Your Comprehensive Case Study should cover the initial assessment through the evaluation of active treatment, as well as available resources and possible int

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Case Study Analysis: Emily Jones

Kiara Bonds

Capella University

SWK5013

November 24, 2024

Case Study Analysis: Emily Jones

Assess Individuals, Families, Groups, Organizations, and Communities 

Differential Diagnoses

Bipolar II Disorder (DSM-5-TR Code 296.89)

Emily's mood swings—high energy and anger followed by depression—are consistent with Bipolar II Disorder. Hypomanic episodes characterize this condition, unlike Bipolar I. Her increased productivity, decreased need for sleep, and irritation suggest hypomania, especially given she is functional and not psychotic or impaired. The depressive episodes, marked by an inability to get out of bed and neglecting daily activities, align with Bipolar II criteria. However, the absence of totally manic symptoms makes this secondary a consideration. Borderline Personality Disorder (DSM-5-TR 301.83)

Emily's history of self-harm, fear of abandonment, and unstable relationships point toward Borderline Personality Disorder. Extreme mood fluctuations, impulsivity, and self-doubt characterize BPD (Mishra et al., 2023). Emily's cutting and belief that others are "for" or "against" her are BPD traits. Chronic emptiness, powerful emotions, and distrust are further signs. Her symptoms are more like a mood disorder; thus, BPD is not the main diagnosis. Cyclothymic Disorder DSM-5-TR Code 301.13)

This diagnosis is characterized by mild, persistent mood swings with the presence of depressive episodes and at least hypomanic ones for at least two years (Bielecki & Gupta, 2022). Emily’s long-term variations in mood, as well as fluctuations of stamina, may fit this. However, her symptoms are more intense than ordinary cyclothymia and show more distinct highs and lows, which indicates a more severe bipolar disorder. Cyclothymic Disorder is not quite probable but can be expected because of her sustained fluctuating mood condition.

Diagnostic Tools

Mood Disorder Questionnaire (MDQ)

The MDQ is a similar tool created to screen bipolar spectrum disorders. The 13 questions are meant to measure manic and hypomanic moods, including high mood, increased energy, and impulsiveness (Carpenter et al., 2020). For Emily, the MDQ can be used to determine if her current symptoms of high energy and irritability are signs of bipolar disorder. The measure applies the attributes of mania to differentiate bipolar illness from other mood or personality disorders. It allows clinicians to make a judgment about whether bipolar disorder requires a more intricate evaluation by checking if key diagnostic variables have remained unnoticed.

Structured Clinical Interview for DSM-5 (SCID-5)

DSM-5 SCID is a comprehensive semi-structured clinical interview that focuses on identifying major mental disorders. There are modules for mood and personality problems. With the help of the SCID-5, Emily could analyze her symptoms, personal history, and behavior. It has all the assessment criteria for Bipolar II, Cyclothymic Disorder, as well as Borderline Personality Disorder, to consider. It also excludes other ailments, thus enhancing the understanding of the disease. The SCID-5 structure reduces clinicians’ biases and boosts diagnostic validity and reliability. Personality Assessment Inventory (PAI)

The PAI is a self-report inventory that covers virtually all major forms of psychological disorders, such as mood disorder, anxiety, and personality (Paulino et al., 2024). Scales for emotional instabilities, interpersonal problems, and self-harm are used to evaluate the case of Emily. Emotional dysregulation and fear of abandonment, as well as the presence of Bipolar disorder and some of the BPD features, could be detected with the help of PAI. To complement the assessment of her mental health, the PAI gives a complete picture of Emily’s psychological well-being; therefore, no coexisting disease processes will be omitted.

Beck Depression Inventory-II (BDI-II)

The BDI-II is used for rating the severity of depression. The test includes the identification of mood, behavior, and somatic symptoms of depression using 21 items(Wang & Gorenstein, 2021). Emily could use the BDI-II to assess the number of her depression episodes for client treatment and evaluation. It is only after evaluating the severity and intensity of depressed symptoms that differentiated mood from personality disorders can be made. The usefulness of the BDI-II is that the tool’s routine application may reveal the effects of intervention on Emily’s mood.

