Theodore Clark Case Study and Counseling

COUNSELING

Counseling: Theodore Clark Case Study

Part 1

Client Name: Theodore Clark

Client Initials: T.C.

Client Age: 40 years

Client Race/ Ethnicity: Black

Self-Identified Gender: Male

Presenting Problem

Clarks’ demographic information includes education, nationality and religion. He has completed a four-year degree from New Mexico State in consumer family science. His nationality is born and bred in Miami. His spiritual belief is none. He belongs to the Black race. His employment history shows that he is a special education program director and had always been granted a promotion. There are no current and relevant legal problems in his life, except that he wants to get a divorce from his wife through legal means. He has previously no history of counseling. 

Currently, the reason for seeking counseling is his family problems and serious concerns over getting a divorce. The onset and duration of concern are observed after he was caught cheating for six months; however, the problem seems to be persistent for the past few months as he was caught cheating on his wife. The wife got more troubled and is constantly on his lookout. The frequency and intensity of symptoms are still mild as he has shown in his behavior with his children; though, he disclosed that he is under constant financial pressure as his wife is selfish with her money. The frequency and intensity could be observed in his irritability, anger, shouting and loud outbursts. He wants peace of mind. The client wants to improve his life by having a divorce to release himself from the continuous stress. 

Family Structure 

His family of origin is his Black ethnic background. Research has shown that Blacks tend to have more psychological distress and the role of the Black race is apparent in low life satisfaction and high depression and anxiety levels (Williams, 2018). There is lower psychological wellbeing among this particular race due these reasons. The significant relationships include the wife and two children. Clark has been married for five years and has two boys; one is 13 years old and the other is 10 years old. These children are from his wife since Clark has been married only once.

Divorces have not been mentioned but since the current marriage has lasted five years until now and the sons’ ages are 13 and 10 years, it shows that the sons are his current wives’ children from her previous marriage. This could also be a source of stress as well as he has to take care of his wife’s children and his shouting on them troubles the wife as well. The current living arrangement only shows the involvement of his wife, children, and himself. There are no major losses or traumas. Also, there is no family mental health history, family substance abuse history, or family violence history. The stage of development impacts and developmental challenges are evident in the fact that he has been experiencing shouting and outrageous outbursts on the children who are not even the source of his troubles. His wife is already disturbed with his cheating and has been greatly bothered by his shouting on her children. These behavioral changes could cause developmental challenges like social complications, such as interactions with people could become troublesome if his mood is full of anger each time.

Multicultural Considerations 

As mentioned earlier, he belongs to the Black race. His religion and faith are currently none. Clark has no ability limitations or impairments. His sexual and effectual orientation could be inferred from his six-month affair, which shows that he is heterosexual. It became known to his wife after cheating on her for such a long time. He is not transgender or cisgender. 

His age is 40 years and according to this information, he belongs to Millennials generation. He has a middle class socioeconomic status and did not experience homelessness as he is currently at a program director post and had been receiving promotions on a constant basis. There is no military upbringing or any such involvement. Further, there is no gang culture, drug culture, or any possibility of having to face the criminal justice system by the client. 

The immigration status is born and bred in Miami and language preference is English. The geographical influences and environmental factors do not seem to relate to his current concern since his stress appears to be from his continuous family stressors. Though, it has been studied that geographical regions do influence racial discrimination and the resulting psychological disorders and stress in the older Black population (Kim et al., 2016). Although, he is still in middle years of his life, Clark’s psychological distress has not developed to serious stages and is only experiencing mild symptoms of stress. Hence, being born and raised in Miami and his age are not of concern regarding is current family stressor situation. Moreover, there is no experience of oppression or marginalization since he has been awarded continuous growth with promotions; if racial discrimination were a hindrance, then marginalization or oppression could have been considered a major obstacle in his peaceful and satisfactory life, which is currently not the case.

                                                                        Part 2

Narrative Summary

The understanding of the problem suggests that the client is under serious stress that he has been experiencing and has been evident in his behavior. For example, he believes in beating his children when it comes to discipline, which is itself an indicator of his rash behavior. Given the ages of his children, he should not be harsh with his kids since, in adolescence age, the children tend to be more rebellious regardless of their social class (Luthar & Ansary, 2005). He is in constant disagreement with his wife, who caught him cheating six months. Soon after being caught, he has been under constant stress and has not been at par with her wife and their marital relationship has not been smooth since then. It has been less than three months since this incident of being caught happened, which helps in inferring that the duration of stress is acute.

The factors contributing to the problem are his wife’s endless skeptical behavior towards him and selfishness in financial affairs. The purpose of the client’s behavior is that he wants to have a divorce to free himself of the mental strain. There are no recurring themes or patterns that emerge in the case facts; although, the client could be on the extreme verge of collapsing when his wife constantly tries to calls and check on him repeatedly. The wife mismanaged his money and repeatedly asks for more. The wife’s car also broke down for which Clark had to pay and get it fixed. These very circumstances are barriers to cope his stress that keep on reappearing on an ongoing basis. The only strength Clark has is the support of his mother, whereas the assets, protective factors, or signs of resilience for Clark are none since he has been recently disturbed by his cheating being caught, his financial pressures and the sudden outburst of his anger on his kids that is further complicating his marital matters. 

