MHC 610 Client Case File Charles “CJ” Jones You are a counselor in an on-campus counseling center. Charles “CJ” Jones is a 21-year-old, single, straight, African American and Lakota man who sought treatment because he “feels lost,” withdrawn from friends, and “worried about money.” He said he had been feeling increasingly depressed for two months, and he attributes this to two essentially concurrent events: the end of a three-year romantic relationship (four months ago) and being unable to find his ideal employment situation. Mr. Jones has been on a job search for around five months. Mr. Jones has supported himself financially since high school and is accustomed to feeling nervous about making ends meet. He has become more worried after breaking up with his longtime live-in girlfriend, so he approached a family friend for financial help. He was turned down, leading him to feel alone in his financial struggles. This disappointment revived long-standing anger and sadness about not feeling close to and supported by either of his parents. His friends taunted him for “falling apart” over wanting to be financially stable saying, “We’re young. You have time to figure this out!” Mr. Jones is a full-time undergraduate student in his final year of college studying computer science; he also works full-time as a midnight-shift warehouse worker. When he finishes his early-morning shift, he finds it hard to “slow down,” and he has trouble sleeping. He has been looking for work daily and applies for jobs that are less physically demanding, with more flexible hours, but never gets past the phone call or interview. His appetite is unchanged, and his physical health is good. His grades have recently declined, and he has become increasingly discouraged about money and about being single. He has not previously sought mental health services, but a supportive cousin suggested seeing a counselor. Mr. Jones was raised as an only child by his mother and her extended family who all identify as African American. Mr. Jones reports that his extended family identifies as Baptist and, in his youth, he spent some time with family members at church; however, he now identifies as spiritual rather than religious. Mr. Jones describes that he has been drawn to exploring the spiritual beliefs and practices of the Lakota Nation. Mr. Jones regularly keeps in touch with his maternal extended family. Growing up, Mr. Jones mentioned he was a “good student and popular kid.” High school was complicated by his mother’s two-year period of unemployment and his experimentation with alcohol and marijuana. He recalled several heavy drinking episodes at age 14 and first use of marijuana at age 15. He smoked marijuana daily for much of his junior year and stopped heavy use under pressure from a girlfriend. At the time of the evaluation, he had “an occasional beer” and limited marijuana use to “being social” several times a month. Mr. Jones described his childhood as “normal,” and that while he had a very close relationship with his mother, it deteriorated in his adolescence. Mr. Jones’s mother decided that he should move out when he finished high school. She was dating a man she subsequently married and wanted time alone with this man. She was clear about her feelings that he needed to be more independent from her and that it was “finally her turn.” Mr. Jones’s father left shortly before his birth, telling his mother, “I didn't sign on for this.” She relayed this story to him often in his childhood. On examination, Mr. Jones is punctual, cooperative, pleasant, attentive, appropriately dressed, and well groomed. He speaks coherently. He appears generally worried and constricted, but he did smile 1 appropriately several times during the interview. He has a quiet, dry sense of humor. He denied suicidality, homicidality, and psychosis. He’s cognitively intact, and his insight and judgment were considered good. In your first session, Mr. Jones communicated to you that as a young biracial man, he is generally expected to be strong and independent, and norms of masculinity have made him hesitant to attend counseling. He further expressed that his family views counseling as something that is only for “crazy people.” He informs you that there may be individuals in his family struggling with addiction and other mental health concerns who are not receiving treatment. 2 2-1 Comprehensive Case Conceptualization Section One Draft Georgette Josephs Department of Counseling, Southern New Hampshire University MHC_610-X5142 treatment Planning in CMHC 22TW5 Dr. Shanice Armstrong June 19, 2022 1 Student Name: Final Project Part One Theoretical Orientation and Integrated Personal Approach The integrated approach that will be used for counseling CJ is Adlerian Theory. Using this theory to conceptualize his problems will entail focusing on his ability to make positive life changes, emphasizing on the aspects of assessment, engagement, insight, and reorientation, with the client working to overcome an inferiority complex and behaving in ways that fulfill his social interest. A patient-centered client-counselor relationship will be developed with the use of Socratic dialogue during sessions aimed at inspiring the development of productive attitudes in confidence and self-worth on the part of the client (Marano, 2017), to enhance his comfort with the therapeutic environment and improve his relationship with the therapist. While coming up with a treatment plan, Adlerian therapy will be used to identify treatment goals and come up with a working structure and framework for effective treatment. The practical approach to treatment will help in structuring a step-by-step