit it to the Submissions Area.
Assignment 2 Grading CriteriaMaximum PointsClient Presenting Issues: Include a brief description of the client and overview of the client’s presenting issues.16Diagnostic Profile Development: Develop an appropriate diagnostic profile.40Cultural Considerations: Describe cross-cultural factors that may influence diagnoses and identify cultural issues that may require additional exploration in treatment.40Health Contributors’ Description: Describe potential health conditions and consider potential impact on the client’s primary and sub-diagnoses and treatment.40Psychosocial/Environmental Contributors’ Description: Describe any psychosocial and environment problems and consider the potential impact on the client, primary and sub-diagnoses, and treatment..40Diagnostic Profile: Provide a complete diagnostic profile for this client.40Counseling Summary: Provide a summary of counseling problem statement, long-term goals, therapist interventions, medications and side effects, modalities, and placement based on diagnostic profile.40Case Finding Summary: Provide a summary of your case findings.16Write in a clear, concise, and organized manner; demonstrate ethical scholarship in accurate representation and attribution of sources (i.e. APA); and display accurate spelling, grammar, and punctuation.28Total:300Attachments
m7_thecaseofmaeve.pdf
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The Case of Maeve
© 2015 Argosy University
The Case of Maeve
Presenting Issue/History of the Problem
Maeve is a 36-year-old, second-generation Irish divorced female who presents for individual counseling.
She reports having some difficulty dealing with her 18-year-old daughter, Niamh, who is currently a
senior in high school. Maeve describes fighting with Niamh daily and being unable to manage her.
Maeve states her daughter was recently arrested on marijuana possession charges and was expelled from
high school. Maeve describes feeling distraught over her lack of ability to control her daughter’s behavior
and describes feeling guilty and responsible for her daughter not being a good kid. She says she has a
conflictual relationship with Niamh’s father, her ex-husband.
Maeve says she feels sad most of the time, irritable, and like she is out of control. In addition, she always
feels hopeless about her future and is not able to see how she can ever improve her life condition. She
reports having enjoyed little in her life and indicates her choice of husbands and boyfriends has been, in
part, a resignation to what was available rather than a real attraction. Her mood is frequently blue, and
she only experiences brief periods of time when her mood is positive and she attempts to mask her
underlying negative affect.
Maeve exhibits high levels of anxiety, expressing ongoing worries regarding her relationship with her
daughter, her finances, her dissatisfaction with her career, her problems in relationships with men, and
her perceived personal deficits. She describes herself as being anxious and ruminative since the age of 8.
She is also quite apprehensive regarding the intentions of men with whom she has interpersonal contact,
reflecting not only her general level of anxiety but also her self-consciousness and antagonistic
suspiciousness. In addition, she also experiences frequent episodes of anger and bitterness, mainly
provoked by sexually aggressive men.
Compensating for these feelings, Maeve demonstrates high levels of escapism. When her high levels of
anxiety and depression are exacerbated by situational factors, she reportedly attempts to reduce these
feelings through overuse of alcohol. This, along with her reported low tolerance for frustration and her
inability to resist cravings, leads to alcoholic binges. She states she binges on weekends using alcohol
and food as a means of trying to regulate her mood.
Behavioral Observations
At the time of assessment, Maeve presents as a well-groomed and neatly dressed woman. She speaks in
a grammatically precise manner with clearly enunciated speech. She often speaks rapidly and intensely,
clearly exhibiting her predominate affect. Her body language is theatrical, and she uses elaborate facial
expressions and arm gestures. When highly anxious or angry, she wrings her hands, paces, or rocks her
foot back and forth. Her affect is intense and variable, ranging from sobbing and screaming, to manic
excitement, and back to sobbing and screaming. She displays rapidly changing emotions and appears
unable to modulate her affect. On the basis of her response style, she appears to be of average
intelligence, with no reported difficulties in concentration or memory. She denies a history of
auditory/visual hallucinations but confirms a history of self-harm, dating back to the age of 12. She states
she has not cut herself in the past six months but often thinks about doing it. She describes having made
one suicide attempt after she found out she was pregnant but states that after she took her mother’s
medication, she called 911. She reports that her parents refused to see her when she was in the hospital.
Family History
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The Case of Maeve
Maeve was born in Lawrence, Kansas, and was the youngest of four children. She has two older brothers,
who are twins, and an older sister. Her siblings and parents, who are devout Catholics, continue to live in
Kansas. Maeve describes her relationship with her family as disengaged. She describes the relationship
with her mother as not supportive, and she has felt that everyone else is more important to her mother
than Maeve is. Despite this, Maeve has always respected her mother and longed for her approval but
describes her mother as domineering and cold during her childhood. Maeve’s father is described as
passive and weak, even though she reports feeling her relationship with her father was a positive one
overall. She attempts to contact her father every couple of months, but he reportedly does not return her
calls. She describes feeling abandoned all over again every time this occurs.
