Grand Roundshi And Thanks For Attending This Case Presentation My Na ✓ Solved

Grand Rounds Hi, and thanks for attending this case presentation. My name is Dr. Stephen Brewer and I am a licensed clinical psychologist in San Diego, California and Assistant Professor of Psychology and Applied Behavioral Sciences at Ashford University. Today, I will be sharing with you the story of Bob. Presenting problem Bob Smith is a 36-year-old man who came to me approximately six months ago with concerns about his career choice and life direction.

He did not have any significant psychiatric symptoms, besides some understandable existential anxiety regarding his future. Bob was cooperative, friendly, open, and knowledgeable about psychology during our first few sessions together. I noticed that he seemed guarded only when talking about his family and childhood experiences. To confirm his identity, I checked his driver’s license to ensure his name was indeed Bob Smith and that he lived close by in a mobile home in Spring Valley. Given his relatively mild symptoms, we decided to meet once a week for supportive psychotherapy so he could work through his anxieties.

I gave him a diagnosis of adjustment disorder with anxiety. History Here’s some background on Bob to give you a sense of who he is. Family Bob grew up as an only child in Edmonton, Canada, in a low-income, conservative, and very religious household. He shared that his father was largely absent during his childhood, as he spent most of the week residing north of Edmonton, where he worked as a mechanic in the oil fields near Fort McMurray. On weekends, Bob’s father would return home and spend as much time as possible with his family.

Bob described his father as warm, caring, and a hard worker. His father reportedly died one year ago. Bob’s mother was described as a strict, rule-based woman who had a short temper and was prone to furious outbursts over trivial matters. She worked in Bob’s junior high as a janitor, which meant that Bob often crossed paths with his mother at school, where she would often check up on him. During Bob’s high school years, Bob’s mother got a new job as a high school librarian.

At 18, Bob moved to San Diego to study psychology at San Diego State University. He lived in the dorms for his first few years, where he easily made friends and joined a fraternity. Bob maintained contact with his parents, but ceased all contact when his mother suggested she would move to San Diego to be closer to him. He graduated with a 3.2 GPA and began working for the county as a psychiatric technician. He worked as a psych tech for 14 years and described it as “fun at first, but it got boring and predictable after a while.†Treatment Bob shared that he has a medical doctor that he visits once every few years for his routine physical.

He denied having any significant medical problems. Additionally, he denied using any illicit substances and reported drinking only on occasion with friends from his fraternity. Collateral About a month ago, I was curious to learn more about Bob from his friends and mother. He was happy to sign a release of information for me to speak with his friends, but he refused to sign one so I could talk with his mother. Still, since his mother’s point of view seemed very important to me, I hired a private detective to find Bob’s mother’s contact information so I could speak with her about Bob’s life and treatment.

Bob’s fraternity friends shared some startling information that I wasn’t expecting to hear. They shared they were relieved that Bob was seeing a psychologist and that they have been trying to convince Bob to see a psychologist for years. They added that Bob’s personality changed significantly approximately three years ago. Where Bob was originally a friendly, gregarious, outgoing individual, he suddenly turned into a suspicious and reclusive man who disappeared for months at a time. They observed Bob losing a significant amount of weight over the course of only a few months, and they suspected drug use of some kind.

According to them, Bob hasn’t been showing up to work regularly and doesn’t return their calls. Current symptoms Here is my problem. Bob’s current presentation in therapy seems to be incongruent with what I’ve only recently learned from his friends. It’s almost as if I’m learning about two completely different people. Although Bob seems to be friendly and open with me, his friends describe him as suspicious and closed off.

This is puzzling. Question Given this new information, how should I make sense of Bob? 4.01 Maintaining Confidentiality Psychologists have a primary obligation and take reasonable precautions to protect confidential information obtained through or stored in any medium, recognizing that the extent and limits of confidentiality may be regulated by law or established by institutional rules or professional or scientific relationship. (See also Standard 2.05, Delegation of Work to Others .) 4.02 Discussing the Limits of Confidentiality (a) Psychologists discuss with persons (including, to the extent feasible, persons who are legally incapable of giving informed consent and their legal representatives) and organizations with whom they establish a scientific or professional relationship (1) the relevant limits of confidentiality and (2) the foreseeable uses of the information generated through their psychological activities. (See also Standard 3.10, Informed Consent .) (b) Unless it is not feasible or is contraindicated, the discussion of confidentiality occurs at the outset of the relationship and thereafter as new circumstances may warrant. (c) Psychologists who offer services, products, or information via electronic transmission inform clients/patients of the risks to privacy and limits of confidentiality.

