Counseling Case Conceptualization

Counseling Case Conceptualization

 

Clinical Mental Health Counseling, Version 1.3

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Counselor:     Jon Carlson                            Client/Case #: Barbara        Date:  3/20/2020                   

 

Symbols

AF=Adult Female; AM=Adult Male; CF=Child Female; CM=Child Male

Ex.=Example; Hx=History; NA=Not Applicable

 

I. Introduction to Client & Significant Others

r AF r AM r CF rCM     Age:_40_____             Ethnicity/Language:    African-American                                          

Occupation/Grade in School: Teacher                                                                                                          

Relational/Family Status:       Divorced with one child called Blake                                                                                               

 

II. Presenting Concern(s)

Client Description of Problem(s):      Barbara has problems with her child, Blake. Blake is the only child of Barbara and for the past few days since turning 13, has been rebellious towards the mother. In a majority of instances such as doing house chores, Barbara has to beg Blake before anything is done and in extreme cases, Blake demands money before doing anything. Also, Blake shouts back at Barbara and this has culminated into parent-child fights. The end result is that Barbara is stressed about the sons behavior.                                                                           

                                                                                                                                                                                                                                                                                                                       

Significant Other/Family Description(s) of Problems:          The other family problem is based on Blake. While the mother is the client here, the main problem is Blake whose actions do not resonate well with the mother. The problems that he possesses includes shouting back at the mother and demanding for payment before doing anything.                                               

                                                                                                                                                                                                                                                                                                                       

Broader System Problem Descriptions: Description of problem from referring party, teachers, relatives, legal system, etc.:

__Mothers__:  From the mother’s point of view, Blake has triggered power conflict in there household. The power conflict pits him to the mother. The mother is convinced that Blakes problem is as a result of him showing her that he can be a responsible son hence the need for independence and also payment for chores done at home.                                                                                                                         

_______:                                                                                                                                            

 

III. Background Information

Trauma/Abuse History (recent and past):       From the conversation, Barbara admits that, she at some point in her life was like Blake.           She was rebellious towards her parents especially in doing some chores and also the need to justify that she was mature while she was an adolescent. Therefore, there is a history of rebellion towards the parents in the family.                                                                                                                                                                                                                              

Substance Use/Abuse (current and past; self, family of origin, significant others):   From the analysis, there is no history of substance use or abuse in the family. Neither Barbara nor Blake take any substance.                                                                                                                                                                                                                                                                                                                                   

Precipitating Events (recent life changes, first symptoms, stressors, etc.):   The key precipitating events are the life changes. Blake turned 13 recently. Before that, he was not a bad kid and he was always co-operative with the mothers decisions. The age change therefore was a precipitating factor.                           

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   

Related Historical Background (family history, related issues, previous counseling, medical/mental health history, etc.):   The previous family history on the problem is related to the mother. Blake’s mother admitted that she was exactly as Blake at some point in her life. She felt that she was old to be independent when she was an adolescent. Also, Barbara admitted that the behavior emancipation in Blake was exactly what she was while growing .                                                                                                                                                                                                                                                                                                                                                                                                                      

 

 

 

 

 

IV. Client Strengths and Diversity

 

Client Strengths

Personal:   Ability to admit that there is a problem and there is a need for change. There is an admission from Blake’s mother that the son has a problem that should be eliminated for his betterment in future.                                                                                                                                                                                                                                                                                   

Relational/Social: There is a strong bond between Blake and Barbara. While Blake some times throws tantrums and insists on doing some things like demanding money before doing chores, Barbara admits that Blake listens often and promises to change.                                                                                                       

                                                                                                                                                     

Spiritual:   There is the presence of a strong spiritual connection in the family. Barbara admits that spiritual directions have helped Blake in the past and she is convinced that they will work in future.                                                                                                                    

                                                                                                                                                     

 

Diversity: Resources and Limitations

Identify potential resources and limitations available to clients based on their age, gender, sexual orientation, cultural background, socio-economic status, religion, regional community, language, family background, family configuration, abilities, etc.

