Summary: Cognitive Behavioral Case Conceptualization

Mr. Davis is a 33 year old male who presented to the ED with homicidal ideation with a plan. Mr. Davis states he has a plan to go out in his yard with a machete and kill someone. Per documentation he states, "I'm going out into the yard with my machete and I am afraid I am going to kill someone. I feel really crazy." He states he has these thoughts towards anyone that does him wrong. At the time of the assessment Mr. Davis is asleep, however becomes awaken and 4x oriented by hearing his name called. He has a history of Bipolar. He denies current suicidal ideation, homicidal ideation, and visual hallucinations. He does endorse auditory hallucination. Mr. Davis reports hearing several people telling him things. He reports his outpatient provider is DayMark and he usually go there twice a month for his Depakote injections, however has not been there since

The intervention that was implemented was the invitation for the father to participate in the therapeutic sessions with his son and ex-wife. I explained the client’s recent behavior and the subsequent admittance to my agency. I clarified that the client’s behavior worsens after their divorce which is evidenced by the increased disciplinary infractions he received at school. The client also became more combatant and argumentative with his mother and siblings as reported by them. I proposed the idea of meeting for a family therapy session to uncover the cognitive reasons behind the

bipolar disorder at the age of 18. client has revised care as well as many different medications to

Based on the information obtained from the intake clinical interview by client Paul Repko, there is some evidence that could potentially define his symptoms as a mental disorder. First, there is some dysfunctional behavior as Paul notices that his attitude as a new divorce is affecting his ability to maintain relationships. Also, his state has caused Paul some distress causing him anxieties in several aspects of his life: financially, romantically and emotionally. Even his loved ones are noticing an increase in aggression since the divorce, especially towards different female characters in his life such as his sister and current girlfriend. Additionally, there is some sense of deviance and dangerousness due to Paul expressing his idea of discipline as a physical punishment, which is not socially acceptable and can potentially turn into abuse. For all these reasons, Paul came voluntarily to overcome his irritability and anxiety he has been experiencing more lately.

The client is grateful to have a supportive family. Being one of eight, he and his siblings are fairly close and have good relationships. The client mentioned a family history of drug and

Presenting Problem: Zachary has required x3 inpatient hospitalization within a 6 month time frame. Zachary struggles with communication in the family dynamics that generally evoke anger, irritability, physical aggression, and suicidal statements. Most recently he was admitted at NNBHC due to SI, HI statements and AWOL behaviors. He is not compliant with medication compliance or participating in outpatient treatment. He states overall mood has been on and off with periods of feeling down. He reports decrease interest in activities.

The client is a 14-year-old Hispanic female in a residential substance abuse treatment rehabilitation center. The client participated in Cognitive Behavioral Therapy anger management group. The client was admitted to the residential program in July of 2016 for her cannabis use. She was referred by Drug Court due to her failure to comply with the program rules. The client has a past of domestic violence and defiant behavior towards her mother and not abiding by curfew.

The client is a 26 year old, single, male, African American. He is an active duty ship’s serviceman seaman serving in the United States Navy, aboard the USS Belleau Wood (LHA-3). Seaman (SN) Fisher is residing on board the USS Belleau Wood (LHA-3) that is permanently stationed at San Diego Naval Base, 32nd Street in California. SN Fisher was given orders to report to Navy Mental Health Services Department on base as Involuntary Command Referral for diagnosis and treatments, to get an evaluation and expert psychiatric recommendation about whether the service member is mentally fit to stay in the United States Navy. SN Fisher is unwilling to begin counseling,

Friedberg and McClure (2015) described case conceptualization as personalized psychological portraits of each individual client (p. 11). When looking at each individual aspect, as well as how they connect with each other, the social worker will be able to get the whole picture of the client (Friedberg & McClure, 2015). The presenting problem is the center of the case conceptualization and has five symptom clusters (Friedberg & McClure, 2015). The five symptom clusters were physiological, mood, behavioral, cognitive, and interpersonal (Friedberg & McClure, 2015). When writing a case conceptualization, history and development, cognitive structures and predisposition, behavioral antecedents and

