COUC-693: Benchmark Case Presentation Assignment
School of Behavioral Sciences, Liberty University
Case Presentation for Justin
Identifying Data
Date of Initial Assessment: 19/02/ 2026
Current Session Number: 3
Pseudonym: Justin
Age: 17
Gender: Male
Sexual Orientation: Heterosexual
Race & Ethnicity: African American
Marital Status: Single
Employment Status: Student
Part I – Intake Information
Reason for Referral/Presenting Problem
Justin’s mother referred him to this outpatient private counselling practice because she was concerned about his emotional dysregulation, anger outbursts, hygiene problems, school truancy, and inability to function independently. Justin is a 17-year-old African American boy who has a diagnosis of high-functioning Autism Spectrum Disorder (ASD) and has further concerns about mood-related symptoms. He becomes easily frustrated when not getting his needs met, yelling and slamming doors several times a week, according to his mother. Justin also has difficulties with personal hygiene, irregular school attendance, irritability, fatigue, and conflict in the home. He said he feels misunderstood and frustrated when others talk about his autism diagnosis, saying, “People keep saying to me, something is wrong with you.” He also reported family stress and the inconsistent involvement of his father as important emotional issues. While recognizing these obstacles, he said that he wanted to go to college, learn to be more independent, and study art. He denied suicidal or homicidal ideation.
Confidentiality
Confidentiality and its restrictions were discussed with the client and his mother. Justin and his mother provided verbal and written consent for treatment, supervision, and session recordings for academic purposes. HIPAA and informed consent forms were filled out before the first session. The client was advised that confidentiality would be upheld with the exception of situations of risk to self or others, suspected abuse, and legal requirements. Justin verbally confirmed his understanding and consent regarding recorded sessions, and it was explained that all recordings would be deleted after educational use.
Source of Information
The information for this intake assessment was gathered from a formal biopsychosocial-spiritual assessment with Justin and his mother. Semi-structured clinical interviews, behavioral observations, mental status examination, psychosocial history, and risk assessment procedures were used for data collection. Formal assessments included the PHQ-9 (Kroenke & Spitzer, 2002), which showed moderately severe depressive symptoms. Information obtained during the assessment led to the diagnoses of Adjustment Disorder with Mixed Anxiety and Depressed mood (F43.23) and Autism Spectrum disorder (F84.0).
Part II: Assessment
Observational Data/Mental Status Exam
Justin was willing to cooperate during the session, but sometimes drifted into side topics. His emotional tone was slightly irritated at times, and he seemed noticeably irritated at others. His verbal communication was logical and coherent, but there was an occasional abrupt change of topics. Justin appeared fully oriented to person, place, time, and situation. His mother often threatened to call the police and institutionalize him if he acted out during the session. The counselor told Justin to stay calm because if he did, the authorities would understand that there was a family conflict and act accordingly. Despite his emotional and behavioural issues, Justin appeared intelligent, future-oriented, and motivated, wanting to do well and create a successful future for himself.
Psychometric Assessment
Depressive symptoms were measured using the PHQ-9 (Kroenke & Spitzer, 2002). Justin’s total score was in the moderate range of depression (15-19). He reported feelings of low mood or depression on more than half of the days (2), sleep disturbances on almost every day (3), fatigue on almost every day (3), changes in appetite on almost every day (3), low self-worth on several days (1), mild psychomotor changes on several days (1), and no suicidal ideation (0). He denied concentration difficulties (0) COUC-693: Benchmark Case Presentation Assignment. At the time of assessment, Justin reported that his emotional problems were not severely affecting his work, home life, or relationships.
Biological Assessment
Justin is a 17-year-old African American, heterosexual male with a diagnosis of high-functioning Autism Spectrum Disorder. He is currently going through puberty and is very sensitive to routine and functioning. Justin resents the labels of autism and is distressed when the diagnosis is mentioned. His emotional and behavioral functioning is clearly affected by biological, psychological, social, and spiritual factors. He also has a major problem with hygiene and may not shower for extended periods of time, which may include days or months.
Sleep
Justin complained of poor sleep and continued fatigue. His depressive symptoms affect his energy level and ability to follow through with daily activities.
Diet
Justin primarily consumes takeout food and enjoys meals and beverages from Starbucks. His mother reported that hunger and failure to meet food expectations can sometimes lead to irritability and emotional outbursts.
Exercise
Justin reported that he does not regularly exercise due to family responsibilities, particularly helping care for his younger siblings.
Medical History
Justin reported no significant medical history or chronic medical conditions.
Medication
Justin reported taking one medication since approximately age 10 without any known adverse side effects. He is also taking a multi-vitamin supplement every day.
History of Developmental Milstone
Justin’s developmental milestones were reportedly within an expected age range with no delays in early childhood development noted, including walking, talking, or basic motor skills. He is described as intelligent, sharp, and well-behaved. Continued difficulties have been noted in later developmental functioning, especially in adaptive and self-care skills such as hygiene lapses, emotional regulation, and flexibility with routines, all of which are consistent with his autism spectrum presentation COUC-693: Benchmark Case Presentation Assignment.
Psychological Assessment
Historical Assessment
Before the current counseling services, Justin denied ever receiving counseling, psychiatric admission, or hospitalization treatment. Some current issues include interpersonal problems, anxiety, depressed mood, emotional dysregulation, and periods of extreme anger.
Trauma History
Justin denied any history of directly experiencing or witnessing traumatic events.
Addiction Screening
Justin denied any history of substance use, addiction, alcohol use, or illicit drug use.
Risk Assessment
The counselor evaluated Justin’s potential for self-harm and violence towards others by questioning him directly about his history of intentional self-destructive behaviors, suicidal ideation, homicidal ideation, and aggression toward others. He denied any previous suicide attempts, suicidal ideation, homicidal ideation, or any intent to harm others. His mother reported concerns about his anger and emotional outbursts, but there were no immediate safety concerns identified during the assessment.
Family Mental Health History
Justin reported that there were no known mental health diagnoses in his family. However, he described his mother as appearing to struggle with what he believes may be an undiagnosed depressive disorder.
Piaget’s Theory of Cognitive Development
Justin’s ability to think abstractly about his future goals, relationships, and independence suggests he is in Piaget’s formal operational stage of cognitive development. The main theoretical model used in treatment is Cognitive Behavioral Therapy (CBT). CBT focuses on helping Justin recognize how distorted or rigid thought patterns, such as believing things “must” happen a certain way, contribute to emotional distress, frustration, anger, and behavioral outbursts. The goals of the CBT interventions are to manage emotional regulation, adapt to change, address social and emotional issues associated with autism, and enhance family relationships (Chand et al., 2023).
Social Assessment
Cultural Factors
Justin is a young African American male who grew up in New Jersey in a single-parent family with an inconsistent father figure. His emotional development and coping skills have been affected by financial restrictions and family stressors. From Justin’s perspective, feeling misunderstood and labeled because of autism contributes to frustration and resentment. Treatment is directed at increasing his awareness of the role of rigid beliefs and unrealistic expectations in emotional distress, anger, and defiant behaviors, which affect his ability to be independent and maintain relationships.
Family of Origin
Justin currently resides with his mother and siblings, and his father lives separately and is inconsistently engaged in the family. He reported having a close relationship with his siblings and provides support with chores and schoolwork. He revealed that he was very close to his mother, even though there was some tension in the family. Justin shared his sadness about his father’s absence and inconsistency while growing up.
Romantic Partner Dynamic
Justin expressed interest in having a committed romantic relationship and stated that he hopes to ask someone out soon, although he feels hesitant and uncertain. He reported wanting a long-term girlfriend in the future.
Current Living Arrangements
The client lives with his mother, siblings, dog, and cat in the family home.
Academic History
Justin is currently a high school senior and hopes to attend college after graduation to pursue an arts degree. He has a particular interest in drawing cartoon characters and is very talented and creative.
Occupational History
The client is currently unemployed and financially dependent on his mother while attending high school.