Engage Anti-Racism, Diversity, Equity, and Inclusion (ADEI) in Practice 

Reflecting on my own bias, power, privilege, and belief system, I recognize that these factors significantly shape my interactions with clients, often in ways I may not consciously control. Each of these concepts –ethnicity, social class, education, and gender –may benefit the social interaction and perception of me and society. For example, being from a fairly well-off context, I may not grasp how different day-to-day life is for people who face systemic racism or those without much money. Due to my education, the resources at my disposal, and being a social worker, I sit in a position of power, which is bound to influence the power dynamic in the therapeutic relationship. It may make the clients feel helpless or afraid to express their emotions or events. In this aspect, my culture and past experiences also guide me in identifying certain behaviors or choices that may contradict those of my clients. These prejudices may cause me to have unconscious beliefs about a client's mental health and familial or cultural decisions. 

To maintain professional relationships and provide quality care for my clients, I must eradicate or neutralize biases, power, privilege, and belief systems of a discriminatory nature before or during the initial contractual phase of my interactions with them; hence, self-awareness will help me to achieve this goal. When the clients are diverse, self-regulation is about being mindful of the reactions that occur within me. For this reason, I will strive to make my practice as ethical, eclectic, and empowering as possible so that clients feel valued and welcome. The following self-regulation tactics will assist me in addressing such problems:

Reflective Practice and Continuous Self-Awareness

Reflective practice might be the most significant and valuable method of self-regulation (Tyler et al., 2022). This means I will always think about what I feel or went through while being around different people. Self-awareness underpins prejudice and power management. I will take time after each client engagement to reflect on my emotions, especially when faced with cultural differences or personal events that test my views. If I feel discomfort or judgment during a session, I will examine where it came from and whether it is founded in my biases or assumptions. Journaling and mindfulness will help me record my experiences and identify problematic behavior and thought patterns. I can better detect and correct my prejudices by continuously practicing these techniques.

Education and Expanding Cultural Competence

To manage my biases and privilege, I will commit to ongoing learning and education. This includes exploring cultural humility, anti-racism, diversity resources, and professional development. Understanding that I cannot fully comprehend the experiences of marginalized groups from my perspective, I will educate myself about the historical, social, and cultural contexts that shape the lives of my clients. Through reading books, watching seminars and participating in activities related to race, privilege and power, I will be able to unlearn and develop a lens of critical thinking. This education will assist me in recognizing and addressing biases of which I have no control and learning more about how I may inadvertently perpetuate privilege in my practice. I will also discover general and specific weft and warp expectations and norms in order to formulate culturally competent and sensitive interventions.

Mindful Engagement and Managing Power Dynamics

Achieving self-regulation requires managing power dynamics in client relationships. Based on occupation, education and social class, I have the power of a social worker. This power can skew the therapeutic dynamic and leave clients feeling helpless, misunderstood, or too afraid to disclose information to their therapist. To respond to this dynamic, I will demonstrate respect and be understanding of clients by developing rapport with them without fostering any judgment. This includes regularly allowing clients to share their thoughts and letting them decide on treatment and goals. I will make clients feel like equal partners to reduce alienation and invalidation. For example, I will use open-ended questions and active listening techniques to ensure the client feels heard and respected. I will not assume their experiences or needs based on my privileges and will ask clarifying questions as needed. I will immediately address power asymmetries in the relationship, such as when a client hesitates to talk freely owing to my professional authority and attempts to open the discourse. This may involve normalizing the client's concerns and affirming their life autonomy and knowledge.

