Comprehensive Assessment Report-with Movie client DUE: Week 7 Before Class You will complete a comprehensive intake. Be sure that your report includes the following sections: Demographic information/Identifying information Reason for Referral Brief history of the Problem Ct history o (Family, Social, Employment, Medical, Psychiatric, etc.; Assessments administered o assessment results, summary, and recommendations, observations during assessment—an MSE (narrative form); Additionally, before the diagnoses, you choose and administer, score, and interpret 2 sets of assessments related to the client’s presenting concerns (not the Adult Symptom Screener and do not duplicate-i.e. two depression screeners). Additionally, you will also complete and a suicide assessment for each client. In addition to the rationale for, also discuss Cultural Considerations of the screeners (use your texts to support). Many screeners will be discussed throughout the course. You then identify a probable diagnosis with clear justification for your diagnoses. Do include any co-morbid diagnoses. Then you will write a treatment plan (2 Goals with 2 Objectives each and 2 Interventions for EACH Objective) 1 SOAP progress note (the progress notes will likely require clinical creativity, but should be logical for the client case). (use first initial and number for client) Finally, you will end with a 2-3-page conceptualization of the client (include relevant references, Gehert, Theory text, research) using the theories and views of your currently identified theoretical orientation, as well the rationale for the theoretical focus. Compile this as one document and submit to the link under Content. USE APA wherever possible. Bruce Wayne is a white male in his late 20’s born in Gotham. He has never been married, does not have children, and he is not currently in a relationship. The client presented to counseling with concerns of recurrent flashbacks and nightmares of the traumatic incident of parents being murdered in front of him. Additionally, he’s seeking counseling because of intense anger, hatred, and violence towards criminals and criminalistic activities. Bruce witnessed the traumatic event of his parents being robbed at gunpoint, then shot and killed. He never received psychiatric treatment after that event occurred and did not divulge information regarding his life between the ages of 8 to 18. It appears Bruce has unresolved and misplaced feelings toward all criminals because his trauma involving a criminal was never addressed. Up until the point of therapy, the client spent most of his young adult life seeking out opportunities to punish and take his anger out on criminals. The week before coming to therapy, the client was in a Chinese prison. He stated he went to prison on purpose just to fight criminals and ensure that justice is served. After his release from prison, he was invited to join a group called the League of Shadows; however, once Bruce saw that the final initiation process included executing a murderer, he set the building ablaze and left the country. Even though he would not murder the criminal, he fought the other members of the group and set the building on fire without any regard as to if the other’s survived or not. The counselor believes that the client will not commit the crime of killing others because his parents were killed, but he will do everything else it takes to ensure justice is served by himself only, even if it includes harming innocent people by accident. Seemingly, the client is not satisfied with leaving law enforcement to combat crimes and ensure justice; he believes that only he can clean up his city. The egotism and entitlement he displays could have stemmed from the client’s upbringing and wealthy status. It could also stem from the client detaching from others and feeling like he has no one he can trust except himself after his parents death. Bruce must become more self-actualized to realize that his behaviors are contradictory and that there are discrepancies between his hatred of criminals and the criminalistic activities he does himself in the name of justice. To assist Bruce in achieving his counseling goals, the person-centered counselor must help the client become more authentic and more fully themselves (Gehart, 2016). Carl Rogers states that there are seven stages a client typically experiences from the time he or she enters counseling to the time he or she becomes self-actualized. To assist the client move through the seven stages of the change process in a Humanistic approach; first, the counselor must internally and externally express genuineness. Gehart (2016) stated that Carl Rogers’s definition of genuineness “emphasizes being freely and deeply one’s self while able to accurately “take in” what is experienced, and simultaneously remaining aware of one’s internal processing of that experience” (p. 235). Next, the counselor must have unconditional positive regard for the client no matter what they say or do. It could likely be very difficult to continue to exude feelings of warmth, respect, and acceptance after hearing the client express his violent behaviors, lack of concern for others, and disregard for law enforcement; however, it is necessary to help the client have positive outcomes from counseling. Lastly, it is imperative to accurately express empathy. The counselor should be able to view the client’s world without getting lost in it or confusing it with his or her own cognitions. To accurately express empathy, the counselor should reflect back to the client, what the client may be feeling; however, there could be negative or positive consequences in Bruce’s case. Humanistic approaches shape counseling around empathy, which could be a barrier for clients with APD. Symptoms of the disorder include not being empathetic or caring about others. However, an empathetic, genuine, counselor who focuses on having unconditional positive regard for the client and an empathetic understanding of the client’s internal frame of thinking, may help the client build trust and learn how to become more empathic. Erford (2019) indicated another humanistic approach derived from Rogers, but was deviated from the nondirective style by Miller and Rollnick is motivational interviewing (MI). Using motivational interviewing can address Bruce’s resistance to the change process while placing the responsibility on him, which will appease his need for independence and help develop self-efficacy (Reichenberg & Seligman, 2016). While humanistic approaches such as, intentional self-disclosure and empathic confrontation could be benefited in therapy, they shouldn’t be used solitarily because of his diagnoses. Because client’s with APD are manipulative and charming, they may try to use deceitfulness to fool the counselor into thinking that they are progressing. Additionally, multicultural limitations of the humanistic approach include lack of structure (Erford, 2019). Therefore, some additional approaches should be integrated into his treatment. In Bruce’s case, CBT approaches such as, Mentalization- Based Therapy (MBT) and psychoeducation groups would assist both disorders because it’s directive, explores violent behaviors, and explores cognitive distortions surrounding his trauma. Overall, the client’s problems are predominantly external, there’s little agency, difficulty recognizing feelings and experiencing the present moment; identity is rigidly defined. He’s unaware of internal contradictions, identifies tension between social expectations and personal desires, has difficulty accepting others and trusting himself (Zuckerman, 2019). Therefore, the prognosis for this client’s improvement is uncertain because he is precarious. The course is expected to be protracted, because the client appears to be refractory to treatment.
