overvIew of the Book - SAGE Publications Inc | s Elphaba Thropp • Animated Characters: Cartoon character Cleveland Brown, Jessie the Yodeling Cowgirl, Tinkerbell,

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1overvIew of the Book

IntroductIon to the Book and Its approach

Welcome to the first edition of Diagnosis and Treatment Planning Skills for Mental Health Professionals: A Popular Culture Casebook. We hope that students and new professionals—as well as their classroom instructors, faculty, and clinical supervisors—will find this book to be an exceptionally effective learning tool for developing the clinical thinking skills needed in today’s world of professional counseling. Clinicians at all levels of education, training, and experience—from those currently in gradu-ate and professional programs, to those cur-rently in residence or preparing for licensure, to those who are seasoned professionals—and in all counseling and mental health disciplines—including professional counselors specializing in community, mental health, school, and col-lege counseling; psychotherapists and marriage and family therapists; clinical social workers; psychologists; psychiatrists; and others in the allied mental health fields—rely on a core set of clinical thinking skills and tools to guide their effective intervention in the lives of their cli-ents. These include: (a) diagnosis, which allows the counselor to describe and communicate about client presentations by matching his or

her observations and the client’s report of symptoms with the criteria for the various dis-orders found in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), (b) case conceptu-alization, which provides the professional with a rationale and framework for working with clients by integrating clients’ presenting thoughts, feelings, and behaviors into meaning-ful patterns, and (c) treatment planning, which integrates the information from the diagnosis and case conceptualization into a coherent therapeutic plan of action. This text fully addresses and illustrates the skills needed in all three of these areas.

Extensive Coverage of Core Clinical Thinking Skills

Historically, most textbooks have focused heavily on the development of just one or two of the core clinical thinking skills we present in this text. They might fully cover use of the DSM-IV-TR to make a diagnosis, methods of moving from theory to practice via a case con-ceptualization, or the steps needed to design a treatment plan—but usually not all of these. By comparison, this text begins with all of the

4 • PART I INTRODUCTION AND OVERVIEW

details associated with multiaxial mental health diagnosis, moves on to a full review of case con-ceptualization specially written for new counsel-ors, and wraps up with the important components of treatment planning. We worked hard to bring all three skills together and show how they are used in connection with one another in actual, everyday practice—and to write each chapter with students and new counselors in mind.

Detailed Case IllustrationsFurther, traditionally, typical counseling and

psychotherapy clinical textbooks have offered only snippets of case illustrations, rather than walking you through case development, step by step, from beginning to end. Often these are partial or whole cases that are amalgams of various cases from the author’s own caseload or are fictitious cases designed to show some aspect of diagnosis, case conceptualization, or treatment planning. In contrast, our textbook provides 30 fully prepared case illustrations—each of which introduces you to the client, shows a professional intake summary, presents and explains a case conceptualization, and develops a fully prepared treatment plan. Most interestingly, the cases from which you will learn and practice using this text are drawn directly from popular culture (i.e., television, movies, literature, advertising, the musical stage, song lyrics, comics, and even video games). We have chosen 30 characters who become fascinating clients, most of whom will be either somewhat or very familiar to you. Together they represent a wide range of indi-vidual differences, including various ages, eth-nic identities, cultures, socioeconomic statuses, and sexual identities. In addition, they illustrate a wide range of presenting concerns, different types of client needs and issues, and various forms and levels of diagnosable disorders. For many of these clients, we also provide recom-mended links to video portrayals of characters, which further brings them to life for you.

