Elisa Assessment and Treatment Plan

Part 1: Intake

According to the Intake document, the client reports of anxiety/stress problems along with low self-esteem. There is no medical history, and the client is not under any medication currently. As mentioned, she is the only child, and she enjoys a good relationship with her father, whereas, her relationship status to her mother is “Okay.” It may indicate that she does not have a healthy relationship with her mother and reflects more of a distant or detached pattern.

The client is the only child of her parents, and according to her, they do not have congenial relationships, and the client often has to play the role of “mediator.”

Responding to the reason to seek counseling, the client response (I have to be here) indicates her indifferent attitude towards the counseling process. This also can be a sign of repressed anger.

She is 18 years old and has recently joined college. Being an adolescent, she is facing usual teenage challenges without having much social support. Anger is also one of the common problems in adolescence (Malin, 2014)that need to screen out.

From Cross-Cutting Measure (CCM-1), The client reports that she avoids situations that make her anxious (item: 8). She also expresses low interest in doing things that indicate mild depression (item:1), but the other part of the item shows she is not depressed or hopeless. This seems to be contradicted and needs to be explored further.

Again item 6, 7, & 8 indicates that the client is not sure of what she is feeling. She does not feel anxious or nervous, but at the same time, she avoids the situations that make her anxious.

Item XII is the indicator of avoiding social situations, and the client reports that she “does not enjoy the company of people around her. This again shows her lack of interest in making friends and be socially interactive. It also depicts that she does not have a clear purpose in her life.

The responses on Item XIII may indicate her denial as in her psychosocial report; she reports that she was caught with alcohol with her friends in her dorm. She also confessed that she was drinking because of her friends and that she “was just buzzed.” There are chances that the client has not shared her problems with CCM-1 correctly. Therefore, it is recommended to assess the client in the following areas;

1. Depression/Anxiety problems
2. Her personality style
3. Social pattern as well as her attachment to her family and friends

As per the psychosocial document, there are no significant stressors in her life. This is again contradictory as she mentions in her report that studies and not having friends are the stresses in her life.

Part 2: Biopsychosocial Assessment

The biopsychosocial assessment reflects that the client is struggling and trying to adjust to her college life. According to her, other than the stress of studies, she finds it difficult to make new friends as all of her old friends had moved to different places. Being the only child and staying away from her parents, the client is feeling aloof and isolated. She is trying to socialize and make new friends. It seems, in this attempt, she tried to get along with her dorm friends and started to drink alcohol with them. She stated that her friends were intoxicated, but she was not. She was drinking just because her friends were drinking. It seems that the client was seeking for her friends’ approval.

The overall report indicates a weak family attachment of the client. She is not aware of her objective in life. She feels isolated and shows a need for social bonding.

The client complains of anxiety and low self-esteem. According to DSM-V, if a person reports three or more of the following symptoms.

1. Excessive worry, restlessness, easily fatigued, irritability, difficulty to keep focus and concentration, sleep disturbance, and muscle tension.
2. The symptoms are there more days than not for at least six months,
3. Inability to control worry
4. The worry or physical symptoms are significantly hampering the individual’s day-to-day social or occupational activities.
5. The symptoms are not related to any physiological effects of a drug/substance or any medication.

From all the available data, the client does not fulfill any criteria of the psychological disorder, according to DSM-5. However, it is recommended to probe further. She is mentioning stress and anxiety and then also denies it. In this case, the client needs to assess her anxiety symptoms, and it is suggested to follow a formal assessment protocol to diagnose the problem and have a better understanding of the client’s problem.

1. Cross-Cutting Measure (CCM) Level 2

CCM level 2 will help understand the client’s symptoms in a better way. The brief yet comprehensive CCM level 2 will enable the psychologist to understand the severity of the symptoms along with the frequency of occurrence.

2. State-Trait Anxiety Inventory (STAI)

State-Trait Anxiety Inventory (STAI) is another effective way to evaluate anxiety symptoms. It is a self-report questionnaire with 40 statements. The individual has to respond on the 4-point Likert scale (Spielberger, 1983)

3. State-Trait Anger Expression Inventory (STAXI)

Similarly, STAXI assesses the intensity of anger at state and trait both levels. It reveals the disposition of anger in the subject. It has 57-items and is helpful for the psychologist to identify the individuals who tend to suppress their anger (Spielberger C. D., 1999). It will be effective to assess the measure of anger expression and anger tendencies in the client.

