Case Study of Danial Assessment Paper

Overview

Your assessment paper on the final Case Study of Danial, Parts 1, 2, and 3 will provide you with an opportunity to consider psychopathology issues from a developmental perspective, and to assess the differences between children, adolescents, and adults. This assessment will provide you with a further understanding of psychopathology and improve your diagnostic skills across the life span.

The Case Study of Danial provides three scenarios at different stages in his life. These scenarios each include:

· A developmental history.

· Family background.

· Reason(s) for referral.

· Basic assessment results.

· Issues in treatment.

After you read each scenario, you will be asked to respond to the same series of questions and to integrate information at each stage of Danial’s life.

Use the Case Study Response Guide to format your assignment for each of the three scenarios. Complete your assessment paper by adding a Part 4 at the end, as described in the instructions.

Instructions

Respond to the questions below ( The Questions to Address for Danial…) for each part of Danial’s case study. Be particularly careful to integrate information from each preceding developmental stage into your responses, as they provide you with valuable history. Then answer the final questions as Part 4.

Think of each part of the case study as your first exposure to Danial, but in each successive part, you will be expected to consider all material from the previous scenarios. For example:

· Part 1: When you respond to the questions in Part 1, all the information you know about Danial is contained in Part 1. Your answers will relate to only this scenario.

· Part 2: When you respond to the questions in Part 2, you will have access to the expanded history. Respond to the scenario presented in Danial, Part 2, but also be aware of his previous history detailed in Part 1. Think of Part 1 as information from a medical record. Be sure to integrate this information into your response to the questions in Part 2.

· Part 3: When you respond to Part 3, you will have access to the full history. Respond to the information presented in Danial, Part 3 at that point. Be sure to integrate his previous history from Parts 1 and 2 into your Part 3 answer.

· Part 4: This is a separate section designed to integrate important issues from this course.

The Questions to Address for Danial, After Each Part (1, 2, and 3)

1. What are your diagnostic hypotheses for Danial in this scenario? Justify your conclusions.

2. Describe what further diagnostic information you need (what further diagnostic evaluation is warranted) at the end of this scenario.

3. From a diathesis-stress perspective, what impact do the cultural, ethnic, and psychosexual issues have on Danial and his family in this scenario, and what other issues may play a role?

Part 4 Questions and Issues

1. Given Danial’s family background and his open homosexuality, what cultural and ethnic factors do you need to be aware of at the different stages of his life, and how would you deal with them in arriving at your diagnoses? Give your reasoning with supporting documentation.

2. Compare and contrast the changing roles of psychosexual diagnoses in the DSM text since the 1950s.

Assessment Requirements

To achieve a successful final assessment outcome, you are expected to meet the following requirements:

· Written communication: Written communication is free of errors that detract from the overall message.

· Thoroughness: The paper must address each question completely. Note: Do not restate the questions in your responses.

· APA formatting: Resources and citations are formatted according to APA (6th Edition) style and formatting.

· Length of paper: Minimum of 12–15 typed double-spaced pages, excluding title page, table of contents, and reference page.

· Font and font size: Arial, 10 point.

Note: Your instructor may also use the APA Writing Feedback Rubric to provide additional feedback on your academic writing. The writing feedback rubric does not affect your assignment grade, but its feedback may factor into the grading criteria, if professional communication and writing is a course competency. Evaluate your own work using this rubric. Refer to the Learner Guide for instructions on viewing instructor feedback.

 

Case Study of Danial, Part 1, 2, and 3

Instructions: Respond to the questions at the end of this case study for EACH separate part. As you progress through the assessment requirements, be careful to integrate information from both the current and preceding parts into your responses, as they provide you with valuable history.

Think of each part as your first exposure to Danial, but in each successive part, consider all material from the previous scenarios. For example:

When you respond to the questions for Part 1, all the information you know about Danial is contained in Part 1. Your answers will relate to ONLY this scenario.

When you respond to the questions for Part 2, you will have access to the expanded history. You will be expected to respond to the scenario presented in Part 2, but you will also be aware of his previous history detailed in Part 1, as if Part 1 was information from a medical record. Be sure to integrate this information into your response to Part 2.

