Case Study

Donald is a 54-year-old paper mill employee. He has adult children and 7 grandchildren with his wife of 30 years. Donald began to experience problems with worrying during his first few years of marriage. He would worry excessively about finances, his job security and performance, fixing up the house, his children and their futures, and his parents' health. Since that time he has also worried uncontrollably about the car breaking down, his grandchildren being harmed, saving enough for retirement, his own health, and his wife's health.

Donald's worry has interfered with his ability to enjoy his life, including holidays and special occasions, as he always feels tense, restless, and on guard. He has also turned down multiple promotions at work due to excessive worry that he couldn't handle the increased stress, responsibilities, and being around others. He often worries about whether his coworkers like him. In addition, Donald worries that he will not be able to keep up with the new technology being used at his job. His worrying also prevented him from exploring other jobs outside of the mill due to worry he would fail and end up losing the family home. His back and neck constantly ache from the tension. His worrying has also led to long-term problems falling asleep. He has become dependent on over-the-counter sleeping pills and is still easily fatigued most days.
Friends and family complain that Donald is always on the go and never sits still, but this is the only way he knows how to block the worries from his mind. Sometimes he experiences upsetting images about his grandchildren being injured or harmed when worrying about them. Twice in the past, these images have been accompanied by feelings associated with a heart attack including sweating palms, dizziness, heart palpitations, and shortness of breath. Each time he went to the emergency room, he was released after tests were run confirming that he was not going to have a heart attack.

Around times of stressful life events (e.g., during his daughter's divorce) Donald tends to experience an increase in his worrying frequency and intensity, but his reaction is always stronger than other people's. After a bad period of worry he often feels depressed for weeks afterwards, including having no pleasure or interest in his usual activities. Donald feels envious of the enjoyment and relaxation other people seem to get from life and he often feels hopeless when it comes to managing his worry. He just does not understand why he is not able to relax the way others do. He is very concerned that he may develop health problems due to his excessive worrying, and he sometimes wonders whether his worrying actually increases the odds of bad things happening to him.

Case Study Instructions

Each Case Study assignment is designed to help you make application of course content to a counseling situation. You are to read the assigned case study, determine the key issues presented, provide diagnostic impressions based upon the DSM-5, and develop treatment recommendations. You will need to follow the Case Study Template for each assignment.

Under diagnostic impressions, be sure to consider other disorders in addition to the main disorder. Provide a rationale for your diagnostic impressions using criteria from the DSM-5, also including reasons for ruling out certain disorders. The goal is to present, in writing, the basis for your diagnostic impressions.

Under treatment recommendations, be sure to consider the biopsychosociospiritual aspects of the case. Make sure your recommendations are relevant to the case, able to be implemented by the client, and have some basis of support from 2-3 references from professional literature.

Case Study Template

Follow the example below as you complete your Case Study assignment. You will have 3 major areas to your case study response: (1) key issues, (2) diagnostic impressions, and (3) treatment recommendations. This assignment needs a current APA-formatted title page, and you are required to cite the sources for the treatment recommendations and include a reference page. It must be 3-4 pages for content. The Case Study assignment is an opportunity for you to think through a clinical case, identify and prioritize key issues involved, consider and clarify relevant diagnostic issues, and formulate treatment recommendations that are most likely to be helpful to the client.

I. Key Issues

A. List in order of importance the key issues you believe are involved in the case study, as if you were the client's counselor. Provide a rationale for the order in which you prioritized issues. What are the most important features to you, and why?

B. Link your rationale to what you believe outcomes of treatment should be for this client. How will your order of priority contribute to a successful outcome for the client?

II. Diagnostic Impressions

A. Based on the information provided in the case study, use the current version of the DSM to accurately diagnose the type(s) of disorder(s) involved. Refer to specific diagnostic criteria when presenting your impressions. What category could this be in? What disorder in that category does this appear to be and why? Provide rationale for diagnosis, giving consideration to differential diagnostic considerations. In other words, what disorders in this category or other closely related categories were considered? Why could this not be any of those disorders?

B. Be sure to consider other disorders in addition to the main disorder. Is there more than one diagnosis? Provide rationale for diagnosing any additional disorders.

III. Treatment Recommendations (cite sources in this section)

A. List your recommendations (e.g., 1., 2., 3., etc.) so that you can clearly delineate what you believe will be of most help to your client. Consider recommendations that will be motivating to your client and reflective of a collaborative approach.

B. Be sure to consider the biopsychosociospiritual aspects of the case. Make sure your recommendations are relevant to the case, able to be implemented by the client, and have some basis of support from professional literature-include your 2-3 academic sources here.