plan and engage the client to promote planned change (Marano, 2017). Goals will be developed based on factors that are important to the patient, such as improving his relationship with family and friends or becoming less worried about money and being single. Based on the set goals, a problem-solving stance will be adopted, addressing how the client can modify things to adapt his plan to changing situations in his personal life and the surrounding environment. The plan will entail encouraging CJ to take active control over his recovery and identify the triggers or thoughts that result in worries about money and relationships, then work on the goals to restructure these thought processes in a positive manner. Background Information Charles “CJ” Jones is a 21-year-old, single, straight, African American and Lakota man. He is currently in his final year of college, and has supported himself financially since high-school after his mother told him to move out upon completion of his high school education. He is struggling to find stable employment, currently holding a position as a midnight-shift warehouse worker, which is presenting him with trouble sleeping. He was raised as an only child by his mother after his father left shortly before his birth. Having grown up with a maternal extended family that identifies as Baptist, CJ has grown up to identify as spiritual rather than religious. He was a good student and popular kid while growing up, but high-school got complicated with his mother’s two-year unemployment stint and experimentation with marijuana and alcohol in his mid-teenage years. he just went through a break-up after a three-year relationship. He currently has an occasional beer and indulges in smoking marijuana several times a month just to be “social”. He appears worried and restrained, but is cognitively intact with good judgement and insight, and is very pleasant, attentive, and cooperative; proving a willingness to get help with his depression through therapy. He is not suicidal, homicidal, or psychotic. His biracial background means he is generally expected to be strong and independent, with masculinity norms having made him hesitant to go to counseling. His family maintains that counseling is for crazy people, despite some of them struggling with mental health concerns and addiction without seeking any form of treatment/intervention. Comprehensive Overview of Presenting Concerns 2 Presenting Concerns: The client’s stressful job and inflexible shifts are presenting him with troubles in sleeping. His grades have recently declined. He is increasingly exhibiting worries about is financial status. His recent break-up with his girlfriend of three years is also manifesting in worries. He feels lost and withdrawn from friends, in addition to his worries about money. Finally, he has an occasional beer and smokes marijuana several times a week in an attempt to deal with his depressed feelings. Current Triggers: One of the major triggers is his struggle finding a stable employment/job, resulting in constant worries about his financial status. His struggles with finding less physically demanding jobs have also contributed to his declining grades. Memories about his break-up are also triggers, and so are his difficult relationships with family and friends who refuse to help him in his financial struggles and keep taunting him for falling apart over his financial worries. Promoters: His heavy drinking and marijuana smoking during his teenage years are promoters that activated the patterns of his behavior. Also, his mother’s decision to make him move out when he finished high school plunged him into the state of financial struggles that have resulted in her constant worries about money. Moreover, the abrupt end of his three-year romantic relationship occurring concurrently with his inability to find ideal employment are major promoters of his behavioral patterns. The fact that he is a first and only child may also serve as promoters for his maladaptive patterns of behavior due to the pressure that comes with the need to maintain the high expectations placed on him to be successful and more responsible; as suggested by Alfred Adler’s birth order theory (Marano, 2017). The expectations of being the first and oldest child tend to oppose those of being an only child, having grown up too dependent on his mother and failing to develop independence or a sense of self. Maladaptive Patterns: CJ feels lost, alone, angry and sad as a result of the concurrent events of his break-up and not being able to find stable employment. Moreover, he feels disappointed in himself for not being able to prevent himself from “falling apart”. Despite his young age, he perceives it as a failure that he has not been able to get stable employment, and the end of a three-year romantic relationship have compounded on his maladaptive patterns of feeling lost, sad, and increasingly depressed. 