When you respond to the questions for Part 3, you will have access to the full history. Respond to the questions with awareness of his previous history, detailed in Part 1 and Part 2. You will be expected integrate this information into your Part 3 answer.

Part 1

Danial is brought to you by his parents when he is seven years old and just starting second grade. He is small for his age and moves in a fashion that could be mistaken for a girl. His mother, Yalda, is 34. She worked as an aide in a pre-school program that Danial attended until he entered kindergarten, “because Danial liked her to be there.” She now works with and for her 39 year-old husband, Nasir, Danial’s father. Nasir owns and manages three convenience stores.

Danial has a 15 year old brother, Salim, who is a very good athlete and already the highest scoring player on a competitive high school soccer team. This Muslim family emigrated from Pakistan ten years ago. They have since helped Yalda’s parents move to the U.S. Assimilation into American culture is somewhat of a struggle from religious and cultural perspectives, particularly as the parents want to hold on to much of their culture of origin. Their English language skills are very good.

When they enter your office, Danial sits very close to his mother on one end of the sofa. His father sits in a separate chair. They speak with a strong Pakistani accent. They are concerned because Danial has been having stomachaches since the new school year started. They think he wants to stay home with Yalda, because he behaved the same way in kindergarten and first grade for the first month or so of school. His complaints about stomachaches, though, are worse this year. He has always wanted someone to stay with him at night until he falls asleep but Nasir put a stop to that at the start of kindergarten, “even though Danial cried like a baby.” Danial is a solid “A-B” student.

Since kindergarten, Danial has awakened frequently at night. He has been found sleeping outside his parents’ bedroom door on a number of nights because he has nightmares about his mother being kidnapped. They are concerned, too, because it was always a battle to get Danial to stay with a babysitter when he was a toddler. Eventually, they could only leave him with Yalda’s parents for an evening because he wouldn’t stop crying if left with anyone else. Throughout the interview, Danial holds tightly to his mother’s sweater or hand, despite her obvious attempts to get him to sit up straight and to move away from her.

You ask Danial if he feels frightened, to which he nods, and says in a soft and somewhat breathy voice, “I worry all the time that something will happen to my mom.” He and his brother speak without accent. You ask if you can talk to him by himself. He responds by clinging to his mother, shaking his head, and saying, “I don’t want to. Don’t make me, please, mommy.” To which his father says, “Good lord,” rolls his eyes, and turns further away from Danial.

Danial’s personal history, and his family’s history on both sides, is unremarkable for mental or medical concerns or for physical or substance use or abuse disorders. There is no history of physical abuse, neglect, or domestic violence. All of Danial’s developmental signs fall within the norm. Other than his concerns of being away from his parents, he has no other behaviors of concern, except, his father says, with another eye roll, “He likes to play with girls and dolls and can’t stand getting dirty. He’ll never be the soccer player his brother is.”

Part 2

Danial is now 16 years old. His mother accompanies him to the interview and tells you about Danial’s evaluation and successful treatment when he was seven. “He was fine after that treatment worked,” Yalda says, “but lately he’s taken staying to himself all the time. He’s always been a little different, too sensitive, you know. He gets tearful now and then. But lately he’s just been nasty to everyone, irritable. And he just can’t sit still. He’s like a cat on a hot tin roof. He can’t remember half of what I tell him. It’s as if he’s forgotten how to think, sometimes. He can’t keep his mind on anything.” She’s also concerned because he only weighs 130 pounds and has lost twenty pounds in the last six weeks without trying. “He eats like a bird,” she says. “He’s lost his appetite.”

Danial appears agitated. He sulks, won’t make eye contact, sits as far away from his mother as he can, and rolls his eyes when she talks. Again, his history is unremarkable for medical concerns, or physical or substance use or abuse disorders, and there is no history of abuse, neglect, or domestic violence. His only psychological history of note is his treatment at age seven. He expresses irritability with his mother for “tricking” him into coming to see a shrink. His mother thinks he is angry because he isn’t sleeping well at night, and hasn’t been sleeping well for several months. Further questions about that do not reveal any manic behavioral concerns.