DSM-5 Diagnosis

From the given particulars of Clark’s case, “adjustment disorder” could be one of the apparent DSM-5 diagnoses of the client’s condition. It is the disorder that occurs from a long-lasting reaction to a disturbing event (Lenora, 2017), which could distort his social relations, such as his reckless behavior towards his children. 

The rationale for the selection of this specific diagnosis is that behavioral stress symptoms were seen within three months of a particular stressor, contributing to acute stress symptoms (Mayo Clinic, 2017). For instance, if the wife has been curious about Clark’s whereabouts due to his 6 months cheating period, then the recent three months could be assumed to be full of stress for Clark, showing his rough behavior with his children. 

Two other diagnoses that were considered include acute stress disorder and unspecified stressor-related disorder (Virginia Commission on Youth, 2017). The reason for choosing these two other diagnoses is that they were close to the Clark’s symptoms but since the signs are still mild, the full diagnosis is unspecified. The stress following a certain incident, which was being caught after having cheated on his wife has triggered and contributed to his daily stress that has resulted from his financial pressures, becoming evident in his shouting on children. However, with the six types of adjustment disorders, Clark’s specific condition relates to that of ‘disturbance of conduct’ (Mayo Clinic, 2017). It is because his reckless behavior with his children is the biggest concern as it involves behavioral problems. The mental health assessment for measuring the identified DSM-5 diagnosis usually fails to differentiate between adjustment disorder and major depression; however, medical expertise is required in the screening tests like the Zung Depression scale, One-Question interview, and the Hospital Anxiety and Depression scale (Casey & Doherty, 2013). 

Theoretical Orientation and Application 

Various psychological theories of PTSD have been linked to adjustment disorder and could be practically used for explaining the theoretical explanations of Clark’s behavior. One of the recent theories, emotional processing theory, has made a development that the events that take place at the time of trauma and the symptoms could interlink to exhibit emotional instability afterward causing major disruptions in daily activities (Brewin & Holmes, 2003, p. 352). In the light of Clark’s case, Clark is showing signs of reckless behavior with his kids and wants to withdraw himself of the stressful condition in the form of seeking a divorce so that the negative schemas that are causing incompetence in his behavior and disturbing his mental peace could be eradicated altogether. 

The preferred theoretical orientation approaches positive change since the client would be free of his negative experiences and would be directed towards more positive circumstances in his life. This makes sense of the client’s present problem since the reinforcement of negative schema would be decreased that cause danger to his emotional responses, resulting in less habituation of fear, reduced levels of anxiety, and avoidance of the memories causing stress (Brewin & Holmes, 2003, p. 353). 

Another counseling theory that was used in previous decades, the anxious apprehension model, contributes on the same lines except that it majorly talks about PTSD disorders, the panic attacks related to the trauma, and traumatic flashbacks (Brewin & Holmes, 2003, p. 351). It somewhat makes sense of the client’s given condition since he wants to avoid the alarms that generate stress for him, for instance, he wants to get rid of his relationship with his wife that is being a constant source of stress for him. Therefore, he is experiencing hyperarousal symptoms in the form of rash behavior with his children that seem to be related to his original trauma. 

Part 3

Treatment Planning 

Using the theoretical foundation of person-centered theory and preferred theoretical orientation explained above, the short-term SMART goal for the client’s treatment could be the elimination of the stress symptoms, which could be achieved by setting sessions with a therapist for short period for the next six months (Comprehensive Rehab, 2019). The interventions and approaches for this short-term goal would include the detailed assessment of the client’s condition including the onset of the problem, its duration, specific symptoms, family history, previous medication (if any), substance abuse or alcohol dependency, education of the client about the ongoing therapy and evaluation of the psycho-therapy sessions for the client (Wiley, n.a.). 

The mid-range SMART goals would include alleviation of the stress-related symptoms and stabilizing the depressive signs that are occurring in his mood. Since he gets irritated easily and shouts frequently, his social connections are in danger that might result in losing his friends and close relations sooner than expected. The mid-range goal would therefore include stabilizing of his mood. This could be done by engaging healthy activities like regular breathing exercises, yoga, physical activity, healthy diet and going out with friends, etc. The long-term SMART goal would include maintaining healthy marital relationship so that life-long satisfaction could be ensured. For this purpose, couple counseling might be helpful since the wife needs to understand that if he has stopped cheating on his wife currently, then he might have become a better man and should be stopped punishing. Also, the wife needs to comprehend that giving her husband the financial stress would collapse their whole family structure, in which their children would suffer as well. Hence, the couple counseling could be beneficial in Clark’s case. 

Ethical and Legal Considerations 

Since most of Clark’s treatment and its relevant goals involve psychotherapy and counseling sessions, the ethical issues in counseling should be considered. The issues of client confidentiality, the right of self-disclosure, setting the right boundaries, and dissemination of information to any third party should be keenly reviewed (Sage Pub, n.a.). 

Personal barriers for solving ethical issues in Clark’s treatment could be an inaccurate evaluation of his cultural considerations and failure to act independently (Akfert, 2012, p. 1809). The steps that could be taken for an intentional and proactive ethical approach include increasing ethnic familiarity and asking questions in the oral survey in which the client could open up about his racial concerns. Also, transference of own values for acting independently could be done by inquiring the medical institute where the therapist works to allow him to take decisions autonomously and free of political influences.