3 Developmental Influences: One of the developmental influences of CJ’s maladaptive functioning can be associated to him being abandoned by his father and getting raised by his mother and extended maternal family. Moreover, the complications he experienced in high school as a result of his mother’s two-year unemployment period resulted in his experimentation with marijuana and alcohol as a teenager. The most important developmental stage in CJ’s life is Erikson’s fifth stage of psychosocial development; Identity vs. Confusion. This stage takes place during the turbulent teenage years, and plays a major role in developing a sense of personal identity that continues to influence behavior and development for the rest of one’s life (Ilame, 2020). During this stage, adolescents tend to explore their independence and develop a sense of self (Ilame, 2020). Teenagers who receive reinforcement and encouragement during this stage develop a strong sense of self and control or independence (Ilame, 2020). CJ’s complicated teenage years, clouded by his mother’s two-year unemployment stint and his experimentation with alcohol and marijuana, are indicative of a failure to successfully navigate the Identity vs. Confusion stage, resulting in him remaining unsure of his beliefs and desires and feelings of insecurity and confusion about his future; hence the intense worries about his financial and emotional independence. Protective Factors: CJ has managed to support himself financially ever since leaving home after high school. The fact that he managed this on his own without the help of friends or parents suggests that he has a strong background on which to build and prosper financially or socially. He currently shows punctual, cooperative, pleasant, and attentive tendencies. Moreover, he does not exhibit any psychotic feelings or thoughts. He has good insight and judgement, and is cognitively intact. These are strengths that could be developed into protective factors to help him deal with current and future problems. His efforts to better himself can present positive treatment outcomes. Co-occurring Disorders: CJ may also be struggling with substance use and addiction disorders, as depicted by his experimentation with alcohol and marijuana in his teenage years, which ballooned into the daily use of marijuana during his junior year and only stopped heavy use due to pressure from a girlfriend. He currently has an occasional beer and limited marijuana use several times a month. He is at a very high risk of going down the slippery slope of addiction, especially because of his current mental health issues related to his break-up and financial struggles that might prompt him to attempt to drown his worries in alcohol and drugs. He admits that there are individuals in his family struggling with mental health concerns and addiction but are not receiving treatment. This points to a family history of mental health issues and substance abuse, which raises the likelihood of mental disorders and substance use disorders. Mental Status Exam: CJ was punctual, cooperative, pleasant, attentive, and well-groomed for the examination. His insight and judgement is good - an indication of being cognitively intact, and he denied psychosis, suicidality, and homicidality. He communicated clearly, and maintained a good mood by smiling appropriately several times while exhibiting a quiet and dry sense of humor. Cultural Considerations 4 Cultural Identity: Mr. Jones admits to belonging to a biracial group or community (as an African American and Lakota man), and as a member of this group, is generally expected to be strong and independent. Cultural Stressors: CJ’s culture and family considers counseling as a thing for “crazy people”, and being a biracial man, he is expected to be strong and independent and not reliant on counseling for his mental health issues. As both an African American and Lakota man, he struggles with maintaining an identity that subscribes to one culture, whether it is based on race, gender, sexuality, or cultural practices. His multiple minority statuses are causing him major stressors as he struggles to overcome the social biases or cultural and spiritual beliefs regarding counseling. Even though he hasn’t admitted to struggling with acculturation stressors, his psychosocial difficulties and struggles establishing a strong social foundation with friends and family can be associated to his struggles of belonging to one group out of the dual minority groups he belongs to. Cultural Influencers: Mr. Jones believes that his cultural and family beliefs, which were rooted in his upbringing, contributed to his distress. As a young biracial man, his culture expects him to be strong and independent, and leave counseling or therapy to the weak and “crazy” people. The pressure to become independent and acquire a stable job with a stable income are causing him great distress and consequently resulting in his maladaptive behaviors. Personality Patterns: The culture that CJ grew up accustomed to significantly influenced his socialization patterns. His dual minority identity as an African American and Lakota man, and the masculinity norms and expectations that his culture placed on him drove him to develop defective socialization patterns that have resulted in the deterioration of his social circle of friends and family. These socialization patterns and cultural expectations have shaped some of the variance of his personality. They have resulted in the increase of pressure to achieve financial and emotional stability at a very early age, contributing to major worries and mental distress that have defined his personality and weak sense of self. Summary 5 Theory-Driven Case Summary: Mr. Jones’ problems and maladaptive patterns can be traced back to his early teenage years in high school, when his mother’s two-year period of unemployment and his subsequent experimentation with alcohol and marijuana offset a sequence of heavy drinking and frequent marijuana use. He showcases some strengths, including being able to financially support himself from a very early age, showcasing mental or cognitive stability that has enabled him to avoid suicidal, homicidal or psychotic feelings/ideations despite his financial worries and break-up, and exhibits good insight and judgement that can help him deal with current and future issues. However, the barriers in his life place him in