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Rock Street, San Francisco

Comprehensive Case Conceptualization
Krysta Carlson
Southern New Hampshire University

Presenting Concerns:
Describe the problem/issue/challenge that the client reports they want help with.

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According to the clinical intake assessment, the client is seeking counseling because she has not been “feeling like herself.” The client is struggling with their mood, nervousness, motivations, and interests in life in general. The client is feeling very tired all of the time and cannot get herself to have energy. It is starting to interfere with her job and ability to participate in her life in general. She has a lot of bad experiences from the past but she is not sure that they are the reasons she is having problems now. Sometimes, the client’s wife observes Amelia staring off into space and she is unable to snap her out of this focused state. She has been experiencing these symptoms more regularly and her partner has also noticed that the severity, frequency and duration of the symptoms are getting worse.

Explain the problem/issue/challenge affecting the client.

This client is struggling with their motivation. She has said that she is lacking interest in life. She also said in the intake assessment that because of these behavioral issues, she has been missing school and work. She is struggling with her job and also her ability to participate in life. It was indicated on the intake assessment that she had feelings of cognitive impairment, abnormal thoughts, disruption of thoughts, dissociate states, obsessions/compulsions, orientation/memory issues, and poor concentration. The client is struggling with their mood and their nervousness. She said on the intake assessment that she has been feeling anger, aggressiveness, anxiety, depression, hopelessness/helplessness, grief, guilt, irritability, paranoia, fearfulness, and worthlessness. She is feeling tired all the time and does not have energy. According to her intake assessment, the client said she is experiencing symptoms such as appetite disturbance, decreased energy, sleep disturbances and panic attacks.

What does the client typically experience and demonstrate when the presenting problem/issue/challenge is activated?
The client typically gets depressed and anxious. She gets very tired and stops doing every day activities. She has also said that her symptoms get worse when she is left home alone, has work project due dates, a family event, and also during the holidays.

What are the results of the quantitative assessments?
This client took several quantitative assessments so that the counselor could better understand the severity of the symptoms that she is going through at this time. The assessments that the client took were: WHODAS 2.0 (World Health Organization Disability Assessment Schedule 2.0), The Personality Inventory for DSM-5—Brief Form (PID-5-BF), The Colombia-Suicide Severity Rating Scale, and the DSM-5 Self-Related Level 1 Cross-Cutting Symptom Measure—Adult. The WHODAS-2.0 assessment includes 36 questions and was used to see if the client is disabled based on how much difficulty she has experienced over the past 30 days. The results of the assessment show that she is considered “moderately disabled.” She scored a 3.25 on this assessment.
The next assessment this client took was the Personality Inventory for DSM-5—Brief Form (PID-5-BF)—Adult. This is a 25 question self-rated personality trait assessment. This assessment assesses five personality traits including negative affect, detachment, antagonism, disinhibition, and psychoticism. She scored a 1.8 for negative affect, a .8 on detachment, a 1 on antagonism, a .33 on disinhibition, and a 1.67 on psychoticism. According to this assessment, she is experiencing moderate negative affect and moderate psychoticism effect.

The next assessment this client took was the Colombia-Suicide Severity Rating Scale. This assessment is used to identify a client’s severity of suicide ideation. She did have thoughts about suicide, but has never acted on those thoughts nor has she come up with a plan to carry out her thoughts. The assessment did show that she is not currently at risk for suicide.

The last assessment this client took was the DSM-5 Self-Related Level 1 Cross-Cutting Symptom Measure-Adult. This assessment was able to pinpoint some more specific symptoms that the client might have. She scored a 2 or greater on feelings of depression, anger, mania, anxiety, somatic symptoms, sleep problems, and repetitive thoughts/behaviors. Because of those results, it was determined that she is experiencing feelings of depression, anger, mania, anxiety, somatic symptoms, sleep problems, and repetitive thoughts and behaviors at least mildly or greater over the past two weeks. There will need to be additional assessments to understand better the symptoms in more detail. The client scored a 1 or greater on the substance abuse domain. This should be looked at further even if a client scores a “1” on the scale (American Psychiatric Association, 2013).