The characters you will meet and analyze in this book include:

• Children’s Characters and Video Game Characters: The Muppets’ Miss Piggy, Mario of video game fame, Gretel, anime superstar Naruto Uzumaki, and Snoopy

• Troubled Youth in Film and on Stage: Twilight’s Edward Cullen, Jamal Malik from Slumdog Millionaire, Juno’s Juno MacGuff, Claire from The Breakfast Club, and Wicked’s Elphaba Thropp

• Animated Characters: Cartoon character Cleveland Brown, Jessie the Yodeling Cowgirl, Tinkerbell, The Simpsons’ Waylon Smithers, and Beauty and the Beast’s Belle

• Adults in Television Sitcoms and Drama: TV drama star Jack Bauer, Golden Girls’ Sophia Petrillo, George Lopez, Star Trek’s Lieutenant Commander Data, and Jack McFarland from Will and Grace

• Characters in Music, Musicals, and Advertising: Dunkin’ Donuts’ Fred the Baker, West Side Story’s Maria, Billie Jean from the Michael Jackson song of the same name, the Beatles’ Eleanor Rigby, and the Geico Caveman

• Characters in Literature and Comics: Misery’s Annie Wilkes, The Color Purple’s Miss Celie, Chief Bromden from One Flew Over the Cuckoo’s Nest, Peter Parker, aka Spider-Man, and A. A. Milne’s Christopher Robin

Rather than offering snippets of these cases, we take you from start to finish—from intake through treatment planning—so that you can develop a full understanding and appreciation of how diagnosis, case conceptualization, and treatment planning skills are applied to rich, complex, and engaging clinical cases. Further, within the discussion of each of these 30 cases, we provide extensive, step-by-step, empirically supported guidelines to help you to develop each of the three critical clinical thinking skills.

how to use part I of the Book

This book is divided into four parts. In Part I, Introduction and Overview, we provide a rationale for using popular culture cases in the development of your case conceptualization, diagnosis, and treatment planning skills. The

Chapter 1 Overview of the Book • 5

current chapter provides readers with an overview of the book’s approach to the learning. Then, in Chapter 2: Popular Culture as a Learning Tool in Counseling and Psychotherapy, we discuss the role of popular culture in our everyday lives, the debate over the effects of popular culture on our lives, the importance of assessing your Popular Culture IQ (PCIQ), the value of using popular culture clients to build a clinical caseload, and how popular culture can be a resource for counselor development and growth. We include the professional perspectives of practicing counselors and real-life client examples. This part of the book sets the stage for the learning that will follow, so to make the best use of Part I, you will want to read the chapters and complete an exercise in Chapter 2 that asks you to begin exploring the 30 case illustrations we will be using later on.

how to use part II of the Book

In Part II, Diagnosis, Case Conceptualization, and Treatment Planning, we provide extensive, didactic coverage of the knowledge, information, and skills you will need to perform diagnosis, case conceptualization, and treatment planning. First, Chapter 3, Clinical Thinking Skills: Diag nosis, Case Conceptualization, and Treatment Planning, introduces and defines the three clinical thinking tools. This chapter was written to show how the different skills are used together in counseling practice and to highlight how students and new professionals can best approach learning and skill development in these areas.

Next, in Chapter 4, Diagnosis: Understanding and Using the DSM-IV-TR, we offer a compre-hensive discussion of the DSM-IV-TR, including diagnosis in the context of professional counsel-ing, the benefits and limitations of diagnosis, and an in-depth analysis of the complete multiax-ial system. Then, in Chapter 5, Case Conceptuali-zation: Making Sense of the Client’s Concerns, we provide a rich discussion of the importance of case conceptualization—and present a detailed discussion of case conceptualization for students

and new professionals using our four-step Inverted Pyramid Method (the process includes problem identification, thematic groupings, theoretical inferences, and narrowed inferences). Finally, Chapter 6, Treatment Planning: Designing a Plan for Change, provides a comprehensive discus-sion of the process of treatment planning, in which we build on the information derived from the diagnosis and case conceptualization in order to create a logical plan of action. We use a four-step approach to the treatment plan includes establishing a behavioral definition of the problem(s), identifying and articulating goals for change, describing the therapeutic intervention(s), and providing outcome measures of change.