Unique Resources:      Young age, which means that there is room for change for Barbara’s son.                                                                                                                                                                                                                                                                          

Potential Limitations: Family configuration. Barbara is a single parent and there is a high likelihood that lack of a father figure is the reason why Blake is rebellious. A father figure would have provided commands which Blake would have to abide to. Therefore, lack of a good family configuration is the main undoing in the case involving Barbara, and Blake.                                                                                                                                                                                                                                                                                   

 

COMPLETE ONE OR MORE OF THE FOLLOWING SECTIONS (V-IX) BASED ON THE THEORY(IES) YOU PLAN TO USE FOR YOUR TREATMENT PLAN

 

V. Psychodynamic Conceptualization

 

Psychodynamic Defense Mechanisms

 

  • Acting Out: Describe: Acting out is engaging in activities as a way of coping with the resulting stress. Barbara acts out when Blake becomes rebellious in doing house chores.
  • Denial: Describe: It refers to the inability to face the resulting reality and, in the case,, Barbara has not fully accepted that Blake is developing on the wrong path of life.                                                                                                   
  • Displacement: Describe: It refers to the transfer of frustrations and feelings to the other objects or people. Blake takes his frustrations to his friends.                                                                                               
  • Help-rejecting complaining: Describe: It describes the inability to accept help. Barbara is convinced that Blake is behaving like that because of the age growth.                                                                                                                               
  • Humor: Describe: It refers to choosing the ironic part of situations. Barbra and Blake’s case does not point out any humor but it could be present in his reference to how friends are given money to work on chores at home.                                                                                                        
  • Passive Aggression: Describe: Being angry when experiencing certain events that lead to aggression is evidenced by the inability to do house chores when not given money.                                                                                                                                   
  • Projection: Describe: Projection is the transfer of own non acceptable qualities to the other people. Projection is not evidenced in the case under analysis.                                                                                                        
  • Projective Identification: Describe:
  • Rationalization: Describe: It refers to avoiding the true reasons why something happened. Barbara believes Blake’s behavior is due to how she used to act while young.                                                                                              
  • Reaction Formation: Describe: It involves treating someone you don’t like in a friendly manner as a way of hiding the true feelings towards that person. Barbara does not like Blake’s behaviors but since he is her child, she behaves in a friendly manner to him.     
  • Repression: Describe: Repression is a defense mechanism whereby information is kept out of conscious. Barbara past defensive behavior came to affect Blake in a manner that is undesired.                                                                                                
  • Splitting: Describe: It refers to the inability to bring both the negative and positive qualities of self into the reality.                                                                                                           
  • Sublimation: Describe: It describes acts of venting bad behaviors into more acceptable activities. Example when Blake is denied money he justifies the behavior by quoting what is done to his friends.                                                                                                                                    
  • Suppression: Describe: Refers to keeping information out of one’s thinking. The unwanted information is kept out as a way of avoiding its influence on the behavior.                                                                                     
  • Other:

 

Object Relational Patterns

Describe relationship with early caregivers in past:       The past relationship of Blake with caregivers was good. Barbara stipulated that Blake did not have any problem while young and his behavior has only emancipated itself when he turned 13.                                                                                                                                                                                                                                                                                                                                                                

Was the attachment with the mother (or equivalent) primarily: q Generally Secure qAnxious and Clingy qAvoidant and Emotionally Distant qOther:     generally tense especially when asked to do something.     

Was the attachment with the father (or equivalent) primarily: : q Generally Secure qAnxious and Clingy qAvoidant and Emotionally Distant qOther:     There was no attachment with the father because he was not there.  

 

Describe present relationship with these caregivers:       The present relationship between Blake and the mother is tense. He does not believe that he can do house chores when asked by the mother. He only believes that he can do the chores when given money by the mother hence the relationship is frosty.                                                                                                                                                                                                 

Describe relational patterns with partner and other current relationships:        The current relationship with the partners is not present because this is a single mother led family.                                                                                                                                                                                                                                                                                                                                

 

Erickson’s Psychosocial Developmental Stage

 

Describe development at each stage up to current stage

Trust vs. Mistrust (Infant stage):  This is the first stage and it involves trust which is as a result of a child depending on the caregivers. It is a stage between birth and one year, and from the analysis of Blake, we can state that he lacked trust while young hence the source of current non-dependability to the mother.                                                                                          

Autonomy vs. Shame and Doubt (Toddler stage):           This stage occurs by two years and it involves development of sense of personal control hence autonomy and shame when doing mistakes. We could refer to Blakes constant need of independence as well developed autonomy.                                        

Initiative vs. Guilt (Preschool age):          This stage involves children asserting power and also the need to control activities around them. Blake’s constant fights with the mother is based on this stage. He is convinced that at 13, he can control his own world.                                                                               

Industry vs. Inferiority (School age):        In this stage which takes place between 5 to 121 years, children develop sense of pride in whatever they do. These children that are encouraged grow up feeling proud of there achievements and those that are bashed develop inferiority.          Blake wants to take pride in whatever he does hence it creates a center of power struggle with the mother.                                            