Erikson’s Psychosocial Stages
Justin is in Erikson’s Intimacy vs. Isolation stage (McLeod, 2025). Justin is still a late adolescent, but shows a need for emotional attachment, significant relationships, and acceptance in the social scene. This is reflected in his interest in developing a romantic relationship and his desire for long-term companionship. His emotional dysregulation, rigid thinking patterns, inability to deal with frustrations, and autism issues, however, hinder him from consistently forming and sustaining healthy interpersonal relationships. Issues of self-acceptance and concerns about talking about autism could also play a role in his social withdrawal, insecurities, and inability to trust or share with other people. Despite these difficulties, Justin is still making strides towards connecting with people in his family and at school, indicating some growth in the area of relational functioning with additional emotional and behavioral support.
Current Social Support
Justin described having supportive relationships with peers, family members, and individuals within his church community. He has recognized these relationships as sources of emotional support.
Significant Life Events
Justin’s parents’ divorce and his father’s unpredictable behavior were significant emotional triggers. He expressed his desire for his father to be more involved in his life and for his family relationships to be better.
Spiritual Assessment
Spiritual/Religious History
The client reported no significant religious upbringing or family religious background.
Present Spiritual/Religious Beliefs
The client expressed his desire to know more about Christianity and to become closer to God.
Fowler’s Stages of Faith Development
Justin seems to be in Fowler’s stage of individuative-reflective faith, in which one starts to consider one’s own beliefs, identity, and spirituality independently (Armstrong, 2020).
Integration Assessment
The counselor evaluated the desirability of having spiritual beliefs included in counseling with Justin. Justin said he would be willing to have sessions on Christianity and spiritual growth.
Client’s Story: Background and Current Concerns
Justin is currently 17 years old and approaching adulthood. His goal is to become gainfully employed, attend college, and eventually reside on his own with supportive services and occasional supervision. The counselor will work with him after graduation to connect him with community and educational services. Justin’s main concerns are high levels of anger towards teachers, emotional regulation issues, school absences, poor hygiene, and conflict within the family around caregiving of his younger siblings. These are stressors that cause chronic frustration, irritability, and poor emotional regulation.
Barriers to Treatment/Success
Factors that make treatment difficult are Justin’s denial and rejection of his autism diagnosis, family dynamics that include enabling behaviors, emotional sensitivity to criticism, and recent emotional distress stemming from parental separation. Family threats of police or institutional placement can also bring about feelings of anxiety, defensiveness, and a lack of willingness to move forward with treatment.
Part III: Diagnosis – 1 page
Principal Diagnosis: (F43.23) Adjustment Disorder with Mixed Anxiety and Depressed Mood, Acute
Diagnosis 2: (F84.0) Autism Spectrum Disorder, Level 1, Requiring Support
Diagnosis 3 / Z-Code: (Z63.5) Disruption of Family by Separation or Divorce
Provisional Diagnosis: (F39) Unspecified Mood Disorder (Provisional)
Differential Diagnosis: (F41.1) Generalized Anxiety Disorder, (F33.1) Major Depressive Disorder, Recurrent Episode, Mild Severity, (F31.9) Bipolar Disorder, Unspecified, (F25.9) Schizoaffective Disorder, Unspecified
Diagnosis Rationale
Justin’s emotional and behavioral symptoms met criteria for Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23) due to the presence of emotional and behavioral symptoms that arose in response to continued psychosocial stressors such as parental separation, family conflict, caring responsibilities, and academic challenges. Justin became irritable and angry, had emotional breakdowns, low motivation, poor hygiene, tiredness, and depressed mood, which worsened over a period of months. His symptoms are consistent with Criterion A of Adjustment Disorder in that they appeared after identifiable stressors, including family instability and school-related stressors (Maercker & Lorenz, 2023). High levels of distress and impairment in functioning, such as school avoidance, social problems, and problems with interpersonal functioning, support Criterion B. It is appropriate to add the “with mixed anxiety and depressed mood” specifier because of the presence of irritability, worry, fatigue, sleep disturbance, sadness, appetite changes, and emotional frustration. Justin’s PHQ-9 score fell within the moderately severe depression range (15–19), further supporting depressive symptomology. The phrase “acute” is suitable, as the symptoms are present for less than 6 months. His symptoms are also not better accounted for by bereavement or by another well-established mental disorder at this time.
Justin also meets the criteria for Autism Spectrum Disorder (F84.0), Level 1 Requiring Support, as evidenced by persistent social, emotional, behavioral, and adaptive functioning difficulties (Mughal et al., 2025). His thinking patterns are rigid, he has emotional regulation issues, is sensitive to changes in routine, has social difficulties, and has major challenges with independent living skills/hygiene. He is reported by family members to need supervision with self-care items and to be having some difficulties functioning on his own. Justin is very sensitive to being talked about as having autism and is upset and angry when it is mentioned, suggesting poor awareness and processing of the autism diagnosis. However, he possesses intellectual attributes, creativity, and long-term thinking, especially in his interests in art and college plans. Symptoms of the disorder have been present over the lifespan and interfere with interpersonal, emotional, and adaptive function.
The Z-code, Disruption of Family by Separation or Divorce (Z63.5) is used because of the emotional consequences of Justin’s parents’ separation and his father’s erratic engagement with him. Justin felt sad and frustrated about his dad’s absence, and said he’d like to have better relationships. He seems to have a lot of problems with emotions, anger, and coping, which may be related to family conflict and instability.
A provisional diagnosis of Unspecified Mood Disorder (F39) has been added as some symptoms of Justin’s behaviour suggest he may have an emerging mood disorder; irritability, mood fluctuation, emotional lability, anger outbursts, sleep disturbance, and tangential thought processes. The family has raised concerns about the possibility of bipolar disorder, schizoaffective disorder, or schizophrenia. But at the time of assessment, there is not enough evidence of manic episodes, psychosis, and/or persistent mood episodes to diagnose a manic disorder. Ongoing observation and evaluation are indicated during treatment.
A range of differentials is still being considered. Justin exhibits features of Generalized Anxiety Disorder (F41.1) such as being irritable, fatigued, emotionally tense, and excessively worried about family conflict, independence, and school functioning. There is, however, a lack of evidence that the anxiety has been present more days than not for at least the past six months in a variety of domains, apart from situational stressors (Munir & Takov, 2022). The diagnosis of Major Depressive Disorder, Recurrent Episode, Mild Severity (F33.1) is also being considered because of the symptoms of low mood, fatigue, poor hygiene, appetite changes, sleep disturbance, and social withdrawal (Bains & Abdijadid, 2023). Currently, however, it is more likely that his depressive symptoms are related to situational stressors or adjustment difficulties rather than a specific major depressive episode. Also, Bipolar Disorder (F31.9) and Schizoaffective Disorder (F25.9) are ruled out possibilities due to occasional tangential thinking, emotional instability, and family concerns about possible psychotic or mood-related symptoms. Currently, Justin doesn’t exhibit enough manic or persistent psychosis or delusions to help confirm these diagnoses. Continuous evaluation will be carried out during the counseling process.
Part IV– Case Conceptualization
Theoretical Orientation
The main theoretical framework underlying treatment is Cognitive Behavioral Therapy (CBT) (Chand et al., 2023). CBT is based on the premise that cognitive processes (automatic thoughts and core beliefs) directly influence emotional responses and behavioral outcomes. Sustaining emotional arousal and maintaining maladaptive behaviors like aggression, avoidance, or withdrawal can be caused by maladaptive or distorted cognitions, including rigid “must” beliefs and all-or-nothing thinking. CBT is a well-established evidence-based therapy for depression, anxiety disorders, adjustment disorders, and emotional regulation problems, especially when combined with behavior therapy (e.g., behavioral activation, cognitive restructuring, skills training) (O’Toole et al., 2025). CBT has also been shown to be effective for adolescents who have a neurodevelopmental disorder, like ASD, as long as interventions are structured, concrete, and skill-based (Hazem et al., 2026).
