Joan’s Case Conceptualization

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Introduction

Joan (fictitious name) is a 48-year-old woman who reports stress and depression. She has lost interest in relationships, exercise, and things she enjoys. She feels extremely exhausted and stressed because of her overwhelming work. The pressure due to the big loan she took is also high. She is emotionally avoidant to her three children because of her work. The feeling of worry about her job security has also increased lately and lacks the assertiveness to share with her manager.

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Case Formulation

The social-cognitive theory (SCT) on character and behavior is a concept that accentuates such cognitive developments as thoughtful and mediating, in the advancement of disposition. These cognitive developments add to cultured behaviors that are dominant to one’s personality. In this theory, persons generate their perception of life events.

Predisposing Factors

Joan comes from a family of “over-achievers”, with a psychological perfectionist character, self-criticalness, the sensation of avoidant to her three children, conscientiousness, and lack of assertiveness to speak to her manager. Her social predisposing factors include her highly stressful work environment for fear of job security. She had a controlling mother who would rebuke her for excessive worry.

Precipitating factors

Precipitating factor related to her stress is linked to the possibility of losing her job. For instance, her condition is precipitated by divorce, resulting in a broken long-term relationship. The big mortgage loan is also a precipitating social factor because it has increased her stress at work, where she is forced to work harder to clear the loan.

Perpetuating factors

Joan is task-focused both at work and at home. This is seen when the husband complains that she is overwhelmed by her work, job, and home. She does not have time for her three children and friends. Her work makes her exhausted; hence catching up with her friends is difficult. Being a perfectionist indicated by her statement, ‘get on top of things” is also perpetuating her situation.

Protective Factors

These are factors that are responsible for Joan’s overall good health despite the distress and depression. Such factors include mechanisms and resilience. Moreover, Joan does not have any substance abuse disorder, close friends, children that are a source of hope and joy, and the absence of family psychiatric history. She is also self-critical about her capacity to cope with stress.

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Assessment Plan

Patient Health Questionnaire-9 (PHQ-9) for Depression

PHQ-9 is an adaptable questionnaire for screening, analyzing, observing, and quantifying the severity of depression. It has scores ranging from “0” for “Not at all” in one extreme and “+3” for “Nearly every day” for the opposite extreme. Notably, it measures the severity of depression or stress and has been validated for use in primary psychiatric care (Haddad et al., 2013). According to Sun et al. (2020), PHQ-9 showed 61% sensitivity and 94% specificity. With a positive of “+3” for all the nine questionnaire questions listed in the PHQ-9 totaling 27, a person can be described as in a severe state of depression. Other scales include: “0-4” for no depression, “5-9” for mild depression, “10-14” for moderate depression, “15-19” for moderately severe depression, and any value above 20 indicates a severe case. Therefore, based on the scale analysis, the tool can be used to assess and screen all major types of depression in terms of severity.

The PHQ-9 assessment tool has a high validity valuation in major depression. For instance, according to Sun et al. (2020), the reliability and validity of the PHQ-9 have been indicated to have sound psychometric features. For instance, the result indicated a test-retest reliability coefficient of 0.737 for the PHQ-9 score with a (P < 0.01). Sun et al. (2020) also suggested that the use of PHQ-9 has high internal consistency after its use for 2 weeks, thus indicating enough discriminant validity for assessing depression. Previous research by Erbe et al. (2016) also indicated PHQ-9 internal consistency of (α = 0.89) on paper as compared to the computer version ((α = 0.88). However, though the tool can be used to assess the psychological features of an individual with depression, it is not subtle to variations in indicators of the same condition (Feng et al., 2016). Therefore, a more accurate measure should involve other tools such as Hamilton Depression Scale.

The Romance Qualities Scale (RQS)/ Relationship Qualities Scale (FQS)

RQS is applied for Joan’s precipitating factor of lacking a romantic partner. It is a self-report questionnaire that measures the value and self-worthiness of a romantic relationship. It comprises 22 subscales, which are often appraised on a five-point Likert Scale from 1 (Absolutely false) to 5 (absolutely true). The scale is developed through five dimensions measures consisting of Conflict, Companionship, Help, Security, and Closeness. Based on Joan’s case that has no romantic relationship after divorcing her husband, the tool can be used to evaluate her need for being in a relationship so that a predictive score can be assessed for her depression.