Identity vs. Role Confusion (Adolescence):         This stage takes place during the teenage years and it involves finding the identity based on sense of self. Through this stage, teenagers find out what they are good at. The feelings of control and independence control the teenagers in this stage.                                                       

Intimacy vs. Isolation (Young adulthood):          This stage occurs in the early adulthood and it involves development of committed relationships. One tends to look for more close relationships with people and the inability to explore the personal relationships leads to self isolation.                                                                 

Generativity vs. Stagnation (Adulthood): In adulthood people continue to build there careers. Those that are successful will be productive to the society and those that are not will stagnate.                                                                       

Ego Integrity vs. Despair (Late Adulthood):       It is the final stage in adulthood and those that have been successful in the society feel more secure while those that have not often feel despair.                                                      

 

Adlerian Style of Life Theme

 

  • Control: Control is based on self and the others. The style of controlling oneself is what Blake is exhibiting, and control of others is what his mother is exhibiting.                           
  • Superiority: Superiority is based on outdoing and also achievements in life. Achieving various things in life leads to superiority and it can be deduced that Blake is aiming at achieving superiority.                                                                                                                       
  • Pleasing: It focuses on pleasing others and avoidance of rejection. It involves possession of friendliness, non-aggressiveness, and likelihood of volunteering. It is evident that Blake lacks this aspect in totatlity.                                                                                                                  
  • Comfort: Blake lacks this aspect because he does not avoid expectations and responsibility. Throughout he wants to be responsible for his actions and also he has massive expectations.                                                                                                            

 

Basic Mistake Misperceptions:      The mistaken convictions that have made Blake to have a faulty adaptation to life is based on comparison with what happens to other homes. Blake is convinced that what happens in other neighborhoods must happen to him.                                                                                                                                                                                                                                                                                                                                                                                                    

 

VI. Humanistic-Existential Conceptualization

 

Expression of Authentic Self

 

Problems: Are problems perceived as internal or external (caused by others, circumstance, etc.)? r Predominantly internal r Mixed r Predominantly external

Agency and Responsibility: Is self or other discussed as agent of story? Does client take clear responsibility for situation? r Strong sense of agency and responsibility r Agency in some areas r Little agency; frequently blames others/situation r Often feels victimized

Recognition and Expression of Feelings: Are feelings readily recognized, owned, and experienced? r Easily expresses feelings r Identifies with prompting r Difficulty recognizing feelings

Here-and-Now Experiencing: Is the client able to experience full range of feelings as they are happening in the present moment? r Easily experiences emotions in present moment r Experiences some present emotions with assistance r Difficulty with present moment experiencing

Personal Constructs and Facades: Is the client able to recognize and go beyond roles? Is identity rigid or tentatively held? r Tentatively held; able to critique and question r Some awareness of facades and construction of identity r Identity rigidly defined; seems like “fact”

Complexity and Contradictions: Are internal contradictions owned and explored? Is client able to fully engage the complexity of identity and life? r Aware of and resolves contradictions r Some recognition of contradictions r Unaware of internal contradictions

Shoulds: Is client able to question socially imposed shoulds and oughts? Can client balance desire to please others and desire to be authentic? r Able to balance authenticity with social obligation

r Identifies tension between social expectations and personal desires r Primarily focuses on external shoulds

List shoulds:                                                                                                         

Acceptance of Others: Is client able to accept others and modify expectations of others to be more realistic?

r Readily accepts others as they are r Recognizes expectations of others are unrealistic but still strong emotional reaction to expectations not being met r Difficulty accepting others as is; always wanting others to change to meet expectations

Trust of Self: Is client able to trust self as process (rather than a stabile object)? r Able to trust and express authentic self r Trust of self in certain contexts r Difficulty trusting self in most contexts

 

Existential Analysis

 

Sources of Life Meaning (as described or demonstrated by client):                                                                                                                                                                                                                                                                                                                                     

General Themes: r Personal achievement/work r Significant other r Children

r Family of origin r Social cause/contributing to others r Religion/spirituality

r Other:                                                                                            

 

Satisfaction with and clarity on life direction:

r Clear sense of meaning that creates resilience in difficult times

r Current problems require making choices related to life direction

r Minimally satisfied with current life direction; wants more from life

r Has reflected little on life direction up to this point; living according to life plan defined by someone/something else

r Other:                                                                                                                    

 

