Introduction
Field practicum opportunities in mental health social work foster interactions between classroom knowledge and real-world examples of challenges theoretically described. Real field situations draw theories closer to practicality, such as the mental health diagnosis experience discussed in this paper. The case is a mental illness diagnosis and treatment procedure for a client with a history of mental illness who is currently showing more clinical symptoms diagnosable using reliable diagnostic manuals as described in the case. The key takeaway from Field Practicum I is that practitioners can accurately diagnose mental illnesses using physical exams and psychological evaluation without lab tests. Moreover, mental illnesses share many symptoms or exist with comorbidities, implying practitioners must address the main issue and all detected comorbidities. The direction taken in this paper is that reliable diagnostic manuals should inform the practitioner’s decision for evidence-based treatment approaches that stabilize a patient’s mental illness cases.
Client Description
Jenny is a young woman in her early 20s who lives with her family (mother, step-dad, and three other siblings) in a modest community. Jenny has a long history of abuse and neglect, having been through traumatic sexual abuse by her foster family; her biological mother physically abused her severely. The client also had an extensive history of mental health instability characterized by difficulty coping with stress, poor management of impulses, and poor self-care. Jenny’s dangerous and impulsive acts often put others at risk, especially the younger members of her family. She had a history of diminished ability to complete normal activities characteristic of daily living. Although the client reported these symptoms as historical challenges causing instability, most of them were still persistent, as explained in the client’s diagnosis next.
Presenting Issues: Diagnosis
The client has numerous persistent psychiatric symptoms that require immediate therapeutic intervention. They are anxiety, threats, impulsivity, and explosive reactions related to the reported inability to cope under stress. The client is easily frustrated and shows runaway behavior and mood swings. Moreover, she is reported to have challenges like disruption, sexual preoccupation, and manipulative behaviors. These issues reflect other reported symptoms such as binge eating, suicidal ideation, and physical aggression towards her peers and school staff. She engaged in sexualized chatrooms, scratched and cut herself when in distress, maintained poor boundaries, burned herself, or hid sharps for self-harm. Her sexual impulses have been historically dangerous as some reported behaviors are that she caused sexual harm to children or had inappropriate contact with younger children. The listed behaviors, self-reported and reported by close family, led to five diagnoses as follows:
The first diagnosis was F33.9 Major Depressive Disorder (MDD), a mental health illness affecting mood. According to the Kim and Jung (2022), a client has major depressive disorder if showing either a depressed mood or loss of interest or pleasure. The Diagnostic and Statistical Manual (DSM-5) outlines several symptoms associated with MDD. The symptoms observed in the client are recurrent thoughts of death, feelings of worthlessness, and a depressed mood that lasts most of the day (Kim & Jung, 2022). MDD is diagnosable if a client’s symptoms, as outlined above, result in clinically significant impairment in cognitive and social functions (Kim & Jung, 2022). Therefore, it is justifiable that Jenny has MDD, which requires immediate attention.
The secondary diagnosis is F40.10 Social Anxiety Disorder, a mental health case with a common comorbidity pattern with MDD. The DSM-5 describes the major symptom of social anxiety disorder as the marked fear of anxiety about an individual’s social situations (Kim & Jung, 2022). Specific symptoms observed in the client’s case are social situations avoidance because social situations provoke fear in the client. These symptoms are supported by the client’s avoidance of social activities (Kim & Jung, 2022). However, there were not many symptoms relatable with the client’s social anxiety disorder diagnosis other than the two marked behaviors.
The client’s symptoms also led to an F94.1 Reactive Attachment Disorder (RAD) diagnosis. The DSM-5 describes the major symptom associated with reactive attachment disorder as consistent emotionally withdrawn behavior, especially for adult caregivers (Kim & Jung, 2022). Persistent social and emotional disturbances indicate the presence of reactive attachment disorder, especially if the client shows behaviors such as diminished emotional responsiveness to social circles or irritability episodes even when there are no prevalent threats (Kim & Jung, 2022). The client showed, among many other behavioral characteristics, the behavioral symptoms associated with reactive attachment disorder.
The listed symptoms of reactive attachment disorder were observable in the client, including other symptoms of F84.0 autism spectrum disorder (ASD). The DSM-5 described the major symptom of ASD as the multiple patterns of deficit in social communication and interaction observed over multiple contexts (Kim & Jung, 2022). The observable characteristic of the client is deficits in developing or maintaining relationships or social interactions through non-verbal communicative behavior (Kim & Jung, 2022). Together with the fifth diagnosis, which is a personal history of self-harm, it is justifiable that the client is placed in a therapeutic group home for urgent support.
Theory Applied to Treatment
The psychodynamic theory of mental health counseling was the most appropriate model for the client’s diagnosed mental health illnesses. Crugnola et al. (2020) described the psychodynamic theory in mental health counseling as the clinical focus on the impacts of experiences on the onset of mental health symptoms. That implies the psychodynamic theory explains that mental health symptoms result from experiences encountered in an individual’s growth and developmental environment. Moreover, the psychodynamic theory best applies to the client’s case because the theory focuses on past experiences (Crugnola et al., 2020). The only alternative that would have applied to this case is the behaviorism theory, which has the exact definitions of the approach as the psychodynamic model, except that behaviorism does not focus on past experiences (Crugnola et al., 2020; Marþinko et al., 2020). Considering the client’s long history of experiences like sexual abuse and neglect, the psychodynamic model most appropriately applies in the diagnosis and therapy, drawing from past experiences to explain the persistent psychiatric symptoms in current diagnoses.
