Case Conceptualization, Case Study Example

Client Pseudonym: Atkins Rayson

Age: 19 years old

Introduction:

Atkins is a 19-year-old male college student who loves comic books and acting. Atkins is self-diagnosed with aspergers and lives with his extended family for which he has a lot of concern. This particular concern is clear in the way he articulates his close relationship with his grandfather and cousin, both of whom are dead. He has a problem with making friends as he puts it and feels comfortable at comic-con because of the presence of a crowd of people. He is however uncomfortable in certain other crowds. He plays his guitar and sings in front of people at a coffee shop, and that even though he started out nervous he eventually relaxed. He also told me he was in the plays in High School. Atkins has a hard time carrying on a conversation and has a hard time making and maintaining eye contact. He also plays with his necklace during our conversation.

Presenting Concern: 

Atkins came to counseling seeking to understand the death of his cousin. His cousin died by way of committing suicide (shot himself). He also has a problem, which is self-diagnosed aspergers. He has trouble making friends, which is a concern to him, and he wants to work on it. He also stated during our second session that his main goal was to work on his aspergers and make friends. Atkins also stated that he felt uncomfortable in certain crowds despite the fact that he is comfortable at comic-con reasoning, which is caused by the crowd of people there. In presenting his problem, Atkins has difficulty carrying on a conversation, has a hard time making and maintaining eye contact, and is fidgety with his necklace during our conversation, which underlines his concern with social skills and interaction.

Background Information:

Growing up, Atkins Rayson has spent a lot of time with his grandparents and extended family stemming from concern about his cousin’s death and fond memories of his departed grandfather. Atkins has close ties with his family and lacks passion of making friends. In high school, he was involved in the plays and has been an ardent fan of comic books. Atkins likes hanging out at the comic-con due to the crowd of people there. His grandfather whom he was close to died last year at around this time. He has had trouble in making friends. It is also notable that, Atkins was present at the time of his grandfather’s demise. Atkins has a cousin who committed suicide by shooting himself. Atkins has a history of playing his guitar and singing in front of people at a coffee shop, something that he started out nervous and eventually relaxed.

Client Strengths:

Atkins has an advantage of good academic performance that has been manifest in him securing a slot in college education. Atkins is also in extracurricular activities, an indication he has multiple talents. These talents are, being a good actor, as well as playing a musical instrument (guitar). The fact that he is good at singing is a social strength for Atkins. Strength is his engagement in a constructive hobby of reading comics, which does not only keep him, occupied, but also involves the mind. Atkins also exhibits quiet strength and inner peace of heart in the face of adversity. His attributes of being kind and showing concern for his extended family are a strong point for him. Atkins is focused and goal oriented and knows what he wants.

Hypotheses:

Most of the stressors that Atkins faces are common in the world of any teenager in college and trying to get a hold on the reality of life. Atkins is faced with stress from the death of a loved one and factually, he seems unable to make friends. The fact that he was present at his grandfather’s deathbed separates him from his peers in terms of experiences. This could be the reason for his aloofness as class experience for him is different from that of his mates at college. Anti-social behavior leads him to believe and self-diagnose himself with aspergers.

The death of his grandfather seems to have dealt Atkins a big blow lowering his self-esteem and confidence. The already traumatizing event of being present at the exact time of his grandfather’s death is aggravated by the suicide of his cousin.

Atkins is keen on understanding his cousin’s death as part of reconciling himself with what seems to plague him (self-diagnosed aspergers).

It is puzzling how Atkins seems not to have any friends outside his extended family yet he desires this so much, n order to make it a priority of the concerns he has. Apart from mention of his cousin and grandfather, there seems to be no mention of his immediate (nuclear) family, which is father, mother, or siblings.

These issues form the working hypotheses or summary of conceptualization in developing my treatment interventions.