Gestalt Contact Boundary Disturbances

  • Desensitization: Failing to notice problems
  • Introjection: Take in others’ views whole and unedited
  • Projection: Assign undesired parts of self to others
  • Retroflection: Direct action to self rather than other
  • Deflection: Avoid direct contact with another or self
  • Egotism: Not allowing outside to influence self
  • Confluence: Agree with another to extent that boundary blurred

Describe:                                                                                                                                                                                                                                                                                

 

VII. Cognitive-Behavioral Conceptualization

 

Baseline of Symptomatic Behavior

 

Symptom #1 (behavioral description):                                                                             

Frequency:                                                                                                                                   

Duration:                                                                                                                          

Context(s):                                                                                                                                   

Events Before:                                                                                                                             

Events After:                                                                                                                               

 

Symptom #2 (behavioral description):                                                                                         

Frequency:                                                                                                                                               

Duration:                                                                                                                                      

Context(s):                                                                                                                                               

Events Before:                                                                                                                             

Events After:                                                                                                                               

 

A-B-C Analysis of Irrational Beliefs

 

Activating Event (“Problem”):                                                                                                    

Consequence (Mood, behavior, etc.):                                                                                          

Mediating Beliefs (Unhelpful beliefs about event that result in C):

 

Beck’s Schema Analysis

Identify frequently used cognitive schemas:

  • Arbitrary inference:
  • Selective abstraction:
  • Overgeneralization:
  • Magnification/Minimization:
  • Personalization:                                                                        
  • Absolutist/dichotomous thinking:
  • Mislabeling:
  • Mindreading:

 

VIII. Family Systems Conceptualization

 

Family Life Cycle Stage

r Single adult r Marriage r Family with Young Children r Family with Adolescent Children r Launching Children r Later Life

Describe struggles with mastering developmental tasks in one of these stages:                                                                                                                                                                                           

 

Typical style for regulating closeness and distance with others:                                                                                                                                                                                                                                                                                                                                                      

 

Boundaries with

Parents: r Enmeshed r Clear r Disengaged r NA: Diversity note:                               

Siblings: r Enmeshed r Clear r Disengaged r NA: Diversity note:                               

Significant Other: r Enmeshed r Clear r Disengaged r NA: Diversity note:                

Children: r Enmeshed r Clear r Disengaged r NA: Diversity note:                             

Extended Family: r Enmeshed r Clear r Disengaged r NA: Diversity note:                

Other:______: r Enmeshed r Clear r Disengaged r NA: Diversity note:                     

 

Triangles/Coalitions

r Coalition in family of origin: Describe:                                                                            

r Coalitions related to significant other: Describe:                                                             

r Other coalitions:                                                                                                                

 

Hierarchy between Self and Parent/Child  r NA

With own children: r Effective r Rigid r Permissive

With parents (for child or young adult): r Effective r Rigid r Permissive

 

Complementary Patterns with                        : rPursuer/distancer; r Over/under functioner;

rEmotional/logical; rGood/bad parent; r Other:__________; Ex:                                                                                                                                                                                  

 

Intergenerational Patterns

Family strengths:                                                                                                                   

Substance/Alcohol Abuse: r N/A; r Hx:                                                                           

Sexual/Physical/Emotional Abuse: r N/A; r Hx:                                                              

Parent/child relations: r N/A; r Hx:                                                                                   

Physical/Mental Disorders: r N/A; r Hx:                                                                          

Historical incidents of presenting problem: r N/A; r Hx:                                                 

 

IX. Solution-Based and Cultural Discourse Conceptualization (Postmodern)

 

Solutions and Unique Outcomes

Attempted Solutions that DIDN’T work:                                                                                                                                                                                                                                                       

 

Exceptions and Unique Outcomes (times, places, relationships, contexts, etc. when problem is less of a problem; behaviors that seem to make things even slightly better):                                                                                                                                                                                                                                                                                                                                                 

 

Miracle Question Answer: If the problem were to be resolved overnight, what would client be doing differently the next day? (Describe in terms of doing X rather than not doing Y).

 

Narrative, Dominant Discourses, and Diversity

 

Dominant Discourses informing definition of problem:

 

  • Cultural, ethnic, SES, religious etc.:                                                                                                                                            
  • Gender, sexual orientation, etc.:                                                                                                                                            
  • Contextual, family and other social discourses:                                                                                                                                            

 

Identity/Self Narratives: How has the problem shaped client’s identity?:                                                                                                                                                                                                                                                                                                                                                                 

 

Local or Preferred Discourses: What is the client’s preferred identity narrative and/or narrative about the problem? Are there local (alternative) discourses about the problem that are preferred?:                                                                                                                                                                                                                                                                                                 

 

 

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