n this assignment I want you to write about fully working through a client’s case like you would
as a clinical psychologist.
What this entails is envisioning yourself receiving a document where you get a basic
information gathered from a screening call one of the clinics admins did to ensure your clinic is
the best fit for the client while getting an understanding of their troubles. You begin to plan the
diagnostic assessment and treatment for the future once a diagnosis is (or is not) received.
After preparing and planning, you present the client case to your supervisor.
I want you to fully flesh out your explanations and justifications to demonstrate your
knowledge and ability to critically think using the information learned in the course. This is a
professionally and academically written paper (do not use first person). Please reference your
sources and create a bibliography/reference list using APA format. DO NOT copy and paste,
please summarize and use your own words.
Good luck!
Use the following case and write a case file answering the following questions:
1. Give a short SUMMARY of the pertinent information. What are the major symptoms the
client is experiencing? Hypothesize on what types of issues you may think is going on in
general (e.g. this may be mood, anxiety perhaps, personality, bipolar etc.?) and why do
you think these issues are going on? (2 MARKS)
2. Hypothesize on a specific diagnosis, outline FULLY the diagnostic criteria that need to be
fulfilled of that diagnosis, what symptoms already fit in what criteria, and which ones
you need to inquire further on. (4 MARKS)
3. What differential diagnosis do you need to make? (i.e. what other issues need to be
ruled out before being able to make a diagnosis? Explain your answer) (3 MARKS)
4. Outside of symptom inquiry, what more would you like to inquire about, know, and ask
the client about(explain your answer and why)? (1 MARKS)
5. What cultural considerations are there and how would you manage them? (2 MARKS)
6. What are the clients risk and protective factors? (1 MARKS)
7. Conceptualize the client using the biopsychosocialspiritual model outlining each aspect
of the client for each part of the model (3 MARKS)
8. Outline step-by-step the diathesis stress for the client (4 MARKS)
9. What is your treatment plan IN DETAIL? (ie. what approach(es) would you use and why?
What would you target first, second and third? Do you think the client needs short term
or long term therapy?) (2 MARKS)
10. What is the clients likely prognosis with treatment? Justify your reasoning based on the
information presented (1 MARKS)
11. Proper in-text referencing and bibliography using APA format (2 marks)
The questions worth more marks require a more in-depth answer to get full marks compared
to the ones worth LESS marks (you should spend less time on the ones worth less marks and
more time on the ones worth more marks)
CASE INFORMATION
Basic info
Carlos was born in 1975 in Philadelphia, Pennsylvania. His parents were both born in Puerto Rico but
moved to the mainland USA before their 4 children were born. Trained in Puerto Rico as a plumber,
Carlos’s father readily found profitable work in the continental United States. Eventually he moved into
selling wholesale plumbing parts and supplies. He worked hard to make his business work and involved
all 4 children in the fledgling company at early ages.
Early life
By the time Carlos graduated from high school and began working in the family business full time, it was
a solid company that sold supplies to plumbers, builders, and contractors in several states. Carlos’s
family assumed that he would make a career for himself in the plumbing supply business. Only an
average student in school, he couldn’t imagine what would have become of him if he had had to make it
on his own. He was proud to carry his load in the family business, and indeed, he felt he had a certain
business expertise that his father and brothers respected.
On the other hand, as the baby in a family business, he had a lower status than his brothers during the
early years of the business. His brothers did not dominate him deliberately; there were just occasional
moments when they would pull rank, so to speak. At the same time, Carlos felt a certain safety and
security in what was basically a loving family atmosphere.
At age 22, Carlos married Sonia, whose family was also from Puerto Rico. They dated in high school and
got engaged 2 years after graduation. Two years later they were married in a large church wedding.
They set up a relatively traditional household, with Carlos working in the family business and Sonia
working part-time while taking college courses online. She gave birth to a daughter within a year of their
marriage; another daughter followed 4 years later, then a son, and then another son.
Beginning of symptoms
At age 39, Carlos, by now the successful part-owner of his family’s plumbing supplies business and the
proud father of 4 children, became increasingly preoccupied with his health. His cousin, who was about
15 years older than Carlos, had recently died of a heart attack. Carlos was saddened by the loss but
didn’t think much more of it at the time. However, within a few months he started to worry about
himself and ultimately was convinced that he might also have a heart condition. He began taking his
pulse constantly and putting his hand to his chest to decide whether his heartbeat was palpable,
believing that a pounding heart could be the sign of a heart attack.