When you talk with Danial alone, you learn that he has only one male friend, “More of a good acquaintance,” he says. “But he’s like me.” The only other people he has spent time with are a couple of girls who are loners, too, and who “accept” him. “We don’t really trust people much. I’m a lot more like them than I am like “the guys.” He rolls his eyes. “You know the ones who think they’re better than everyone.” He studies his fingernails, which you notice have been polished with a clear nail polish. You ask him about his relationships with “the guys” and he snaps angrily at you. “They’re like my older brother’s friends. A bunch of jocks. To them, I’m a worthless piece of garbage.” He laughs. “And maybe I am. Ha! Maybe!? Who am I kidding? I’m not worth the dirt on the bottom of my brother’s running shoes! Just ask my old man. My brother was a college jock! Daddy’s star! The big college soccer player!”

For the last two months Danial has not wanted to spend time with anyone, and withdraws to his room whenever he can escape the family. He has withdrawn from his already small group of acquaintances as well as family, and lost interest in almost everything, including band and the theater group, both of which he has dropped out of in the last two months. You get the impression that Danial has started buying half-pint bottles of vodka from an acquaintance in the past month, but he will tell you no more about this once it comes out. You ask if he feels depressed and he snaps at you irritably that he is not. He denies any reason for not wanting to see people or for his loss of interest in almost everything he used to do. “Nothing’s happened to me, I just don’t want to be around people, any people, including you.” He denies feeling suicidal but mentions playing with his father’s revolver the previous week, holding the muzzle to his head and clicking the trigger to imagine what it would feel like if it was loaded. He thinks about death a lot, he says, “But it’s only an existential dream. We’re all going to die. It’s just a matter of when.” At this, he smiles again, as if to himself.

Part 3

Danial, 25, works as a draftsman for a large architectural design firm. It is a fairly solitary job. He’s come to see you because, “My boss told me to get help, or else. Bottom line: He wants to fire me, but his boss, my uncle, won’t let him.” He smiles and says, “It’s good to know people in high places.”

Danial’s physician also referred him, and has sent you Danial’s previous treatment records (Parts 1 and 2), which indicate no significant medical concerns. You ask why he thinks his boss wants to fire him and are told, “He’s always making jokes about me behind my back. I hear ‘em all laughing. I’m his star draftsman, but he doesn’t pay me what I’m worth. I’m sure he pays the others more than he pays me, not that they’ll say boo about that. They have kind of a pact, I think, to keep stuff like that from me. And my boss only gives me compliments to get me to work harder. He’s not fooling me. Neither are the others. They’re jealous because of my uncle and . . . other things. You know the kind of stuff I mean.”

You ask him to tell you more. He frowns at you, stares, then shakes his head. “You’re in on this, aren’t you!?” He laughs. “Sure. I see it now. He gives me the names of three therapists and tells me to see one. Smart. I’ll bet he paid the three of you to do what he wants. You all knew I was coming to one of you! To think I was dumb enough to believe that with three names to choose from this had to be on the up-and-up.” He shakes his head. “Jeez!”

You explain that you don’t know his boss. “Yeah,” Danial says, “I believe you. Now, I suppose you’ve got a bridge to sell me.” You explain that he is welcome to choose any therapist he wants, and that if he prefers to end the session he is free to choose another therapist. “Sure,” he says, “so you can tell my boss I walked out, and he still gets me to work with someone in his pocket. I’m not falling for that. I’m here. I’ll work with you. He said I needed therapy and my uncle went along with it. So, I’m getting therapy. I’m not playing my boss’s game. But I don’t want you sending him any little messages about what we talk about.” You agree that everything you talk about will be confidential unless (in the spirit of informed consent) there’s a potential Danial could harm himself or someone else. “Did he tell you I was a danger to him?” he asks. “Is that what this is about? You can’t trust the man. He’ll say anything to get his way.” You reiterate that you have never spoken with his boss.