Narrative of the Case Conceptualization
Presentation of the Problem
Justin is a 17-year-old male with a history of emotional dysregulation and chronic irritability, frequent temper tantrums, school avoidance, poor hygiene, and depressed mood. Symptoms have been present for several months, with varying degrees of intensity, and are elicited by failure to meet expectations (often in relation to hunger, changes to routine, school demands, family conflict). He often feels frustrated and may have behavioral reactions like yelling, slamming doors, and not doing tasks. The PHQ-9 score of 15-19 is indicative of moderately severe depressive symptoms, such as fatigue almost every day, sleep problems, appetite changes, and low mood. On a functional level, these symptoms affect his performance in school, in his daily activities, and in his relationships with family. Justin also exhibits cognitive rigidity, often when speaking about his autism diagnosis, leading to emotional escalation and resistance. He is currently aware of his challenges as stemming from external frustrations (family stressors, school demands), and it seems that he may have some deeper cognitive distortions that are driving emotional reactivity and behavioral instability..
Precipitating/Triggering Factors
Family stressors such as parental separation, inconsistent father involvement, and increased family responsibilities seem to coincide with the onset and worsening of Justin’s symptoms. Other precipitants are academic stress during his last year of high school, social expectations, and the conflicts over his diagnosis of Autism Spectrum Disorder. These stressors are increasing emotional reactivity and emotional dysregulation and have led to increased school avoidance.
Patterns of Maladaptive Behaviors/Coping and Functional Coping/Resiliency
Justin’s coping mechanisms are maladaptive, such as yelling/emotional outbursts, avoidance of school, resistance to hygiene, and withdrawal when overwhelmed. He also exhibits cognitive inflexibility when he encounters stressors, especially when expectations are not met, and this can become exacerbated if the stressors occur. However, Justin also demonstrates functional coping and resilience. He helps out his mother with housework, including pet care, and despite some attendance problems, is enrolled in school. He shows a positive interest in art and future college aspirations, with a sense of motivation and future orientation. His attitude towards change seems to be ambivalent; he wants to be independent and succeed, but has difficulties in emotional self-regulation and adaptive coping.
Predisposing Factors
Justin’s developmental predispositions include Autism Spectrum Disorder, which affects his emotional regulation, flexibility, and social functioning. Vulnerability is compounded by ongoing difficulties with hygiene and routine maintenance, and early difficulties with adaptive skills. Factors related to family structure, such as lack of consistent fathers’ involvement in the child’s life and living in a single-parent family, also factor into emotional insecurity and a lack of coping models. His cognitive rigidity and sensitivity to change increase his risk for stress-related emotional escalation.
Perpetuating Factors of the Problem(s)
Justin’s presenting issues are sustained by several factors. Conflict and lack of consistency within the family strengthen unstable family relationships. School avoidance and irregularities in personal care habits perpetuate maladaptive coping styles, and episodes of emotional outburst may trigger family reactions, such as threats of punishment or incarceration, which heighten anxiety and resistance. Emotional reactivity is exacerbated by rigid “must” beliefs (cognitive distortions) that increase the association of “must” statements with emotions, for example, “things must go my way”. Lack of structured coping skills for emotional regulation also perpetuates difficulties in managing stress (Flores-Kanter et al., 2021).
Protective Factors/Strengths
Justin has a range of strengths, such as intellectual skills, artistic talent (specifically drawing), and his future-oriented aspirations for college and creative endeavors. He has some involvement in school and/or household duties, including caregiving. He also demonstrates the ability to be sensitive and connected to others within the family structure, especially to siblings and his mother. His willingness to participate in counseling and absence of suicidal or homicidal ideation are additional protective factors.
Prognosis
Justin’s prognosis is guarded with therapeutic engagement. His young age, cognitive strengths, and interest in future goals suggest good potential for improvement. However, factors like cognitive rigidity, familial stress, denial of diagnosis, and inconsistent emotional regulation can impede progress. Structured CBT interventions, family involvement, and skills-based emotional regulation training will lead to meaningful improvement in functioning over time.
Applying a Theoretical Lens
In the CBT view, Justin’s emotional and behavioral issues stem from maladaptive core beliefs and cognitive distortions, such as absolute thinking styles (a belief that things must go a certain way) or hostile reactions to others or feelings of failure when expectations are not met (Chand et al., 2023). These beliefs give rise to automatic thoughts that amplify feelings of anger, frustration, and irritation, leading to behavioral reactions such as avoidance, aggression, and refusal behaviors. CBT views Justin’s difficulties with his autism as a cognitive flexibility and coping problem and not a problem of defiant behaviour, so treatment is directed at skill acquisition (learning), not punishment.
Interventions will be based around cognitive restructuring to identify and challenge rigid thinking patterns, behaviour activation to enhance school attendance and hygiene habits, and structured skills training to enhance emotional regulation and problem-solving. Social skills training and role-playing will be used to enhance communication and family interaction. CBT-based approaches for adolescents with emotional dysregulation and autism spectrum features suggest the use of visual supports and repetition of skills for increasing understanding and generalization (Smrithy & Chandrasekaran, 2026).
Part V – Spiritual Integration
Personal Integration Approach
The integration model chosen is the Allies model (Krause, 2026). This model centers on the idea that psychology and the Christian faith are complementary sources of truth; Scripture is the ultimate source of truth, but psychological science offers valuable insights into human functioning and behaviour. In this context, all truth is viewed as God’s truth, and psychological models like CBT may be ethically and effectively applied from a Christian perspective. Given Justin’s needs, this approach is suitable as it provides evidence-based treatment of emotional dysregulation, cognitive rigidity, and behavioral issues, and is also spiritually flexible in order to accommodate a client’s readiness and desire to explore spirituality. It also encourages developmentally appropriate integration, particularly with Justin’s growing curiosity about Christianity and his need to learn more about faith.
Implicit Integration
Spiritual integration is used implicitly and with due consideration to Justin’s autonomy, developmental level, and curiosity to explore spirituality without imposing religious belief. For example, spiritual values can be explored in sessions, including our sense of self-worth, identity, forgiveness, purpose, and hope, without religious language, unless the client brings it up. The counselor can also demonstrate principles that are compatible with Christian values, such as compassion, patience, and restoration, while maintaining a client-centered and culturally sensitive approach in alignment with the American Counseling Association [ACA] Code of Ethics (2014), particularly A.4.b, which emphasizes avoiding imposition of counselor values. The counselor uses prayer privately prior to and after sessions as a means of seeking God’s wisdom and guidance regarding how to best help the client, but it is not included in sessions unless requested by Justin. CBT interventions may indirectly address spiritual issues involving meaning, identity, and coping with family separation.
Explicit Integration
Explicit spiritual integration is introduced only based on Justin’s expressed interest and consent. Justin showed some interest in learning more about Christianity and a desire to get to know God, thus allowing for some, but not too much, spiritually focused content to be included. If appropriate, there may be open discussion about Christian beliefs and values and the role of spirituality in coping with stress, managing emotions, and the development of identity in sessions. Intervention strategies can involve discussing the meaning of faith-based vocabulary like grace, forgiveness, and patience in Justin’s thinking and responses to difficult situations. Scripture-based reflections or spiritual discussions may be used in a supportive and non-directive manner, ensuring that Justin remains free to accept or reject these ideas.
Spiritual integration is carefully aligned with CBT techniques by asking reflective questions such as how Justin’s beliefs about God, purpose, or identity influence his thoughts and emotional responses. However, care is taken to avoid directing or prescribing religious beliefs, in accordance with ACA ethical standards (2014), ensuring that counseling remains client-led. If Justin’s openness to faith decreases, spiritual content would be reduced or removed entirely to maintain ethical practice and respect for client autonomy.
Part VI – Treatment Plan
Treatment Plan
Problems
1.
F43.23 Adjustment Disorder with Mixed Anxiety and Depressed Mood (acute)
– irritability, anger outbursts when needs are not met, school avoidance, withdrawal from daily routines (e.g., hygiene neglect), emotional dysregulation, anxiety, and low mood related to environmental stressors.
2.
F84.0 Autism Spectrum Disorder
– rigidity in thinking, difficulty with emotional regulation and transitions, sensory and routine-related distress, hygiene noncompliance, and difficulty interpreting/expressing emotional states effectively.
3.
Z63.8 Other specified problems related to primary support group (family relational strain)
– ongoing tension within the family system, caregiver stress, and conflict surrounding expectations, routines, and behavioral responses.
