- Based on what the clinician has learned during the intake, what are some of the symptoms a clinician should look for, or ask about, when working with this client during the initial sessions? Explain each symptom.
The clinician should quiz Meredith for signs of withdrawal from friends and family. People with mental health problems withdraw from family and friends and choose to spend most of their time alone. In connection to this, the clinician can quiz Meredith on her ability to understand those close to her. Questions like, do you get angry with people near you easily? Do you get along with many people around you? What is the nature of your relationship with those near you? (Hesse). People with mental health problems are irritable and find it hard to get along with people around them
The clinician can also ask whether Meredith has excessive fears and worries or feelings of guilt. People suffering from mental health usually have low self esteem and have heightened feelings of guilt (ncbi.nlm.nih.gov). In addition, mental health patients are detached from reality. They experience hallucinations even if this may happen on a small scale. The clinician should quiz the client for such symptoms.
- What other historical information might a counselor want to ask about?
The counselor might ask the client about the use of medication to deal with her condition. What medication used to work and what did not work or what did the client like or dislike and why? Moreover, the counselor might want to know what or when does the client’s condition deteriorate or get better. Are there times of the day when the client feels extremely disturbed or stressed? Are there certain events and occurrences that the client can associate with the worsening or improvement of her condition?
- What might a clinician want to know about Meredith’s alcohol use and why?
The clinician would want to know whether alcohol use causes Meredith to feel better about her situation or whether it worsens her condition. Once the clinician establishes this issue, she is in a good position to narrow down to specific mental health disorders. As such, the clinician will be able to draft workable and sustainable solutions to Meredith’s problems that do not involve alcohol use.
Although Meredith states that she drinks occasionally, the clinician might want to know the amount she takes during such moments. Moreover, the clinician might want to know whether Meredith is comfortable with taking alcohol or of she has ever tried to stop and failed among other related issues. Meredith’s response to this query should help the clinician to establish her level of alcohol dependence and, therefore, draft a sustainable solution to mental health recovery and alcohol use.
- What might a clinician want to know about her eating, sleeping, and stress, and why?
The clinician might want to know whether Meredith is afraid of gaining weight and has significant disturbance about her body shape and size. Confirmation of these issues affirms a case of anorexia nervosa (ncbi.nlm.nih.gov). The clinician might also want to establish whether Meredith has an issue with binge eating and uses inappropriate compensatory methods to avoid gaining weight. Conformation of these issues attests to bulimia nervosa (ncbi.nlm.nih.gov). In addition, the clinician may want to know whether Meredith feels that her appetite for food is normal, has subsided or increased.
Concerning sleep, the clinician might want to know the average length of time she sleeps, whether she had difficulty falling asleep or staying asleep. Moreover, Meredith might need to tell the clinician whether she uses any sleeping assistance devices or methods. In case Meredith uses some devices or methods, the clinician might check on the health use f the methods and devices and their importance in her recovery process. Concerning stress, she might have to tell the clinician the events, people, or pertinent issues that cause her stress to soar or subside. The clinician will recommend and intensify that she does more of what keeps the stress at bay.
- What conditions would the clinician want to explore when working with this client? Explain why.
The clinician can explore personality disorders. Several of the client’s complaints point to issues with her personality because they revolve around impairment in functioning, internal distress, rigid and maladaptive behavior patterns.
The clinician might also explore for Borderline Personality Disorder (BPD). BPD has several symptoms that Meredith exhibits such as instability in interpersonal relationships and heightened impulsivity (ncbi.nlm.nih.gov). People suffering from the condition also take substances to try to quell the condition loss of control and tension.
The clinician could also explore mood and anxiety disorders in Meredith. The two types of disorders are more prevalent in women as compared to men. They are also highly common in the world. Meredith complains that she cannot sleep, eat and that her work is suffering because she cannot think. These issues point to anxiety that causes changes in her moods and as such, she could be suffering from a mood and anxiety disorder.
- If Meredith reported that her friends have said that she is “crazy, talking too fast, hyperactive, and unable to pay attention,” what diagnoses would you also explore?
The above symptoms point to a case of Attention Deficit or Hyperactivity Disorder (AD/HD).
- How would the clinician determine if Meredith was experiencing a co-occurring disorder or a single diagnosis?
The clinician would determine if Meredith was experiencing a co-occurring disorder by checking for the following historical issues. First would be Meredith’s background. This includes her family, marital status, legal status, financial status, education, and housing among several other related issues. Secondly, the clinician should query Meredith on substance abuse on issues such as age of first use, primary drugs used, family history of substance use. Thirdly, the clinician should establish a full history of the mental health problems prevalent in Meredith’s family. In case there is a pattern on Meredith’s current condition and issues in her history, then she has Co-Occurring Disorder (COD) or disorders that run in her family and there is need for member of her family to go for COD checkups. However, if there is no pattern, it is termed as a single diagnosis and it is not alarming as to require checkups on Meredith’s family members.
- Meredith explains in a future appointment that she is in love with Andy, but is scared that her parents will not like this person. She states that she feels stressed out about someone finding out how much she loves this person. It is noticeable that Meredith is not using pronouns. What other issues might a counselor want to explore? How does this interact with the diagnosis, or does it?
In this case, Meredith suffers from a personality disorder. It would be beneficial for the counselor to explore BPD or Antisocial Personality Disorder (APD). The stressful feelings that Meredith has, the fears, and presumptions point to internal distress that emanates from wrong perception of the situation at hand (ncbi.nlm.nih.gov). At 24 years of age, Meredith fits the age at which someone can suffer from personality disorders. In particular, it would be good for the counselor to explore BPD, which is characterized by frantic efforts, by the patient to avoid real or imagined abandonment as well as unstable self-image.
Center for Substance Abuse Treatment. Substance Abuse Treatment for Persons with Co- Occurring Disorders. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2005. (Treatment Improvement Protocol (TIP) Series, No. 42.) Available from: http://www.ncbi.nlm.nih.gov/books/NBK64197/ Hesse Morten, Integrated psychological treatment for substance use and co-morbid anxiety or depression vs. treatment for substance use alone. A systematic review of the published literature