4.03 Recording Before recording the voices or images of individuals to whom they provide services, psychologists obtain permission from all such persons or their legal representatives. (See also Standards 8.03, Informed Consent for Recording Voices and Images in Research ; 8.05, Dispensing with Informed Consent for Research ; and 8.07, Deception in Research .) 4.04 Minimizing Intrusions on Privacy (a) Psychologists include in written and oral reports and consultations, only information germane to the purpose for which the communication is made. (b) Psychologists discuss confidential information obtained in their work only for appropriate scientific or professional purposes and only with persons clearly concerned with such matters.

4.05 Disclosures (a) Psychologists may disclose confidential information with the appropriate consent of the organizational client, the individual client/patient, or another legally authorized person on behalf of the client/patient unless prohibited by law. (b) Psychologists disclose confidential information without the consent of the individual only as mandated by law, or where permitted by law for a valid purpose such as to (1) provide needed professional services; (2) obtain appropriate professional consultations; (3) protect the client/patient, psychologist, or others from harm; or (4) obtain payment for services from a client/patient, in which instance disclosure is limited to the minimum that is necessary to achieve the purpose. (See also Standard 6.04e, Fees and Financial Arrangements .) 4.06 Consultations When consulting with colleagues, (1) psychologists do not disclose confidential information that reasonably could lead to the identification of a client/patient, research participant, or other person or organization with whom they have a confidential relationship unless they have obtained the prior consent of the person or organization or the disclosure cannot be avoided, and (2) they disclose information only to the extent necessary to achieve the purposes of the consultation. (See also Standard 4.01, Maintaining Confidentiality .) 4.07 Use of Confidential Information for Didactic or Other Purposes Psychologists do not disclose in their writings, lectures, or other public media, confidential, personally identifiable information concerning their clients/patients, students, research participants, organizational clients, or other recipients of their services that they obtained during the course of their work, unless (1) they take reasonable steps to disguise the person or organization, (2)

Paper for above instructions

Introduction

Psychology often poses challenging dilemmas, particularly in contexts where patient narratives differ significantly from observations made by collateral sources. This case presentation introduces Bob Smith, a 36-year-old man experiencing existential anxiety regarding his career and life direction. Though initially opening up about his feelings, discrepancies between his self-reported experiences and the observations from friends create a complex therapeutic landscape. This paper will analyze Bob's situation by employing psychological principles, exploring possible explanations for his dual narratives, and discussing ethical considerations around confidentiality.

Case Analysis

Presenting Problem

Bob presented with existential anxiety without significant psychiatric symptoms. His concerns were about his career alignment and life choices. The diagnosis of adjustment disorder with anxiety was made, indicating a maladaptive response to stressors, particularly concerning his life transitions (American Psychiatric Association [APA], 2013).

Family Background

Bob's family dynamics provide crucial insights into his behavior. Raised in a conservative, religious household with a distant father and a strict mother, Bob's familial relationships seem to have negatively impacted his emotional and psychological well-being. Research indicates that early family experiences can significantly shape adult relational dynamics and self-perception (Bowlby, 1982; Mikulincer & Shaver, 2007). The absence of his father and the controlling nature of his mother likely contributed to Bob's initial enthusiastic personality transitioning into suspicion and withdrawal in later years.

Friends' Observations

The information gathered from Bob's friends indicated a stark contrast to Bob's self-presentation. They reported behavioral changes over the past three years, noting Bob's reclusiveness and significant weight loss, which raised suspicions of drug use. These observations may imply an underlying mental health issue unaddressed in therapy sessions. The discrepancy raises questions about the reliability of self-reports during therapy versus the observations of people in the patient's social circle (Yanos et al., 2010).

Therapeutic Implications

A Dual Personality?