Each of these chapters gives readers an intro-duction, sets the professional counseling context, offers step-by-step instructions regarding each aspect of the skill covered, and then presents a “Pulling It All Together” section. Each chapter provides professional viewpoints and several also provide clinical snapshots drawn from prac-tice, they all suggest ample skill-building and learning exercises, and give clear learning goals. In addition, the chapters include as many helpful tables and figures as possible. To most effec-tively use Part II, you will want to read the chap-ters in sequence, keep track of your learning goals, complete as many of the exercises as pos-sible, continue exploring the 30 case illustra-tions, and follow the various suggestions for practice and application.

specIal features In parts I and II

As we have indicated, at selected points in the text, you will find several special features. These include:

• Snapshots: Professional Perspectives • Clinical Spotlights • Skill and Learning Exercises

You will find each of these features set off in highlighted boxes. The Snapshots: Professional Perspectives share the impressions of practitioners


as they relate to the material covered. The Clinical Spotlights add to the learning by sharing a few, selected real-life client experiences.The Skill and Learning Exercises suggest activities you can use to integrate the material covered, most often by referring to and using this text’s popular culture case illustrations. We hope you will read all of the snapshots and spotlights, and engage in the learning activities, when you come to them in your reading. These can be approached on your own, working with a partner, or as group exercises during class meetings.

how to use part III of the Book

Building on the information and knowledge covered in Chapters 3 through 6, in Part III: Diagnosis, Case Conceptualization, and Treat-ment Planning: 30 Case Illustrations, we go on to illustrate the clinical thinking tools using our case examples. In this part of the book, we take you from start to finish in the analysis of each of the 30 popular culture–based cases—moving from intake to assessment and case concept-ualization to diagnosis and finally to treatment planning. Each case can be read all on its own. We explain what was done to complete the intake, the counselor’s decision-making during

diagnosis, the clinician’s thought process during case conceptualization, and the method followed to build the treatment plan.

We have attempted to make our 30-client “case-load” as illustrative as possible. As you will see in Table 1.1, by reviewing all 30 case illustrations, you will find examples covering nearly every class of diagnosable disorders and other conditions found in the DSM-IV-TR. Somewhere among the cases you should be able to find the presenting concerns and client needs that are of most interest to you, are most relevant to your professional inter-ests, and most salient to your educational and train-ing focus. Further, you can widen your knowledge base by examining all of the cases in detail in order to see how concerns drawn from every corner of diagnosis are addressed.

We also have attempted to present a wide range of theoretical and practice approaches when forming our case conceptualizations and designing our treatment plans. As you will see in Table 1.2, by reviewing all 30 case illustrations, you will find examples covering nearly all of the major theoretical approaches commonly used in practice, extensive examples using psychothera-peutic integrations that combine multiple approaches, and further examples using eclectic and solution-focused methods. Here again, you are likely to find illustrations using many of the approaches that will be most important in your own education and clinical training, and in real-life practice. Wherever possible, we have empha-sized evidence-based practices; elsewhere, we explain the practical rationale for the counseling method selected.

Further, along with showcasing a broad range of presenting concerns and a mixture of treat-ment approaches, we have worked to build a caseload that emphasizes and illustrates the indi-vidual differences typically seen among clients. As Table 1.3 shows, our 30 cases are relatively diverse. Throughout Part III, we identify the sig-nificant demographic features that differentiate our clients according to age, ethnicity, culture, American or international residence, socioeco-nomic status, sexual/gender identity, and additional

Figure 1.1 Special Features Found in Highlight Boxes

Snapshots: Professional Perspectives

Present selected impressions of practicing counselors

Clinical Spotlights

Present selected themes from real-life client experiences

Skill and Learning Exercises

Present suggested activities for integrating chapter material

(Continued)


