PSY650 Discussions Week 2 – …

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due Nov 17 at 1:59am

Week 2 – Discussion 53 53

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Your ini!al discussion thread is due on Day 3 (Thursday) and you have un!l Day 7 (Monday) to respond to your classmates. Your grade will reflect both the quality of your ini!al post and the depth of your responses. Refer to the Discussion Forum Grading Rubric under the Se"ngs icon above for guidance on how your discussion will be evaluated.

Assessment and Diagnosis “Under the Gun”

Prior to beginning work on this discussion, review Standard 9: Assessment in the APA’s Ethical Principles of Psychologists and Code of Conduct and DSM-5.

It is recommended that you read Chapters 1 and 2 The assessment process in the APA handbook of tes!ng and assessment in psychology, Vol. 2: Tes!ng and assessment in clinical and counseling psychology (2013) e-book, as well as the Kielbasa, Pomerantz, Krohn, and Sullivan (2004) “How Does Clients' Method of Payment Influence Psychologists' Diagnos!c Decisions?” and the Pomerantz and Segrist (2006) “The Influence of Payment Method on Psychologists' Diagnos!c Decisions Regarding Minimally Impaired Clients” ar!cles for further informa!on about how payment method influences the assessment and diagnosis process.

For this discussion, you will assume the role of a clinical or counseling psychologist and diagnose a hypothe!cal client. Begin by reviewing the PSY650 Week Two Case Studies Minimize File Preview

document and select one of the clients to diagnose.

In your ini!al post, compare the assessments typically used by clinical and counseling psychologists, and explain which assessment techniques (e.g., tests, surveys, interviews, client records, observa!onal data) you might use to aid in your diagnosis of your selected client. Describe any addi!onal informa!on you would need to help formulate your diagnosis, and propose specific ques!ons you might ask the client in order to obtain this informa!on from him or her. Iden!fy which theore!cal orienta!on you would use with this client and explain how this orienta!on might influence the assessment and/or diagnos!c process. Using the DSM-5 manual, propose a diagnosis for the client in the chosen case study.

Analyze the case and your agency’s required !meline for diagnosing from an ethical perspec!ve. Considering the amount of informa!on you currently have for your client, explain whether or not it is ethical to render a diagnosis within the required !meframe. Evaluate the case and describe whether or not it is jus!fiable in this situa!on to render a diagnosis in order to obtain a third party payment.

Guided Response: Review several of your colleagues’ posts and respond to at least two of your peers who chose a different case than you by 11:59 p.m. on Day 7 of the week. You are encouraged to post your required replies earlier in the week to promote more meaningful interac!ve discourse in this discussion.

In your responses, evaluate whether your peer took into account the ethical guidelines outlined in the APA’s Ethical Principles of Psychologist and Code of Conduct when he or she assessed and diagnosed the client. Suggest addi!onal ques!ons your peer might ask the client. Propose an alterna!ve diagnosis that might arise from the addi!onal ques!ons you have suggested.

Con!nue to monitor the discussion forum un!l 5:00 p.m. Mountain Standard Time (MST) on Day 7 of the week and respond to anyone who replies to your ini!al post.

ZOOM

PSY650 Week Two Case Studies

You are a psychologist working for an agency whose policy states that an assessment and

diagnosis must be rendered within 48 hours of an initial session with a client. Please review and choose one of the following cases to diagnose.

The Case of Amanda Amanda is a 16-year-old Hispanic female that was referred to treatment due to body image issues.

Her parents believe that she has an eating disorder because she restricts her food intake and exercises excessively. Amanda denies any compensatory behaviors, but reports the following

symptoms: anxiety, trouble sleeping through the night, and not feeling like a worthwhile person. She has reservations about seeking treatment because confidentiality is not guaranteed. She has

agreed to attend the first session and opted to use insurance to pay for it. Her insurance company will allot her 8 sessions upon receipt of her diagnosis. What diagnosis would you give Amanda?

The Case of Charles Charles is a 33-year-old African American male seeking treatment due to suicidal ideation. He is

currently going through divorce proceedings and reports feeling agitated, angry, sad, and stressed most days. He is concerned that his relationship issues have begun to impact his responsibilities at

work and fears losing his job. Charles is open to seeking treatment, but his insurance provider is out-of-network. His insurance company is willing to reimburse him for up to 8 sessions if an

acceptable diagnosis is submitted. What diagnosis would you give Charles?