Counselor Observations (i.e., Larger System & Developmental Perspective):

From the conceptualization of Atkins’ problem, he is definitely a victim of acute Post Traumatic Stress Disorder (PTSD), which is known for causing a person to remain isolated and exhibit anti-social traits detrimental if not checked. In Atkins case, the loss of his grandfather (formerly) and cousin (presently) are clearly traumatizing and in effect contributing factors to the social issue he is experiencing. This PTSD syndrome has resulted in his avoidance behaviors of being alone yet even in a crowd he appears lonely. Another effect is decreased capacity to interact with other people, as he seems not to be experiencing the same situations as them, thus remaining isolated in the process. Definitely, there is clinically significant impairment or distress of his social relations because of the PTSD.

Most teenagers in their late teens have undergone a series of changes ranging from physical, physiological, emotional, psychological, to mental changes. These changes coupled with such experiences as loss of loved ones, rejection, unfounded fears, family feuds, or the world philosophies at large may result in what is common to this age group, a crisis in identity.

However, this should not be the case for Atkins who contrary to his self-diagnosis with aspergers engages in pretty outgoing activities such as participating in the plays and playing his guitar as well as singing in front of people at a coffee shop.

Treatment interventions are necessary to address the fact that Atkins on one side has characteristics that point to great sociability (extrovert) and on the other hand is quite introverted by exhibiting shyness.

Overall Conceptualization:

On the overall, Atkins is genuinely affected by the deaths in his family. From the observations made on analysis of his behavior, it is evident that Atkins needs treatment to overcome the social issues facing him.

Multi-axial Diagnosis (DSM-IV-TR):

Axis I: Diagnostic code, 0 – Inadequate clinical information.

Axis II: Diagnostic code, 51-60 – Moderate difficulty in social functioning

Axis III: ICD-9-CM code, 0 – No medical information given.

Axis IV:

• Problems with primary support group Specify: N/A
• Problems related to the social environment Specify: Has trouble making friends.
• Educational problems Specify: N/A
• Occupational problems Specify: N/A
• Housing problems Specify: N/A
• Economic problems Specify: N/A
• Problems with access to health care Specify: N/A
• Problems related to interaction with the legal system Specify: N/A
• Other psychosocial and environmental problems Specify: Perturbed by loss of grandfather and cousin’s death.

AXIS V: Global Assessment of Functioning Scale

Score: _5_ _9_

Time frame: _2__years_____

Status at the Beginning of Treatment:

At the beginning of treatment, Atkins was confused, disturbed, and saddened by the state of things in his life. He was also anxious as to whether he would be able to make progress and benefit from the counseling sessions.

Presenting Concerns: The presenting concerns were understanding his cousin’s death and working on his asperger’s

Treatment Goals:

• The first goal in seeking treatment for Atkins is to work on his aspergers and to make friends.
• The second goal is to be able to overcome the loss of his cousin through therapy.
• Last but not least it would be expedient for Atkins to develop self-esteem in order to exercise his gifts (utilize his strengths) in sustaining gains made in therapy.

Prognosis:

From this case conceptualization overview of Atkins Rayson, it will take six sessions (an hour each) for a duration of three months (a session every fortnight) in order to assess the social progress made. As for trauma recovery, this will constitute part of the first three sessions, which I believe are enough for considerable progress.

Suggested or Implemented Interventions:

I intend to approach Atkins case from a perspective of REBT (Rational Emotive Behavior Therapy) in behavioral therapy. This will help in getting Atkins to focus his mind to think rationally in the face of the traumatizing events that have taken place in his life concerning those he loves. Irrational thinking in Atkins’ case would lead to self-hate, which in turn causes behavior that is self-destructive and mostly causes one to isolate him or herself eventually. I would combine this with CBT (Cognitive Behavioral Therapy) in order to achieve the goal of helping Atkins to overcome the recent loss of his cousin.

These forms of therapy seek to change the way Atkins, as a victim of some traumatic experiences, acts, and feels. CBT especially focuses on transforming patterns of behavior or thinking that result in negative emotions. The plan is to get Atkins to open up concerning the traumatic events and in doing so, point him to the positive good of having him around to leave an impact in his own life by starting to act alive (social awakening).

By helping Atkins to understand and appreciate what he has, will help him let go of the past and live a full life presently and apply the skills obtained to future situations (problems). This effort will be aided by the Solution-Focused Brief Theory (SFBT) whose basis is principles of exploring events the client’s past before rising of the problem.