Client Page Diagnoses and Presenting Problems Illustrated

DSM-IV-TR Section DSM-IV-TR Axis I and Axis II Diagnoses

Miss Piggy 130 Personality Disorders Borderline Personality Disorder

Mario 142 Substance-Related Disorders

Sleep Disorder

Cocaine Dependence, Alcohol Abuse

Substance-Induced Sleep Disorder

Gretel 156 Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence

Oppositional Defiant Disorder

Naruto 167 Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence

Attention-Deficit/Hyperactivity DisorderConduct Disorder

Snoopy 185 Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence

Autistic Disorder

Edward Cullen 202 Mood Disorders Major Depressive Disorder

Jamal Malik 215 Anxiety Disorders Acute Stress Disorder

Juno 225 Other Conditions That May Be a Focus of Clinical Attention

Parent-Child Problem

Claire 237 Eating Disorders

Substance-Related Disorders

Impulse Control Disorders Not Classified Elsewhere

Eating Disorder Not Otherwise Specified

Cannabis Abuse

Trichotillomania

Elphaba 249 Somatoform Disorder

Personality Disorder

Body Dysmorphic Disorder

Antisocial Personality Disorder Features

Cleveland Brown

266 Substance-Related Disorder

Mood Disorder

Sexual and Gender Identity Disorders

Other Conditions That May Be a Focus of Clinical Attention

Alcohol Abuse

Dysthymic Disorder

Erectile Dysfunction

Relational Problem Not Otherwise Specified

Jessie 282 Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence

Reactive Attachment Disorder

Table 1.1 Our Popular Culture Caseload: DSM-IV-TR Diagnoses and Presenting Concerns

(Continued)




Tinkerbell 292 Schizophrenia and Other Psychotic Disorders

Personality Disorders

Schizoaffective Disorder

Borderline Personality Disorder Features

Waylon Smithers

306 Other Conditions That May Be a Focus of Clinical Attention

Identity Problem

The Beast’s Belle

318 Anxiety Disorder


Social Phobia

Avoidant Features

Jack Bauer 335 Anxiety Disorder



Posttraumatic Stress Disorder

Bereavement

Antisocial Personality Disorder Features

Sophia 347 Delirium, Dementia, Amnestic, and Other Cognitive Disorders

Dementia of the Alzheimer’s Type

George Lopez 359 Adjustment Disorders


Adjustment Disorder With Mixed Mood

Acculturation Problem

Lieutenant Commander Data

373 Mood Disorders

Mental Disorders Due to a General Medical Condition


Major Depressive Disorder

Amnestic Disorder Due to a General Medical Disorder

Identity Problem

Religious or Spiritual Problem

Jack McFarland

388 Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence

Mood Disorders


Attention-Deficit/Hyperactivity Disorder


Histrionic Personality Disorder Features

Fred the Baker 410 Adjustment Disorders Adjustment Disorder With Depressed Mood

Maria 423 Anxiety Disorders


Acute Stress Disorder

Bereavement

Table 1.1 (Continued)




Billie Jean 434 Schizophrenia and Other Psychotic Disorders

Delusional Disorder

Eleanor Rigby 447 Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence

Mental Disorders Due to a General Medical Condition

Mental Retardation

Mood Disorder Due to a General Medical Condition

Geico Caveman

458 Adjustment Disorders


Adjustment Disorder With Depressed Mood

Identity Problem, Acculturation Problem

Annie Wilkes 474 Mood Disorders

Personality Disorders

Bipolar Disorder

Antisocial Personality Disorder

Miss Celie 488 Mood Disorders

Anxiety Disorders

Dysthymic Disorder

Posttraumatic Stress Disorder

Chief Bromden

503 Schizophrenia and Other Psychotic Disorders

Schizophrenia

Peter Parker 517 Mood Disorders

Mental Disorder due to a General Medical Condition


Personality Change due to a General Medical Condition

Christopher Robin

532 Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence

Asperger’s Disorder

contextual features such as educational status; factors of religion, spirituality, or faith; and involvement in occupational settings, school systems, or the legal system. Wherever relevant, you will find case information illustrating the thought processes needed to form diagnoses, case conceptualizations, and treatment plans that are responsive to individual differences.