Goals for Change
1.
Adjustment Disorder (F43.23)
· Decrease frequency and intensity of anger outbursts from daily/weekly episodes to no more than 1 mild episode per week within 8–10 weeks.
· Increase emotional regulation skills so client can identify feelings and use at least 2 coping strategies before behavioral escalation.
· Improve school attendance consistency to at least 80–90% of scheduled school days.
2.
Autism Spectrum Disorder (F84.0)
· Increase adaptive daily functioning, including completion of hygiene routine (showering, grooming) at least 4–5 days per week.
· Improve flexibility in response to unmet needs (e.g., hunger delays, schedule changes) using coping tools instead of behavioral escalation.
· Strengthen communication of needs using structured verbal expression or visual prompts.
Family Relational Stress (Z63.8)
Reduce family conflict related to expectations and routines through improved communication patterns.
Increase caregiver-client collaboration in setting a consistent daily structure.
Improve emotional understanding between the client and caregiver system.
Objectives & Therapeutic Interventions
The client is expected to engage in approximately
12–16 weekly CBT-informed sessions
, integrating behavioral, cognitive, and family-support strategies (Beck, 2021; Jongsma et al., 2014).
1. F43.23 Adjustment Disorder with Mixed Anxiety and Depressed Mood
Goal A: Recognize and reduce maladaptive emotional and behavioral responses
Objective – Client will identify at least 3 triggers for anger and anxiety responses (e.g., hunger delays, school demands, routine disruption).
· Intervention: Counselor will provide psychoeducation on CBT model (thought–feeling–behavior connection).
· Intervention: Counselor will assist client in completing structured emotion logs.
· Intervention: Use visual aids to support emotional identification.
Objective – Client will demonstrate use of at least 2 coping skills before escalation (e.g., deep breathing, pause strategy).
· Intervention: Counselor will teach coping skills training and behavioral rehearsal.
· Intervention: Counselor will use role-play scenarios involving frustration triggers.
· Intervention: Reinforce adaptive coping through positive reinforcement strategies.
Goal B: Increase adaptive functioning and reduce avoidance behaviors
Objective – Client will attend school at least 4 days per week consistently over a 4-week period.
· Intervention: Counselor will collaborate with family to develop a structured routine plan.
· Intervention: Counselor will use behavioral activation strategies tied to personal interests (e.g., drawing, creative goals).
· Intervention: Provide a reinforcement system for attendance consistency.
Objective – Client will participate in at least 1 structured daily responsibility (home or school-related).
· Intervention: Counselor will use task breakdown strategies for executive functioning support.
· Intervention: Counselor will provide visual scheduling tools.
· Intervention: Reinforce completion of tasks using a reward-based system.
2. F84.0 Autism Spectrum Disorder
Goal A: Improve daily living skills and hygiene consistency
Objective – Client will complete hygiene routine (showering, grooming) at least 4–5 days weekly.
· Intervention: Counselor will use behavioral chaining and step-by-step visual routines.
· Intervention: Counselor will collaborate with caregiver to establish structured reminders.
· Intervention: Reinforce completion using a token or reward system.
Objective – Client will independently initiate at least 1 self-care activity daily.
Intervention: Counselor will teach routine-building using habit stacking strategies.
Intervention: Counselor will use modeling and guided practice.
Intervention: Reinforce autonomy-building behaviors.
Goal B: Improve emotional regulation and flexibility
Objective – Client will reduce aggressive responses (e.g., door slamming) by 50% within 8–10 weeks.
· Intervention: Counselor will implement CBT-based frustration tolerance training.
· Intervention: Counselor will teach replacement behaviors for anger expression.
· Intervention: Use social stories to model adaptive responses.
Objective – Client will identify alternative responses during unmet needs situations.
· Intervention: Counselor will use role-play and rehearsal of real-life scenarios.
· Intervention: Counselor will incorporate interest-based engagement (e.g., drawing, animated references like
Bluey
) to enhance engagement.
· Intervention: Reinforce flexible thinking patterns.
3. Z63.8 Family Relational Stress
Goal A: Improve family communication and reduce conflict
Objective – Family will participate in structured communication sessions weekly.
· Intervention: Counselor will provide psychoeducation on effective communication skills.
· Intervention: Counselor will teach “I-statements” and active listening techniques.
· Intervention: Facilitate family role-play exercises.
Objective – Family will establish consistent daily routine expectations collaboratively.
· Intervention: Counselor will assist in creating shared behavioral contracts.
· Intervention: Counselor will support the caregiver in reinforcing consistent expectations.
· Intervention: Provide psychoeducation on autism-informed parenting strategies.
Outcome Measures of Change
· Reduction in anger outbursts (self-report and caregiver report).
· Improved hygiene consistency tracked via weekly checklist.
· Increased school attendance percentage.
· Improved emotional regulation scores via session rating scales.
· Pre- and post-assessment using standardized measures (e.g., PHQ-9, GAD-7 adapted as needed, behavioral tracking logs).
· Caregiver and client report of improved communication and reduced family conflict.
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https://www.ncbi.nlm.nih.gov/books/NBK441870/
O’Toole, M. S., Ramsdal, N. B., Nørskov, C. S., Roepstorff, I. T., Buskbjerg, C. D. R., Mads , B., Christiansen, N., & Elkjær, E. (2025). Cognitive behavioral therapies are evidence-based – based on what? A systematic review and meta-analysis of recent randomized controlled trials of cognitive behavioral therapies for depression.
Journal of Affective Disorders
, 119791–119791.
https://doi.org/10.1016/j.jad.2025.119791
Smrithy, G. S., & Chandrasekaran, B. (2026). Toward an integrated cognitive–contemplative framework for student mental health: A conceptual analysis of Vedic psychological principles and cognitive behavioral therapy in education.
Frontiers in Education
,
11
.
https://doi.org/10.3389/feduc.2026.1817984
COUC-693: Benchmark Case Presentation Assignment
Benchmark Case Presentation Assignment Instructions
The benchmark case presentation will be in oral and written formats across the program. In some courses, you will only have to focus on certain aspects of the case presentation (e.g., assessment, diagnosis, treatment planning, case conceptualization, etc.). Your written paper should about 10 pages, not including title or reference pages, double-spaced (except in the treatment plan chart), and follow APA professional guidelines format. You should have at least 5 recent academic sources, specifically in the diagnosis, case conceptualization, treatment planning, and integration sections. Please be concise yet thorough in covering the information requested.
Identifying Data
Date of Initial Assessment:
Current Session Number:
Pseudonym (DO NOT use the actual client’s real name):
Age:
Gender:
Sexual Orientation:
Race & Ethnicity:
Marital Status:
Employment Status:
Part I – Intake Information – 1 to 1.5 pages
Reason for Referral/Presenting Problem
In this section, offer the referral status (i.e., self-referred, school referral, court-ordered) and provide the initial reason for the referral. This may be a triggering event, such as a divorce, death, pandemic, loss of employment, bullying, or a client-reported increase in signs, symptoms, impaired functioning, etc. Ideally, offering direct quotes on how the client describes the reason. This is a short paragraph in length. Include a 1-sentence description of the type of Mental Health Setting in which you counseled this client. Be sure to include a brief description of the presenting problems/symptoms the client is experiencing. This problem(s)/symptom(s) represents the initial focus/concern for which the client is seeking counseling, and your description of this problem/symptom should include objective and measurable information, including the frequency, intensity, and impacts of the problem(s). To protect the confidentiality of your client, please refer to them by a pseudonym in your case presentation.
Confidentiality
This section should include a statement indicating that confidentiality was reviewed and the limitations therein. In addition, provide the procedures used for reviewing confidentiality with your client.
Source of Information
Provide the source and method of data collection used in preparing this report. This includes both formal and informal assessments in the summary, as well as throughout the case presentation, as necessary to support your conclusions. A semi-structured interview is necessary in this section, but you should also include a battery of formal and other assessments (e.g., DSM-5 cross-cutting measures, GAD-7, PHQ-9, PCL-5, etc.).
