Meredith Case Study and Clinical Approach

Psychology -- Counseling -- Meredith Case Study

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 look for or ask about symptoms of alcoholism, tendency toward other substance abuse, depression, anxiety disorder, obsessive-compulsive disorder, agoraphobia and paranoia. Alcoholism would be explored because Meredith's history is rife with alcohol abuse on both sides of her family, including: two paternal uncles who may be alcoholics; maternal mother died early, with a question of alcohol use; and her father heavily uses alcohol. In addition, Meredith uses alcohol, sometimes in order to sleep. Tendency toward other substance abuse should be explored because Meredith's mother uses opiates for back pain and Meredith believes she needs medication to help her sleep. Depression should be explored because Meredith reports serious disruptions of sleeping, eating and work, possible "migraines" and feeling out of control, all of which can be symptoms of clinical depression. Anxiety Disorder should be explored because she reports anxiety-related symptoms of inability to sleep, eat, work well, feeling out of control, "migraines" and feeling stressed out; in addition, her sister, Sarah, is reportedly afraid to go outside and almost seems afraid of everyone. Obsessive-compulsive Disorder should be explored because Meredith's sister, Sarah, washes her hair constantly and that tendency in her family, along with Meredith's report of depression-anxiety-related symptoms may signal OCD. Agoraphobia should be explored because Meredith's sister, Sarah, is afraid to go outside and refuses to go to school. Finally, Paranoia should be explored because Meredith's sister, Sarah, is scared to go outside, almost seems afraid of everyone and thinks everyone is talking about her - she refuses to go to high school. In addition, all these symptoms exhibited/revealed by Meredith have the backdrop of a paternal aunt who was hospitalized for two years with an undisclosed mental illness.

2. What other historical information might a counselor want to ask about?

The counselor would want to further explore the mental health history of the paternal aunt who was hospitalized with an undisclosed mental illness for two years, the official cause of the maternal grandmother's death, and more information on the mother's opioid use/reported prescription for back pain.

3. What might a clinician want to know about Meredith's alcohol use and why?

The clinician might want to know how often Meredith drinks alcohol, how much she drinks on each occasion, whether her alcohol use has increased. Perhaps the counselor would want Meredith to keep a journal of her alcohol use to accurately gauge the frequency and extent of alcohol use, bring that journal to her sessions and use it to discuss her alcohol use. Certainly Meredith's family history of extensive alcohol use on both sides of her family, coupled with Meredith's own use and reliance on alcohol to sleep would concern her counselor.

4. What might a clinician want to know about her eating, sleeping, and stress, and why?

A clinician would want to know all the circumstances surrounding her disrupted sleeping, disrupted sleeping and stress: when did it start; what triggers it; how does it further affect her; how does she cope with it; does it occur with her other symptoms or sometimes alone; is it unremitting or recurrent; if recurrent, when does it cease and is there anything connected with the cessation.

5. What conditions would the clinician want to explore when working with this client? Explain why.

If by "conditions" you mean environments, the clinician would want to explore Meredith's: relationships with her separate family members and her family as a whole, including their relationship, work, and whether and to what extent there are relevant past occurrences and current triggers for Meredith's symptoms; work situation, including her duties, her work history there, her coworkers, her boss (es), her patients, and whether and to what extent there are triggers for Meredith's symptoms.

6. 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? Could Meredith be suffering from a substance-induced disorder? Explain.

Based on the statements in this question, the counselor should also explore the possibility of Attention Deficit Hyperactivity Disorder (ADHD), as appearing "crazy, talking too fast, hyperactive, and unable to pay attention are all classic symptoms of ADHD. Meredith could certainly be suffering from a substance-induced disorder, as alcohol abuse is highly associated with ADHD in adults. Of course, there is also the possibility that Meredith is less than forthcoming about her other substance use, which could mean that methamphetamine, cocaine or other stimulant drug is causing her to exhibit ADHD symptoms.

7. How would the clinician determine if Meredith was experiencing a co-occurring disorder or a single diagnosis?

The counselor would determine if Meredith is experiencing a co-occurring disorder or a single diagnosis by carefully detailing regarding each symptom: when did it start; what triggers it; how does it further affect her; how does she cope with it; does it occur with her other symptoms or sometimes alone; is it unremitting or recurrent; if recurrent, when does it cease and is there anything connected with the cessation.. In addition, the clinician would ask Meredith to keep a journal of her daily experiences, including her symptoms and the circumstances surrounding them, bring that journal with her to each session and use the journal to discuss her experiences/symptoms

8. 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?

Due to Meredith's absence of pronouns, the clinician would want to explore the possibility of Expressive Language Disorder, which is far more common in children but may also be present in adults due to genetics, brain damage or poor nutrition. The counselor should have Meredith tested to determine whether genetics, brain damage/trauma or poor nutrition are responsible for or contribute to her possible symptoms of alcoholism, tendency toward other substance abuse, depression, anxiety disorder, obsessive-compulsive disorder, agoraphobia and paranoia.