Case of david

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Texas A&M University, Kingsville *

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5305

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Psychology

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Dec 6, 2023

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docx

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Case Conceptualization Identifying information David is a 28-year-old Hispanic man diagnosed with severe mental illness, most likely schizophrenia. He has been experiencing auditory hallucinations for nine years and has been hospitalized 30 times. He expresses his frustration with the mental health system, which he believes has failed him and robbed him of his identity. Despite takins have persisted, leaving him despite taking medication feeling stupid. During his fi four hours late, prompting t during his first therapy session therapist to initiate weekly home visits for a year. David will soon be joining a program in Hawaii that offers a sanctuary for individuals with severe mental illnesses. David possesses remarkable character and creative abilities, showcasing his skills in painting and bilingual poetry writing. During the therapy sessions, he exhibited remarkable resilience and refrained from placing blame or expressing self-pity, despite enduring extreme loneliness. History of presenting illness David reports hearing voices and having a speech impediment. The voice he hears is critical and calls him lazy, which has a destructive effect on his daily functioning. The voice is very dictatorial and started around nine years ago when David felt he was making progress. At first, the voices gained David's trust, but they later turned on him when they obtained special knowledge about his past. These symptoms have led to David being forcibly hospitalized 30 times. David has been hearing voices for around nine years, and they have been a constant presence in his life. The voices are very destructive to his daily functioning, and they cause him to feel criticized and judged. This has led to unrelenting loneliness and has affected his self- esteem. The speech impediment also affects his ability to communicate with others, which further adds to his isolation. David desires to be understood and respected. He wants to share his life with others and experience companionship. He seeks therapy to understand his symptoms better and find ways to manage his voice and improve his daily functioning. Background information David's family background is not extensively described, but it is known that he has a mother, father, and an unspecified number of sisters, who all believe he has schizophrenia. David's family believes that he has schizophrenia, and his parents have even had him hospitalized before. David is not very social and has not mentioned any relationships. There is not much information about David's education, except that he has attended institutions for his mental illness. David has been previously diagnosed with schizophrenia and experiences auditory hallucinations. The well-intentioned efforts to persuade David that his vivid experiences were not "real" but rather a symptom of "schizophrenia" only served to distance him even more. This significant disconnect between David's perception and the attempts to label it as a mental

illness caused further alienation. He has a smoking habit, which he attributes to the voices in his head. He has taken medication but states that they have not stopped his voice. David feels the devastation he has experienced because of the intrusion of voices and the loss of his self- determination through forced hospitalizations and injections of neuroleptic medications. Personal Strengths/Weaknesses David demonstrates strengths such as resilience, self-awareness, and perseverance, as he has sought help to manage his symptoms, despite struggling with voice and a speech impediment for many years. He is aware of the impact of his symptoms on his daily life and seeks to improve his situation. However, David also has weaknesses in coping skills, social support, and communication skills. He has not yet developed practical coping skills to manage the voice and speech impediment, resulting in multiple hospitalizations. Additionally, he desires more social connections and feels lonely, suggesting he may lack a strong support network. Furthermore, his speech impediment affects his communication ability, making it harder for him to form social connections and express himself clearly. Therapeutic Goals David presents with several issues that could be addressed through therapy. One of the most significant issues he faces is the ongoing presence of critical and destructive voices, which may require developing coping skills to manage these voices and reduce their impact on his daily life as a primary therapeutic goal. David reports that his symptoms, including the voice and speech impediment, impact his ability to communicate with others and engage in daily activities. Developing strategies to improve his daily functioning could help him feel more connected and empowered. Additionally, his feeling robbed of his identity suggests underlying issues related to past trauma that need to be explored. David reports feeling extraordinarily isolated and desires to experience friendship; developing a support network, whether by therapy or other means, could be a therapeutic goal. Furthermore, David reports feeling unintelligent and criticized due to the voices he hears. Developing strategies to improve his self-esteem could help him feel more confident and empowered daily. David demonstrates remarkable artistic abilities, including painting and poetry writing. Encouraging and promoting his creativity could help him feel more fulfilled and connected to others. Finally, since traditional medication-based treatment has not been effective for him and has even been detrimental to his well-being, exploring alternative treatment options, such as mindfulness meditation or other complementary therapies, could be a therapeutic goal. Case conceptualization/Analysis David's presenting problems can be explained by a need for more congruence between his self- concept and actual experiences. He may have developed an incongruent self-concept due to

societal expectations or significant others' influence, leading to anxiety and distress. The causes of David's issues may include a history of critical experiences, conflicting societal pressures, and unresolved emotions. The discrepancy between his ideal and actual self may have resulted in a lack of self-acceptance, self-worth, and self-esteem. To help David reach his therapeutic goals, a Person-Centered therapist would use techniques like reflective listening and unconditional positive regard. These methods help clients gain insight, feel accepted, and promote self-worth. Exploring David's feelings and thoughts about himself and his experiences through open-ended questions can also be helpful. The therapist may first focus on the voices David hears and his distress, helping him identify the underlying causes and develop coping skills. The therapist may target David's lack of self-worth and self-esteem by exploring his values and beliefs, identifying strengths and weaknesses, and using positive reinforcement and praise. Overall, the Person-Centered approach aims to create a supportive and accepting environment that facilitates growth and self-discovery. Using reflective listening, unconditional positive regard, and exploring experiences, therapists can help clients like David develop a positive self-concept. Critique When working with clients from different cultural backgrounds, person-centered therapy can be helpful since it heavily emphasizes the individual's own experiences and personal reality. The theory acknowledges that a person's cultural background and societal expectations impact how they perceive themselves and their experiences. Regardless of the client's cultural background, the person-centered approach emphasizes the therapist's ability to provide a supportive and accepting atmosphere that encourages the client's self-discovery and growth. In David's situation, the person-centered strategy can encourage self-acceptance and self-worth while assisting him in understanding his experiences and feelings. David can feel heard, validated, and appreciated due to the reflective listening and unconditional positive regard strategies utilized in this therapy, which benefit patients from different cultural backgrounds. Understanding David's particular cultural environment and how it has influenced his self-concept can also be accomplished by asking open-ended questions about his thoughts, feelings, and experiences. It is essential to recognize that the person-centered approach may partially address David's cultural factors. For instance, this therapy may not specifically address his race/ethnicity, sexual orientation, or religion/spirituality. In order to effectively treat David, it is crucial to be culturally aware, sympathetic, and aware of how cultural influences may affect David's experiences. In conclusion, individuals like David might benefit from the person-centered approach. Clients from many cultural backgrounds can benefit from the technique because of its emphasis on the individual's subjective reality and the therapist's capacity to develop a supportive environment.

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