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Trennan Perez Nov 11, 2023

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Assessment in clinical and counseling psychology involves gathering informa!on about an individual's psychological func!oning to aid in diagnosis and treatment planning. Clinical and counseling psychologists may use various assessment techniques, including tests, surveys, interviews, client records, and observa!onal data.

Assessment Tools: 1. Clinical Interviews: Conduc!ng interviews with Amanda to gather informa!on about her background, family history, current concerns, and the development of her body image issues.

2. Psychological Tests and Surveys: Administering standardized tests to assess Amanda's cogni!ve func!oning, mood, and personality traits. Specific measures related to ea!ng a"tudes and behaviors may also be employed.

3. Observa!onal Data: Observing Amanda's behavior in different contexts, such as her interac!ons with family, friends, and her approach to food and exercise.

4. Client Records: Reviewing any available medical records, school records, or previous psychological assessments to gain a comprehensive understanding of Amanda's history.

Formula!ng Diagnosis – Addi!onal Informa!on: 1. Medical History: Informa!on about Amanda's physical health and any poten!al underlying medical condi!ons.

2. Detailed Ea!ng Pa$erns: A thorough explora!on of Amanda's ea!ng habits, pa$erns, and any compensatory behaviors.

3. Family Dynamics: Understanding the dynamics within Amanda's family that might contribute to her body image issues.

Poten!al Ques!ons: 1. Can you describe a typical day of meals for you? 2. How do you feel about your body and appearance? 3. Are there any specific events or situa!ons that trigger your anxiety? 4. Can you share more about your sleep pa$erns and any specific difficul!es you encounter? 5. Have you experienced any recent changes or stressors in your life?

Theore!cal Orienta!on: Given the informa!on provided, a psychodynamic or cogni!ve-behavioral theore!cal orienta!on may be relevant. Psychodynamic approaches could explore underlying conflicts and early life experiences, while cogni!ve-behavioral approaches may focus on iden!fying and challenging nega!ve thought pa$erns related to body image.

Proposed DSM-5 Diagnosis: Without a full assessment, it is challenging to provide a specific diagnosis. However, based on the presented symptoms, a provisional diagnosis might be "Unspecified Feeding or Ea!ng Disorder," pending further evalua!on.

Ethical Considera!ons: The ethical perspec!ve involves balancing the need for a !mely diagnosis with the responsibility to provide accurate and comprehensive informa!on. Given the limited informa!on, it may be ethical to provide a provisional diagnosis for insurance purposes, but ongoing assessment and refinement of the diagnosis are necessary. It is crucial to maintain confiden!ality, address Amanda's concerns, and engage her collabora!vely in the assessment and treatment process. Balancing the agency's required !meline with ethical considera!ons is essen!al, and transparency about the diagnos!c process and its evolving nature should be communicated to Amanda.

Shirley Saar Tuesday

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Trennan,

Excellent discussion response.

One of the most important aspects of the clinical interview with Amanda will be to clarify concerns with her ea!ng pa$erns: Ask about die!ng history, weight, restric!ve and binge ea!ng, exercise pa$erns, purging, a"tudes about weight, family history of ea!ng problems, family a"tudes about ea!ng, and stressors in her life. Proper diagnosis will require us to consider comorbidity/differen!al diagnosis such as OCD, Substance Use Disorder, Depression, and/or chronic sexual abuse. Treatment for Amanda's ea!ng disorder will require a team approach that minimally includes a primary care physician, family support, a nutri!onist, and a mental health professional that specializes in ea!ng disorders. Elements of effec!ve ea!ng disorder treatment include Psychoeduca!on, Nutri!onal Care or Recommenda!on, Problem Solving, Self-Monitoring, Cogni!ve Processing, Goal Se"ng, Maintenance/Relapse Preven!on, Mo!va!onal Enhancement, Ac!vity Selec!on, Asser!veness Training, Caregiver Coping, Caregiver-Directed Nutri!on, Communica!on Skills, Performance Feedback, Physical Exercise or Educa!on, and Social Skills Training.

