Aida_Labrada_Assignment 2_ Psychosocial Assessment Part I

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1 Assignment #2: Psychosocial Assessment Part I By Aida Labrada SOWK 523 Foundations of Integrative Social Work Practice I University of Southern California Professor Peggy Stewart

2 Assignment #2: Psychosocial Assessment Part I Client’s Name: Tony Johnson Presentation: Little interest or pleasure in doing things. Feeling down, depressed, or hopeless. Recurrent behavioral outbursts, aggressiveness expressed is very out of proportion, and recurrent aggressive outbursts are not premeditated. Feeling bad about himself (failure to have let his wife down), thoughts he would be better off dead, or hurting himself. Precipitant: Tony’s wife, Lisa, passed away a year ago due to cancer. He feels lost and hopeless without his wife, he has little to no interest in doing things he once enjoyed and is constantly rude and means to others as a way of not caring for life anymore. Admits he currently threw a brick at the back of a vehicle because the driver did not stop properly at a pedestrian cross walk. Predisposition: - Biological: Paternal history of dementia - Psychological: Wishes he would have died instead of his wife. Has decided a manner of revenge against the world is to be mean and not care about anyone or himself. - Social: Tony’s best friend is also Lisa’s younger brother, Matt. Tony and Max work together for a newspaper. Coworkers: Lenny, Sandy, and Kath. Father’s nurse: Emma. Anne – a widow, whom he met at the graveyard, and discusses his feelings of grief, guilt, and failure. Daphne/Roxy – sex worker that he befriends through drug dealer. Cultural:

3 British white, male. He identifies as an atheist, heterosexual. Preferred pronounces he/him/his. College education. His socioeconomic status is of upper-middle class. Perpetuants: Small support group. Recently has become friends with a widow, who shares advice and knowledge with him. Tony has also befriended a local drug user in order to obtain drugs (narcotics) in hopes of numbing the pain. Through the drug user, Tony befriends a sex worker named, Roxy. Patterns: Tony keeps everyone at a distance to not show his vulnerable side. Protective factors and strengths: Compassionate, empathetic, caring, funny, and creative. Loyal to his family and friends, loves his dog, Brandy, and does not want to leave her alone. Tony has access to various resources and seems to be in the pre-contemplation stage of treatment. Plan (treatment): Motivational Interviewing to help Tony resolve his ambivalent feelings and insecurities. Will provide the client with supportive and strength-based counseling. Once rapport and trust is built, would like to introduce CBT therapy to the client to assist with identifying the relationship between thoughts, emotions, and behaviors. Also examining options and alternatives available to Tony to use, instead of previous patterns. Prognosis: Good, Tony has many strengths, and his small support group truly cares and encourages Tony to get better. Given Tony is very self-aware of his feelings and the reasoning behind those feelings, CBT should be effective to help Tony further make decisions to help him with his grief and depression. Case conceptualization statement:

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4 Tony presents with major depressive disorder and intermittent explosive disorder. His wife of 25 years, died of cancer a year ago. He is having difficulties with transitioning away from grief and continuing his life without his wife. He has one best friend, Matt, who is also his brother-in-law. Tony presents with some type of avoidant – attachment- personality and typically avoids close relationships. Since the passing of his wife, Tony keeps a distance from Matt and will occasionally become verbally aggressive and emotionally distant. Tony has this outburst of aggression at least once a day. He will lash out at friends and coworkers, occasionally becoming verbally aggressive with strangers. Some perpetuating factors include Tony’s small support system and living with guilt/failure regarding his wife’s passing. He spends most of his time re-watching old videos filmed with or by his wife. He visits his father daily, who is in a memory care facility for dementia. Tony states that it is difficult to visit his father as he continuously asks for Lisa, and he has to once again remind his father that Lisa has passed. He feels that all his co-workers pity him, and their behavior makes him feel uncomfortable. Therefore, creating a scenario where Tony becomes irate. Tony’s protective factors and strengths include his compassion, he is loyal to his father – whom he visits daily regardless of how much he dislikes visiting him, he loves his nephew, George, and enjoys spending time with him. In fact, Tony walks passed George’s school daily during recess to say hello and check in on him. Additional protective factors for Tony are his friendship with Anne and Roxy, who are assisting him greatly by being empathetic and nonjudgmental. He has health insurance. His wife took out life insurance, which has left Tony with enough financial resources to not have to stress about debt. He is open to the idea of counseling and working collaboratively in treatment.

5 The following biopsychosocial factors attempt to explain Tony’s depression and intermittent outbursts. Tony feels as if he failed his wife by not being able to protect her from cancer and her passing. He wishes he would have died instead of his wife. At times, he wishes he would have spent more time with Lisa, while she was still alive. Tony also regrets not working harder for the newspaper and promoting up through his employer. He acknowledges that he did not pursue promotions due to his wife’s illness. He feels that his coworkers pity him due to them knowing that he attempted to commit suicide. He feels judged and constantly monitored by others, including Matt. Tony’s father and mother (deceased), were married for many years before his mother passed. His father never remarried, living Tony with an additional sense of failure because his marriage was not as long as his parents. He does not intend to date or remarry as he is still in love with Lisa and prefers to stay single and have no sexual relations. Tony’s father has a history of outbursts and insulting individuals when he does not get his way, and Tony believes he learned that behavior from his father. Facilitating a highly supportive, empathic, and encouraging counseling relationship, treatment will consist of cognitive behavioral therapy for Tony to be able to identify the relationship between thoughts, emotions, and behavior, examine options and alternatives, label distortions, and listen to advantages and disadvantages. These skills will be implemented through modeling and role-play. His challenges with grief will be addressed with a referral to grief counseling, either group or individual therapy will be determined by which session Tony feels safer. Socratic questioning will address Tony’s negative self-talk; mindfulness practice and breathing techniques will be taught to Tony for him to implement when he begins to feel overwhelmed with his thoughts. The outcome of therapy with Tony is judged to be positive, given Tony is wanting to address his negative thoughts, and integration of Tony’s protective factors (friends) will further provide Tony with strengths.

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