Engage with Individuals, Families, Groups, Organizations, and Communities 

Cultural Needs of the Client in a Mental Health Setting

Culture is important in-patient care, especially in mental health institutions. For this reason, cultural background influences the perception and use of mental health care. For example, culture may affect the client’s perceptions of mental health, i.e., mental health and mental health issues are biologically based on sin, punishment for wrongdoing, or weakness. Certain cultural beliefs, such as religious beliefs as a strong Christian, may affect Emily’s perception and management of mental health issues. Studies show that religious individuals may find solace in spiritual leadership or prayer rather than professional counseling (Dein, 2020). It is crucial to develop awareness about Emily’s religion and how religion impacts her mental health to provide culturally appropriate treatment. Clinicians should respect these values and work with the client to address spiritual aspects of care as part of her treatment.

Furthermore, the field studies demonstrate that people from some cultures face mental health stigma, which prevents them from seeking help. For instance, several families and cultures, such as religious and immigrant ones, may consider mental disorders as embarrassing or something that must be concealed (Subu et al., 2022). Such stigma hinders clients from seeking professional help, which may mean they are not forthcoming about their symptoms. For instance, Emily's reluctance to seek treatment because of church clergy may be caused by this stigma. Consequently, clinicians must appreciate these cultural factors and counter stigma by eradicating prejudiced ambiance. Therefore, culturally appropriate mental health care needs to consider and respect clients' religious beliefs, possible prejudices concerning mental disorders, and the readiness to include or cooperate with other culturally acceptable patient support.

Engaging the Client to Encourage Continued Treatment

One should establish rapport and understanding of her personal and cultural values to elicit Emily and ensure she continues seeking treatment. Since Emily seems quite reluctant about undergoing therapy due to her religion, the first step I will take is to address her concerns regarding the same and adapt to the beliefs she holds. This supports her feelings and helps her to balance religion and the potential benefits of mental health care. I will focus on her desire to raise her children and maintain her beliefs, proving how therapy can assist her in both missions. I will also acknowledge her concerns about the mental health profession and explore how to integrate her spirituality into her treatment plan, whether it is religious practices or counseling with an open-minded practitioner.

The response to her concerns requires understanding and free expression of emotions. Thus, by frequently asking Emily how she feels about different parts of treatment, I can help her assume responsibility for changing treatment decisions. Cultural humility facilitates a collaborative therapeutic relationship where Emily understands I accept her authority over her life and experiences. This need for flexibility in the treatment might make her feel more comfortable by either joining her therapy with religion counseling or joining faith community assistance, giving her a higher chance of continuing her therapy.

Using Technology as an Aid

Implementing technology to enhance mental health treatment may also reinforce cultural sensitivity. The use of technology can provide resources and make therapy not as horrifying for Emily, who has certain cultural and personal beliefs not to seek traditional treatment. For instance, telehealth services are a convenient way of getting therapy since the process can be quite personal, thus avoiding face-to-face contact with the therapist or other patients (Greenwood et al., 2022). Telehealth could assist Emily in getting comfortable with treatment in a safer, more private environment from home. Due to the flexible agenda, online therapy might be more appropriate for Emily as she may be stressed with her home and job responsibilities.

Another approach to applying the technology is to suggest suitable mental health apps based on cultural and individual values. Among current mindfulness, relaxation, and stress management applications, many of them contain prayer or meditation. Emily’s apps can support her faith-aligned app treatment outside the station through Self-care routines. Most applications provide mood tracking, and Emily and her therapist can use it to monitor the symptoms. Technology can also offer culturally appropriate psychoeducation materials to decrease stigma and increase mental healthcare knowledge in Emily’s existence. For example, religious and spiritual practice associations can address resources that humanistic-type approaches to sharing material, which may be more palatable and acceptable to clients such as Emily.