Specific Techniques Used
Techniques used with the client were brief therapies and stabilization efforts for regulating the observed mental health symptoms. The psychodynamic model of mental health counseling supports multiple brief intervention approaches for handling clinically observed mental health symptoms such as those associated with the client. The model promotes self-reflection and self-examination on the client’s side, making it easy to apply effective psychoanalysis and appropriate intervention (Cieri & Esposito, 2019). Therefore, the client’s self-examination and self-reflection techniques enabled the application of other interventions like brief psychodynamic and group psychodynamic therapy as a replacement for family therapy.
The brief psychodynamic therapy lasted only three sessions, as the technique was only useful for establishing a therapeutic connection for preparing the client for a group home intervention. According to Crugnola et al. (2020), brief psychodynamic therapy is useful in identifying circumstances leading to mental health illness and client briefing on temporary coping mechanisms. The reason for using a brief psychodynamic therapy is that the client had some acute symptoms associated with the diagnosed mental health illnesses, especially ASD and MDD. Therefore, the brief therapy was the onset of the therapy journey anticipated for the client once she joins the group home for counseling.
A specific technique used in the group home for structured support and therapeutic intervention was long-term cognitive-behavioral therapy (CBT). The CBT core principle for addressing the client’s challenges states that psychological challenges result from faulty ways of thinking or observed and acquired patterns of unhelpful behavior (Weiner et al., 2020). Therefore, the CBT approach helped restructure the client’s thinking patterns by replacing maladaptive techniques with confidence, resilience, and positive coping skills. According to Robinson et al. (2020), both high-intensity and low-intensity CBT calms a client’s mind either by making them resilient to their fears or by using role-playing to fend off problematic interactions with peers and colleagues. Therefore, the client needed close monitoring to ascertain the CBT efficacy identifiable from behavioral changes and improved coping mechanisms.
Client Response
The client showed responsiveness in the first few days of the visit and therapy, where the client was cooperative with a remarkable change in socialization behavior. Given the weight of the symptoms associated with the comorbid mental health illnesses, much of the recovery progress was to take place at the recommended group therapy home. Therefore, the only observable data obtained from the field practicum was the brief psychodynamic therapy given to the client before recommending the group home therapy. The reason is that the group therapy home professionals could not share client information without the client’s consent. However, since the client showed signs of positive behavioral change, it was anticipated that CBT under the psychodynamic model would promote positive outcomes.
Future Directions
The recommended therapy focused on cognitive behavioral therapy (CBT), evidence-based therapy for promoting positive adaptive behavior, resilience, and coping skills for patients experiencing mental illness symptoms. However, since interpersonal challenges were characterized by poor social behavior and tendencies to harm others on the path to fulfilling impulsive tendencies, the recommended future direction is that such a client undergo interpersonal therapy (IPT) alongside CBT. Moreover, mental health social workers treating clients using the IPT and CBT combined approaches should record and declare the recovery progress comparable to CBT alone.
Conclusion
The client’s history of mental health symptoms and persistent psychiatric symptoms led to the diagnosis of five mental illness conditions. They were major depressive disorder, social anxiety disorder, reactive attachment disorder, autism spectrum disorder, and personal history of self-harm. The DSM-5 manual’s explanation of the disorders matched most of the client’s reported and self-reported symptoms like impulsivity, anxiety, and explosive reactions. Therefore, the psychodynamic theory was the most suitable model for examining the client’s past experiences and their impacts on the persistent psychiatric symptoms. The model also informed two treatment approaches: brief psychodynamic therapy and CBT, though recommended for long-term therapy in a group home setting. The recommended future direction is that a client, such as the one in this case, should undergo interpersonal therapy combined with CBT to test changes in recovery duration and sustainability outcomes.
References
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Crugnola, C., Preti, E., Bottini, M., Rosaria Fontana, M., Sarno, I., Ierardi, E., & Madeddu, F. (2020). Effectiveness of a university counseling intervention based on a psychodynamic approach.Bulletin of the Menninger Clinic, 84(4), 373-398. Web.
Kim, K., & Jung, W. (2022). A Critical Review of the Definition of Mental Disorders in DSM (Diagnostic and Statistical Manual of Mental Disorders). Korean Journal of Philosophy, 150, 309-331. Web.
Marčinko, D., Jakovljević, M., Jakšić, N., Bjedov, S., & Mindoljević Drakulić, A. (2020). The importance of psychodynamic approach during COVID-19 pandemic. Psychiatria Danubina, 32(1), 15-21. Web.
Robinson, L., Kellett, S., & Delgadillo, J. (2020). Dose‐response patterns in low and high intensity cognitive behavioral therapy for common mental health problems.Depression and Anxiety, 37(3), 285-294. Web.
Weiner, L., Berna, F., Nourry, N., Severac, F., Vidailhet, P., & Mengin, A. C. (2020). Efficacy of an online cognitive behavioral therapy program developed for healthcare workers during the COVID-19 pandemic: The reduction of Stress (REST) study protocol for a randomized controlled trial.Trials, 21(1), 1-10. Web.