COUNSELING PSYCHOLOGY COMPREHENSIVE EXAMINATION

CASE VIGNETTE: Utilize this scenario as the basis for your responses to the prompts (listed following the vignette).

Julie Lewis is a 72 year old African American woman. Three months ago, Julie underwent back surgery to treat chronic back pain and numbness in her left leg. Julie decided to seek your counseling services because she is not “bouncing back” from the surgery the way she had expected. Julie describes having little energy and sleeping a lot since the surgery. She also frequently gets very upset when driving. She describes feeling nervous and very angry by how inconsiderate and dangerous other drivers behave, to the extent that she often finds herself yelling and screaming at other cars when she is driving. On two occasions, she has become so upset that she has turned around and gone home rather than complete her trip.

Julie is semi-retired and works 2 night shifts per week at a hospital as a psychiatric nurse. Since the surgery, Julie finds working a 12 hour shift to be especially exhausting. She often spends the day after she works a night shift in her nightgown all day rather than getting dressed and leaving the house. She lives alone in a condo near the hospital where she works. Julie admits that she feels sad and lonely much of the time. She realizes that the amount of time she spends wishing that other people would do things the right way is not healthy, but she also cannot seem to stop. She reports being on antidepressant medication off and on for most of her life. She had taken Wellbutrin for a number of years, but she reports it stopped working about two years ago. She has recently begun taking Celexa.

Julie has been divorced twice, and has been single for approximately that past 15 years. She has three grown children, two sons and a daughter. She describes having good relationships with her children, but she also feels that her children have their own lives and she does not want to be a bother to them. Julie describes both of her marriages as disasters. Julie was married to her first husband for almost 20 years, and he is the father of her children. Her first husband had little consideration for Julie’s feelings, and he had multiple affairs while they were married. Julie describes her second husband as a loser who depended on Julie financially and emotionally. While Julie had always known that he was a drinker, he developed a problem with alcohol a few years into their marriage. Julie tried to put up with the substance abuse as long as she could, but, after 17 years of marriage, Julie divorced her second husband. She has not spoken to her second husband in years, and she has no idea where he is now.

Julie describes the family she grew up in as very strict, and any affection in the family was given to her younger sister, who according to Julie could do no wrong in their parents’ eyes. Julie, on the other hand, felt like she could not do anything right for her parents, no matter how hard she tried. Julie’s family was very active in their conservative church while she was growing up, but Julie now describes herself as an atheist. She does not have positive views about organized religion, and she believes religion as a way to repress and control people.

Directions:
Compose a well-written and organized essay in response to each of the following questions. When writing your response, please:

1) Use the most current APA (6th edition) Style, with 1-inch margin, double-spaced, 12 pt font, with a reference list at the end.

2) Write clearly and concisely.

3) Cite appropriate and especially current literature (empirical and/or theoretical).

4) Avoid all sexist idioms and allusions.

5) Remember to demonstrate your multicultural competence where appropriate.

PROFESSIONAL PRACTICE

1. Assessment: What assessment would you conduct to enhance your understanding of the client’s problems and how would they direct your diagnostic formation? In addition, what formal assessment procedures (conducted either by you or by someone you would refer to) would enhance your understanding of the problems and direct your treatment planning? Why?

2. Diagnosis: Develop a differential diagnosis. What are your diagnostic considerations? Indicate why you are considering these possible diagnoses by providing specific evidence from the vignette. Be sure to include relevant information from the vignette to support your answer and give a 5-axis diagnosis (including use of V codes) at the end of this question. What additional information do you need for each of the possible diagnoses in order to confirm your diagnoses and rule out the others?

3. Theory – Theoretical Conceptualization:

a. Using the diagnosis you developed above, provide ONE theoretically grounded case conceptualization for the client, based on the theory you choose for your treatment approach. In other words, offer at least one theoretical explanation of what has caused the symptoms displayed by your client (why does your client have these symptoms?).

b. Develop a therapeutic treatment plan for the client based upon your theoretical conceptualization above. Please make sure you identify the name of the theory your treatment plan is based on, using appropriate headings. Provide the empirical evidence with appropriate citations to support your choice of theory and the treatment plan that you are recommending for use with this client. Be sure to discuss the effectiveness and limitations in working with this particular client (including effectiveness/limitations in working with this particular client’s background using the above theories and treatment plans).

INTERPERSONAL EFFECTIVENESS – SELF-AWARENESS

4. What might be some of the transference and counter transference issues between you and the client? What are your areas of growth (what do you need to work on) that will be addressed while working with this client?

ETHICS

Using an ethical decision making model, answer the following,

5. What are the ethical and legal dilemmas this vignette introduced? What would be your immediate steps and why? Please be specific and make sure that you describe your process of ethical decision making and the solutions/consequences this process might lead to.

DIVERSITY

6. Given the client’s ethnicity and background, what factors or cultural considerations would you take into account in rendering diagnoses, case conceptualization, and treatment planning? What other cultural factors may be salient for this client?

7. What are the relevant multicultural theories and/or models that you would use in working with this client? Discuss how you would incorporate them in your work.

RESEARCH VIGNETTE:

The director of the mental health agency that you work for has asked you to provide evidence of the value of the agency’s services in order to help secure ongoing funding for the agency. The director has asked you to design a study to show the usefulness of the counseling services that the clients at the agency receive. The agency is located in a large urban area and serves primarily low-income individuals from a variety of racial and ethnic backgrounds. Specifically, the director has asked you to first find or develop a reliable and valid means of defining and measuring the benefits of counseling services for the agency’s clients. Secondly, after you have a means of measuring counseling benefits, the director would like you to design a study to examine the level of benefits that your agency’s counseling services provide in order to demonstrate those benefits to funding sources.

Directions:

Please compose a well-written and organized paper addressing each of the following points.

Discussion Section:

Implications, multicultural sensitivity, and ethical considerations.