Knowledge base development through case study synthesis and reporting

Terrorism: Convergence Between Terrorism Organized Crimes in Mexico

Assessment Report for Marceline

Demographic Information

D.O.B. 1/10/1993

123 Crawford Lane

Age

Florida

Sex: Female

Phone: +54-675 5545

Ethnicity: Caucasian

Presenting Problem or Reason for Referral

Marceline is a 19yr old that is self-referred, with a 26-month-old male child. Marceline is very frustrated with her child and her boyfriend, Leon, for whom she is seeking counseling. Marceline's frustration with her child is making her think of giving him off to her mother-in-law. M reports feeling frustrated, uses alcohol and other substances to calm her nerves, is miserable from her job loss four months ago, and mounting bills. M also indicates to be confused on to stay with Leone her current live in boyfriend or gets back to her husband Michael the father to Michael Junior. She also indicates to be depressed with suicidal thoughts, which she overcomes with alcohol and substance abuse. The need for referring Marceline arises from the apparent hazard and unhealthy condition in her studio, from her indication of using alcohol in the evening, with Leone after picking M. Jr. There is indication that the use of alcohol by Marceline or substances to calm her nerves presents a safety and health hazard if she cooks and cares for her son under the influence. Based on the self-report by Marceline an assessment was conducted in assisting in determining a diagnosis and a course of treatment.

Ethical Considerations

An assessment of Marceline began with obtaining consent from Marceline and explaining to her the importance of the counseling session rather than working with Leone. The goal is to have Marceline work around her issues, and with time if the treatment requires include Leone or Michael in the treatment process. This began by disregarding what the mother-in-law was indicating about Marceline and Michael, and allowing Marceline to participate in the counseling session voluntarily without inhibition. According to the APA code of ethics (2012), there is need to maintain privacy and confidentiality by reducing interruptions from family members during the sessions as seen with the mother-in-law's phone call. According to the APA code of ethics, there is need to minimize intrusions on privacy, by not informing on reports or communicating with a fellow psychologist when professional assistance is required. Therefore, this implies that a need to maintain and determine disclosures procedures with the consent of Marceline. At this point, Marceline is made aware that if she requires her mother-in-law to be informed, she should indicate in writing. However, the prerogative is to maintain confidentiality and minimal disclosure to family members. Since Marceline had initially begun by indicating to search for help for Leone, the session begins by defining the limits of confidentiality.

Family Background

Marceline indicates that she comes from a single parent home, where she was raised by her mother after her father walked out on them when she was five years. She has a younger brother of 18 years who she indicates to present him as a confident, well groomed, and attentive young man. Marceline indicates that these are positive characteristics of her brother, whom she also indicates to be a high school dropout. Marceline says her family is a happy and open family that enjoys the company of others and each other. However, despite this apparent happiness, Marceline has not visited her mother in the last three years after eloping with Michael. Marceline argues that the first years after her father left were the most difficult, but their mother pulled through. She was able to maintain her job and provide for them.

However, despite Marceline's indication of a healthy working relationship at home, she cannot maintain a strong eye contact while talking, and cannot express her ideas in a knowledgeable manner. Marceline indicates that her mother maintained a tight and limited social life consisting of four female friends, who were all single mothers, with only one an unmarried woman. The friends were constantly visiting Marceline's home and held open, trusting, and friendly relationships in which they raised their children. Marceline says her mother believed in strong Christian values that were marked by faithfulness, devotion, loyalty, and family. These devotions imply her father's departure was an emotional and mental blow to the mother. Despite the values and close social group, Marceline makes an impression that they were raised in fear. She reports that her mother drank a lot of bourbon, which she mixed her coffee, and was often frustrated and high. In her state, her mother limited her social life, prevented Marceline and her bother to have any contact with people, even with relatives. She at times would blame herself for her husband walking out on them, or would in a bout of drunkenness insult and abuse Marceline and her brother.

Significant Medical Counseling History

The initial interaction with Marceline produces reports of depression, frustration, substance abuse, and suicidal thoughts from the patient and in her family background. Therefore, an analysis of her medical psychological and counseling history is carried out. It is revealed that by fifteen years, Marceline was evaluated using several psychological tests and counseling treatment and therapy recommended. According to the APA code of ethics (2012), the assessment requires obtaining permission from Marceline to obtain her medical and counseling history. Marceline gives her consent, and the history indicates at fifteen she had undergone a psychological assessment using the DASS (Depression, Anxiety, Stress/Tension Scale) that has 42 items. The report indicates using the DASs scale with fourteen basic symptoms, in which Marceline responded to statements in the scale with a four point likert scale (Kaplan & Saccuzzo, 2005). In the scale, 0-did not apply to me, 1-applied to me to some degree, or some of the time, 2-applied to me a considerable degree, or a good part of the time, and 3-applied to me very much, or most of the time (Kaplan & Saccuzzo, 2005). The scores indicate at the time Marceline's scores for depression and stress were high with a mean of 8 and 5 respectively. At the time, Marceline has an elevated score on the anxiety sub-scale with a mean of 18.