Part II: Assessment – 4 to 6 pages
Offer clinically relevant background information on the client. Write this out in paragraph format – no bullet points. The section should include the following in this order:
Observational Data/Mental Status Exam
This section should include all components of the Mental Status Exam, including observations, mood, speech, affect, cognition, perception, thoughts, behavior, insight, and judgment.
Psychometric Assessment
This section should include which, if any, assessments, inventories, or psychological scales were used to assess the client, along with their scores and results.
Biological Assessment
Demographic Information: age, gender, sexual orientation, ethnicity, marital status, children, etc.
Each of the following sub-sections should have a level-three heading:
Sleep
Diet
Exercise
Medical History
Medication – include the reason for the medication
Other pertinent information (this could include history of developmental milestones, sexual adjustment, pornography use, menstrual cycle for women, number of pregnancies/births, fertility issues, testosterone levels for men, etc.)
Psychological Assessment
Historical assessment – including whether the client has been to counseling in the past, any psychiatric hospitalizations, or any previous mental health diagnoses
Trauma history
Addiction Screening, including substance use history: Description of client’s alcohol/drug use, patterns of use, and last use; as well as how often the client uses and how much.
Risk Assessment – include
how
you assessed the client’s risk.
Family Mental Health History
Piaget’s Theory of Cognitive Development
Social Assessment
Cultural Factors – Does the client have any factors such as acculturation, discrimination, etc. that impact the client and may be a source of signs, symptoms? How would the client explain the problem from their cultural lens?
Family of Origin – identifying information about the client, parents, and siblings (i.e., ages, occupations, etc.). Client’s perception of the home environment and relationships within the family. Critical family incidents may be included.
Romantic partner dynamic – include any information about the client’s current relationship that would be helpful.
Current Living Arrangements
Academic History – Description of pertinent information in relation to educational background, including academic achievement, school instances that were significant for understanding the individual and the client’s attitude toward education. Any assessment information would be helpful.
Occupational History – A description of the client’s vocational history. Emphasis should be placed on current occupational functioning, history of work problems, and reason for change. Quality of work, satisfaction, and interests.
Erikson’s Psychosocial Stages – what stage is the client currently in, and what stage should the client developmentally be in according to Erikson’s theory?
Current Social Support
Recent/Historical Life Adjustments or Significant Life Events
Spiritual Assessment
Spiritual/Religious History
Present Spiritual/Religious Beliefs – Does the client believe in God? Attend church? What role does religious affiliation play in the client’s life? Are spiritual resources or issues important to the client? How does the client describe God? What is the state of the client’s spiritual awareness?
Fowler’s Stages of Faith Development – What stage is the client currently in?
Integration Assessment – Did you assess whether the client would like their spiritual beliefs to be incorporated into the counseling process? In what specific ways would the client like their beliefs incorporated (prayer, Scripture, spiritual discussion, etc.?)
History of Presenting Problem
Offer historical as well as present signs, symptoms, onset, duration, frequency, severity, areas of dysfunction, and other relevant data that will be needed for diagnosis and case conceptualization. Write this out in paragraph format – no bullet points. Do not include a diagnosis here.
Barriers to Treatment/Success
Are there personality factors, stages of change influences, or contextual factors that would influence the success of treatment?
Part III: Diagnosis – 1 page
Principal Diagnosis –
Primary diagnosis, including ICD-10 code, severity, specifiers, etc.
Diagnosis 2 or z-code –
Diagnosis, ICD-10 code, severity, specifiers, etc.
Diagnosis 3 or z-code –
Diagnosis, ICD-10 code, severity, specifiers, etc.
Provisional Diagnosis –
These diagnoses include those that you believe the client meets, but you are tentative in your determination. Provisional diagnoses are often applied at the start of the counseling process and then fully confirmed as Primary Diagnoses as time goes on.
Differential Diagnosis –
Be sure to include diagnoses that you are still assessing for to rule them out (For example, you may be ruling out Generalized Anxiety Disorder, but the client has not yet had anxiety for 6 months or longer, so you’re keeping it as a rule-out diagnosis). These are diagnoses that you want to “watch” and consider as alternative explanations for the client’s problems/symptoms.
Offer all your diagnoses and Z-codes in order of priority. Include the ICD-10 code, severity, specifiers, etc., for each disorder. The first diagnosis is called the principal diagnosis. If the client does not meet all the criteria for a disorder, and it is likely that they will if you had more information, offer that it is provisional – ex, Generalized anxiety disorder (provisional).
Diagnosis Rationale
When writing this section, offer each disorder’s criteria with case data to support the diagnosis. Do not simply repeat the criteria from the DSM; provide the specific criterion AND then offer objective evidence from the client’s case to justify/explain how this criterion is met. If a criterion is not met for an aspect of a diagnosis, be sure to include an explanation with objective, measurable evidence for this as well. For each diagnosis, offer a separate paragraph in the diagnostic impression/rationale. Below are examples of incorrect and correct ways to write it up:
Not correct – The client has marked fear about one or more social situations. The individual fears that he will act in a way or show anxiety symptoms that will be negatively evaluated (offered DSM criteria only).
Not correct – The client is depressed and noted sadness during the interview. The client isolated herself at home (problem, did not connect to DSM criteria).
Correct – The client has marked fear in several social situations as evidenced by her fear when presenting in class, turning in a paper, and speaking with classmates (A1). She is fearful to speak up when feeling wronged by her supervisor, avoids chatting with co-workers, and isolates herself at home when asked to attend social events (A2). Her fears are founded on that she will act in ways that will be perceived negatively by instructors, classmates, and coworkers(B3). Offer criteria and case study data to support it.
Make sure to use Z codes as needed that are found in the back of the DSM-5. At times if no disorder is appropriate, a z-code may be what is principal diagnosis.
Make sure to offer a paragraph of z-codes in the diagnostic impression/rationale.
The first paragraph is only for the principal diagnosis, the next paragraph is on the second disorder, and then additional paragraphs are for the other disorders. Each paragraph is to focus on only one disorder. It is like building a court defense. If your records are subpoenaed or you transfer a client to another counselor, they are not questioning your diagnosis as being incorrect, inconclusive based on the diagnostic discussion. For the final paragraph, discuss your differential diagnosis.
This section should include a concise rationale for each diagnosis, differential diagnoses, and Z codes provided above.
Part IV– Case Conceptualization – 1 page
Theoretical Orientation
This should be one paragraph where one theory is chosen, the major concepts are explained, and shown to be evidence-based using peer-reviewed journals.
Narrative of the Case Conceptualization
In this section, you will provide a conceptualization of the “whole person” by synthesizing the information provided in Part II and framing it within Sperry’s model of conceptualization. Include the following elements in this narrative.
Presentation of the Problem: Provide a detailed and comprehensive description of the presenting problem(s) with objective and measurable information, including the onset, duration, frequency, severity/intensity, and impairment/impacts of the problem(s) on daily life, with specific examples. Provide a hypothesis on the root causes of the current problem/functioning. Synthesize and summarize the client’s experience and the client’s understanding of the problem, the world, and relationships.
Precipitating/triggering factors: These include factors that contributed to the onset of the problem. Consider why the client is coming to counseling
now
. What changed in their life to bring them to counseling?
Patterns of maladaptive behaviors/coping and functional coping/resiliency: Discuss the client’s attempts to resolve the problem and their tendencies for certain ways of coping and managing the problem. Include a hypothesis on the client’s beliefs about resolving the problem and the client’s perspective of what a positive outcome in counseling will look like.
Predisposing factors: Synthesize the client’s bio/ psycho/ social/ level of functioning/ spiritual influences and how these factors may predispose the client to certain types of problems or challenges.
Perpetuating factors of the problem(s): Explain the factors in the client’s life that “fuel” the problem, exacerbate it, or contribute to it. These factors may be internal, environmental, circumstantial, or relational.
Protective factors/strengths: Discuss the client’s internal resources, functional ways of coping, areas of support and external resources that can be utilized in counseling/treatment.
Prognosis: Explain your hypothesis on the client’s needs for successful counseling outcomes, including an identification of potential barriers to success.