Dr. Saar

Michelle Ybarra Thursday

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Hi Trennan,

Good job on your post, you did a great job. Your poten!al ques!ons were straight to the point for the case of Amanda. I think the best ques!on in your list was "How do you feel about your body and appearance", I think this ques!on is really good but it can also backfire. It is a risky ques!on but can also get all the answers you want. Maybe asking this ques!on at the end would be best and also to ask it depending on the answers you are ge"ng for the other ques!ons. And say Amanda doesn't like this ques!on or doesn't respond to it well then I would ask, "What do you see as your ideal body type, and what do you look down upon". And you can see what her views are on this and discuss her goal and her mindset in her current situa!on. Your ethical considera!ons were also on point; you did a very great job on that. It is crucial to maintain confiden!ality and to address Amanda's concerns. Again, great job on your discussion for this week.

My best,

Michelle Y.

Yolanda Dorsey Yesterday

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Trennan, your post is very impressive. I agree with you about balancing the need for a !mely diagnosis with the responsibility to provide accurate and comprehensive informa!on. It involves considera!on, as you need to be aware of issues regarding people's health, safety, and iden!ty (that is, confiden!ality of informa!on). The one that resonated with me the most in your list of ques!ons was, "How do you feel about your body and appearance." As a female, we are o&en concerned with our appearance, but focusing on the weight of an individual with an ea!ng disorder o&en cause harm. There is already evidence that they are struggling with low self-esteem. It would be okay to ask Amanda, "Do you feel your weight is important to your iden!ty?" It allows her to reflect on what is important to her and why. You did an amazing job addressing Amanda's concerns and maintaining confiden!ality.

Yolanda Dorsey Nov 13, 2023

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Hello, Dr. Saar and classmates,

Assessment and Diagnosis of Amanda’s Case

Amanda’s case is crucial for a diagnosis study. The case entails tes!ng and assessment. Based on the case, the assessment techniques that best suit the client are interviews, tests, and observa!onal data. In the interview, I will explore Amanda's ea!ng habits of Amanda, exercise rou!nes, feelings, and self- worth (Geisinger et al., 2013). In the tests, I will engage in two types of tests: psychological tests and standardized tests. In standardized tests, I will choose the tests that are more clearly related to the client's status. I will gather informa!on from Amanda's behavior, food consump!on, and exercise pa$erns in the observa!onal data.

Addi!onal informa!on required from Amanda includes informa!on on her daily rou!ne and interpersonal rela!onships. For example, I can ask her; how o&en do you do your exercises? I would also like to know more about her emo!onal state before and a&er having restric!ve and excessive exercise. A ques!on like “What do your friends like ea!ng?” can help know if the restric!ve ea!ng comes from the friends. In addi!on to that, family dynamics could lead to trouble sleeping through the night.

I would employ the cogni!ve-behavioral theore!cal orienta!on with Amanda because it can help her know the rela!onship between her thoughts, feelings, and behaviors concerning body image and self-worth. The DSM-5 diagnosis, based on the descrip!on and available symptoms, could be an ea!ng disorder (First, 2013).

The agency's required !meline for diagnosis could lead to ethical concerns. Forty-eight hours given for Amanda's case could lead to a rushed diagnos!c process, which might interfere with the accuracy of the diagnosis. More !me alloca!on, like the addi!on of 24 hours, could be be$er. A balanced !meline for the case would be significant, enabling a comprehensive understanding of Amanda's situa!on.

Since Amanda has reserva!ons about seeking treatment due to the absence of confiden!ality and prefers to use an insurance company for payment, discussing the poten!al implica!ons of a third-party payment is essen!al. Therefore, it is jus!fiable to render a diagnosis to obtain a third-party payment. However, it will be crucial to ensure informed consent and discuss the limits of confiden!ality (Pomerantz & Segrist, 2006).

References

First, M. B. (2013). DSM-5 handbook of differen"al diagnosis. American Psychiatric Pub.