Intervene with Individuals, Families, Groups, Organizations, and Communities

Mental Health Theory: Attachment Theory

Attachment Theory, initiated by John Bowlby and continued by Mary Ainsworth, highlights the influence of early relationships on a person’s emotional functioning, interpersonal interactions, and mental well-being (Nganyu, 2023). In particular, the theory discusses how the ability of a child and later an adult to develop healthy relationships depends on their primary caretakers. This may have resulted in the development of an attachment style mainly due to her mother's rigid and unresponsive nature and the father’s lack of affection and comfort when the child needed it. Studies have supported that childhood insecure attachment leads to some emotions, for example, emotional regulation difficulty, abandonment fear, and relational concern ( Momeñe et al., 2024). Insecure attachment is demonstrated by Emily’s poor ability to form and maintain close relationships, her trust issues, and her anxiety about rejection. This explanation accounts for the fluctuations in her mood, self-harming behavior (which could be used to manage pain), and relationship troubles. Seeking help through therapy for Emily means that her anxieties originating from her attachment injuries will be effectively resolved and, therefore, her conjugal and parental relationships will be healthier and more secure. Intervention for Emily's Family: Family Therapy

A recommended type of intervention for Emily’s family would be Family Therapy aimed at enhancing the communication between the family members, changing unconstructive patterns of behavior, as well as coping with the stress stemming from Emily’s mental disorders. Family therapy involves Emily, her husband, Jack, and their children, and it frees up a lot of feelings and frustrations while the clients are in a safe environment. Emily’s behavior and changed moods impact family relationships; her children ignore her, and her husband is anxious. Couples and family therapy can assist the family members in understanding how Emily’s condition affects them and help them become more tolerant and cooperative. The therapist can introduce conflict-solving, communication, or a set of boundaries to the family through therapy. This intervention would also assist Jack and the children in learning about Emily’s mental health problems and how best they can assist her without supporting her behavior. Family therapy can also help prevent communication breakdown where one family member tends to blame the other, which may cause stress, and help each family member develop healthy ways of dealing with their problem.

Applying Attachment Theory to the Intervention

Attachment Theory helps explain when family therapy is appropriate for Emily’s family. Attachment Theory posits that childhood relationships are a template for how people view and engage with the world around them. It can be deduced that Emily has trust issues related to attachment with her parents, and presently, she is struggling with trust in relationships; thus, Familial therapy can assist in attachment healing by enhancing the familial bond. The therapist can assist Emily and Jack in understanding how Emily’s attachment endures her response to Jack and how Jack’s attachment type shapes his response to Emily. Through proper therapy, Emily can form better family relationships since safety, trust, understanding, and communication will likely be enhanced. This intervention assists Emily in reconnecting with her loved ones emotionally, which can help her overcome her fear of abandonment and problems in relationships. Moreover, increased communication and support within the family could decrease stress levels and improve the quality of family function, which would probably benefit Emily’s mental state and mood stability.

References

Bielecki, J. E., & Gupta, V. (2022). Cyclothymic Disorder. PubMed; StatPearls Publishing. https://pubmed.ncbi.nlm.nih.gov/32491800/

Carpenter, R. W., Stanton, K., Emery, N. N., & Zimmerman, M. (2020). Positive and Negative Activation in the Mood Disorder Questionnaire: Associations with psychopathology and emotion dysregulation in a clinical sample. Assessment, 27(2), 219–231. https://doi.org/10.1177/1073191119851574

Dein, S. (2020). Religious healing and mental health. Mental Health, Religion & Culture, 23(8), 657–665. https://doi.org/10.1080/13674676.2020.1834220

Greenwood, H., Krzyzaniak, N., Peiris, R., Clark, J., Scott, A. M., Cardona, M., Griffith, R., & Glasziou, P. (2022). Telehealth Versus Face-to-face Psychotherapy for Less Common Mental Health Conditions: Systematic Review and Meta-analysis of Randomized Controlled Trials. JMIR Mental Health, 9(3). https://doi.org/10.2196/31780

Mishra, S., Rawekar, A., & Sapkale, B. (2023). A Comprehensive Literature Review of Borderline Personality Disorder: Unraveling Complexity From Diagnosis to Treatment. Cureus, 15(11). https://doi.org/10.7759/cureus.49293