Trauma History
Maeve indicates she stopped talking to her family after she told her parents the oldest of her twin
brothers molested her from the age of 4 until the age of 9, when he moved out of the home. Maeve
states that upon her disclosure of the abuse, her mother said, “That is not possible. You are lying as
always,” and ignored her. Maeve states her mother would not let her father speak to Maeve after this
disclosure, and Maeve still resents this. Maeve reveals specifics of her abuse history and reports she has
several specific memories of the abuse that she could “not get out of my head.” She describes having
some difficulty falling asleep at night because she is worried she would have dreams about her brother
coming into her room late at night. She describes feeling scared and alone when she was a child and
reports that she always loves her brother and does not always “trust my memories.” She recalls one
incident when she was 8 years old of being forced to perform oral sex and states if she engages in this
sexual behavior now, she experiences intense nausea.
Relationship History
Maeve describes a problematic relationship history. She dated throughout high school but denies having
any serious relationships until she was 17 years of age. Her first sexual experience reportedly occurred
when she was 17 ½ years old, which resulted in pregnancy. She describes her first sexual experience as
disgusting and indicates that at first, she became angry to learn she was pregnant, but over time, she
discovered she was happy to have someone there who would always love her. Maeve describes being
raised in a strict Catholic family, and the relationship between Maeve and her daughter’s father did not
last through the pregnancy, because her mother forbade her from seeing him. Maeve recalls her mother
telling her she “brought shame upon the family,” but her mother allegedly did not allow her to have an
abortion due to her family’s religious beliefs. Maeve denies any religious affiliation.
At the time of treatment, Maeve had been divorced for five years. This was her third marriage, with each
marriage characterized by intense emotionality and high levels of conflict. Maeve’s first marriage
occurred at the age of 21 with a man of Hispanic descent who was willing to help care for her daughter.
She states this marriage ended when her husband died in a car crash two years into their marriage.
Maeve’s second marriage, at the age of 26, was to a very conservative man who believed in traditional
family roles. Maeve describes her attempts to adopt a traditional role by allowing her husband to hold all
of the power in the relationship but states she had difficulty not asserting herself. She remembers feeling
unhappy and having extramarital trysts one year into their marriage. She divorced him two years later,
when she was 28 years old. In addition, she reports having a problematic communication style, where she
tries to manipulate interpersonal situations rather than discussing her concerns directly. Her
manipulations become more oppositional with her husbands, with whom she initially acts as if she wants
them to control everything, but when they attempted to take responsibility for making decisions, she
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©2015 Argosy University
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The Case of Maeve
covertly resists by taking actions to undercut them. This leads to chronic but covert power struggles with
her husbands. Maeve reports that her third marriage ended after she gave her husband herpes, which
she contracted after she participated in a one-night stand. She reports she found out her husband was
having an affair, and acted out, sleeping with several men in a 6-month time frame, during which time
she contracted herpes. She denies currently dating but states she would “hook up with guys” from a
herpes dating website when she does not want to feel alone.
Maeve reportedly has few close friends and describes friendships as difficult, emotionally intense, but
transient and superficial. She states most of her friendships are with men, but the relationships typically
end abruptly due to interpersonal conflict. Maeve states she really does not have any support system
except for the friends that she has made on social media sites. Although when in public, she makes an
effort to smile and act warmly toward others, her interpersonal warmth is quite shallow. She is very
involved in her own difficulties, so much so that extending herself to make deeper contact with others is
too stressful.
Educational/Work History
Maeve reports completing 3 years of college between the ages of 19 and 22 but withdrawing from school
due to severe depressive symptoms and motivational problems. Maeve states she never returned to
college and feels guilty about this. She has worked for the past seven years as a waitress at a local
restaurant and bar. She describes working at a variety of jobs, including retail jobs, waitressing,
bartending, and, for a 6-month period of time, stripping. Maeve denies any military history.
Substance Use History
Maeve reports some substance use history dating back to the age of 13. She reports she had her first
drink at that time and describes intermittent drinking binges since. She reports receiving a driving-underthe-influence (DUI) charge at the age of 24 but denies having alcohol-related problems. She states she
experimented with marijuana, mushrooms, and cocaine when she was in her midtwenties as well but
denies long-term or current use.
Family Mental Health History
Maeve states she is unsure of any family mental illness. She thinks her mother is unhappy and depressed
but knows her mother has never had any treatment. She says there is also something “obviously wrong
with my brother who traumatized me.”
Medical/Medication History
Maeve was initially diagnosed with type I diabetes 10 years ago but denies feeling her diabetes is under
control. She states she does not like using insulin but does so “I won’t die” and reports she missed her last
endocrinologist appointment on purpose. She reports a known allergy to penicillin. She also reports a
recent weight gain of 50 pounds, resulting in a bone marrow index (BMI) of 32, placing her in the obese
range. She states she is unwilling to take any psychotropic medications and indicates she tried taking
Prozac when she was 23 but did not like how it made her feel. She denies taking any other medication
other than one for her chronic high blood pressure.
Strengths/Interests
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Diagnosis and Treatment of Behavioral and Emotional Disorders
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The Case of Maeve
Maeve appears to have difficulty identifying her character strengths and is only able to say she is a good
worker. She reports she likes to shop and spends time reading mystery novels. She says she does not
spend time on enjoyable activities at this time and that she prefers to sleep. Often times, she sleeps over
12 hours a day.
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Diagnosis and Treatment of Behavioral and Emotional Disorders
©2015 Argosy University
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