Application: Time-Limited Dynamic Psychotherapy—Case Conceptualization

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Application: Time-Limited Dynamic Psychotherapy—Case Conceptualization

The field of psychotherapy is moving in a direction where short-or brief-term therapies are in high demand. The reasons for this shift in therapeutic "time" perspective include, to name a few, the evolution and revision of theory that allows the shortening of the typical therapeutic time frame, pressure from managed care organizations to shorten the number of covered psychotherapy sessions, and the adaptation of psychodynamic theory to environments beyond private practice or psychoanalysis. This week, you examine time-limited dynamic psychotherapy (TLDP), a short-term psychodynamic therapy considered more medium-term length than other therapeutic approaches espousing a "short-term" focus.
In this Application Assignment, you evaluate Case Study: Sam through the lens of time-limited dynamic psychotherapy. Developing a comprehensive case conceptualization is a challenging exercise that requires you to integrate what you know about the client with what you understand about a theory and apply that information to a working treatment plan. This process requires you to develop a preliminary diagnosis and to evaluate the unique contextual considerations each client brings to treatment, in this instance, Sam, from this week's case study. Because case conceptualization is such a complex process, a Case Conceptualization Exemplar is provided as a guide.

To prepare for this assignment:

  • Review the "Psychodynamic Approaches" sections on the DVD, Counseling: Theories in Action. Pay particular attention to the methods used by the therapists to gather information related to their clients' presenting issues. Discern some of the basic techniques associated with psychodynamic and brief therapies.
  • Review Dr. Norcross' course media presentation "Psychodynamic Orientation Foundations". Pay particular attention to his discussion on short or brief psychodynamic therapies.
  • Review Case Study: Sam and begin to develop a preliminary diagnosis of Sam's presenting problems.
  • Download and familiarize yourself with the Case Conceptualization Exemplar and the Case Conceptualization Template.
  • Review this week's assigned articles on short-term psychodynamic theories, and think about conceptualizing Case Study: Sam from a short-term psychodynamic perspective, specifically time-limited dynamic psychotherapy (TLDP).
  • Review, if necessary, Chapters 1, 2, and 3 in Clinical Process: From Conceptualization to Treatment Planning. Think about how you can use the information from these chapters when you conceptualize Case Study: Sam.
  • Consider the benefits and challenges of using a short-term psychodynamic therapy. Think about how you would address the challenges.
  • Consult the DSM-5 and review Case Study: Sam. Formulate a preliminary diagnosis for Sam's presenting issues.
  • Review this week's Web sites for empirically supported treatments appropriate for your diagnosis of Sam's presenting issues. (The ESTs should also support TLDP.)

The assignment: (The completed template should be 2-3 pages)

  • Complete the Case Conceptualization Template for Case Study: Sam through the lens of time-limited dynamic psychotherapy. Practice your evidence-based practice skills by using empirically supported treatments.

Support your Application Assignment with specific references to all resources used in its preparation. You are asked to provide a reference list only for those resources not included in the Learning Resources for this course. Keep in mind the importance of using empirically supported research to support your points of view.