Because of the results of the previous assessments more assessments were needed to see the severity of the symptoms identified by the DSM-5 Self-Related Level 1 Cross-Cutting Symptom Measure-Adult. It was best to get a better look in the client’s anxiety. So the LEVEL 2—Anxiety—Adult (PROMIS Emotional Distress—Anxiety—Short Form) as well as the Severity Measure for Panic Disorder—Adult were given to the client. The results from the LEVEL 2—Anxiety—Adult showed that she is experiencing severe anxiety. She scored a t-score of 72.9. Scores that are 70 and over are associated with greater severity of anxiety (American Psychiatric Association, 2013). On the Severity Measure for Panic Disorder—Adult assessment, the score was a 3 which indicates that she may have severe panic disorder (American Psychiatric Association, 2013).

What is the relationship between the data from the quantitative and qualitative assessments?
The quantitative assessments shows the numbers related to the clients mental health diagnosis. The qualitative assessments show the severity of the disorder that the client has. The both combined help understand where the client needs the most help and what they struggle with and what the counselor needs to address and the severity of the need. For this client both kinds of assessments were incorporated in order to have a well-rounded conceptualization of the clients presenting concerns. The first assessment was the initial intake interview. This is a qualitative assessment and it was done in an interview format. Then there was a Culture Formulation Interview. This assessment is also a qualitative assessment in nature and it helps to better understand how the client views herself in relation to her cultural background. After learning more about the client’s symptoms from both assessments, the types of quantitative assessments were decided based on her current concerns. The quantitative assessments were then used to determine severity, frequency, and duration of the symptoms that she is experiencing. The results of the quantitative assessments are consistent with the symptoms that the client has shared in her initial intake assessment and culture formation interview. The client will need to be monitored because of her suicide ideation just to make sure there is not a direct threat to the safety. Even though there is not a pressing concern that the she will act on the thoughts she is having, it is important to monitor and make sure there is a plan in place.
Discuss the following considerations related to the assessments used.

The assessments were centered on the client’s symptoms and what she was experiencing. They assessed her sleep, anxiety, anger, and depression. These all helped to see what level the client was at when it came to her symptoms. After getting to know the client better, the quantitative assessments were chosen to help go deeper into her concerns. The WHODAS 2.0 was chosen to understand any functional impairment that the client has because of her health and mental health conditions. The DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure—Adult was used to determine any additional psychiatric diagnoses. The Columbia-Suicide Severity Rating Scale was to see if the client was experiencing suicidal ideation. This was chosen because the results on the Cross-Cutting Symptom Measure identified that it would be best to inquire further about her suicidal tendencies. The PID-5-BF was used to assess her personality. After understanding more about Amelia’s symptoms from the Cross-Cutting Measure, LEVEL 2—Anxiety—Adult and the Severity Measure for Panic Disorder—Adult was given to the client. These assessments were given to assess the severity of anxiety that she experiences.
As with every assessment, you want to make sure that the assessments are reliable and also go along with the client’s symptoms and behaviors. Assessing to assess is not helpful to the counselor or to the client. The assessments chosen for this client are all considered reliable and valid assessments by the DSM-5. Each assessment that has been referenced above is designed to be used with adult clients. In order for an assessment to be considered reliable, the assessment must be given in a timely manner. Each assessment signifies a time period for the client to reflect upon when answering the questions. The validity of each assessment is outlined in each of the specific assessments. Validity is referred to as the description of the situations in which it would be appropriate for a counselor to use the particular instrument and how the results should be interpreted (Watson ; Flamez, 2014, pg. 84.)
In this case, only a few assessments were used based on what the client told the counselor. The limitations could be that this client is experiencing other behaviors or symptoms in her life that she has not yet disclosed to her counselor. This will limit the diagnosis and the treatment. This client works as a Licensed Professional Counselor and treats students with family issues and school performance problems. Because of this, she may be familiar with the types of assessments being administered and she might have a bias when answering the assessments. The assessments would need to be checked to see if they can be used with clients who identify as multi-racial. If the assessments are not deemed reliable and valid for a diverse population, it could lead to misdiagnosing her or over diagnosing her symptoms.
As a counselor, you want to make sure that you are upfront and honest when it comes to giving out the assessments. The counselor should put it into words that the client would understand and also know what exactly they are taking and why. Informed consent in this area is very important and also helps build trust among the counselor and the client. The counselor needs to consider her age, cultural background, and intellectual disability. Because the client disclosed that she has been previously diagnosed with dyslexia, you will need to keep this information in mind because she may feel stressed about her performance on the assessments. She also may need additional time on the assessments. She also mentioned in her intake interview that she has difficulty with reading and spelling. The counselor must always abide by the ACA Code of Ethics when administering any type of assessment and be competent in the scoring techniques utilized by each assessment.

