AFTER READING THE CASE STUDY, ANSWER QUESTIONS 1-6 IN PARAGRAPH FORM. DIAGNOSE USING DSM-V AND PROVIDE SUPPORTING EVIDENCE FROM THE DSM AND CLASS RESOURCES AS TO WHY YOU MADE THE DIAGNOSIS. When recommending a treatment approach for the client, be specific and explain why the recommended treatment approach is a good one for the client/how the treatment will benefit the client.
*Case Study*
Name: Maggie Weinzapfel
Age: 26
Ethnicity: Caucasian
Marital status: Single
Intake Information
Maggie, a 26-year-old Caucasian female, contacted the Family Guidance Center after breaking up with her fiance, whom she had been dating for the last 4 years. Maggie is a mechanical engineer at a fiber optics corporation in a small Southern town. She makes a good salary, owns her home, and recently bought a new car. Maggie moved from the large, metropolitan area in the Northeast where she had met her boyfriend to this rather small Southern town approximately 1 year ago when she procured her present job. Her parents and siblings also live in the Northeast. Maggie has two sisters, both in their 20s, and two teenage brothers who still live with their parents.
When Maggie called the clinic, she stated that she desperately needed to talk with someone as soon as possible. The intake worker wrote in her notes that the client “sounded panicky” when making an appointment to see a counselor. You are scheduled to see Maggie the day after she called.
Intake Interview
You meet Maggie in the waiting room at the agency. Maggie appears very disheveled. Her baggy pants and sweatshirt are wrinkled, and it looks as if she forgot to brush her long, wavy hair. She is pacing slowly back and forth and appears to be staring at her feet. She runs her hands through her hair continuously and looks generally distressed. Every now and then, she sighs deeply and shakes her head as if responding to some internal dialogue. You greet Maggie in the waiting room by introducing yourself and shaking her hand, which feels sweaty and limp. As you and Maggie walk down the hall to your office, Maggie bursts into tears and says, “Oh, I’m so embarrassed; I don’t know what I’m doing here.” As you and Maggie enter your office, you reassure Maggie that it’s safe for her to express her feelings with you, offer her a chair, and provide her with a box of tissues.
You begin by gently asking Maggie where she would like to start. Maggie states that she broke off her engagement with her boyfriend, Leonardo, approximately 6 weeks ago. She says they had been arguing constantly for the past 6 months about where they were going to live. She wanted to keep her job and live in a small town, but he wanted to live in a large city and didn’t want to leave his family in the North. He told her that Italian families are very close: “We stick together and want to see each other. I grew up in this city; I’ve been to the same church my whole life; and I intend to die in this city. If you’re going to be my wife, you have to be willing to join my family because I’m not leaving.”
Maggie tells you that she chose her current job partly because the insurance company that Leonardo worked for had offices in this town and he could transfer to the South and keep his job. Maggie says, “During the past year, I’ve been going up there to see Leonardo at least once a month for a weekend. I only had 2 days with him, and we spent all day Sunday at his mother and father’s house. His mother treats him like a baby and does everything for him. I think she resents me for taking away her little boy. She’s friendly enough, but there’s tension between us. Lately, his parents have been talking a lot about us getting a house down the street from them. I just couldn’t stand that!” Maggie states that she began feeling like an outsider and an intruder. “Leonardo was unhappy unless I agreed to everything he wanted,” Maggie says glumly.
Maggie states that since the breakup she has had great difficulty sleeping. She often sleeps only 2 or 3 hours a night. She states that she has also lost her appetite and has dropped 15 pounds in the past month. In a very shaky voice, she tells you, “I’ve been having so much trouble with my job lately. I can’t focus on what I’m doing for more than 3 minutes before I’m off thinking about Leonardo. It’s so hard it makes me want to cry.” She says she’s missed work completely on four occasions during the last month when she just stayed in bed all day and watched soap operas on TV. Since the breakup with Leonardo, she says she feels ugly, unlovable, and hopeless about ever getting married.
You decide to find out more about Maggie’s difficulties over the past month. You ask her if there are any other ways in which the breakup with her boyfriend has affected her. She tells you that she is normally a very avid reader of mystery books and lately hasn’t been able to get past the first chapter. She also likes to go to community events on the weekends with friends, but since she has lived in this town, she has been so consumed with her work and her relationship with Leonardo that she hasn’t made any good friends. “Oh, you know, I’ve gotten acquainted with some people, but I don’t know them very well and it just seems so hard to pick up the phone and call them. I doubt if they’d want to do anything with me anyway. I think I’m just a loser all the way around.”
You ask her if she really thinks it’s over with Leonardo. She states that the last time he called, they just got into a shouting match. “By the end of the conversation I decided I just had to end this relationship and get on with my life,” Maggie says despondently. “I really believe that, too. I just don’t know where I’m going to find the energy to do it. When I do sleep, I have nightmares about fights with Leonardo. It’s begun to take its toll on me, I think.”
You say, “Maggie, you’ve mentioned having problems sleeping, and I was wondering whether you were having trouble going to sleep or problems waking up in the middle of the night and not being able to get back to sleep.” Maggie states that her biggest problem is her inability to sleep through the night. She says she wakes up around 2 A.M. and often cannot get back to sleep until it’s almost time to get up. “Then I feel groggy and unable to function very well the rest of the day,” she hesitantly tells you in a quiet voice.
You also ask her if she’s had any suicidal thoughts or had any plans for hurting herself due to this upsetting situation. Maggie responds that she has thought about just wanting to end all this pain, especially at night when she is alone. You ask her if she has taken those thoughts any further and considered how she might “end it all.” She tells you that she doesn’t think she could ever actually hurt herself since it is against her religion and she believes it would be wrong to commit suicide. You explain to Maggie that if she ever begins having thoughts of how she might hurt herself that it would be important for her to talk with you about those thoughts and feelings. Maggie agrees that she will discuss those issues with you should they arise.
When you ask Maggie about her family of origin, she states that she’s always gotten along well with everyone in her family except her mother. She says that ever since she was little, her mother has wanted her to always act like the oldest. “She always tells me that I have to be the responsible one because I’m the oldest, and I don’t think she really cares about whether I’m happy or not.” When Maggie told her mother that the relationship with Leonardo had ended, her mother just told her to grow up and get over it. Maggie says she’s never been able to go to her mother with a problem. “I’m not sure my mother is a very happy person. She’s more concerned about what the neighbors will think than whether or not we are content with our lives. Ever since I was little, my mother would get in one of her moods and close herself in the bedroom and not come out for days.” Maggie states that she has a much closer relationship with her father, who has called several times to see if she’s okay.
Before leaving your office, Maggie tells you she’s really glad she came to talk today. She says, “It’s taken a big load off my shoulders.” Maggie states that this is the first time in several weeks that she can remember not having a headache. She agrees to come back and see you at the same time next week.
Pomeroy, E. (2015). The clinical assessment workbook: Balancing strengths and differential diagnosis. (2nd ed.). Boston, MA: Cengage Learning. 1)What behaviors would you have Maggie track during the week? (Explain)
2)What do you see as some of Maggie’s strengths?
3)Describe two or three approaches Maggie might use to develop a local social support system.
4)What diagnosis would you give Maggie after this initial interview?
5)List the psychosocial and cultural factors as Z codes impacting Maggie.
*Use the link below for Z-codes* https://www.psychdb.com/teaching/dsm-v-icd-z-codes
6)Discuss one recommended treatment approach for Maggie’s diagnosis.