Case Study of Sandi

Counselor Intern: Camp Best

Counseling 621

November 15, 2011

Client Description

•Sandi•28 year old Caucasian female

•University of Mississippi Graduate Student

•Family of origin issues•Identity, self-esteem and anxiety

issues due to perfectionism

Purpose of Assessments

BASIS –A•Utilizing the B.E.T.A. framework of Background, Emotions, Thoughts or Actions, this assessment is a good match for client who is a “B” with a strong influence from her background and family of origin•Instrument is based on the concept that an individual’s interpersonal style or worldview is developed in the context of their family of origin and then remains fairly stable throughout their life. •Helpful in gathering insights into how these early influences might be affecting current behavior, problem-solving and personal style

MAAS – Mindful Attention Awareness Scale•Good match for stable client demonstrating no discernible disorders, but with presenting issues of mild anxiety, perfectionism and struggles with identity.•Mindfulness practices can be utilized for anxiety reduction, increased awareness of self , a stronger connection with self and increased overall well-being.

Assessment Procedures and Protocol

Early SessionsGathered information informally without formal intake assessment on medical/developmental history; familial psychiatric history; school/academic/work history and home behavior/social history over the course of first two/three sessions.

BASIS – AAdministered in 7th week Self-scoring assessment65 QuestionsUtilizes two separate scales for assessing Lifestyle Themes and the General Approach to Life (HELPS)

MAAS Administered in 7th weekSelf-scoring assessmentsMAAS has 15 items and uses a 6-point Likert Scale

Medical/Developmental History

•Client has no serious medical issues other than reporting mild hypo-glycemia

•Client has never been diagnosed with any serious psychological disorder

•Client saw a therapist for a period of time when she was in undergraduate school with

relationship issues•Client has self-professed mild anxiety

Familial Psychiatric History

•Client reported no history of serious psychiatric issues with family members

•Client’s brother is gay and has struggled with anger, depression and anxiety

School/Academic/Work History

•Client excelled academically throughout her K-12 grades as well as in undergraduate school

and presented no problems in this area

•Client has been in school most of her adult life and has only held part-time, graduate-

assistantship or internship positions and reported no problems in these areas

Home Behavior/Social

•Client reports strong ties with family of origin: mother, father and older brother who is gay•Parents are conservative, Christians

•Father is perfectionist•Mother is peacemaker and non-confrontational•Brother was perceived as “trouble-maker”

•Client is self-professed quiet, “perfect” daughter to provide parents with relief from troubles with her brother•Client happily married for 3 years with no children

Assessments Used & Appropriate Interpretations

BASIS – AAssessed five major themes or interpersonal styles: •Belonging/Social Interest(BSI); •Going Along(GA); •Taking Charge(TC); •Wanting Recognition (WR); and •Being Cautious(BC)

Also used HELPS scale to further assess:• Harshness (H); •Entitlement (E); •Liked by All (L); •Striving for Perfection (P); and •Softness (S)

Assessments Used & Appropriate Interpretations (cont.)

MMSE (Mindful Attention Awareness Scale)•Assesses self-awareness because it focuses on determining the presence or absence of attention to what is occurring in the present moment•Assumes that higher levels of mindfulness facilitate self-regulation, psychological health and enriched moment to moment experience•Assumes that higher scores indicate that the individual is more aware of and receptive to inner experiences and more thoughtful about their overt behavior•Assumes that higher scores indicate that the individual is more “in tune” with their emotional states and are more likely to fulfill their basic psychological needs.•Assumes that higher scores indicate an individual who is less likely to be anxious, self-conscious and ruminative

Summary of FindingsBASIS – A•GA – Going Along: Client scored extremely high in this area confirming intense desire to get along, avoid confrontation, and closely follow expectations •WR – Wanting Recognition: Client scored quite high in this area indicating high need for approval for successes•TC – Taking Charge: Client scored moderately high in this area indicating comfort with being task-oriented and leading others

HELPS•E – Entitlement: Client scored positive here indicating enjoyment of special attention and the expectation that her needs will be met•P – Striving for Perfection: Client scored positive here indicating possession of high standards, sensitivity to making mistakes, confidence in doing many things successfully and well-developed resources for dealing with life’s situations

Summary of Findings (cont.)

MAAS•Client scored 3.467, with 1 being the lowest and 6 being the highest score•National mean of 3.724•The higher the score, the higher the level of overall mindfulness, awareness of self and ability to deal with stress•Indicates that improvements can be made in mindfulness in order to achieve better self awareness and reduce anxiety and stress

DSM-IV Diagnosis

Client does not present with a classified mental disorder and therefore no DSM

diagnosis is warranted.

Treatment Plan and Recommendations

•Continue to work with client on identifying and accepting her strong connections with her family of origin and the powerful influences that they have had upon her dualistic thinking and perfectionism. •Continue to work with client on identifying her habitual way of adopting dualistic thinking that forces her into perfectionism rather than allowing herself to be human and flawed.•Continue to use journaling and art therapy to give the client an opportunity to explore some of her feelings and emotions around her identity as the “perfect” daughter and to begin to identify those areas in her life where she can safely become more human and flawed. •Utilize mindfulness, deep-breathing, and other relaxation practices in session and at home to increase self-awareness and reduce anxiety and stress.

References

Brown, K. & Ryan, R. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84 (4), 822-848.

Kern, R. (1998). BASIS-A: Interpretive Key and Guide for Clinicians. Highlands, North Carolina: TRT Associates.