The medical report indicates that Marceline was also assessed using the Social Avoidance and Distress Scale (SADs). This scale uses 28 true or false questionnaire items that quantify social anxiety and distress. The medical report indicated a need to evaluate Marceline from two different aspects of anxiety given her family background. This was based on discomfort, anxiety, fear, distress, and avoidance of social situations, and the true-false scale, responses are rated 0-lowest avoidance and distress, and 28-highest avoidance and distress (Alloy et al., 1990). The test shows that Marceline had a score of 27, which was high, indicating that she was distress and tended to avoid social situations. The report indicates that the initial assessment found that Marceline's social isolation was the result of her mother's depression and denial. This reflected on Marceline who was acting out and externalizing. The report indicates that Marceline at 15 was difficult, defiant, and aggressive, associated with parent-teen interactions problems. Marceline was placed in a counseling program that also involved her mother to deal with the more general marital, family, or family therapy. The report identified Marceline was depressed with anti-social distress a reflection of problems in adjustment reactions to her parent's separation and her mother's commands. The counseling goals at the time dealt with improving parental management skills and competencies in dealing with children behavior problems associated with family issues. It also focused on increasing parental knowledge of cause of behavior problems in Marceline, and the underlying concepts and principles associated with social learning of children's behavior. Thirdly, it focused on improving Marceline's coping skills and cooperation with parent's rules and handling parental maladjustments. Fourthly, the counseling focused on improving family harmony by improving parental use of positive consequences, provision of clear guidance, instructions, discipline, and emotional skills. Fifth, the program aimed at assisting in improving Marceline and her mother's problem solving skills and communication skills during interactions a problem-focused discussion. Lastly, the counseling focused on altering parental beliefs and behaviors that were reflecting on Marceline, and assist parent to learn proper parent-teen problem-focused interactions.

However, though the parent-teen problem-focused approach is a successful counseling tool for children from problem family backgrounds, the programs did not succeed in Marceline's case. This is because Marceline was removed from the program by her mother who had strong spiritual beliefs. Marceline's mother identified that Marceline and her family required to follow the teachings of their Christian beliefs rather than attend counseling. Apart from this counseling program, Marceline is physically healthy, has not suffered any childhood or teenage diseases apart from the common cold, sore throats, and bruises and cuts. Marceline is healthy without congenital or acquired diseases, and had a normal birth.

Substance Use and Abuse

Marceline states that she uses alcohol to calm down, but it is apparent she drinks every day especially in the evening after picking Michael Junior from her mother-in-law. Marceline also indicates to use "other stuff" occasionally to calm her down, especially when she feels depressed and has suicidal thoughts. It is evident that there is a lot of alcohol and substance abuse in Marceline's studio house, either by her or her boyfriend. Moreover, Marceline has been raised in a home that frequently abused alcohol.

Education and Vocational History

Marceline states that she completed her high school, but did not pursue college or tertiary training. However, it is evident that Marceline is lying about completing high school; she eloped with Michael at only 16, got married and had a child.

Marceline states that she has worked in several stores prior to working with the current grocery stores. Her first job was as a waiter at a local dinner, where she reports being happy and enjoying working. She reports she had a healthy working relationship, and was able to maintain a strong eye contact with customers as she served them. She indicates that she enjoyed working at the diner where she met "really nice men." When asked why she left the job, Marceline indicates she was not fired but walked out because the owner was jealous of her close social group. It is evident that Marceline was fired from the diner for her flattery behavior that was creating a negative image for the diner. After this job, Marceline found work with a grocery store where she currently works.