Applying a theoretical lens: Based on your conceptualization, how does your theory of counseling conceptualize this client? Describe the counseling process and goals from this theoretical orientation for this unique client. This section should reference and apply sources for application of theory such as counseling theories books, journal articles, etc.
Part V – Spiritual Integration – 1 page
This entire section should be a reflection about integration. It should include the following subsections:
Personal Integration Approach
Which integration approach are you using with this client, as described by Johnson’s (2010) Psychology and Christianity: Five Views or Entwistle’s (2015) Integrative Approaches to Psychology and Christianity, or King and Ford’s (2024) Christian Integration in Counselor Education, chapter two? (This subsection can be the same for Practicum, Internship 1, and Internship 2 if it has not changed.)
Implicit Integration
Include how you
implicitly
integrate faith into this client’s counseling in an ethical manner.
Explicit Integration
Include how you
explicitly
integrate faith into this client’s counseling in an ethical manner. If the client does not desire their faith to be integrated, it would be appropriate to state this and cite the relevant ACA
Code of Ethics
(2014).
Part VI – Treatment Plan – 1 page
Include the following treatment plan table:
Treatment Plan
Problems
1. Write out the client’s problems by order of problem (1. GAD – anxiety, restlessness, etc.; 2. Major Depressive Disorder – depressed mood, trouble concentrating, etc.)
2. You may have more than one problem to write out. For example, you may have major depressive disorder, generalized anxiety disorder, and Z62.820 parent-child relational problem, then write out these three problems (1, 2, 3).
Goals for Change
1. First problem here
· Write up specific, measurable (e.g., reduce, eliminate, increase, etc.) outcome goals.
2. Second problem here
· Write up the next set of specific, measurable outcome goals for this problem.
Objectives & Therapeutic Interventions
Offer your theory here and estimate treatment length based on the severity of the problems. For example, mild depression may be resolving in 5 to 10 weeks, but personality disorder in 5 to 10 years. If the client was depressed and had a personality disorder, you would treat the depression first and then the personality disorder. Also, within each problem you would tier the approach (e.g., you would not attempt to do cognitive restructuring without first offering education on the cognitive model, identifying the problematic situation, and conditional assumptions). Offer citations here that are used to support the interventions used (e.g., Jones & Jones, 2020) and offer full citations in references below. If the client has requested spiritual integration, be sure to include those spiritually relevant objectives and interventions.
1. Offer the first problem here.
A. Write the first goal here.
· Write the first objective (client will do…)
· Write your theoretical interventions (counselor will do…)
· Next intervention (as many interventions as needed to meet the objective).
· Write the second objective (client will do…)
· Write your theoretical interventions (counselor will do…)
· Next intervention (as many interventions as needed to meet the objective).
B. Write the second goal here.
· Write the first objective (client will do…)
· Write your theoretical interventions (counselor will do…)
· Next intervention (as many interventions as needed to meet the objective).
· Write the second objective (client will do…)
· Write your theoretical interventions (counselor will do…)
· Next intervention (as many interventions as needed to meet the objective).
2. Second problem as needed
· Write up the next step of tiered objectives and theoretically based interventions.
Outcome Measures of Change
Offer what the changes would look like for the client (increased euphoric moods, attentiveness, prosocial behaviors) as measured by…
· Offer how you will measure when the outcomes have been met.
· As practicum and internship students, you should be using both formal and informal assessments (e.g., PHQ-9, GAD-7, PCL-5, self-report, etc.).
References
(on separate page per APA 7)
COUC-693: Benchmark Case Presentation Assignment
Case Presentation of Justin
Identifying Data
Date of Initial Assessment: 02/19/2026
Current Session Number: 3
PSEUDO Name: Justin
Age: 17
Gender: Male
Sexual Orientation: Heterosexual
Race & Ethnicity: African American
Marital Status: Single
Employment Status : Student
——————————————————
Part I: Intake Information
Reason for Referral/Presenting Problem
Justin’s mother referred her 17-year-old African American son, a heterosexual high school senior, to this private practice for support. He lives with her and his sibling, remains single, and underwent an initial evaluation on February 19, 2026; this marks his third session. Diagnosed as high-functioning on the autism spectrum with possible bipolar disorder, schizoaffective disorder, or schizophrenia, he requires supervision for daily self-care to avoid risks like household hazards. His mother expresses concerns over potential aggression, prompting close monitoring. Although unable to reside alone now, he may transition to supported employment and semi-independent living after turning 18, with periodic check-ins and community resources arranged post-graduation. He reports no suicidal or homicidal thoughts, shows measurable advancement toward therapy objectives, and receives encouragement to sustain this momentum.
……………………………………………………………………………………..——————————————————————————————-
**Confidentiality**
I reviewed privacy guidelines and exceptions with the client, who provided written approval for both individual and group faculty supervision. She completed and uploaded her HIPAA and informed consent documents online prior to the initial session. Protocols for in-person or telehealth meetings were discussed, assuring that information shared remains private between client and therapist, aside from supervisor review. Disclosure would occur only for risks of self-harm, harm to others, or suspected child/elder abuse. Prior to this meeting, Justine was reminded of her prior authorization for session audio/video recording to support academic demonstrations, with files to be erased post-assignment; she verbally reaffirmed her agreement.
Source of Information
The intake data came directly from the client’s mother during the agency’s mandated biopsychosocial-spiritual evaluation. This session covered her medical background, mental health details, key personal history, and a safety screening, yielding diagnoses of F43.23 (Adjustment Disorder with Mixed Anxiety and Depressed Mood) and F84.0 (Autism Spectrum Disorder). Details were also gathered from Justin and his mother via a comprehensive review spanning emotional, physical, relational, and hazard-related areas.
Part II: Assessment
Observational Data/Mental Status Exam
The mother often warned him that she would summon officers, who would commit him to an institution. I urged him to stay composed, explaining that authorities would likely transport her for psychiatric evaluation instead if he remained serene upon their arrival. Justin appeared cooperative overall, though his thinking occasionally veered into unrelated areas. His emotional display varied, showing hints of irritation beneath the surface. Verbal expression stayed logical, yet shifted abruptly across subjects at times. He seemed fully aware of his identity, surroundings, and the present moment. Such a promising young man, eager to achieve success and build a meaningful future. Indeed, younger siblings can’t exit the standard school transport because Jordan uses one designed for disabilities.
Psychometric Assessment
In the PHQ-9 psychometric evaluation, the total score falls between 15 and 19, signaling moderately severe depression. Key responses include feeling down or hopeless more than half the days (score: 2), sleep disturbances nearly every day (3), persistent fatigue almost daily (3), appetite changes daily (3), self-worth issues on several days (1), no concentration problems (0), mild psychomotor changes on several days (1), and no suicidal thoughts (0). Overall functioning remains unaffected, with no difficulties in work, home tasks, or relationships. For full details, consult the scoring guide (Kroenke & Spitzer, 2002, Psychiatric Annals, 32(9)).
Biological Assessment
Justin, a 17-year-old African American heterosexual male with high-functioning autism, is navigating puberty. While on the spectrum, he dislikes labels and faces significant hygiene challenges, such as skipping showers for days or months. Biological, psychological, social, and spiritual elements all impact his mental and emotional health, with autism-related anxiety amplifying sensitivity to bodily and routine changes.
Diet
Justin enjoys Starbucks and takeout food as his primary diet choices
Exercise
His responsibilities as the eldest sibling leave no time for exercise.
———————————————————————————————
Medical History
He reports no prior medical conditions.
—————————————————————————-
Medication
The client has no other medications in her history except one taken since age 10, with no known adverse effects. She also takes a daily women’s multivitamin.
History of Developmental Milestones
Justine has achieved every developmental milestone right on schedule. His therapist describes him as intelligent, sharp, and well-mannered.
Menstrual Cycle
The male client, who has high-functioning autism and is navigating puberty, does not experience a menstrual cycle.
Psychological Assessment
Historical Assessment
In the psychological evaluation’s historical review, the client denied any prior counseling or mental health care. Key concerns involve interpersonal struggles, anxious feelings, low mood, and outbursts of intense rage.