Current Triggers:
Describe the triggers (people, places, things, and sensory experiences) that activate the behavioral, cognitive, emotional, and physiological patterns that result in the client’s presenting problem/issue/challenge.

The client stated that work project due dates, holidays, family events, and being home alone after work all are triggers in her life that cause her to become depressed and anxious. She has also stated how difficult it can be to be live in the world where you are constantly pigeon holed into being 1 thing in your identity. She is experiencing severe anxiety. The client’s mother does not approve of her marriage. Even though she has been married for 22 years, her family feels like it is the real reason for her unhappiness. Her mom does not believe that counseling will help fix her problems. Her mom believes that she should confide in a priest. The relationship with her mom seems to cause her more anxiety. Her job is also a trigger. She can’t seem to keep up with due dates. She stated that her job schedule is difficult to maintain. She also does not like being home alone after work. When she is left alone, the symptoms and anxiety get worse.

Discuss the following considerations related to the assessments used:
In relation to current triggers, what are the reliability and validity considerations in using each assessment with this client?
I believe that this client has a lot of anger built up over her feelings. This would be a reliable and valid assessment for her to do. I also think the client is depressed and anxious do to her family and being alone when she would much rather be with someone. Those assessments were valid and reliable for that situation. I also believe that project due dates could be a cause of her sleep and exhaustion. That assessment was valid and reliable as well due to her symptoms and complaints and lack of energy.
In relation to current triggers, what is the limitation associated with using each assessment with this client?
I believe that each client could allays have more information in their life that the counselor may be unaware of. The limitations with these assessments would be the accuracy of the client’s information. She might be holding something back that could be a leading factor into her triggers.
Maladaptive Patterns
A. Explain the inflexible and/or ineffective manner the client is feeling (emotions), the current triggers, and the presenting concerns.

The client is struggling with their mood and their nervousness. The current triggers are work project due dates, holidays, family events, and being home alone after work. The concern for this client would be her mood and how much it play apart in her everyday life and also how she is nervous so much it’s affecting her life. This client has used the words “always” and “most of the time” in the assessments. These are red flags when reading through the assessments. “The unpredictability of panic attacks lead to avoidant behavior resulting in isolation, impaired functioning, and lower quality of life” (Schwartze, Barowski, Strauss, Burlingame, Barth, & Rosendahl, 2017). This describes the client. She isolates because she fears her next panic attack.
Explain the inflexible and/or ineffective manner the client is thinking (cognitions), the current triggers, and the presenting concerns.

The client is struggling with her job and also her ability to participate in life. The current triggers are work project due dates, holidays, family events, and being home alone after work. The concern with the client would be the ability to currently hold down a job because of her stability in life. The client is no longer enjoying life nor participating in it, and therefore is not coping well. She has continuously distracted herself to avoid thinking about panic attacks. Instead of focusing on what she needs to accomplish, she is more worried about not having a panic attack and this is not helping her productivity or motivation.Explain the inflexible and/or ineffective manner the client is behaving (actions) in reaction to the current triggers and the presenting concerns.

The client is struggling with her motivation and also lacking interest in life. The client does not seem to want to engage in things that she used to like to do. This is a concern because not engaging in life is a sign of depression. This could eventually lead to her not wanting to live if the triggers are not taken care of. Previously she turned to drugs and alcohol to help cope with her symptoms. She has not used these coping activities recently though. The counselor should remember her substance use when going forward with counseling. The client does tend to internalize her feelings. She will isolate herself and not ask for help even if she needs it. Because of this, she has started missing work. This causes her anxiety to get worse because she is missing her due dates on work projects.
Explain the inflexible and/or ineffective manner in which the client is experiencing (physiology) the current triggers and the presenting concerns.

