Case Study- Mental Health and Counselling

Assessment Details and Instructions

2500 words
Assessment type- Case Study
14 references – referenced in APA style (7th ed.)

Purpose:
The purpose of a case study is to present an intensive, systematic investigation of an individual, group, community or some other unit. In this assessment, students will select one of the mental health conditions studied in this unit to demonstrate professional knowledge and understanding of a person living with this condition.
Students will provide an analysis of a low-prevalence mental health condition covered in this unit comprising presenting problems that the person may bring to counselling, and demonstrate knowledge and skills in case conceptualization, assessment and development of an evidence-based intervention plan. Ethical issues and potential challenges will be critically analyzed.
Process:
• Students select one of the case scenarios of selected low-prevalence mental health conditions: obsessive-compulsive disorder (OCD), hoarding disorder, bipolar disorder I, schizophrenia, or borderline personality disorder.
• Provide a general overview of the selected mental health condition (not specific to the case), including key symptoms, risk factors, and prevalence in Australia. Provide a tentative diagnosis based on the DSM-5 criteria for the selected mental health condition
• Develop a case conceptualization based on the 5-P model, including presenting issues, predisposing factors, precipitating factors, perpetuating/maintaining factors, and protective factors. Elements from the case study need to be drawn upon here to support the case conceptualization
• Suggest validated diagnostic tools that could be used to support diagnosis and suggest an intervention plan based on relevant and highly evidence-informed practice.
• Identify and critically evaluate ethical and professional challenges.
• The paper needs to include an introduction and a summary/conclusion, and needs to be referenced in APA style (7th ed.)
Task and steps
TASKS
1. Select one of the Assessment case scenarios. ( scenarios below )
2. Provide a general overview of the selected mental health condition (not specific to the case), including key symptoms, risk factors, and prevalence in Australia.
3. Provide a tentative diagnosis based on the DSM-5 criteria for the selected mental health condition.
4. Develop a case conceptualisation based on the 5-P model, including presenting issues, predisposing factors, precipitating factors, perpetuating/maintaining factors, and protective factors. Elements from the case study need to be drawn upon here to support the case conceptualisation.
5. Suggest validated diagnostic tools that could be used to support diagnosis.
6. Suggest an intervention plan based on relevant and highly evidence-informed practice.
7. Identify and critically evaluate ethical and professional challenges.

Case Scenarios
For this Assessment , please choose one of the following four scenarios.
Case scenario 1
Alyssa is a 28-year-old woman who is seeking therapy because she fears that her relationship is “breaking up again”. She says that her partner of 12 months, Ava, has threatened to leave on previous occasions but that “this time it feels real”. She states that “I think I have gone too far this time, yelling at Ava and throwing my phone at her”. Alyssa says that she tried to be everything Ava wanted her to be, changing her clothes, hair, and interests, to the point that she no longer knows who she is. Alyssa says that sometimes Ava is “absolutely amazing” and that she is grateful that Ava “rescued her” but that, at other times, Ava ignores her and does not answer her phone for hours during the day. She says that, at those times, she wonders whether Ava no longer wants to be in the relationship, and this makes her angry, lash out at Ava and go on shopping sprees, spending much more than she can afford. Afterwards – like now – she regrets her behaviour, berates herself, and panics that Ava will leave her. Alyssa reports that she has been cutting her legs since she was a teenager and 18 months years ago tried to suicide by overdosing on sleeping pills. She says that things improved dramatically when she met Ava, who “really understood me”. She also found employment that she liked and where she thought that her colleagues understood her. However, she said that recently it seems that “everyone is turning on me again”. The stress of “never knowing where I’m at” sometimes makes her “zone out” and lose track of time. When asked about suicidal ideation by the therapist, Alyssa says that she has no plan to suicide but that, sometimes, suicide seems like “the only way to get off the rollercoaster”.
Case scenario 2
Omer is a 19-year-old university student who was brought to the campus counsellor by campus security. He was picked up sitting on a ledge on the second floor of a building, talking to doves, and reporting that he can understand the doves’ communication and they talk to him. He denies that he wanted to jump off the ledge and states that, on the contrary, roofs and ledges are “some of the few safe spaces left”. He says that he enjoys the doves’ company and that he no longer trusts people since he his car and unit were bugged, and since he is being monitored by secret agents. He said that he no longer uses his phone or laptop so that he cannot be tracked easily. Omer successfully completed his first year at university, but his grades declined over the last six months and he has all but withdrawn from his courses. He says that secret agents started following him sporadically about a year ago but increased their surveillance after he moved into his own place about six months ago. He says that he stopped seeing his friends around that time as he suspects that they were feeding information to the secret service before he moved out. At the counsellor’s practice, Omer speaks with a monotone voice and has restricted affect. He sometimes seems to look up at the corners of the room as if searching for something. He assures the counsellor that he does not use alcohol or illicit drugs because “I need to stay on the top of my game”. He states that his uncle had been “murdered by secret agents at a psychiatric hospital” and that he needs to be alert so that he will not suffer the same fate.