Trauma History
Justine History of trauma or has neither directly encountered nor observed any traumatic events.
Addiction Screening
———————————————————————————————————-
Justine reported no history of addiction.
Risk Assessment
I counselor evaluated the client’s potential for self-harm or violence toward others by inquiring about past incidents and any ongoing thoughts of suicide or harming someone else. The client denied prior suicide attempts, present suicidal thoughts, or any history or current intent to commit homicide
.
Family Mental Health History
The client reports no known mental health diagnoses for his parent. However, he describes his mother’s condition as an undiagnosed depressive disorder.
Piaget’s Theory of Cognitive Development
Same as the template please re word it
Justin ….. Cognitive Behavioral Therapy (CBT) is a psychological theory.
The main idea is to understand how distorted thinking (such as the belief that one “must attain or want”) the thought can lead to negative emotions (like anger and frustration) and behaviors (such as outbursts and refusals) that hinder personal independence COUC-693: Benchmark Case Presentation Assignment.
The application of CBT addresses adapting to change, managing social and emotional challenges associated with autism, and enhancing family relationships
Social Assessment
Cultural Factors
Justin, a young African American man from modest means raised in New Jersey, grew up in a single-mother household after his father vanished from his life. The core focus explores how flawed mindsets—like insisting one absolutely needs to achieve specific aims—spark harmful feelings such as irritation and resentment, plus actions like tantrums and defiance, all of which block pathways to self-sufficiency. It also tackles interpersonal and affective hurdles tied to autism while fostering stronger family ties.
Family of Origin
The client mother and his siblings reside together but the father reside apart. He enjoys a strong bond with his sibling, pitching in on household tasks and schoolwork like a caring older brother. Deeply attached to his mom, whom he adores, he grew up without his dad’s steady presence—his father would occasionally drop by to see them before vanishing again.
.
Romantic Partner Dynamic
The client desires a committed partnership and wants to ask her out soon, though he feels hesitant about it overall. Deep down, he longs for a long-term girlfriend.
Current Living Arrangements
Justine shares her home with her mother, siblings, dog, and cat.
Academic History
The client is a high school senior this year, aspiring to attend college and pursue an arts degree. He has a strong passion for drawing, especially cartoon characters.
Occupational History
Justine attends high school, holds no employment, and lives with his mother and siblings.
Erikson’s Psychosocial Stages
Jusitn is in
Erikson’s stage of Intimacy vs. Isolation (McLeod, 2023).
Current Social Support
The client described a robust support system anchored by college acquaintances, while maintaining tight bonds with her church community. In her view, she enjoys plenty of positive connections.
Significant Life Events
The client shared that his parents have separated, leaving him deeply upset. He longs for his father to stay involved in his life and for the family to preserve a positive bond.
Spiritual Assessment
Spiritual/Religious History
Justine reported no history of religious background nor family religion background
Present Spiritual/Religious Beliefs
Client would love to learn more about religion and possibility of becoming a Christian
Fowler’s Stages of Faith Development
the client would fit under————- Fowler’s fourth stage of faith development, called “individuative-reflective faith. Fowler (Armstrong, 2020)
Integration Assessment
Following the client assessment, I asked if he wanted to integrate religion into counseling. He indicated openness to learning more about Christianity and growing closer to God.
Client’s Story: Background and Current Concerns
Clients, currently 17, turns 18 soon and could then pursue employment. Though unable to reside alone without aid, he might thrive in independent housing with occasional check-ins from a supporter. After high school graduation this year while gearing up for college and his first junior prom I’ll link him to suitable post-education services. Key challenges include intense anger toward his teacher, poor emotional regulation, school absences and truancy, plus home tensions from family duties like sibling caregiving, fueling ongoing frustration.
Barriers to Treatment/Success
Challenges to accessing treatment arise from denial of the autism diagnosis, enabling behaviors by family members (such as threats about routines), and a recent emotional setback involving separation from his parent COUC-693: Benchmark Case Presentation Assignment.
Part III: Diagnosis
Primary Diagnosis F43.23: Adjustment disorder with mixed anxiety and depressed mood
F84.0 — Autism Spectrum Disorder
Differential Diagnosis
Diagnosis Rationale
For several months, the client has avoided school attendance and personal hygiene. Episodes of intense frustration arise from unfulfilled needs, like hunger, often intensifying into aggressive actions such as slamming doors. While relatives suspect Autism Spectrum Disorder, the client rejects the idea and responds with fury when it’s mentioned.
Part IV: Case Conceptualization
Theoretical Orientation
T approach centers on cognitive behavioral therapy (CBT), targeting distorted beliefs—like the rigid idea that something “must” be achieved or desired—which fuel intense emotions such as rage and irritation, triggering defiant reactions and resistance. In individuals with autism, this stems from limited coping skills and adaptive strategies. CBT’s core aim is to reveal how these flawed mindsets spark unhelpful responses that undermine self-reliance, while its practical tools promote flexibility amid transitions, better handling of interpersonal and affective difficulties linked to autism, and stronger family bonds.
Narrative of the Case Conceptualization
Presentation of the Problem
Research strongly supports cognitive-behavioral therapy (CBT) as an effective treatment for anxiety, depression, and adjustment disorders. By examining links between thinking patterns and behaviors, it helps ease symptoms using strategies like cognitive restructuring, behavioral activation, social skills training, visual puberty education, role-playing, and visual aids.
Patterns of maladaptive behaviors/coping and functional coping/resiliency
In response to this emotional pain, Justing help his mom walk her dogs and take care of cats he is currently go to school,
Predisposing factors
Perpetuating factors of the problem(s)
Prognosis
Applying a theoretical lens
.
Part V: Spiritual Integration
Personal Integration Approach
Implicit Integration
ACA, 2014).
Treatment Plan
Diagnosis: F43.23: Adjustment Disorder with Mixed Anxiety and Depressed Mood; F84.0: Autism Spectrum Disorder
Anger outbursts linked to unmet desires (e.g., food), escalating to physical behaviors such as door-slamming.
• Family reports suggest a possibility of Autism Spectrum Disorder, though the client denies it and reacts with anger when the topic arises.
Goal 1: Reduce anger and irritation when demands are not met (such as during mealtime). Intervention: Conduct CBT sessions to identify the connections between thoughts, feelings, and behaviors; engage in role-playing to develop coping strategies.
• Goal 2: Encourage more consistent school attendance and maintain personal cleanliness.
Apply behavioral activation techniques to guide individuals in creating objectives tied to their long-term dreams, such as pursuing higher education or producing YouTube videos. Discuss challenges and advantages linked to autism traits without clinical terms, respecting their aversion to labels. Incorporate personal hobbies—like sketching or nods to the show Bluey—to enhance engagement.
Problems
1.
Goals for Change
A. .
Objectives & Therapeutic Interventions
Goal(s):
Objective
–.
·
Intervention:
=
·
Intervention
·
Objective
–
·
Intervention:
·
Intervention:
·
Intervention:
belief.
Goal(s):
A.
Objective
–
Intervention:
C
Objective
– Client will identify and engage in good sleep hygiene.
·
Intervention:
.
Objective
.
·
Intervention:
Goal:
Objective
–
Intervention:
Objective
–
·
Intervention:
Outcome Measures of Change
·
References
Case Presentation of Ellie
Jane Doe (Student Name)
School of Behavioral Sciences, Liberty University
COUC-693: Benchmark Case Presentation Assignment
Author Note
Jane Doe
https://orcid.org/#####
I have no conflicts of interests to disclose.
Correspondence concerning this paper should be addressed to Jane Doe, 1971 University Blvd., Lynchburg, VA 24515. Email: Jane.Doe@liberty.edu
Case Presentation of Ellie
Identifying Data
Date of Initial Assessment: 04/11/2025
Current Session Number: 5
PSEUDO Name: Ellie
Age: 25
Gender: Female
Sexual Orientation: Heterosexual
Race & Ethnicity: Caucasian/Non-Hispanic
Marital Status: Partnered / Cohabitating
Employment Status: Fulltime
Part I: Intake Information
Reason for Referral/Presenting Problem
Ellie is self-referred to this private practice. She reported that she has been feeling “anxious”, “sad”, and has had difficulty concentrating for the last 4 months. She reported isolating and withdrawing from her boyfriend, family, and friends, and that “all I want to do is sleep.” About 4 months ago, the client learned that her father had been cheating on her mother for the past year. She said, “Learning this about my father has been devastating, as I always thought he was a good and faithful man. I always looked up to him. If I can’t trust him, then I can’t trust anyone.”