The client is feeling tired all the time and does not have energy. This is a concern because these symptoms will not help her become much active in living day to day. This is also a concern because these symptoms are also a sign of depression. She has been having a hard time sleeping and staying asleep.

Discuss the following considerations related to the assessments used.

In relation to maladaptive patterns, what are the reliability and validity considerations in using each assessment with this client?
One of the considerations that counselor wants when using these assessments is to facilitate new learning and new thought patterns among the client. The counselor wants to strengthen the will to give up her old patterns by showing her how the assessment recorded her symptoms.
In relation to maladaptive patterns, what are the limitations associated with using each assessment with this client?
The client might not want to give up her patterns of thinking because that is what she is used to. This could be a limitation if the client is not ready to change or to take ideas from the counselor.
How does the literature selected impact your understanding of the client’s experience?
I believe that the literature helped me become more aware of what the client is going through and also how else I can better help her through this process and the assessing.
IV. Developmental Influences
What are the experiences from the client’s development (birth to the present) that influence the development of the presenting concerns?
According to the CFI assessment, the client has a troubled past. She had been seeing a counselor on and off since she was a teenager. She has been on medications to treat her anxiety, depression, and control her moods. She claims these are from bad experiences in the past and she needed them to cope with those experiences. She also tried many different therapy techniques which include EMDR, psychoanalysis, and talk therapy. During the interview, the client also revealed that she was in a bad car accident when she was little. During this accident, she broke her legs pretty badly. This was probably one of those bad experiences for her and probably traumatized her. “The trauma, when excessive, causes the brain to use up major supplies of repressive chemicals, such as serotonin. This impairs the proper functioning of the inhibitory system, our defense system” (Janov, 2013, p. 53).Also, the client lost her father when she was a pre-teen. This was sudden for her and her family. This memory could possibly cause pain as well as panic attacks. The client was bullied most of her school years. She revealed that her father was emotionally abusive to her and her family. Her boyfriend in high school was also emotionally abusive to her. These past experiences could also be leading to the client’s panic attacks. “Secure attachments in childhood and adulthood, and well-developed capacities for symbolization, mentalization, and affect regulation, influence individuals to be more resilient to the traumas and stressful events of everyday life (Taylor, 2010).”
What are the developmental factors that promote the client’s maladaptive functioning patterns?
The client was one of five siblings and grew up in a religious family. She was raised Roman Catholic. She is of African American and Filipino descent. She mentioned during her interview that it is difficult growing up and trying to have to pick one side of her identity and culture. She is proud of who she is and both of her identities. She isn’t just one or the other. These feelings might be the cause of why she isolates her feelings. She might believe that people won’t understand her feelings and that could be why she internalizes them. As an adult, the client is no longer Catholic and has different beliefs than her family. This may have caused some relationship problems among her family. This could be one of the reasons that the client has attachment issues and some problems with her personality development. This client seems to not be able to handle stressful situations in a healthy way. Most people, who experience panic attacks, usually have unhealthy coping mechanisms. This client tries to avoid memories, past experiences, and thoughts that trigger her. This client avoids things, people, and places that cause the panic attacks. She isolates herself to aide in this habit. Because of this she misses deadlines at work, feeling more anxiety, and lacking sleep.
What are the developmental factors that promote the client’s adaptive functioning patterns?
This client does have a good support system which plays a huge part into how she functions. She currently does not use alcohol or drugs to treat her panic attacks. She previously did, so that is a good sign she stopped using them. She now uses her wife and therapist to help her cope with the current panic attacks. She is seeking treatment and is using the right tools to cope. The client also starting taking up some hobbies. She revealed that she likes to go biking, exercise, and knit. She also enjoys taking walks, spending time with her wife, watching television, and reading.