Coccaro, Posternak and Zimmerman stated that originally intermittent explosive disorder was thought to be a rare disorder. After further recently conducted studies, the disorder appears to be common and often times goes undiagnosed, or is falsely diagnosed. Most of the time, it goes undiagnosed due to medical professional’s lack of awareness and understanding regarding the disorder. Coccaro, Postermark and Zimmerman found in recent studies that the percent of the population with the disorder is 6%. (as cited in McCloskey et al, 2008). Even though it has been discovered that IED is more common than previously thought, the disorder still may be underestimated. IED may still be under diagnosed because the DSM-IV criteria for diagnosing someone with IED is solely based on physical aggression. It does not take into account verbal aggression that is not proportional to provocation one experiences. Examples of verbal aggression are arguing, insulting and making threats. McClosky, Lee, Berman, Noblett and Coccaro (2008) have found that intense verbal aggression outbursts with no physical acts of violence maybe a type of nonphysical IED. Intense verbal aggression can be treated similarly to normal IED.

She explained that the two separated for a few months, but counseling was helpful. The patient denied any suicidal or homicidal ideation, intent, or history of attempts. She also denied any previous psychiatric diagnosis, hospitalizations. The patient denied a history of hallucinations or

Mental Health History: Client denies hx of depression, however, reports that he has recently broken up with his girlfriend, with whom he was engaged to be married. Client reports that his maternal Aunt has experienced depression in the past, and she currently takes medication for this issue, but client is unaware of the medication. Client indicates that he has felt anxious in the past, but does not believe this has created any issues for him in terms of functioning. Client reports feeling down and having a desire

Client is a 55-year-old woman who came in seeking services for counseling and possible community resources referrals. Client has no significant biological history that could explain her feelings of sadness and depression in the past few months. However, client lost her mother in April of this year and has had a hard time coping with this loss. After the death of her mother, her responsibilities of caring for her father increased as well. The client describes symptoms of situational depression, which is referred to as adjustment disorder. The differential diagnosis of this client is Adjustment disorder with mixed anxiety and depressed mood. The emotional and behavioral symptoms began after client’s mother passed away. The symptoms were initially worse right after the death and have only improved slightly. This client was not ready to seek services until recently, when she realized that she is not feeling that much better despite the passing of time. The client is reporting a depressed mood, worry, difficulty with sleep patterns, and a lack of interest in things that once brought her joy. There is significant impairment in the functioning of client’s emotional and physical health at this time. The depression and anxiety related disturbances do not meet criteria for another mental health disorder at this present time. However, it would be vital to monitor this client for major depressive disorder if symptoms do not improve. Client is dealing with one of the most significant

The client has difficulties with interpersonal skills because of his past negative experiences growing up. The client tends to perceive other individual’s body language or comments as negative and an attack on the client causing him to get angry and anxious because of his past experiences in his childhood. When the client is asked about how he knows the intentions of others, the client states that “ I can tell.” However, the client cannot give any details that prove it was the individual’s true intentions. For example “When I come downstairs, my roommate stairs at me like I am not supposed to be downstairs.” Due to past experiences, the client holds these faulty beliefs that may not hold true today. The actions of others that the client perceives as negative brings the client the feelings from childhood of being an outcast, worthless, hopeless, and unwanted. When these feelings occur, the client self-medicates with cannabis as a coping strategy. The client’s faulty thinking causes him significant harm to his relationships with family, housemates, and church. Rational Emotive Behavior Therapy will be used to show the client that the event does not cause his depression, anger, and anxiety but his beliefs about the event causes his depression, anger, and

These severe outbursts may be displayed as a tantrum, fit, or argument and can be frequent and out of control. If this aggressive behavior is not dealt with it can lead to serious acts of assault or property damage. There is a difference between someone who can control these outbursts and someone who can’t. The National Institute of Mental Health on its website reports from a study conducted in 2001-2003 that depending on how broadly it is defined, IED affects as many as “7.3% of adults – 11.5-16 million Americans” – in their lifetime ("Intermittent Explosive Disorder Affects up to 16 Million," 2012). To be diagnosed with the IED a patient must have had three outbursts of impulsive aggressive behavior at any time during their life time. An outburst would happen suddenly, for no reason and include an aggressive behavior which may either harm another person or another person’s property. In most cases, people with IED usually feel relief or pleasure after having an episode. An individual who suffers from IED feels compelled to act on their impulses not caring about the consequences of their actions. When a person is able to decide whether or not to act on an impulse, he makes a choice. With patients who suffer from IED, there is no choice. Some health professionals believe IED is a symptom of another mental disorder rather than a separate one. According to an article entitled