Momeñe, J., Estévez, A., Griffiths, M. D., Macía, P., Herrero, M., Olave, L., & Itziar Iruarrizaga. (2024). The Impact of Insecure Attachment on Emotional Dependence on a Partner: The Mediating Role of Negative Emotional Rejection. Behavioral Sciences, 14(10), 909–909. https://doi.org/10.3390/bs14100909

Nganyu, G. N. (2023). The Role of Attachment Theory in Understanding and Treating Psychological Disorders. ShahidiHub International Journal of Education, Humanities & Social Science, 1(1), 38–55. https://shahidihub.org/shahidihub/index.php/jehss/article/view/194

Paulino, M. R. M., Edens, J. F., Moniz, M., Moura, O., Rijo, D., & Mário Rodrigues Simões. (2024). Personality assessment inventory (PAI) in forensic and correctional settings: A comprehensive review. Journal of Forensic and Legal Medicine, 103, 102661–102661. https://doi.org/10.1016/j.jflm.2024.102661

Subu, M. A., Holmes, D., Arumugam, A., Al-Yateem, N., Maria Dias, J., Rahman, S. A., Waluyo, I., Ahmed, F. R., & Abraham, M. S. (2022). Traditional, religious, and cultural perspectives on mental illness: a qualitative study on causal beliefs and treatment use. International Journal of Qualitative Studies on Health and Well-Being, 17(1). https://doi.org/10.1080/17482631.2022.2123090

Tyler, J., Boldi, M.-O., & Cherubini, M. (2022). Contemporary self-reflective practices: A large-scale survey. Acta Psychologica, 230, 103768. https://doi.org/10.1016/j.actpsy.2022.103768

Wang, Y.-P., & Gorenstein, C. (2021, January 1). Chapter 16 – The Beck depression inventory: Uses and applications (C. R. Martin, L.-A. Hunter, V. B. Patel, V. R. Preedy, & R. Rajendram, Eds.). ScienceDirect; Academic Press. https://www.sciencedirect.com/science/article/pii/B9780128179338000207

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Biopsychosocial Assessment

Student’s name

Institutional affiliation

Course name

Professor’s name

Due date

Biopsychosocial Assessment

Date: [Insert Date Here]

Client Name: Emily Jones

Referral Source: Self (Prompted by Husband)

DOB: [Insert DOB Here]

Demographics:

Emily Jones is a 35-year-old White, married, cisgender, heterosexual female residing with her husband, Jack, and their two children, Pete (8) and Taylor (10). Emily identifies as Christian and has been heavily involved in her church. She is employed part-time as an accountant and holds a master's degree. The family's church community is a significant part of their lives. However, Emily's engagement with the church has recently been a source of familial tension due to conflicting views on mental health treatment.

Presenting Problem and History of Symptoms:

Emily was brought to therapy by her husband, Jack, who has expressed significant concern regarding Emily's erratic behaviors. Jack threatened to divorce her if she did not seek help, and Emily herself acknowledged attending reluctantly. Over the past few weeks, Emily has shown signs of elevated energy, staying awake for days and displaying behaviors she perceives as highly productive. She describes her current mood as the best she has felt in a long time, during which she has read the Bible cover to cover, completed a substantial work project, and cleaned her house extensively. However, her husband and children report distress over Emily's recent behavioral changes. Jack describes Emily as irritable and prone to anger, especially if he or the children do not meet her expectations. Emily has missed obligations for her children's extracurricular activities, and her behavior has impacted her children emotionally, with Pete avoiding her and Taylor reporting discomfort with Emily’s sudden interest in activities typically suited for a younger child.

In addition to her current high-energy episode, Jack mentions that Emily experienced a low mood two weeks prior, during which she struggled to get out of bed and engage in daily self-care. Jack shared that these episodes of fluctuating moods have increased in frequency and intensity over time. Emily's past also includes a hospitalization at age 15 due to depression, where she engaged in self-harm as a coping mechanism. She continues to experience intermittent suicidal ideation and occasional cutting to alleviate stress. However, she asserts she would not harm herself due to her religious beliefs and commitment to her children.