Case Scenario 3
Ju is a 42-year-old woman who is worried about losing her employment and is seeing a workplace counsellor. She says that she was always somewhat anxious, even as a child, and has been worrying about things all her life. One of her worries is that she will contract a fatal disease when touching a lift button, a door handle, or a railing. She says that she knows that his fear is irrational but that she cannot help being afraid of touching things that hundreds of other people have touched. She reports that she was under considerable stress about 5 years ago, when hse had to retrain at work, felt financially insecure and, at the same time, had health concerns. At that time, she developed an intense fear that her home was unlocked and would be broken into. She started having intrusive thoughts that it would be her fault if the house was burgled if she did not repeatedly check all the locks. Ju says that she now checks the doors and windows twice in the morning and at least twice at night, each time in a specific sequence. She says that checking in a specific sequence usually reduces her fear of making a mistake. However, sometimes she gets up in the middle of the night to check the doors and windows again. Ju reports that her intrusive thoughts about making mistakes are getting worse and that her checking rituals are taking up more and more of her time, leading her to be late for work most days of the week. Sometimes she feels compelled to drive home from work to check whether doors and windows are properly locked. Her colleagues have noticed that she arrives late in the morning and sometimes disappears for an hour during the day without explanation. Ju is worried about losing her employment and a colleague encouraged her to see the workplace counsellor.
Case scenario 4
Ron is a 60-year-old male who came to counselling because his wife had presented him with the ultimatum that either he would seek help, or she would divorce him. Ron says that he does not want to lose his wife but, at the same time, thinks that she is worrying too much and just does not understand him. Ron reports the example of his financial investments. He says that, over the years, he has engaged in several get-rich-quick investments, each time working for days with little sleep and little food. He says that he has changed his work frequently “to stay on top of things” and has come close to revolutionising the field of finance several times. He states that, rather than supporting him in his endeavours, his wife wants him to stop making risky investments because she, unnecessarily, worries that they will lose their retirement fund. Ron recalls that he used to have “manic times” when he was younger, during which he engaged in many high-risk behaviours, such as binge drinking, auto racing, and multiple unsafe sexual relationships. He says that his life was a constant cycle of ups and downs but that he has quietened down a lot since then. He reports that he rarely experiences “highs” now and that, more recently, he has been feeling tired and sometimes teary. He also says the feels increasingly irritated by people around him and no longer enjoys socialising the way he used to. He says that he cannot stop ruminating about what he has done with his life, the opportunities he missed engaging with their children who are now adults and live overseas, the bad decisions he made, whether he could have been a better husband, and whether the world would be better off without him. He says that he still does not need much sleep but that this is not a problem.

Questions

The person in the case study would likely meet criteria for one main diagnosis (based on DSM-5 criteria). It may be possible in some of the case studies that there are indications for a possible additional diagnosis but the symptoms would not be as clearly meeting DSM-5 criteria. You could mention it, is this is the case, but the treatment plan needs to focus on the main diagnosis.