Promotors
What are the present experiences (onset to present) that influence the maintenance of the presenting concerns?
Recently, the client’s dog passed away. This probably caused heartache and sadness. She is also finding it very hard to stay motivated enough to go to work. She has been isolating more and her anxiety has been getting worse. According to the Severity Measure for Panic Disorder—adult, she has been having more panic attacks. She has also been more worried and nervous. She has also stated that she feels others are out to get her. This client also has a lot of stress in her life currently. “Many relationship, health, and occupational stressors are essentially continuous (Conway, Rutter, Brown, 2016).” She hasn’t been performing well at her job, her family has been questioning her relationship with her wife, and her symptoms are harming her overall health. All of these are big stressors in her life.
What are the present factors that promote the client’s maladaptive functioning patterns?
This client has a tendency to isolate and not ask anyone around her for help. She has been continuously staring into space and preparing herself for the next panic attack. Therefore, she is missing important deadlines at her job. By doing this, she is promoting more symptoms and in return she is having more anxiety, nervousness, and thoughts of losing control and dying. According to the Severity Measure for Panic Disorder—Adult, the client has stated that most of the time she experiences her heart racing, sweatiness, trouble breathing, faintness, and shakiness. These symptoms are a sign of her anxiety and actually cause panic attacks. She also has a possible emotional disorder according to some of her symptoms such as internalizing everything. She has stated that her family also suffers from anxiety and depression. That could also be another reason why she struggles so much with panic attacks and anxiety. “Unique components of panic have been proposed including, dizziness, manifestations of autonomic arousal, and somatic symptoms (Taylor, 2010).”
What are the present factors that promote the client’s adaptive functioning patterns?
She has decided to stay in contact with her family, friends, and her wife. Even though she has stayed in contact with her friends, she struggles to make new friends. She claims she is a good friend though and that she always keeps others feelings in mind. She has also stated that she still does her hobbies such as bike riding, exercising, and knitting. Because of the support of her friends and family and the ongoing participation of hobbies, she will probably continue on in treatment. The client stated that one of her strengths is the ability to forgive others. She has also stated that she is compassionate. This might also be a good way to cope with the symptoms she is experiencing.
VI. Cultural Identity
How does the client identify with the following cultural characteristics?
This client identifies as a 42 year old female. She identifies as American. She identifies as biracial: African American and Filipino. She stated that she was diagnosed with dyslexia. Because of this, she struggles with her reading and spelling. Math and science though are her strong subjects. According to WHODAS 2.0, this client is considered moderately disabled. She identifies as lesbian and has been married to her wife for 22 years. She did state that she was in an abusive relationship with her boyfriend growing up. He emotionally and mentally abused her. She claims to have been sexually active with four different partners, but did not state what gender they were. The client is not a part of any religious groups. Her family is Roman Catholic though and that is how she was brought up. Her mother tries to talk her into coming back to the religion since she is still faithfully practicing Catholicism. These clients fit into the middle class category because her job occupation is a counselor. In order to be in that position, she would have her master’s degree.
Which of the cultural characteristics from above does the client use to define a sense of belonging and use to define an identity?
This client is proud of her cultural background and has stated so. She has stated that she is both African American and Filipino. She believes that they are both really important into understanding who she is as a person. She has stated people think of her as black at first, but she feels that she is more than that. This client also is very adamant of who she is when it comes to her sexual identity. She has been married to her wife for 22 years and she has stated that she is an amazing support system for her. She feels like her wife’s support helps with the problems going on in her life. She likes when her wife just listens to her because it makes her feel seen and heard.
Summarize how cultural identity has influenced the client’s development (birth to present).