The duality of Bob's personalities presents an expansive opportunity for exploration. While he appears engaged and open in therapy, his friends perceive him as suspicious and withdrawn. This incongruence may suggest several underlying issues:
1. Coping Mechanisms: Bob might utilize therapy as a coping mechanism for his anxiety while failing to acknowledge deeper psychological issues (Linley & Joseph, 2004).
2. Identity Conflict: Bob may be experiencing a conflict between his self-identity shaped by social expectations and the reality of his lived experience (Erikson, 1980).
3. Psychosocial Stressors: Increased existential pressure over time has likely exacerbated his preexisting issues, manifesting as changes in personality (Friedman, 2000).

Moving Forward with Treatment

In light of these findings, it is essential to reassess the treatment approach. Here are several steps to consider:
1. Enhanced Psychoeducation: Ensure Bob clearly understands the therapeutic aim and the importance of being truthful about his experiences.
2. Explore Family Dynamics: Delve deeper into family relationships to address any unresolved issues stemming from childhood.
3. Substance Use Exploration: Assess for potential substance abuse, building a therapeutic alliance that encourages honesty about lifestyle choices (Miller & Rollnick, 2013).
4. Utilization of Collateral Information: Bringing friends into therapy, with Bob's consent, might help clarify discrepancies and provide additional support.

Ethical Considerations

Confidentiality and Disclosure

The ethical framework governing Bob's therapy is guided primarily by the APA Ethical Principles of Psychologists and Code of Conduct (APA, 2017). Confidentiality is paramount in building a therapeutic alliance; it encourages openness from the client (Weinstock, 2000). In this case, ethical considerations arise around the contrasting perspectives on confidentiality when engaging collateral sources.
1. Limits of Confidentiality: Discussing the limits of confidentiality with Bob is critical, especially as friends offer insights that significantly diverge from Bob's narrative.
2. Seeking Consent for Collateral Information: While Bob consented to speak with friends, his refusal to engage with his mother highlights the sensitivity of family dynamics.
3. Possibility of Harm: If there is a risk of harm (due to possible substance abuse), the psychologists face an ethical dilemma regarding disclosure without patient consent (Knapp & VandeCreek, 2012).

Steps Forward

To navigate these challenges, the following steps can be taken:
1. Reiterate the Importance of Disclosure: Encourage open dialogue about how his past influences his current behavior and present-day choices.
2. Reassure Confidentiality: Reassure Bob that his confidentiality will be respected unless ethical guidelines require exceptions.
3. Therapeutic Monitoring: Regularly monitor Bob's symptoms and mood states to prevent any future crises related to potential substance abuse.

Conclusion

Bob's case exemplifies the complexities and ethical intricacies present in clinical psychology. A robust understanding of his family history, coupled with careful consideration of duality in self-presentation and underlying issues, can pave the way for more effective therapeutic outcomes. Noting the discrepancies in perspectives from Bob and his friends can also enrich the therapeutic process, fostering a deeper understanding of his experiences. Navigating confidentiality ethically while pursuing a resolution for Bob's presenting problem highlights the nuanced responsibility psychologists have in the therapeutic landscape.

References

1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: Author.
2. American Psychological Association. (2017). Ethical Principles of Psychologists and Code of Conduct. Washington, DC.
3. Bowlby, J. (1982). Attachment and Loss: Volume I. Attachment. New York, NY: Basic Books.
4. Erikson, E. H. (1980). Identity and the Life Cycle. New York, NY: W. W. Norton & Company.
5. Friedman, H. S. (2000). Personality and Health: Current Research Directions. Health Psychology, 19(1), 2-10.
6. Knapp, S., & VandeCreek, L. (2012). Ethical Issues in Psychotherapy: Standards and Practices. American Psychological Association.
7. Linley, P. A., & Joseph, S. (2004). Positive Psychology in Practice. Hoboken, NJ: Wiley.
8. Mikulincer, M., & Shaver, P. R. (2007). Attachment in Adulthood: Structure, Dynamics, and Change. New York, NY: Guilford Press.
9. Miller, W. R., & Rollnick, S. (2013). Motivational Interviewing: Helping People Change (3rd ed.). New York, NY: Guilford Press.
10. Weinstock, R. (2000). The Economics of Confidentiality in the Context of Psychotherapy. Professional Psychology: Research and Practice, 31(4), 359-364.