Taken together, the 30 cases found in the six chapters comprising Part III of the book present

a wide range of examples of clinical thinking as it is applied to child, adolescent, and adult clients representing a diverse set of populations, pre-senting a wide range of concerns and needs, and for whom a variety counseling approaches are used. You can make the most of the cases in Part III by following all of the learning and skill building exercise found in the earlier chapters, most of which refer to our case illustrations; reading through, comparing and contrasting, and

(Continued)


Client Page Theoretical and Treatment Approaches Represented

Individual Counseling and Psychotherapy Additional Treatment Modalities

Miss Piggy 130 Dialectical Behavior Therapy Case Management

Mario 142 Integrative:

Multicomponent Psychosocial Intervention Approach

Motivational Interviewing

Inpatient Treatment

Narcotics Anonymous (NA)

Gretel 156 Integrative:

Client-Centered Play Therapy

Cognitive Behavioral Play Therapy

Family Play Therapy

Naruto 167 Multicomponent Psychosocial Intervention Approach

Psychopharmacology Consultation

Family Counseling

Parent Support Group

Snoopy 185 Eclectic:

DIR (Floor Time) Therapy

Behavior Therapy

Expressive Creative Arts Play Therapy

Family Counseling and Psychoeducation

Social Skills Psychoeducational Group

Edward Cullen 202 Integrative:

Cognitive Behavior Therapy

Interpersonal Psychotherapy


Family Counseling

Jamal Malik 215 Brief Solution-Focused Counseling

Emphasizing Cognitive Behavioral Interventions With Adolescents


Relaxation Training

Juno 225 Client-Centered Counseling Family Counseling

Support Group

Claire 237 Brief Contemporary Psychodynamic Psychotherapy

Group Counseling

Elphaba 249 Cognitive Behavior Therapy Gestalt-Oriented Group Counseling

Table 1.2 Our Popular Culture Caseload: Theoretical Approaches to Case Conceptualization and Treatment Planning




Cleveland Brown

266 Integrative:

Schema Focused Cognitive Therapy

Interpersonal Psychotherapy

Couples Counseling

Family Counseling

Jessie 282 Theraplay Dyadic Family Therapy

Tinkerbell 292 Solution-Focused Counseling

Emphasizing Cognitive Interventions and Dialectical Behavioral Interventions

Inpatient Hospitalization


Waylon Smithers

306 Person-Centered Counseling

The Beast’s Belle

318 Cognitive Behavior Therapy

Jack Bauer 335 Cognitive Behavior Therapy Eye Movement Desensitization and Reprocessing and Exposure

Relaxation Training

Sophia 347 Integrative:

Behavior Therapy

Cognitive Stimulation Therapy

Family Counseling and Psychoeducation

George Lopez 359 Reality Therapy

Lieutenant Commander Data

373 Integrative:


Existential Counseling

Group Counseling

Jack McFarland

388 Integrative:

Brief Psychodynamic Psychotherapy


Career Planning

Relaxation Training

Fred the Baker 410 Person-Centered Counseling

Maria 423 Cognitive Behavior Therapy Bereavement Support Group

Billie Jean 434 Brief Solution-Focused Counseling

Emphasizing Cognitive Interventions With Adolescents


Family Counseling

Day Treatment With Group and Psychoeducational Group Counseling

(Continued)




Eleanor Rigby 447 Brief Solution-Focused Counseling General Medical Pharmacology Referral

Support Group

Geico Caveman

458 Adlerian Therapy

Annie Wilkes 474 Cognitive Behavior Therapy Inpatient Hospitalization


Psychoeducational Group Counseling

Miss Celie 488 Integrative:

Schema-Focused Cognitive Therapy

Feminist Therapy

Support Group

Chief Bromden

503 Integrative:


Cognitive Remediation


Day Treatment With Group and Individual Counseling

Psychoeducational Group Counseling

Peter Parker 517 Integrative:


Reality Therapy

Stress Management Training

Christopher Robin

532 Expressive Creative Arts Play Therapy Parent Consultation

Teacher Consultation

Table 1.2 (Continued)

Note: As we have written the case scenarios in this book, many of our characters are experiencing complex situations that can be characterized as diagnosable mental health concerns. In addition, as often occurs in your real-life work as counselors and psychotherapists, you will find that many of these characters are experiencing more than one concern. These types of diagnos-able and co-occurring client situations sometimes require, or suggest the need for, multiple forms of counseling and other interventions. The counseling approaches and interventions you will find presented in this table and in our 30 case conceptualiza-tions and treatment plans were selected from among the most important approaches taught in counseling theories classes, from today’s documented best mental health practices, and from evidence-based counseling recommendations derived mostly from large-scale treatment outcome studies and meta-analyses of treatment outcome research. They are a starting point for clinical conversation!

13

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forming your own impressions and critiques of, the entire group of cases; and/or by focusing especially closely on a few clients you find most useful or salient and studying these in greater detail.

how to use part Iv of the Book

Part IV wraps up the textbook with two final chapters: Chapter 13, Epilogue, and Chapter 14, Getting to Know the Clients Through Internet Sources, Published Literature, and Film. In Chapter 13, Epilogue, we bring it all together for you by summarizing what we have attempted to accomplish in the book, that is, teaching you how to implement diagnosis, case conceptualization, and treatment planning skills in the context of analyzing 30 cases drawn from the personages in popular culture. We then offer a number of caveats regarding popular culture and clinical work that will further guide you in the development of these skills. We also try to make the case for incorporating the intriguing lives of popular culture characters, when useful, in your professional world—whether it be in the counseling office, classroom, or supervisory relationship. Chapter 13 concludes by offering a number of “next learning steps” through which you can continue developing your clinical thinking skills.

Bringing the book to a close, Chapter 14, Getting to Know the Clients Through Internet Sources, Published Literature, and Film, then provides readers with a variety of web links lead-ing to audio and video portrayals, further back-ground and life span information, and more his-torical context that we think will allow you to get to know our clients even more personally and in even greater detail. You can use these websites to bring alive our illustration caseload.

We believe it is important for you to read and understand the caveats and limitations we have

outlined pertaining to the popular culture charac-ters we the selected, the methods we used to trans-form them into counseling clients, and the clinical choices we made. This will help you develop your own critical counseling insights about clinical thinking. Likewise, because use of this text is just the beginning of your skill development, we hope you will make note of the next learning steps we recommend. Being able to see, hear, and learn more about the characters will enable to you to more fully engage in the clinical thinking process as you learn from our case write-ups. Naturally, we also hope that you will consider the value of popular culture in professional counseling educa-tion, training, and practice!

chapter summary and wrap-up

Part I of our text sets the stage for the learning to follow. In it, Chapter 1 has given an overview of the book’s organization and contents, and Chapter 2 will orient readers to the use of popu-lar culture in the learning process. In the first chapter, we outlined the critical contents to be found in Part II of the book—where Chapters 3, 4, 5, and 6 fully cover all of the details needed to begin practicing diagnosis, case conceptual-ization, and treatment planning. The chapter also previewed the 30 separate, start-to-finish case examples you will find in Part III of the text. The three tables in Chapter 1 presented easy-to-use summaries of the characters, divided according to presenting concerns and needs, counseling and psychotherapeutic approaches used in the cases, and individual differences. You are likely to refer back to these tables throughout the learning when searching for specific types of case illustrations. Our hope is that the book will be exceptionally valuable to you in your development as a counseling professional.

(Continued)

Documents

overvIew of the Book - SAGE Publications Inc | s Elphaba Thropp • Animated Characters: Cartoon character Cleveland Brown, Jessie the Yodeling Cowgirl, Tinkerbell,