Resources
-Template for and video on how to create a 5-P case formulation: https://www.youtube.com/watch?v=i6s6irScy0o
–Section II of the Diagnostic and Statistical Manual of Mental Disorders (5th ed., DSM-5; American Psychiatric Association, 2013)
–article on 5-P case formulation – Textbook: Barlow, D. (2021). Clinical Handbook of Psychological Disorders: A Step-By-Step Treatment Manual (6th ed.).
–APS Review on evidence-based psychological interventions

How to do case studies
Case Study
A case study requires you to analyse and write about a person, a scenario or an organisation. You might be given information about the case in the assessment description, or you may be required to invent or find your own case. The purpose of a case study is to apply the concepts and theories you have learnt about in class to the particular case. Always refer to the marking criteria and instructions in your unit outline as each discipline has its own requirements for a case study.
Content
Some case study assignments may require you to provide a short summary of the case in your own words, especially if you have provided your own case study. This will help provide context for the rest of your analysis. The main part of the assignment will involve you applying the concepts and theories you have learnt about to the case study. This means that you will be referencing research and theory to support your ideas. A case study might also require you to provide examples of what you would say to a client or another person in the case, and what they might say. These are called verbatim examples.

Structure
Most case studies need to be structured in the same way as an essay, with an introduction, a series of body paragraphs and a conclusion. However, unlike essays, case studies usually have headings based on information in the task description or marking criteria. For example, a client case study assessment that asks students to identify the main issues and prepare a plan of action may have headings such as Summary of the case, Identification of main issues, Recommended action plan.

Style
Case studies require you to write in the third person (people’s names, he/she/they, the counsellor, the client, and so forth) when discussing the theories or research of authors, or the client, the professional or the organisation in the case. A case study might require you to use first person (‘I’, ‘my’ etc) to provide your own reflections about the case, its personal impact on you, or how you would apply theories and skills to the case. Check with your educator about whether you should use first person.
Tip
Make sure you have a good balance between describing your case study and analysing it. Many students fall into the trap of being too descriptive when writing about their case. Some ways to include analysis are:
• Explaining and giving reasons
• Comparing and contrasting
• Making suggestions and recommendations
• Supporting your ideas with information from sources

Marking criteria
1- Content: Demonstrated knowledge and understanding of prevalent mental health condition; (not specific to case) including key symptoms, risk factors, and prevalence in Australia. Tentative diagnosis contextualized to scenario client based on the DSM-5 criteria
 Sophisticated demonstration of knowledge and understanding of prevalent mental health condition key symptoms, risk factors, and prevalence in Australia. Tentative diagnosis based on DSM-5 criteria.
2- Application: Demonstrated knowledge and skills in developing a case conceptualization that is evidence-informed, contextualized to client scenario and based on the 5-P model including: presenting issues and predisposing, precipitating, perpetuating/maintaining and protective factors.
 Sophisticated demonstration of knowledge and skills in developing a case conceptualization n that is evidence informed, contextualized to client scenario and based on the 5- P model. All five aspects of the model addressed.
3- Critical thinking / analysis / evaluation: Demonstrated knowledge and understanding of potentially useful validated diagnostic tools that could be used to support diagnosis and an intervention plan based on relevant, evidence-informed practice and attends to any potential ethical and professional challenges.
 that could be used to support diagnosis and an intervention plan based on relevant, evidence informed practice and attends to any potential ethical and professional challenges. At least 3 highly relevant and validated diagnostic tools applied.
4- Evidence: Demonstrated knowledge and skills in identifying and including relevant academically rigorous theoretical and empirical literature pertaining to the mental health condition and case conceptualization model.
 Sources included in the case scenario application are consistently academically rigorous and highly pertinent to the mental health condition and case conceptualization model.
5- Academic literacies:
 Written and presented to an exemplary academic standard i.e., diligent command and adherence to the specified genre; the communication is clear and logical. No errors in grammar, punctuation and or spelling. No errors in APA referencing and formatting.