Geisinger, K. F., Bracken, B. A., Carlson, J. F., Hansen, J.-I. C., Kuncel, N. R., Reise, S. P., & Rodriguez, M. C. (Eds.). (2013). APA handbook of tes"ng and assessment in psychology, Vol. 2. Tes"ng and assessment in clinical and counseling psychology. American Psychological Associa!on. h$ps://doi.org/10.1037/14048-000

Pomerantz, A. M., & Segrist, D. J. (2006). The influence of payment method on psychologists' diagnos!c decisions regarding minimally impaired clients. Ethics & Behavior, 16(3), 253-263. h$ps://doi.org/10.1207/s15327019eb1603_5

Shirley Saar Tuesday

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Yolanda,

Adjustment disorder is always a good star!ng diagnosis to get insurance companies to begin to pay and give us more !me to see if there is more going on with the client.

It is possible that this client has an Anxiety Disorder, Major Depressive Disorder, or an Ea!ng Disorder, which could be diagnosed later a&er more informa!on is gathered. These diagnoses would be foremost in my mind as I began to assess her.

Substance abuse is another factor we need to ask this client about because it is o&en comorbid as well. The ea!ng and substance use disorders share similar features of carvings and compulsive use/behaviors. They involve the same neural systems which are implicated in regulatory self-control and reward.

I would ask this client about recent stressful life events which o&en ini!ate ea!ng disorders in adolescents. Younger females with ea!ng disorders commonly deny "fear of fat" and many individuals have a period of changed ea!ng behavior before mee!ng the full diagnos!c criteria for Anorexia Nervosa. I would observe the client's personality during the therapy sessions. Anorexics o&en have obsessive traits.

In terms of differen!al diagnosis (the process of considering different diagnoses and determining are the correct ones the client has), considering MDD when severe weight loss occurs in MDD it is not accompanied by a desire for excessive weight loss or an intense fear of gaining weight. This is what dis!nguishes it from Anorexia. I would ask the client about her social life because Social Anxiety Disorder can also have features that overlap with Anorexia (usually involves not wan!ng to be seen ea!ng by other people in anorexia). Obsessive Compulsive Disorder also must be considered but for this diagnosis to be correct there must be significant obsessions that are not related to food, just like for Social Anxiety Disorder to be the correct diagnosis, there must be significant social fears unrelated to ea!ng situa!ons.

Dr. Saar

Trennan Perez Thursday

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Hi Yolanda!

Great post! Your comprehensive approach to Amanda's case is well-considered, incorpora!ng various assessment techniques and addressing the importance of addi!onal informa!on. Your choice of the cogni!ve-behavioral theore!cal orienta!on aligns with its effec!veness in addressing issues related to body image and self-worth. Highligh!ng the ethical concerns regarding the agency's !meline is crucial, emphasizing the need for a balanced !meframe for a more accurate diagnosis. Exploring the implica!ons of third-party payment and emphasizing informed consent and confiden!ality discussions further demonstrate your a$en!on to ethical considera!ons. Overall, your though'ul and thorough approach to Amanda's case showcases a holis!c perspec!ve on assessment and diagnosis.

Best,

Trennan

Michelle Ybarra Thursday

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Hi Yolanda,

Great job on your post. I also picked Amanda's case, it was very interes!ng to me. For your ques!ons when you men!oned, " A ques!on like “What do your friends like ea!ng?” can help know if the restric!ve ea!ng comes from the friends". This is very good because if you ask about her perspec!ve on her friends then she will not hold herself back and she would tell you all the nega!ve foods she see and then ones she it trying to avoid cause she sees her friends ea!ng it. I also agree when you stated, "Since Amanda has reserva!ons about seeking treatment due to the absence of confiden!ality and prefers to use an insurance company for payment, discussing the poten!al implica!ons of a third-party payment is essen!al". It is very essen!al but it is also crucial to ensure informed consent as you men!oned above in order to discuss the limits of confiden!ality. I liked how you had a good number of references to back up your informa!on. Again, great job on your post.

My best,

Michelle Y.

Adam Henning Tuesday

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Hello Classmates and Dr. Saar,

Overview of the case: Charles is a 33-year-old African-American male seeking treatment due to suicidal idea!on. He is currently going through divorce proceedings and reports feeling agitated, angry, sad, and stressed most days. He is concerned that his rela!onship issues have begun to impact his responsibili!es at work and fears losing his job. Charles is open to seeking treatment, but his insurance provider is out-of-network. His insurance company is willing to reimburse him for up to 8 sessions if an acceptable diagnosis is submi$ed. What diagnosis would you give Charles?