This client grew up in a bi racial family. According to the assessment, she has been struggling with this identity for a long time. Her family questions her sexual identity. She also feels like no one understands what it’s like to be bi-racial. Her family believes that the reason why she is experiencing problems is because of her sexual identity. The client has stated that she had a boyfriend who emotionally and mentally abused her. In her initial interview, she also said that she was bullied for most of her childhood. Her father was also emotionally abusive. Her whole family experienced the abuse of her father. These past experiences could be is what is causing her panic attacks and anxiety. She also may have experienced bullying because of her sexual identity. This could also be a cause of her anxiety.
This client also feels misunderstood because of being biracial. According to her, she believes that other counselors have not really cared about her background and not really take that into consideration when counseling her. She believes sessions would be more beneficial if counselors brought her cultural identity into the session. She said that it is very difficult to have to choose between the two races. According to that, she seems like she doesn’t know where she fits in this world.
This client was Roman Catholic, but because of how she identifies sexually, she is not welcomed into that religion. This could be the cause of tension among her family, since they are still practicing Catholics. The shift from Catholicism to no religion could have caused additional tension between the client and her family growing up.

What are the ethical considerations necessary when using these assessments with this client?
It is very important that counselor’s take the cultural background of the client into consideration (American Psychiatric Association, 2013). Because this client identifies as African American as well as Filipino, it is important that the assessments have no racial bias. If they aren’t valid for a diverse population, then they might not present the client well, and the counselor could misdiagnose her. The client feels like she has always been forced into choose one race over the other. She used the word pigeon holed. She has already been through prejudice in her life and feels like a minority. As a counselor, it is important to not further that discrimination. She has also asked that her cultural background be brought into consideration. She feels like she does better when this is brought into account. As a counselor, you need to make sure that the client’s identity is brought into the assessments in order for the results to be ethical.
VII. Cultural Stressors
Summarize the dominate culture for your geographic area using all cultural characteristics listed above.
I live in New Hampshire where most people living here are Caucasian. We have the freedom to decide which religion we want to practice. Christianity is prevalent here in New Hampshire though. This state does allow same sex marriage. Most people in New Hampshire are middle class citizens. Most have also graduated from high school. Not as many though have a college degree. The US Consensus Bureau found that 93.4% of New Hampshire’s population is white, 2.4% of the population is Asian, 2.2% of the population identifies as two or more races, 1% Black or African American, and 0.6% some other race (U.S Census Bureau, 2016). With this, the largest ancestry groups residing in New Hampshire include French and French Canadian (23.3%), Irish (20.5%), English (16.1%), Italian (10%), German (8.3%), and American (5.2%) (U.S Census Bureau, 2016).

Consider the culture identity of the client and identify the similarities and differences between the dominant culture and the client’s cultural identity.
This client does not associate with any religion. In New Hampshire, people get to choose whatever religion they would like to be a part of. The fact that she can decided however she wants is good for the client. She doesn’t have to feel any pressure when it comes to religion. She has been critisized by her family for not participating in Catholicism. Knowing that she does not have to be Catholic gives her freedom. Because this client is part of the middle class, she fits right in with the majority of the people in New Hampshire. The concern she would have living in New Hampshire is that most of the population is Caucasian. This might not help her when it comes to her bi racial identity. She might isolate herself even more being in New Hampshire because she might feel that no one can relate to here. She might believe that people will think of her as rich and therefore not take her problems seriously.
Explain how the similarities between culture identities have impacted the client’s psychosocial experience.

This client is a middle class citizen. She is well educated and has no criminal background. She treats others who have problems in school and also those who have problems within their families. She has been doing this for 10 years. In New Hampshire she would be well respected for her profession with the youth and very much needed. This specific area does have a serious opioid crisis and it has been affecting many families and children. Her skills are definitely needed in the area. This client may be able to talk more freely about her identity as both a Filipino and an African American female. There are various organizations that are run by volunteers that focus on providing a welcoming and inclusive environment for everyone. She could also get involved in the churches in New Hampshire that do not discriminate against LGQTQ individuals. This might help her if she ever explores religion again.
Explain how the differences between culture identities have impacted the client’s psychosocial stress.