Before instituting the tool, a client is asked to select the friend whom they reflected as the key or closest to them and to answer the questionnaire on the scale with their real connection or association with the person in mind. According to Margherita et al. (2018), the five dimensions of the RQS showed a high internal consistency coefficient above the 0.5 mark. In research by Chonody et al. (2016), the use of the assessment tool exhibited decent face validity, evidenced convergent construct validity, discriminant validity along with robust test-retest reliability. Furthermore, the measure validated a high internal consistency with a score of (0.891, p<.001) (Chonody et al., 2016). Notably, though the RQS is a scale for measuring strength-based romantic or relationship values, the RQ scale has items that are majorly focused on the positive elements, rather than the problems-focussed agenda. Issues to do with a strained relationship such as causes of divorce or non-romantic behavior and little time for a relationship may be rendered unevaluated.

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The Big Three Perfectionism Scale (BTPS)

This is a self-administer questionnaire with a 45-item subscale for measuring such three units of perfectionism as rigid perfectionism, self-critical perfectionism, and narcissistic perfectionism comprising the 10 core perfectionism aspects. According to Sperry and Sperry (2012), the effects of perfectionism manifest when an individual indicates symptoms or excuses for failing to meet life expectations such as responsibilities because of false conviction. The BTPS has scales constructed by applying the SCT theory of social interest, thus reducing the chances of omission specific to the core contents of the scale, and affording greater reliability and permission in assessment.

The scale was formed to appraise the inflexible insistence that an individual’s personal view based on performance must be faultless, perfect, and without flaws. The assessment tool has further been indicated to have higher internal consistency as evaluated by Cronbach’s alpha, which was between 0.79-0.89 based on the 10 facets, and 0.92-0.93 based on the three global factors (Kaçar-Başaran et al., 2020). The Kaçar-Başaran et al’s (2020) research also confirmed that the measuring tool had high test-retest reliability score after 2 weeks of initialization for both the long (BTPS-45) and the short (BTPS-16), thus high predictive validity (Feher et al., 2019). As such, the aspect of perfectionistic self-viewing is revealed to be exceptionally forecast with several maladjustments (Nealis et al., 2015). As result, through monitoring for either trait degrees of perfectionism, the outcomes suggest narcissistic perfectionism with increased incremental validity.

Resilience Scale for Adults (RSA) for Protective Factor

The RSA is another self-report questionnaire targeting the resilience of an individual to cope with stressful situations. According to Windle et al. (2011), the RSA is a highly rated scale with its application in both healthcare and psychological settings. Based on Friborg et al. (2003) research, the measure is factored on five scale items that are used to analyze both intrapersonal and interpersonal protective factors as resilience to advance adaptation to adversity (as cited in Windle et al., 2011). For instance, such factors as family backing and consistency, external support organizations, and dispositional insolences and actions underwrite extremely resilient persons. They include Personal and social competence, social and personal structure, and family coherence.

In this case, individual replies designate how affirmative each item is concerning the accomplice using a 7-point Likert scale ranging from approving to disapproving. Higher scores are suggestive of resilience and lower scores indicate no resilience. RSA is also used to measure the liaison between disposition, aptitude, and resilience. For instance, there is a relationship between personality and resilience factors, such as the connection between advanced personal competence and raised expressive constancy. This is in support of Windle et al. (2011), who determined that the RSA is exceedingly useful for evaluating the protective factors which hinder or deliver defense against psychological disorders. In research conducted by Basim and Cetin (2011), the alpha coefficients for the resilience sub-units were highly rated at 0.66 and 0.81 with test-retest reliability of 0.68 and 0.81 for all the support and family factors.

Analysis

During engagement, it is imperative to be open to the client when discussing the task assessment by being friendly so that they can feel a sense of belonging. This enables the building of trust and confidence, thus showing excellent listening and questioning expertise is significant in identifying the true cause of the problems. As such, the practitioner should engage the client through close eye contact, empathy, and responding to the patient emphatically by focusing on the client’s thought process and feelings. To ensure the client sees the value of the assessment processes, the use of the “All About Me” assessment criterion is highly recommended. According to Jacobs & Keegan (2018), meaningful engagement in personal change processes requires identifying that reactions are not simply “all about me”. In essence, the client will feel self-worth and the drive to want treatments.

The concept of beneficence, which encompasses treating Joan against her predisposing factors and the cost involved, would mean Joan quitting her Job because it is a source of precipitating stress for lack of job security. As such, the practitioner can apply the principle of non-maleficence, indicating that though harm exists through a treatment process, there is a greater benefit. With the loan amount to be paid by Joan, she might refuse the treatment process that involves her quitting her employment, even though it is a major factor in giving her family little time. Forced to respect the principle of autonomy, the treatment of the client might prove very challenging.