a major risk of a mental crumble. His most recent break-up and financial struggles, as well as being withdrawn from friends and feeling lost, are major barriers to his mental health wellbeing. He is also manifesting possible addictive patterns by indulging in the occasional beer and smoking marijuana several times a month. CJ’s failure to effectively navigate through the Identity vs. Confusion stage of psychosocial development during his teenage years has resulted in him developing a personality laden with feelings of insecurity and confusion about his financial and emotional stability, hence his constant worries and mental distress. Moreover, his culture and family beliefs, as well as the norms of masculinity, have put a lot of pressure on him expecting him to be strong and independent, and discouraged him from attending counseling; hence acting as one of the major barriers to his successful treatment. The pressure to succeed that has dominated his life can also be associated to Alfred Adler’s birth order theory, which classifies him as the first/oldest and only child. As an only child, he spent most of his time socializing with older adults, hence always seeing himself as a “small person” (Marano, 2017). He became dependent on his parents for support, only to be ‘kicked out’ at a very young age. He then plunged into the pressure of being the oldest child, with high expectations of responsibility and leadership abilities feeding into his worries, as well as the unreasonable expectations of his family, masculinity norms, and culture. Adlerian theory will be the model on which CJ’s treatment plan will be based. The four stages of Adlerian therapy; engagement, assessment, insight, and reorientation, will be used for effective treatment, with the main treatment goals to be achieved being to help him overcome his worries and financial/emotional insecurities and feelings of insecurity that fulfill the social interest amid the barriers. The main goal (object of change) of Adlerian therapy will be encouragement. CJ admits to be discouraged about different important aspects of his life, including money and his romantic or social relationships. However, encouragement will not be based on simply changing CJ’s behavior, but on instilling confidence and courage to change (Wong, 2014). Adlerian therapy associates the development of problems among clients to the prevalence of feelings of inferiority which play a major role in their social disconnection (Sperry, 2018). CJ’s presenting problems can, therefore, be associated to feelings of inferiority emanating from his financial struggles and inability to land stable employment, as well as the disconnect that resulted from him leaving home at an early age, not feeling supported or close to his parents, and losing friends who constantly taunted him for “falling apart” because of his financial worries. The focus will, therefore, be based more on modifying his motivation than his behavior. Adlerian therapy maintains that encouragement facilitates the development of a client’s inner resources and courage towards positive change. This will be implemented through the skills or techniques of communicating faith in CJ, non-verbal acceptance of his choices, pointing out his strengths, validating his goals, reflective listening, and positive reframing (Wong, 2014). 6 Summary of Conceptualization Presented to the Client: Your culture and family’s beliefs about counseling and the need for a biracial man like you to appear strong and independent are pressuring you to succeed and distressing you. Moreover, your recent break-up and inability to land a stable job or income are increasing your maladaptive worries. Another of your major weaknesses comes from your inability to develop a strong sense of self as a teenager, forcing you to always feel insecure and confused, hence the constant worries about money and social/romantic relationships. Adlerian theory will be used to establish an effective treatment plan, paying close attention to the four stages of engagement, assessment, insight, and reorientation to come up with a working plan. The development of your problems can be closely associated to the prevalence of feelings of inferiority contributing to social disconnection. The setting of goals will also be paramount during the treatment plan. The engagement stage will aim to fulfill the goal of establishing a healthy therapeutic relationship, with collaboration, support, and encouragement to help you address your problems. This will be followed by an insight stage during which you will be offered an interpretation of your situation and possible reasons about how your past experiences have contributed to your current struggles suggested. It will be up to you to decide whether the theoretical interpretations are useful or accurate to your preferred model or plan of treatment. The next step will be to “reorient” you to develop new strategies to handle the struggles in your daily life. The major goals to reorient in this case will be based on addressing your feelings of inferiority and social disconnectedness that have been proven to be the main source of your maladaptive worries and behaviors. 