Projective tests are also effective tools to assess unusual thoughts or a high level of anxiety or other mental disorders. Rorschach Inkblot Test, the Contemporized-Themes Concerning Blacks test, the Thematic Apperception Test (TAT), Rotter Incomplete Sentence Blank (RISB) and the TEMAS (Tell-Me-A-Story) are some of the examples of good projective tests.

1. Thematic Apperception Test

This projective test is an effective measure to evaluate an individual’s thoughts pattern, attitudes through emotional responses to a set of ambiguous cards. The subject is shown a TAT picture card and asked to narrate a story. Through his responses, the individual reveals his needs and motivation. In this case, this technique will be helpful to know the client’s inner needs and personality.

Keeping in view, the short term goals ae suggested;

1. Comprehensive assessment about client’s symptoms of anxiety and depression
2. Educating her about her mental health
3. Treatment/Psychotherapy for Anxiety/Depression
4. Conveying the findings to the client and her family
5. Guiding them about the treatment plan

Part 3: Treatment Plan

1. Psychoeducation: Psychoeducation is one of the fundamental parts of any treatment plan. After developing a good rapport, the client should be probed for further details of her problems. Then the therapist can explain to her the nature of her problem and how she can work on these problems to have better personal and social life. According to (Otto, 2003)psychoeducation, along with cognitive-behavioral strategies, increases the prognosis of the problem. Psychoeducation, if conducted professionally, helps boost the confidence of the individual. He finds the strength in himself to face and embrace the challenges.

In this session, after the client’s consent, the treatment strategies will be discussed. She will be informed about her appointment schedule and homework assignments.

2. Relaxation Exercise: The client will be taught Deep breathing exercise, and Progressive Muscle Relaxation exercises to have better control over herself in stressful conditions. It is inevitable that an individual experiences muscle tension and shallow breathing. It is helpful to be aware of the physical sensations and learn to practice relaxation exercises regularly. For adolescents, deep breathing exercise and Progressive Muscle Relaxation (PMR) is especially recommended to harness their physiological and psychological growth spurts.
3. Psychotherapy: Cognitive Behavior Therapy (CBT) is suggested to be carried out in step-by-step sessions. CBT is said to be one of the most effective therapies to treat anxiety disorders (Otto, Harrington & Sachs 2003). CBT works on the cognitive restructuring of the client and teaches to learn better and effective ways to deal with her worries and day to day stress. In this case, the client’s thoughts and beliefs will be focused and how they affect her feelings and actions. The following targets will be achieved through CBT;
   1. Identify problem
   2. Understanding of the automatic thoughts
   3. Challenging the underlying wrong assumptions
   4. Developing a better understanding of others’ actions and motivations
   5. Avoid overgeneralization and blaming others.
   6. Developing positive thoughts and perspectives
4. Family therapy: In this case, Family therapy is very important to improve communication between the client and her parents. The client should be taken into confidence before speaking to her parents. Resolving internal conflicts can help the client, and she can feel secure and strong to handle the usual stress in her life regarding studies and friends. Family therapy also plays an effective role in order to manage and resolve anger issues.
5. Follow up sessions: Follow up sessions are helpful to develop an insight into the client’s progress. Once therapy is completed, there are chances of recurrence of the problem; follow-up sessions reduce this risk. It also helps keep the progress and deal with the upcoming challenges effectively.

Part 4: Referral

It is suggested that it would be helpful for the client to have sessions with a counselor to develop a better life approach. She needs to know the purpose of her life. A life coach can explain to her the importance of the objective and purpose of life. He can motivate her to set realistic goals and how to pursue them successfully.

Bibliography

Malin, H. R. (2014). Adolescent purpose development: Exploring empathy, discovering roles, shifting priorities, and creating pathways. Journal of Research on Adolescence.

Otto, M. W.-H. (2003). Psychoeducational and cognitive-behavioral strategies in the management of the bipolar disorder. Journal of Affective Disorders.

Spielberger, C. D. (1983). Manual for the State-Trait Anxiety Inventory (Form Y). Palo Alto: Consulting Psychologists Press.

Spielberger, C. D. (1999). Measuring anxiety and anger with the State-Trait Anxiety Inventory (STAI) and the State-Trait Anger Expression Inventory (STAXI). Lawrence Erlbaum Associates Publishers.