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Psychotherapy Interventions II Case Conceptualization Exemplar Student Name: Case Name/#: Case Study Exemplar: Linda 1. Problem identification and definition: [1–2 paragraphs] [Primary and contributing concerns for the client] • • • • • Client concerns: Cognitive abilities Client concerns: Feeling “anxious,” associated with being accepted by others Clinical concerns: Interpersonal isolation Clinical concerns: Self-devaluation, adequacy Clinical concerns: Depressive symptoms 2. Contextual considerations: [1–2 paragraphs] [What ethical, legal, cultural, or other key considerations need to be considered with this client when creating a treatment plan?] • Given no family, friends, or beliefs were identified as a support base, it would seem there are no resources on which Linda might rely. • Given her sustained employment, attempts at effecting change, and selfreferral, it seems as Linda may have the capacity for insight, ability to sustain, and motivation for change. 3. Diagnosis Axis I: [Be sure to provide full title and code] 300.04 Dysthymic Disorder Axis II: V71.09 No diagnosis on Axis II Axis III: None Axis IV: Reccurring headaches within last 6 months AXIS V: GAF = 45–55 Severe symptoms of impaired social and interpersonal relationships Moderate symptoms of flat affect Case Conceptualization Exemplar (CONT.) Diagnostic comments: [1 paragraph] [Provide a brief comment (no more than 1 paragraph) on the justification for your diagnosis] 1) Disturbance of mood: Exaggerated feelings of self-depreciation, self-doubt, lack of energy, problems with sleep, “headaches,” impaired decision making. 2) Dysthymic Disorder: Prolonged duration of “low self-esteem,” “feeling of hopelessness,” “depressed mood, most of day.” 4. Theoretical conceptualization: [1–2 paragraphs] [How would your selected theoretical orientation explain the primary issues for this client, and thus which interventions/treatments would be best suited for this client?] 1) Long-standing concerns of self-worth and acceptance may be rooted in unconscious wish to be nurtured. 2) Given this, the mother/child bonding and attachment may have been impaired, early impairment may have led to “stunted” personality development and associated limited defenses, blunted libidinal energy, being self-absorbed, unmet dependency. 3) Given the long-standing and deep-rooted nature of the impairment that appears to have impacted most domains of this individual’s life, major personality change would seem the most appropriate goal for this client. 4) Given the lack of external supporting relationships, the client/patient relationship may be viewed as a source of “working out” the early parent/child relationships. A psychodynamic orientation may best meet these two issues. 5. Treatment plan Case Conceptualization Exemplar (CONT.) Presenting Issue #1: Questions and concerns over cognitive abilities, interpersonal relationships, and self-worth. Strengths: Sustained employment exemplifying “reality” and ego strength. Through intermittent and unsuccessful attempts at looking outside of self for “remedies,” client may show desire and recognized need for change. Barriers: School-academic history, birth order, “teasing” from male siblings, genetic influences, anxiety over intellectual functioning—all of which suggests early and long-standing issues resulting in a sustained personality structure. Goals: While symptom reduction is an obvious end, to uncover unconscious motivations and to develop successful “attachment” are basic to effect their being change. Interventions: Note: Though cognitive testing may be an obvious intervention, given the conceptualization, this would support the client’s need to look outside herself for “answers,” therefore, this option is rejected. Modality/Duration: Use long-term psychotherapy focusing on the psychotherapeutic relationship and exploration of self. Three weekly 50-minute sessions for up to 2 years Measure of Progress: Monitor progression of therapy sessions assessing transference and “uncovering.” Empirically Supported References: CASE CONCEPTUALIZATION Student Name: Case Name / #: 1. Problem identification & definition: [1–2 paragraphs] [Primary and contributing concerns for the client] 2. Contextual considerations: [1–2 paragraphs] [What ethical, legal, cultural, or other key considerations need to be considered with this client when creating a treatment plan?] 3. Diagnosis Axis I: [be sure to provide full title and code] Axis II: Axis III: Axis IV: AXIS V: GAF = Diagnostic Comments: [1 paragraph] [Here, provide a brief—no more than 1 paragraph—comment on the justification for your diagnosis] 4. Theoretical Conceptualization: [1–2 paragraphs] [How would your selected theoretical orientation explain the primary issues for this client, and thus which interventions / treatments would be best suited for this client?] 5. Treatment Plan Presenting Issue #1: CASE CONCEPTUALIZATION Strengths: Barriers: Goals: Interventions: Modality / Duration: Measure of Progress: Presenting Issue #2: Strengths: Barriers: Goals: Interventions: Modality / Duration: Measure of Progress: Presenting Issue #3: Strengths: Barriers: Goals: Interventions: Modality / Duration: Measure of Progress: References from Empirically Supported Research Psychotherapy Interventions II Case Study: Sam Name: Sam Gender: Male Age: 32 Religion: Eastern Orthodox Christian Ethnicity: Greek American Relationship Status: Divorced Description of Presenting Issue: Sam was referred to you by a colleague at work who was concerned about Sam’s recent poor performance at work, marked by bouts of angry outbursts, moodiness, and sarcasm towards coworkers. Sam appears to be a relatively bright, articulate individual who is employed as a photographic editor at a large marketing firm. Sam’s major concern is the stress that he is feeling at his current job. He is concerned that his supervisor does not recognize his efforts, and is trying to “keep him on the back burner” and prevent future advancement in the organization. Sam is very frustrated by this, as he reports that when he first started working at the company, his supervisor “was an amazing mentor who literally took me under his wing.” Sam reports that he has done “everything that he could” to win back the approval of his supervisor. Sam says he feels “empty and bored” lately. He is considering making a career change but is not certain what he would like to do next. He reports that he has an active social life, going out several times per week to clubs and bars. Although Sam does not use recreational drugs, he does note that he sometimes “drinks too much when he is out partying.” Recently, he was involved in a physical fight with another man at a bar. Although currently single, Sam was married twice previously (for 2 and 5 years, respectively). He described his second divorce as particularly painful, during which he was briefly hospitalized for a failed suicide attempt. He is very eager to be in a relationship now, and believes that he just has not found “the right woman.” Occupational History: Sam has had frequent changes in type and place of employment. He has worked in a variety of settings. Educational History: Sam attended college, but left midway through his senior year. Medical History: Hospitalization at age 26 for suicide attempt, and at age 30 for gall bladder surgery. No current medications or treatment. Family History: Sam has one older (age 34) and one younger (age 28) sister. Both are married and live in the same town as Sam. Sam’s parents are still married, but when Sam was a young boy, his father suffered a “nervous breakdown” and left the family for 6 months. His parents are both retired, and travel frequently. He describes his father as a “serious, distant, hard-working man” and his mother as a “soft, warm, saint who put up with too much from everyone.” Alcohol/Substance Use: During adolescence, Sam experimented with a wide range of illegal drugs and prescription medications. Since his mid-20s, he has restricted his substance use to alcohol to 3–6 drinks per night, 2–3 nights per week. ...
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Tutor Answer

MercyK254
School: UIUC

Hello, I look forwar to working with you
Attached.

CASE CONCEPTUALIZATION
Student Name:

Case Name: Sam

1. Problem identification & definition:
Clients Concerns: He is stressed at his current place of work
Clients Concerns: He feels like his work is not appreciated by his supervisor
Clients Concerns: Feelings of emptiness and boredom
Clients Concerns: Self-devaluation and feelings of inadequacy

2. Contextual considerations:


Sam has the capability to change because he has married sisters who live in the same town
as he does. His parents especially his mother who he describes as soft and warm could
help be motivated to change. They might offer a support base which Sam might rely on.



Sam’s use of illegal drugs, alcohol a...

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Anonymous
Excellent job

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