7 References Ilame, V. (2020). Critical analysis of Erik Erikson psychosocial theory of development. https://doi.org/10.22161/ijels.book.veena.ilame.critical Marano, K. (2017). An analysis of empirical validity of Alfred Adler’s theory of birth order. Aletheia, 2(1). https://doi.org/10.21081/ax0082 Sperry, J. (2018). Evidence-based Adlerian therapy: Special issue. The Journal of Individual Psychology, 74(3), 245246. https://doi.org/10.1353/jip.2018.0016 Wong, Y. J. (2014). The Psychology of Encouragement: Theory, Research, and Applications. The Counseling Psychologist, 43(2), 178216. https://doi.org/10.1177/0011000014545091 8 MHC 610 Final Project Part Two Guidelines and Rubric: Diagnosis Overview The final project for this course is the creation of a treatment plan, also known as a comprehensive case conceptualization. The final project is broken into four smaller submissions. The diagnosis portion of the treatment plan is the second submission for your final project. It is suggested that you think back to what you have developed for clients’ case studies in the diagnosis course as you will fill in the sections of the treatment plan due in Week Four. Please include Primary, Secondary, and Tertiary diagnoses in this section of your CCC. Secondary and Tertiary diagnoses can be codes from the “Other Conditions That May Be a Focus of Clinical Attention” section of the DSM-5. You will need to apply feedback from this submission to submit the final treatment plan in Week Nine. Please note that Part One and Part Two of the final project will need to be submitted in Week Nine to inform the treatment, but they will not be regraded. In this assignment, you will demonstrate your mastery of the following course outcomes:   MHC-610-02: Apply principles of advocacy toward promoting culturally competent counseling as it supports treatment planning MHC-610-04: Evaluate the use of evidence-based intervention strategies to inform treatment planning Prompt Specifically, you must address the critical elements listed below. Most of the critical elements align with a particular course outcome (shown in brackets). I. II. III. Diagnosis [MHC-610-04] A. Justify the DSM dimensional diagnosis to diagnostic confirmation. Diagnosis Justification [MHC-610-02] A. Justify dimensional diagnosis, synthesizing diagnostic criteria, developmental patterns, and observable behavior. Consider how to address the level of care and how to advocate for the client. Assessments [MHC-610-04] A. List appropriate and relevant assessments used for treatment planning. Final Project Pathway Final Project Part One Submission: Assessment In Week Three, you will submit the assessment portion of the treatment plan. It should be a complete, polished artifact containing all the critical elements of the final product. This submission will be graded with the Final Project Part One Rubric. 1 Final Project Part Two Submission: Diagnosis In Week Four, you will submit the diagnosis portion of the treatment plan. It should be a complete, polished artifact containing all the critical elements of the final product. This submission will be graded with the Final Project Part Two Rubric. Final Project Part Three Submission: Treatment Plan In Week Nine, you will submit your finished treatment plan. It should be a complete, polished artifact containing all the critical elements of the final product, along with the assessment and diagnosis portions completed in Parts One and Two. Note that the assessment and diagnosis portions will not be graded in Week Nine, but they will inform the treatment plan. This submission will be graded with the Final Project Part Three Rubric. Final Project Part Four Submission: Reflection In Week Ten, you will submit your reflection on the treatment plan. This will be done using the Q&A tool within Bongo. This submission will be graded with the Final Project Part Four Rubric. Final Project Part Two Rubric Guidelines for Submission: Use the Comprehensive Case Conceptualization Template, linked in the Resources section of Week One, to complete this assignment. The diagnosis portion of the treatment plan must be filled in using information from the client case study. Critical Elements Diagnosis [MHC-610-04] Exemplary (100%) Meets “Proficient” criteria and provides keen insight into the diagnosis Proficient (90%) Justifies the DSM dimensional diagnosis to diagnostic confirmation Diagnosis Justification [MHC-610-02] Meets “Proficient” criteria and provides keen insight into justifying the diagnosis of the client Justifies dimensional diagnosis, synthesizing diagnostic criteria, developmental patterns, and observable behavior Assessments [MHC-610-04] Meets “Proficient” criteria and shows keen insight into how the assessments will support treatment planning Submission is free of errors related to citations, grammar, spelling, syntax, and organization and is presented in a professional and easy-to-read format Lists appropriate and relevant assessments used for treatment planning Articulation of Response Submission has no major errors related to citations, grammar, spelling, syntax, or organization 2 Needs Improvement (70%) Justifies the DSM dimensional diagnosis to diagnostic confirmation, but contains inaccuracies Justifies dimensional diagnosis, synthesizing diagnostic criteria, developmental patterns, and observable behavior, but lacks detail or contains inaccuracies Lists the irrelevant or conflicting assessments used for treatment planning Not Evident (0%) Does not justify the DSM dimensional diagnosis to diagnostic confirmation Value 30 Does not justify dimensional diagnosis, synthesizing diagnostic criteria, developmental patterns, and observable behavior Does not list assessments used for treatment planning 30 Submission has major errors related to citations, grammar, spelling, syntax, or organization that negatively impact readability and articulation of main ideas Submission has critical errors related to citations, grammar, spelling, syntax, or organization that prevent understanding of ideas 10 30 Critical Elements Exemplary (100%) Proficient (90%) Needs Improvement (70%) Not Evident (0%) Total 3 Value 100%