History of Mental Illness and Previous Mental Health Treatment:

Emily’s mental health struggles date back to adolescence when she was hospitalized for depression at 15. Her self-harming behaviors were noticed by her parents, who initially believed she had attempted suicide. Although Emily denies having had suicidal intentions at that time, she reported using cutting as a way to cope with emotional distress. During her hospitalization, she was prescribed Prozac, which she found ineffective and unhelpful. Emily eventually ceased the medication after leaving for college, feeling her parents’ control over her mental health decisions had lessened. Since then, she has not sought formal mental health treatment. Despite occasional suicidal thoughts and continued self-harming behaviors, Emily is adamant about not seeking psychiatric help, expressing distrust of medical professionals.

Medical and Physical Health History:

Emily has a medical history of hypothyroidism and is on prescribed medication for the condition. No history of other chronic illnesses, major surgeries, or recent traumatic injuries was reported. Jack reported that Emily is resistant to the treatment with health providers despite her depressive symptoms. Her high-energy/sleepless mood states during her manic episodes may exacerbate her thyroid condition, although there have been no reported recent examinations or medication adjustments.

Family History:

Emily describes her childhood as strained. Her family dynamics were sometimes difficult. Emily was raised with one younger sister- the "golden child." She had a contentious relationship with her parents in that her mother was strict primarily and critical of her. Emily reports she felt unsupported by her father, as he worked a great deal and rarely, if ever, participated in discipline. Her mother, too, being an educator in the same elementary school where Emily was enrolled, had high expectations from her academically and would always show disappointment due to struggles at school. She attributes this struggle during her childhood years-including bullying and her performance at school, the expectations imposed on her by the family, and the lack of emotional support. Recently, she has had disputes with her sister, who advised her to seek mental health care. She rarely sees her.

Social History:

Emily reports a complicated social history, stating that she has struggled to maintain successful friendships. Her distrust and/or fear of abandonment limit dependent connections; hence her past relationships were short-lived. Despite having a few childhood friends, she has struggled to maintain them. Currently, her social world is small; however, she does have acquaintances through her church community and as an accountant. Her distrust toward coworkers and feelings of isolation contribute to her sense of disconnection from others. Her behaviors over the last few months have created tension among her religious community within the church, especially because many clergy have advised against her seeking treatment for her mental health.

Client Strengths and Protective Factors

The positive aspects of Emily's situation include her education, part-time employment as an accountant, and her work with the church. She has struggled with establishing and maintaining a support system; her current support includes herself, her husband, Jack, and the church, which, at this time, is serving more as a source of stressors. One key protective feature is the concern for her children, as she emphasizes being there for the children. Although religious considerations have been a factor for Emily in resisting the search for formal treatment for her mental health, they provide a foundation of hope and resilience.

Diagnosis: F31.9 Bipolar I Disorder, Unspecified

A probable working diagnosis is F31.9 Bipolar I Disorder, Unspecified. Emily experiences periods of high energy, decreased need for sleep, and excessive productivity, followed by depressive episodes where she avoids basic self-care. Her elevated mood, impulsivity, irritability, and grandiosity during these highs, coupled with her history of depression and self-harm, indicate bipolar traits. These mood swings disrupt family life, reflecting classic characteristics of Bipolar I Disorder (National Institute of Mental Health, 2024).

Treatment Recommendations and Referrals

Recommended treatment could be individual therapy, family counseling, psychoeducation, follow-up with primary care, and community support. It will be useful to initiate Emily with Cognitive Behavioral Therapy for mood fluctuation, interpersonal issues, and self-harming behaviors. Family counseling sessions with Jack should be recommended to address marital stress and family dynamics and improve communication (Gupta & Ganguly, 2020). Psychoeducation can raise Emily and her family's awareness about the signs of mood disorders and the available treatments, with the aim of reducing the stigma associated with mental health services (Bahrami & Khalifa, 2022).

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