Eventually, Carlos went to see his doctor, even though he had just had a checkup a few months before.
The doctor performed an electrocardiogram (EKG) in his office; the results were completely normal.
Carlos left the doctor’s office reassured in a factual sense, but somehow it didn’t help his mood. “A heart
attack is still possible,” he thought.
In the succeeding weeks, he could not get over the idea of disaster striking. He envisioned the effect his
death would have on his wife, children, and brothers and found it devastating. On several nights he
awoke with an overwhelming sense of despair and sobbed quietly to himself while Sonia lay asleep next
to him.
At work, Carlos lost all interest in his usual activities and could barely focus his thoughts at times. What
did anything matter, he thought, when such tragedy could strike? At home he just sat and moped. He
looked at his children as if they were already orphans, and tears would come to his eyes.
Carlos decided to see his doctor again. This time, the physician told Carlos that his preoccupation with
the idea of a heart attack was getting out of hand. “You’re fine, my friend, so stop your worrying.” As the
doctor spoke, Carlos’s eyes welled up with tears, and the doctor realized that this patient was more
troubled than he had at first suspected and suggested medication. Carlos was shaken at the idea of
medication gave him the feeling that the real threat to his well-being was not a heart attack but rather
mental illness. In fact, Carlos’s older sister had been diagnosed with schizophrenia years ago and had
spent the past 2 decades in and out of institutions and he focused on the possibility that a similar fate
could befall him.
Eventually, he was prescribed antianxiety/anitdepressants. Carlos would simply have to follow the
medication regimen. He began taking the medication but after a few days concluded that he didn’t like
the side effects. He called his dr. and told him that he felt like he was about to “jump out of his skin.”
The dr explained that the jitters were sometimes an initial side effects but that they often dissipated
with time. He urged Carlos to continue with the medication a bit longer. However, Carlos simply couldn’t
stand this feeling and pushed for a change. He switched Carlos to a similar medication. Although the
patient had fewer jittery side effects, he didn’t seem to derive much benefit from the new medication.
Furthermore, the sexual side effects were more than he could handle. His feeling of despair persisted,
apparently fueled by his sense of defeat at not getting better with medication in the first place.
The longer Carlos remained with his symptoms, the more he became convinced that he was indeed
headed toward a nervous breakdown, like his sister before him. Eventually, he was refusing outright to
go to work, and his dr. felt it would be best to hospitalize him so a concentrated effort could be
launched to find an effective medication regimen. Unfortunately, this also meant that Carlos’s worst
fears were now (in his eyes) about to be realized.
Carlos spent 3 weeks in the hospital, where various combinations of antidepressant and antianxiety
drugs were tried. Ultimately, one combination provided some relief. Carlos was discharged from the
hospital. Although no longer hospitalized, Carlos was nevertheless struggling mightily. He hoped that if
he just continued to take the medication and kept the demands on himself to a minimum, he would
gradually recover.
Accordingly, he cut his work hours by half, stopped seeing customers, and restricted his activities at the
office to paperwork and occasional meetings with his brothers. In his spare time, he thought it best to
lead a minimalist existence. At home, he told his wife he could no longer help take care of the children
or do any other household chores. Accordingly, he spent his spare time napping, jogging in the park, and
trying to watch an occasional television show.
The summer went fairly well by Carlos’s current standards. As in the past, the family made their
weekend trips to the beach, and Carlos resumed playing softball in his summer league. He was starting
to feel a little bit better. Maybe, he thought, this whole horrible business would soon be behind him. As
the summer drew to a close, however, Carlos started to get an uneasy feeling, which gradually built into
a sense of impending doom.
Somehow, he had gotten it into his mind that the end of summer would signal a turning point for him.
He became convinced that with the approaching fall, he would either recover or descend into an abyss.
Unfortunately, it was the latter. When fall arrived and Carlos still did not feel completely better, he lost
hope of ever recovering, and his condition started to deteriorate again. He became preoccupied with
the possibility of becoming sick again, and in due time this preoccupation grew into the previous
symptom picture.
Upon insistence from his wife and other family members and Dr, Carlos contacted this clinic to seek
services from a psychologist to receive a diagnostic assessment to clarify what is going on and to receive
