Case study 18: Julia Psychologist: How would you rate your overall health?

Case study 18: Julia

Psychologist: How would you rate your overall health?

Julia: I feel that my overall health is good. I have finally been able to loose most of my baby fat, which is helping me in many ways. I am able to run good while sticking to a diet that is working for me. I started out weighing 145 pounds, but my weight and eating habits were not healthy and were affecting my running performance. So, my coach inspired me to exercise a bit more while maintaining a healthier diet. Since then, I am down to 103 pounds and on a strict diet, which has helped me improve my running times and maintain my weight. This really works for me as I am continuing to do good academically and I’m able to keep my scholarship. Overall, I feel I’m in good health.

Psychologist: What do you feel are your greatest successes and biggest challenges?

Julia: I feel my greatest successes are the fact that I’m able to maintain good grades while improving my running times. Academics have always been important in my parent’s eyes, so I strive to maintain good grades. It’s always been difficult though because I feel like no matter how hard I try my mom doesn’t think I perform to the best of my ability. This sometimes puts stress on me and makes me feel that I need to try harder even though I’m putting in great effort.

My biggest challenges are trying to juggle college life and trying to make people understand that I’m taking good care of myself. People are nagging me telling me that I’m too skinny, that I don’t eat enough, and I’m exercising too much. This is hard for me because I did exactly what my coach wanted. I lost weight, stuck to a strict diet, and improved my running times. To top it off, I’m doing well in school.  Now, I still feel that it’s not good enough. I thought my coach and my mom would be proud of me, but I guess they’re not.

Psychologist: Are you currently experiencing anxiety, sadness, or depressive symptoms?

Julia: I get a little bit sad because I don’t have time to really hang out with friends anymore. I discovered this last semester when it came time for finals. I became stressed because I waited too long to prepare for my finals. So, I decided this semester I was going to do things differently. I am going to study throughout the semester so that I don’t get overwhelmed or stressed when it comes to taking my finals. Plus, I was really tired of hearing others comment about my weight and eating that it’s just easier to be by myself so I don’t have to deal with it. I’m just so focused on what I need to be doing in my life right now that socializing just doesn’t fit into my schedule. Focusing on my studies and running is really time consuming and I just don’t have time for other things right now. I’m happy just being by myself and focusing on my routine. So, I guess I don’t really have symptoms of anxiety, sadness, or depression.

Rationale:

The initial assessment is a critical part of the evaluation process. According to Akhtar (2009) the initial assessment provides an opportunity to evaluate the nature and severity of the client’s psychopathology as well as provides both parties a chance to get an emotional understanding of each other.  Assessing how Julia feels about her overall health is important. This question would provide the psychologist with a better understanding about Julia’s attitude and how she views her health. Although her medical doctor may provide a different, concerning point of view, it is important for Julia to realize that she is not in good health. Julia’s body weight is concerning as a common symptom of Anorexia Nervosa (AN) is purposely consuming less food in order to decrease body weight and is lower when compared to other individuals of the same age and gender (Gorenstein & Comer, 2015). In addition, assessing Julia’s responses to her greatest successes and biggest challenges is also an important question. Uncovering information in various ways such as having an in depth conversation is critical as gathering data assist in making a diagnosis and implementing a treatment plan. For example, there may be a stressor-related disorder as noted in the DSM-5 made easy: The Clinician’s Guide to Diagnosis that may be relative to Julia’s condition as well (Morrison, 2014). Therefore, allowing Julia to elaborate on what she feels are some of her strengths and weaknesses may provide the psychologist with some underlying and additional information. Direct questioning is a great strategy for encouraging the client to elaborate while the psychologist listens in a non-judgmental way in order to gather important patient related information (Akhtar, 2009). Finally, symptoms of anxiety, sadness, and depression can be linked to AN. According to Gorenstein & Comer (2015) individuals with AN commonly struggle with other conditions such as depression and anxiety disorders. Thus, it is important to get an understanding of the patient’s perspective and possibly uncover some warning signs related to the disorders. After watching the video on PTSD, I realized that although individuals who are diagnosed with the same disorder may have similar symptoms, they all have different needs. Thus, it is important to assess individuals and implement a treatment plan that is unique to that individual in order to increase their health and well-being.

References

Akhtar, S. (2009). Turning points in dynamic psychotherapy : Initial assessment, boundaries, money, disruptions and suicidal crises. London, England: Karnac Books. Retrieved from http://www.ebrary.com (Links to an external site.)Links to an external site.

Gorenstein, E., & Comer, J. (2015). Case studies in abnormal psychology (2nd ed.). New York, NY: Worth Publishers. ISBN: 9780716772736

Morrison, J. (2014). DSM-5 made easy: The clinician’s guide to diagnosis. New York, NY: The Guilford Press.