Case Conceptualization (Signature Assignment)
Using the case vignette provided for this assignment by your instructor, consider the following questions for your brief (2-4 page) case conceptualization:
1) What factors (biological, psychological, sociocultural) led to the development of the presenting concerns? In other words, conceptualize how the person’s symptoms developed?
2) What is the current diagnosis?
3) In your paper, to support your diagnosis and treatment, address each section included in the table below (diagnosis, rationale, treatment plan, research considerations, and cultural considerations).
Standards Addressed: CACREP 2016 II F.3.e, V CMHC C.2.b, C.2.d, C.2.g, C.2.h
Program Goal 7: Assessment and Diagnosis: To understand the knowledge and skills necessary to facilitate comprehensive client assessment and diagnostic processes.
Outcome 7.1: Students will demonstrate understanding of assessment and diagnosis.
Benchmark: The target mean performance will be 3.0 on a 4.0 scale or higher for 75% of students.
Jenny, a white 16-year-old girl, from an upper middle class family, arrived at the clinic with her mother, Stella. Jenny was recently released from the hospital after an unsuccessful suicide attempt. Jenny’s mother had found her on the bathroom floor, unconscious, amid empty bottles of nonprescription drugs: Advil, Tylenol, Sudafed. Fortunately, the ambulance arrived in time. What scared Stella the most was that there were no warning signs of depression and suicide. Or were there?
In elementary school, Jenny won awards for track and field and was voted most popular girl in her Grade 5 class. She continued dance lessons and gymnastics and competed in several regional meets with relative success. Jenny seemed to be a born leader, and her popularity with the other children was readily apparent. It seemed as though there was no stopping her. When Stella thought back, there may have been early warning signs that all was not well.
Middle school seemed to launch Jenny into early adolescence, and her responses to change or adjustments in her life started to trigger more intense and extreme reactions. Stella recalled when Jenny’s class schedule was changed by the guidance counselor, Jenny came home extremely irritated and agitated, complaining that the counselor had no right to do this to her. She demanded that her parents go to the school and have the schedule changed. Stella and Carl tried to reason with Jenny after they talked to the guidance counselor on the telephone. However, Jenny said they were all in on the conspiracy against her. She was up most of the night on the telephone with classmates, trying to organize a protest. The next day, she was very agitated and angry at her friends for not supporting her in the protest. Were it not for the fact that Jenny was so popular, Stella was sure that these behaviors would have cut off all her social contacts. However, Jenny continued to be very popular with her peers. She was a formidable leader, beautiful, full of life, and assertive.
Jenny seemed to embrace the transition to high school at a time when others were thrown off balance by the increased number of students and having so many different teachers. Jenny signed up for a number of school clubs, such as the Girls Athletic Club and the Glee Club, and although few would have had the courage to attempt it, she even tried out for the Junior Cheerleading Squad. She did not make the team, which was devastating for her, but she vowed that the following year, she would come back with a vengeance. During her freshman year, Jenny continued to be actively involved in sports and school clubs and told herself that she would rather play on the girls’ volleyball team than be a cheerleader anyway, since they got to travel to conferences. Jenny and her parents continued to have disagreements throughout the year, with Jenny wanting to stay out later and go on dates that her parents did not approve of.
That summer, Jenny got a job as a camp counselor and spent the summer at camp away from her parents. When she returned in the fall, it was as if the break had restored all harmony, and her parents felt as if they had finally gotten their daughter back. In the fall, Jenny tried out again for the Junior Cheerleading Squad, and this time, she made it. Jenny was elated about being selected for the team and was eager to show off her new cheers and routines for her parents at home. However, shortly thereafter, things began to go noticeably out of control. Socially, Jenny began pushing the limits with her parents and dressing very provocatively, despite their protests. Jenny’s behavior became more erratic. One day, Jenny decided that the cheerleading uniforms needed to be revamped: The skirts were too long and the design on the front of the sweater was outdated. For the next week, Jenny was relentless. She became obsessed with getting the uniforms changed. She rarely slept and, instead, was consumed with ideas on how to improve the cheerleading outfits. She talked nonstop about cheerleading outfits, to the point that her parents asked her to please stop. Jenny would run home from school each day and search the Internet for costume designs. She spoke on the phone most of the night. Jenny’s mother picked up the extension by mistake one time and couldn’t believe how much Jenny rambled on about buying material, sewing patterns, pantsuits, designs, European fashion trends, and megaphones. Much of what Jenny was rambling on about seemed to make no sense. Of course, when her mother questioned her about the conversation, Jenny was furious at her mother for picking up the extension and eavesdropping on her.
Eventually, Jenny’s friends stopped calling. Jenny was now spending more and more time on the Internet at night when she was supposed to be doing her homework. She told her parents that she was doing “research”; what she didn’t reveal was that her research was focused on trying to locate a uniform designer that the school could hire to redesign the uniforms. Ultimately, she began drawing her own designs and spending hours at night cutting out patterns and trying new designs. She was convinced that she had the talent to become a world-famous uniform designer and ran up expensive phone bills trying to contact clothing manufacturers across the United States who might support her line of uniforms: Jeunesse by Jenny. She got the name from the French word for “youth.” She felt totally empowered; it was as if she had magical senses. Colors were more intense, sounds were more reverberating, and touch was more penetrating. No one could possibly understand how euphoric her life had become.
During that week, Jenny amassed hundreds of dollars in international phone calls. Her parents were furious, and Jenny was upset, saying that they didn’t support her. Maybe they would believe her when she became famous. The problem intensified the night her mother found yards and yards of new fabric stuffed in a box in the basement along with dozens of pictures of cheerleading uniforms. Some of the cloth had been cut into patches and sewn together to make patterns. That’s when her mother found out that Jenny had also been secretly drinking alcohol. Jenny admitted to drinking wine because, “that’s what all the famous French fashion designers drink.” Like everything else, Jenny’s drinking was out of control… but according to her, it was the only way she could get 1-2 hours of sleep.
No one seemed to understand how intense Jenny could be. Her parents were the only windows on her all-night vigils, extensive phone bills and fabric bills, and constant diatribes at home. Yet her parents somehow felt powerless to intervene, because they were constantly being reminded by parents of other teenagers that Jenny was “the all-American girl” and that they were fortunate to have such a talented and motivated daughter. Finally, after all the glitter and sparkle came the crash . . . the awful crash. The mood swing was devastating. In the hospital, Jenny admitted to her parents that she began to feel out of control about a week before the suicide attempt. Jenny had been on the phone for hours, frantically attempting to organize a party that would be the biggest and best party ever, where she would launch her new “Jeunesse” line of cheerleading uniforms, but by the time the party was to begin, her mood had spiraled into a deep depression. It was as if someone had pulled the floor out from under her. Jenny felt riveted to the bed, immobile, as if her feet were stuck in buckets of poured concrete, and she was being sucked into the horrible pain of a black hole. It was as if someone had vacuumed out her very soul. The emptiness and the pain were unbearable. She felt as if she were worthless and would never amount to anything.
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