Sometimes, assessment tools present limitations in their results. Most questionnaires, for instance, the one used in this assessment contained fixed answer responses to the questions in questionnaire forms. In this case, forced response choices may lead to respondents expressing false opinions because their rejoinders might not have been captured in the questionnaires. Moreover, the results from the assessment plan are only meant to reflect perception, despite the that they may encompass indirect data.

References

Basim, N. H., & Cetin, F (2011). The reliability and validity of the Resilience Scale for Adults-Turkish Version. Turkish Journal of Psychiatry, 22(2), 104-114.

Chonody, J. M., Gabb, J., Killian, M., & Dunk-West, P. (2016). Measuring relationship quality in an international study. Research on Social Work Practice, 28(8), 920-930. Web.

Erbe, D., Eichert, H., Rietz, C., & Ebert, D. (2016). Interformat reliability of the patient health questionnaire: Validation of the computerized version of the PHQ-9. Internet Interventions, 5, 1-4. Web.

Feher, A., Smith, M. M., Saklofske, D. H., Plouffe, R. A., Wilson, C. A., & Sherry, S. B. (2019). The big three perfectionism scale–short form (BTPS-SF): Development of a brief self-report measure of multidimensional perfectionism. Journal of Psychoeducational Assessment, 38(1), 37-52. Web.

Feng, Y., Huang, W., Tian, T., Wang, G., Hu, C., Chiu, H. F., Ungvari, G. S., Kilbourne, A. M., & Xiang, Y. (2016). The psychometric properties of the quick inventory of depressive symptomatology-self-Report (QIDS-SR) and the patient health questionnaire-9 (PHQ-9) in depressed inpatients in China. Psychiatry Research, 243, 92-96. Web.

Jacobs, G., & Keegan, A. (2018). Ethical considerations and change recipients’ reactions:‘It’s not all about me’. Journal of Business Ethics, 152(1), 73-90. Web.

Haddad, M., Walters, P., Phillips, R., Tsakok, J., Williams, P., Mann, A., & Tylee, A. (2013). Detecting depression in patients with coronary heart disease: A diagnostic evaluation of the PHQ-9 and HADS-D in primary care, findings from the UPBEAT-UK study. PLoS ONE, 8(10), e78493. Web.

Kaçar-Başaran, S., Gökdağ, C., Erdoğan-Yıldırım, Z., & Yorulmaz, O. (2020). A different view to perfectionism: An investigation of the psychometric properties of the big three perfectionism scale in a Turkish community sample. Current Psychology. Web.

Margherita, G., Gargiulo, A., Troisi, G., Tessitore, F., & Kapusta, N. D. (2018). Italian validation of the capacity to love inventory: Preliminary results. Frontiers in Psychology, 9. Web.

Nealis, L. J., Sherry, S. B., Sherry, D. L., Stewart, S. H., & Macneil, M. A. (2015). Toward a better understanding of narcissistic perfectionism: Evidence of factorial validity, incremental validity, and mediating mechanisms. Journal of Research in Personality, 57, 11-25. Web.

Sperry, L., & Sperry, J. (2012). Case Conceptualization: Mastering this competency with ease and confidence (1st ed.). Routledge.

Sun, Y., Fu, Z., Bo, Q., Mao, Z., Ma, X., & Wang, C (2020). The reliability and validity of PHQ-9 in patients with major depressive disorder in psychiatric hospital. BMC Psychiatry 20, 1-7. Web.

Windle, G. (2011). What is resilience? A review and concept analysis. Reviews in Clinical Gerontology, 21(2), 152–169. Web.

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"Joan’s Case Conceptualization." PsychologyWriting, 29 June 2022, psychologywriting.com/joans-case-conceptualization/.

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PsychologyWriting. (2022) 'Joan’s Case Conceptualization'. 29 June.

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PsychologyWriting. 2022. "Joan’s Case Conceptualization." June 29, 2022. https://psychologywriting.com/joans-case-conceptualization/.

1. PsychologyWriting. "Joan’s Case Conceptualization." June 29, 2022. https://psychologywriting.com/joans-case-conceptualization/.


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PsychologyWriting. "Joan’s Case Conceptualization." June 29, 2022. https://psychologywriting.com/joans-case-conceptualization/.