She indicates enjoying working here, as the store had better and flexible working hours she could attend to Michael junior. In addition, the grocery store provided medical cover, which the diner did not. However, she prefers working at the diner from the amount of tips she received. It is at the grocery store she met Leone, her current boyfriend. Their relationship appears to have a negative impact on her job, since Marceline indicates that it was discouraged and frowned upon by management. Marceline states that the grocery manager indicated that dating a fellow colleague was considered a violation of the code of ethics. She states that their problems began when Leone was fired from the job, for a variety of reasons she considers not relevant. Marceline indicates that the grocery store manager cited issues like lateness, rudeness to management, and drunkenness as reasons for firing Leone. Marceline believes that these reasons did not exist, as it was a means to separate the two. She states that at the same time, she got depressed and began drinking to reduce her stress. Marceline indicates that her drinking had never interfered with her work, as her frustration from her working hours at the store being reduced caused her stress. Overall, Marceline appears to have little vocational training or tertiary level education apart from her high school education.

Mental Status

Marceline is currently working at the grocery store, but under fewer hours reducing her income level. This is causing stress as it has forced her and her boyfriend to move to a smaller studio apartment, which is very different from the large house they were living. The fact that her boyfriend is not working adds to the stress, as she indicates the plan was to buy the previous house. Marceline is also frustrated from the constant cries and choric her 26-month-old baby boy is presenting. This is driving her to drink, and a constant strain in her relationship with Leone who is also frustrated with the baby. It is evident that Marceline is almost giving her on living and her son from her suicidal thoughts, and thoughts of giving her baby to her mother-in-law. Marceline is also confused on what to do with her life, her job, her baby, her current boyfriend or her husband.

Assessment Results

Marceline was assessed using the Depression, Anxiety, Stress/Tension Scale (DASS) on a 42 items scale. The tests shows that Marceline has very high scores on the subscale for depression and stress at a mean of 18 and 20 respectively, but has a high score on the subscales of anxiety and tension with a mean of 8 and 10.

Marceline was also assessed on the IPIP-NEO, which has several sub-domains to measure personality, on a short test of 120 items. The main five or broad domains for the test are extraversion with 24 items, agreeableness with 24 items, neuroticism, openness, and conscientiousness with 24 items each. This test was used since it uses an in depth analysis of the personality of a person, including any aspect that is considered negative. This is necessary since in the background assessment, it is evident that Marceline has issues and possible problems reflected in her personality. Responses are presented according to a five-point Likert-Type scale (Kaplan & Saccuzzo, 2005). Scores that fall below 30 for any domain are considered low, scores in the range 30-70 are average, and those above 70 are high. Marceline's scores are indicated in the table below.

Extraversion

47.33

Agreeableness

60.03

Conscientiousness

35.67

Neuroticism

37.67

Openness to Experience

66.83

Friendliness

50

Trust

34

Self-Efficacy

45

Anxiety

23

Imagination

45

Gregariousness

35

Morality

45

Orderliness

35

Anger

21

Artistic Interest

34

Assertiveness

20

Altruism

87

Dutifulness

25

Depression

34

Emotionality

87

Activity Level

45

Cooperation

67

Achievement-Striving

34

Self-Consciousness

56

Adventurousness

79

Excitement-Seeking

89

Modesty

54

Self-Discipline

35

Immoderation

47

Intellect

89

Cheerfulness

45

Sympathy

75

Cautiousness

40

Vulnerability

45

Liberalism

67

Marceline is not friendly, but can express herself verbally. She at first appears friendly and sociable, but upon further interaction, it is evident that she has poor social skills. Marceline's strong spiritual background does not appear to support her principles and beliefs for she reacts to emotion. Her social skills are very poor, for she is an extrovert that projects her emotions and thoughts on others. This explains her inability to interact with her child, which both frustrates her and her son. The IPIP-NEO (Extraversion, Agreeableness, and Neuroticism domains) indicates that Marceline is extremely depressed, with symptoms of confusion, frustration, anxiety, and nervousness, with thoughts of committing suicide. The results indicate that she enjoys familiar social settings, likes the grocery store, her mother-in-law's house, and her studio apartment, with a poor social life that is hindered by depression. Marceline is more likely to depict a social and friendly mood that encourages others, but avoids any circumstance that will keep her or drive her to a public place he is likely to meet her former classmates and age mates.

The Hamilton Depression Rating Scale (HAMD) is used to assess the symptoms and quantify the severity of depressive symptoms (Kaplan & Saccuzzo, 2005). This scale is used on Marceline for it can assess the symptoms of depression especially on a person already diagnosed with depression. The rating of the scale is on a 17 items of evaluation, with four extra items including derealization, diurnal variation, paranoid symptoms, and obsessional symptoms (Kaplan & Saccuzzo, 2005). The 17 items are related on a five-point likert scale of 0-4, and eight items on a three-point likert scale from 0-2.