Case Study:
The Case of Amanda
Patient:
The patient is a 16-year-old Hispanic female who was referred to treatment due to alleged body image issues.
Brief Background History:
The patient’s parents suspect that the patient is suffering from an eating disorder due to the patient’s self-restriction of food intake and her excessive exercise routine. The patient denies compensatory behaviors; however, the patient reveals that she suffers from a number of symptoms, to include: anxiety, trouble sleeping through the night, and feelings of worthlessness. The patient has expressed reservations about seeking treatment due to the lack of guaranteed confidentiality; however, the patient has agreed to attend the first session.
Clinical and Counseling psychologists utilize a number of assessments to manage and treat their patients. For instance, clinical and counseling psychologists use assessment batteries, surveys, personality inventories, observational data, interviews, etc. There are a number of assessment approaches that can be implemented in the effort to gather data for diagnostic and treatment purposes. In terms of which assessments would be beneficial in aiding in the diagnosis of the current patient, I would employ a multi-method approach and utilize interviews, observational data, client records, and possibly a combination of tests and surveys to understand the extent of the patient’s symptoms.
While there is some useful information provided, I would gather additional information from the patient before making any sort of diagnosis. First, I need to establish rapport. After establishing rapport and trust, I want to know when the disordered eating habits began, how the patient feels about her eating and exercise habits, what her home life and school life are like, why and when she feels anxious, etc. In order to obtain this sort of information, I would pose the following questions:
· What brought you in to see me today?
· How do you feel about being here?
· Have you ever felt like you are overweight?
· How do you feel about eating?
· How does exercising so frequently make you feel?
· What would happen if you didn’t restrict your food intake or exercise so often?
· What is your relationship with your parents like?
· What is your relationship(s) like with your peers at school?
· Do you tend to be an anxious or nervous person?
· You mentioned having troubles with sleeping through the night and feelings of worthlessness, are you depressed?
These questions, I believe, are a good starting point to get to know the patient better and enables me to observe whether she can readily and coherently respond. I utilized primarily “open” questions because, as maintained by Sommers-Flanagan and Sommers-Flanagan (2013), “Open questions facilitate verbal output because they typically require more than a single-word response” (Ch. 4, p. 99).
The theoretical orientation I would use with this client would be cognitive behavioral therapy (CBT). The reason I would use this orientation is because based on reported behaviors and symptoms, the patient does exhibit some compensatory behaviors. CBT is a great way to teach patients alternative ways to manage things like anxiety and guilt that can come along with disordered eating habits. CBT has been most successful in teaching patients about the dangers of certain compensatory behaviors and has worked to aid in the development of more suitable coping mechanisms (Cowden and Gans, 2017). Thus, I believe this theoretical orientation would help guide both the assessment, diagnostic, and treatment process for this patient in a supportive fashion.
Based on the provided information, I would provide a provisional diagnosis of Anorexia Nervosa. According to the DSM-5 criteria, there are three primary characteristics of anorexia nervosa, these include: “persistent energy intake restriction; intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain; and a disturbance in self-perceived weight or shape.” (APA, 2013, section 2).
According to my agency, a diagnosis for this patient must be provided within 48 hours upon the initial session with the client. While this is a rather typical timeframe to provide assessments and determine a diagnosis, some cases require more time. Considering the lack of information I have on my client, I would feel uncomfortable providing a definitive diagnosis and to ensure I uphold ethical guidelines, would request at least one other counseling session to garner more information from my client and conduct further assessment if necessary. Thus, while it has been found that those patients paying via managed care generally receive a diagnosis (Kielbasa, Pomerantz, Krohn, and Sullivan, 2004; Pomerantz and Segrist, 2006), I would not provide a diagnosis just to obtain a third party payment. I feel that providing a diagnosis primarily based on whether or not an agency will be paid is largely unethical in that it could result in the misdiagnosis of a patient. Misdiagnosing a patient can have some extremely adverse outcomes, most especially for the patient who is trusting and relying on the professional to help and treat them.
American Psychological Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing.
Cowden, S. and Gans, S. (2017). What Are Compensatory Behaviors in People with Eating Disorders? Retrieved from https://www.verywell.com/excessive-exercise-eating-disorder-symptom-4062773
Sommers-Flanagan, J., & Sommers-Flanagan, R. (2013). Clinical interviewing (5th ed.) [E-book]. Hoboken, N.J.: John Wiley & Sons.
Kielbasa, A. M., Pomerantz, A. M., Krohn, E. J., & Sullivan, B. F. (2004). How does clients' method of payment influence psychologists' diagnostic decisions? Ethics & Behavior, 14(2), 187-195. doi:10.1207/s15327019eb1402_6
Pomerantz, A. M., & Segrist, D. J. (2006). The influence of payment method on psychologists' diagnostic decisions regarding minimally impaired clients. Ethics & Behavior, 16(3), 253-263.
doi:10.1207/s15327019eb1603_5
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