In a few minutes, he calms down and asks, “So what do we do in this so-called ‘therapy’?” You suggest that he tell you about himself, maybe what his boss is concerned about, or what he (Danial) might want help with. After another discussion about confidentiality, he insists that you to sign a note stating that you will not reveal anything to anyone about what he says unless it’s about hurting himself or someone else, “Because I’m not going to hurt anyone unless they try to get me first.” You sign the agreement. Only then does he begin to talk about himself, after insisting, “I don’t want you writing all this down. And if you break our agreement, I’ll sue you. I will. Believe me.”

 

You ask about his earlier emotional issues and the event with his father’s revolver, which you read in the records. “I’m not depressed, if that’s what you’re thinking. I like everyone and everything, I just don’t trust ‘em,” he says. “I’m happy. I sleep fine. I’m not losing weight. I’m not here for happy pills. I’m just here to find out how to get my boss off my back.” He smirks. “And, maybe, how to know if my partner is having an affair. I’ve never been able to prove anything, but . . . I know he is, and he gives me signs all the time. I just haven’t caught him at it.”

Danial is reluctant to talk about himself, but eventually answers some questions after making you explain why you are asking each one. You learn that he drinks three to five highballs a day on weekends, “sometimes more, lots more once in awhile,” and that he has ongoing trouble with his family of origin, whom, he says, “tried to hold him hostage” to old country ways. He tells you his parents don’t understand him and are always “snooping” into his life, which is why he changes his cell phone every couple of months.

“Besides,” he adds sarcastically, “There are no gay Muslims, you know. My dad tells me that all the time.” He wags his head. “Hell, almost everyone at the firm is gay, and we come from all over the world. What’s he think—that Allah only makes Christians and atheists gay?”

Mental Status Evaluation (MSE) Checklist

1. Appearance 0. Physical Appearance. Client appears stated age, appears older, or appears younger, hairstyle, fingernails, and so on. 0. Dress. Appropriate, clean, pressed, wrinkled, disheveled, and so on. 0. Hygiene. Clean, well groomed, presence of body odor, and so on. 1. Behavior and Mannerisms 1. Gait limping, slow, hurried, and so on. 1. Posture. Slumped or rigid. 1. Eye Contact. 1. Mannerisms. Foot tapping, eye blinking, hand rolling, head nodding, and so on. 1. Attitude 2. Toward Interviewer. 2. Toward Treatment. 2. Toward Others. 1. Mood and Affect 3. Mood. Sad, elated, happy, bored, and so on. 3. Affect. Outward expression of mood such as smiling, frowning, crying, or laughing. 3. Appropriateness. Does the affect match the mood and the situation? 1. Speech 4. Quantity. Talkative, poverty of speech, and so on. 4. Quality. Circumlocution, monotonous, loquacious, loud, and so on. 4. Rate of Production. Mumbles, slow production, pressured speech, and so on. 1. Perceptual Disturbances 5. Hallucinations. False perceptions. 5. Illusions. Misperceptions of reality.

1. Thought 6. Thought Content. Delusions, obsessions, phobias, suicidal ideation, homicidal ideation, and so on. 6. Thought Processes. Flight of ideas, poverty of thought, relevancy, and so on. 1. Sensorium and Cognition 7. Alertness. Awareness of surroundings, goal-directed thinking, responding to the environment, and so on. 7. Orientation. Person, place, time, and situation. 7. Memory and Concentration. Remote, recent past, recent, and immediate recall. 7. Abstract Thinking. Conceptual thinking, ability to understand abstract ideas, ability to use inductive and deductive reasoning. 7. Intellect and Fund of Knowledge basic knowledge and intelligence. 1. Impulse Control 8. Sexual. Ability or lack of ability to control sexual impulses. 8. Physical. Ability or lack of ability to control physical impulses such as hitting, biting, or yelling. 8. Social. Ability or lack of ability to control social impulses. 1. Judgment and Insight 9. Social Judgment. Awareness of others, empathy, social decision making, and so on. 9. Insight. Awareness and understanding of one’s mental illness, insight into cause, effect, and course of illness. 9. Reliability. Is the client a good source of information, is he or she honest, aware, and able to report to the therapist his or her daily happenings?