Supplementary informa!on on this case: Charles is inclined to seek therapy. Charles has suicidal thoughts, is anxious, expresses the emo!ons of anger, expresses the emo!on of sorrow, experiences being stressed, is afraid that his rela!onship struggles have begun to interfere with his working obliga!ons in addi!on to being worried about losing his job.

Ques!ons to ask to aid in the diagnosis: 1. How would your co-workers and superiors describe you? 2. What were the problems in your marriage? 3. When did the suicidal thoughts begin and how o&en do you have them? 4. How long have you been married? 5. Do you partake in alcohol or any kind of drugs? If so, what kind and how o&en? 6. Do you feel safe at home, at work, or alone? 7. Does anyone in your family suffer from depression, anxiety, or any other form of mental illness?

From the Humanis!c Lens: Borrowing the self-concept from Carl Rodgers, Charles displays an incongruence with the self-concept. Charles's ideal self ( e.g., the married version of himself) is no longer in harmony with his self-image( e.g., the current version of Charles or the way Charles sees himself). Your self-concept is incongruent if your percep!on of yourself ( self-image) along with your ideal self (the person you would prefer to be) don't coincide. Self-esteem may be badly impacted by this discrepancy (n.d.). As stated by Park and Yang (2017), having poor self-esteem can nega!vely impact your psychological well-being and cause issues like depression and feelings of anxiety.

U!lizing Abraham Maslow's Hierarchy of Needs theory. Abraham Maslow thought that humans had innate demands or mo!va!ons that are similar to those of animals at the beginning of their development (Griffin et al., 2023). Consequently, there are five levels in the hierarchy of requirements. In addi!on to going through a divorce, Charles is experiencing thoughts of suicide and worries about losing his employment, which may suggest he is deficient in love and belonging, safety and security, and lastly, the self-esteem that he needs. You cannot advance in the hierarchy of needs without fulfilling that need. Put another way, we would need to come up with a plan of ac!on (e.g., the feeling of belonging requirements) before we were able to assist Charles in achieving esteem needs.

See Maslow's hierarchy of needs theory below:

Psychotherapy in depression: As stated by Karrouri et al.,(2021),"Depression-focused psychotherapy is typically considered the ini!al treatment method for mild to moderate MDD. Based on significant clinical evidence, two specific psychotherapeu!c methods are recommended: Cogni!ve-behavioral therapy (CBT) and interpersonal therapy (IPT)"(para.34).

Diagnosis Major Depressive Disorder: Major Depressive Disorder (MDD), another name for clinical depression, is a serious medical illness that can have an influence on many aspects of your life. It affects your emo!ons, ac!ons, and a number of bodily processes (Kessler & Bromet, 2013). According to Bains and Abdijadid (2023), MDD is more prevalent in those without significant interpersonal interac!ons as well as those who have been bereaved, divorced, or estranged. Charles has symptoms that are consistent with MDD.

To aid in the diagnosis, the Pa!ent Health Ques!onnaire-9 (PHQ-9) is a true-false is mul!func!onal tool used to screen for, diagnose, monitor, and assess the level of intensity for depression (Bains & Abdijadid, 2023; Siniscalchi et al., 2020).

Ethical Considera!ons: Given the quan!ty of informa!on I presently have regarding Charles, it is ethical to make a diagnosis within the !me range specified. As cited by the American Psychological Associa!on. (2017), "One purpose of the tes!ng is to evaluate decisional capacity. Informed consent includes an explana!on of the nature and purpose of the assessment, fees, involvement of third par!es, and limits of confiden!ality and sufficient opportunity for the client/pa!ent to ask ques!ons and receive answers" ( Sec. 9. C). In this case, it is said that Charles is willing to seek treatment, despite the fact that in order to determine a diagnosis as well as design a strategy for treatment, we would need to prepare a consent document for Charles to sign and agree to.

References

American Psychological Associa!on. (2017, January 1). Ethical principles of psychologists and code of conduct. American

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