In New Hampshire, this client would be considered a minority. According to the US Consensus Bureau, New Hampshire has a population that is still predominantly white (93.4%). This could cause some stress she is already struggling with how others perceive her based on her skin color.
How does this factor impact the presenting concerns and current trigger?
Because this client’s identity affects her every day, it also affects everyone who is around her and how she interacts with others. This might be because of where she lives. Because she is a minority in the area where she lives, this could be one of the reasons why she has anxious feelings, fearfulness, worthlessness, and depression. It is difficult for her to find a place in society where she belongs. This client’s sexual identity is also affecting her greatly. Her family does not accept that she is a lesbian. This could cause her to feel limited into what she can share with her family. Her mother tries to get her to reconsider her sexual identity and also to get back into church and religion. She can’t talk to her mom about any of her therapy sessions because her mom believes that religion can fix the problem, not therapy. Her sexual identity could be the leading cause of her abuse growing up.
VIII. Cultural Influencers
What are the beliefs the client holds regarding the cause of the client’s distress, condition, or impairment?
This client does not know the root of her problems. Even though she has been to numerous therapy sessions, she still does not understand how her problem goes along with her diagnosis. She would like to know the primary concern. She is not sure if the problem is all her traumatic experiences from her past. In her assessment she stated that she has tried numerous things to help her such as medication, praying, talking to someone, and tracking her moods but none of them seemed to help her. She wants a counselor who will help her get to the root of it all and help her pinpoint what the problem is.
What are the beliefs the client’s close relationships regarding the cause of the client’s distress, condition, or impairment?
This client’s family believes that she is unhappy and has problems because of her sexual identity. Her wife believes that her problems and unhappiness is because of working too much at her job. According to the CFI assessment that she took, these issues are what are causing her conflict among her close relationships with her family.
How will these beliefs impact your conceptualization of the presenting concerns and the goals of treatment?
All of the above issues should be taken into consideration to help figure out the clients concerns. The symptoms that she is presenting need to be observed in order to find out the presenting problem. The counselor should ask more questions about her family and the relationship she has with them. A medical history will also be needed because the client stated that her family has suffered from depression and anxiety. The counselor should also ask more about the family’s beliefs. The counselor might even be able to do a family counseling session with the siblings and mother to gain more insight. This would need the clients consent first before doing this. The counselor will need to set up goals for the client and see if that would be okay with her. The treatment plan should have the client fully involved. Because of her stated previous concerns, the counselor needs to make sure that they pay attention to her background and culture and how that relates to the ongoing problems.
What are the ethical considerations necessary when using these assessments with this client?
It is very important that counselor’s take the cultural background of the client into consideration. (American Psychiatric Association, 2013). Because this client identifies as African American as well as Filipino, it is important that the assessments have no racial bias. If they aren’t valid for a diverse population, then they might not present the client well, and the counselor could misdiagnose her. The client feels like she has always been forced into choose one race over the other. She used the word pigeon holed. She has already been through prejudice in her life and feels like a minority. As a counselor, it is important to not further that discrimination. She has also asked that her cultural background be brought into consideration. She feels like she does better when this is brought into account. As a counselor, you need to make sure that the client’s identity is brought into the assessments in order for the results to be ethical.

IX. Personality Patterns Summary
A. Summarize the general personality characteristics of the client.

1. Openness to experience:
This client has mentioned that she struggles with making new friends. She has said that she only has three close friends. She has a problem with starting friendships but seems finding keeping them. She stated on the Severity Measure for Panic Disorder—adult that she typically leaves events or get together early because of her panic attacks. Her anxiety seems to be causing her to not go to places where there will be social interaction. She has said in her initial intake interview, that she struggles with reaching out to others to ask them for help so she tends to isolate a lot because of that.
Conscientiousness:
This client stated in her interview that she’s been missing deadlines at work. She is struggling with the motivation to participate in life, especially her daily activities. In the Severity Measure for Panic Disorder—Adult assessment, she has stated that she prepares for the next panic attack. She avoids places or people that she knows might cause another panic attack. She is constantly distracting herself so she doesn’t have to think about the next panic attack. Her health and her job are being affected by this.
Extraversion:
This client has been struggling with her social life. She has lost all motivation to do the things that she used to do including hobbies. She has been isolating and has been internalizing her feelings. She has stated that she has three close friends but does not do well in social settings. According to the Personality Inventory for DSM-5-Brief Form—Adult assessment, she has stated that she rarely gets excited for anything anymore. The only support she says she has is her wife and her family.
Agreeableness:
This client seems friendly and kind. She seems to make sure that others are taken care of. She thinks of others often. She takes good care of her wife from what she has said. She has stated that she makes a good partner. She rarely hurts others feelings according to the Personality Inventory for DSM-5-Brief Form—Adult assessment. She also said that she rarely uses people. According to the assessment, she doesn’t take advantage of others.
Emotional stability:
This client’s emotions are not stable. According to the Level 2—Anxiety—Adult assessment, she has stated that she constantly feels worried, anxious, nervous, tense, and uneasy. According to Severity Measure for Panic Disorder—Adult, she states that over half the time she feels like she is losing control, going crazy, dying, all because of her panic attacks.

References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

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