Confidentiality
The confidentiality and the limits were reviewed with the client. The client provided verbal and written consent to videotaping their sessions for both individual supervision and faculty group supervision. Ellie signed her HIPAA and informed consent forms and uploaded them to the website before her first appointment. Since sessions with this client are conducted via telehealth, the confidentiality protocol was reviewed. The client was informed that confidentiality would be maintained between her and the counselor, except for supervisory oversight. Confidentiality would only be breached if the client disclosed intent to harm herself or others, or in cases of known elder or child abuse. Before this session, the client was reminded of the confidentiality agreement previously signed, which permitted the recording and videotaping of sessions for use in class presentations. It was also reiterated that all recordings would be deleted upon completion of the assignment. The client verbally confirmed her consent to these recordings.
Source of Information
The information in the intake was provided directly from the client herself during a formal biopsychosocial-spiritual assessment required by the agency. She was assessed during the intake session for her medical, psychological, and other relevant history, including a risk assessment, the GAD-7 (Spitzer et al., 2006), and the PHQ-9 (Kroenke & Spitzer, 2002). Her Likert scale rating of her problem at intake revealed that she feels that her problems are completely interfering with her life, and she is not very optimistic that she can change them.
Part II: Assessment
Observational Data/Mental Status Exam
Ellie was neatly dressed and appeared healthy and relaxed with somewhat fidgety motor activity. Her insight and judgment seemed good, and her affect was appropriate. Her mood was euthymic. During the duration of the meeting, she was oriented to person, place, and time. Her memory was intact. Her attention and concentration were good. Her thought content was appropriate. Her perception and flow of thought were unremarkable. Her interview behavior was appropriate and cooperative, but she was either picking at her nails or biting them throughout the session. Her speech pattern was normal throughout. She was thoughtful and articulate, although she was frequently tearful when discussing her relationships.
Psychometric Assessment
The following assessments were administered to Ellie: (1) the GAD-7 (Spitzer et al., 2006) to assess her anxiety, and she scored 16, indicating severe anxiety; (2) the PHQ-9 (Kroenke & Spitzer, 2002) to assess levels of depression. Ellie scored a 9 on the assessment, indicating mild depression; (3) a Likert scale was used to assess the level of interference that the presenting problems are causing (0-10, with 0 being not at all and 10 being extreme interference), and Ellie indicated that the level of interference was an ‘8’.
Biological Assessment
Ellie is a 25-year-old, Caucasian, heterosexual female who is in a committed relationship and cohabiting with her boyfriend. She has no children and has had no pregnancies. Ellie reported her last physical was seven months ago during an annual OBGYN visit. She reported no relevant medical history but notes she did break her arm “a few years back.” Ellie appears to be average height and weight for her age and does not appear to be underweight or overweight.
Sleep
Ellie shared she averages about eight to ten hours of sleep a night but reported recently struggling to fall asleep. Client reported using an herbal tea in the last several weeks to increase her ability to fall asleep, which she noted has been helping her relax. Client reported that “all I want to do is sleep. On weekends, I take a lot of naps and struggle to get up and motivated in the morning.”
Diet
The client reported “I eat mostly good,” but reported skipping several meals a week, which usually include breakfast and lunch, due to feeling overly anxious. She states, “Sometimes my stomach is just in knots, so the thought of eating makes me feel worse.” Client reported no history of eating disorder or time when overweight/underweight was an issue. The client reported that she usually has one cup of coffee in the morning, but otherwise she does not consume caffeine, “except for the occasional specialty coffee, but that’s less than once a week.”
Exercise
Ellie reported that she was regularly exercising 3-4 times a week up until she learned about her dad’s affair. She reported “no longer having energy to go to the gym.” Client notes being “mad at myself for being so lazy.” She reported that she also used to enjoy taking her dog to the park and walking, but she mostly just lets him out in the backyard now.
Medical History
The client reported no medical history. She reported that her last physical exam was seven months ago, where she received a clean bill of health.
Medication
The client reported no medication history other than Yaz birth control that she has been on since she was 17 years old and reported no known side effects. She also reported taking a women’s daily multivitamin.
History of Developmental Milestones
Ellie reported that she met all her developmental milestones at the appropriate ages. She reported that her parents described her as a “motivated” baby and that she crawled and walked early, and that she taught herself her ABCs before she was even two years old.
Menstrual Cycle
The client reported that she has a history of painful menstrual cycles that were irregular before being prescribed Yaz, an oral contraceptive pill. She reported that since being on Yaz for the last eight years, her week of menses is more normal and without pain.
Psychological Assessment
Historical Assessment
The client reported having no previous counseling or mental health treatment. She reported having a previous time when she felt depressed, but that she did not receive any counseling or help for it.
Trauma History
Ellie reported no history of trauma that she has personally experienced or witnessed.
Addiction Screening
Ellie reported no history of addiction. She reported consuming alcohol “on occasion socially” and that she never has more than two drinks. Ellie reported no use of illicit drugs. She reported that she smoked marijuana a few times as a teenager, but that she never liked it and doesn’t do it anymore.
Risk Assessment
The counselor assessed the client’s risk by asking if she had ever harmed herself or anyone else, as well as whether she had current suicidal or homicidal ideations. The client reported that she has had no suicidal attempts in her history or current suicidal ideations. The client also reported no homicidal history or current ideations.
Family Mental Health History
Ellie reported that her father does not have any mental health diagnoses that she knows of, but she reported that her mother has what she describes as undiagnosed depressive disorder and that “she’s always been a worrier.”
Piaget’s Theory of Cognitive Development
Ellie is in Piaget’s fourth stage, the formal operational stage. This was evident by how Ellie described how her father’s affair has now made her question whether she can trust anyone, including her boyfriend. She stated, “If my own dad can fool me and my mom, then anyone can fool me. I’d never know if he was cheating on me.” Ellie’s occupation also confirms her stage of cognitive development, as she is a project manager who manages a small team of individuals.
Social Assessment
Cultural Factors
Ellie is a young Caucasian female with a medium socioeconomic status who was born and raised in New Jersey. She reported that her father is Italian American and her mother is German. She reported that her father’s Italian background was important in her upbringing and that “family was everything”, which is partially why she can’t believe that her father cheated on her mother. She reported her parents “doing well for themselves” financially and that they always expected their kids to work hard.
Family of Origin
Ellie’s mother and father live approximately 30 minutes away, and her 28-year-old brother lives with his wife and child on the other side of the state. She reported that she and her brother talk a couple of times a month. When describing her relationship with her parents, Ellie states that growing up, they had a typically warm and loving relationship. She reported being very close with her mom, whom she talks to several times a week. She reported that she used to be close with her father, but that she’s not talking to him right now because she’s “so angry with him, I can hardly stand to look at him.” Ellie reported thinking that she was not “enough” for her father to be loyal to her mom, and that if he loved her more, he would have been faithful because he would have seen how his actions would hurt Ellie. Her maternal grandparents are a few miles away and have always been very supportive of her.
Romantic Partner Dynamic
Ellie reported that she and her boyfriend have been in a committed relationship for three years. She reported that her relationship with her boyfriend is good, but that he’s noticed her withdrawing from some of the fun things they typically do together. She reported that they usually go on one or two dates a week and that she “hasn’t been interested.” She also reported “struggling to trust him lately.”
Current Living Arrangements
Ellie lives with her boyfriend and several pets (a dog and two cats) in an apartment. Ellie reported that she and her boyfriend have lived together for the last year.
Academic History
Ellie has a bachelor’s degree in business management. She reported that she was always a straight-A student and that she graduated from high school when she was 17 and from college at 20 years old. She reported loving school and that she was good at it, but that she took it very seriously.
Occupational History
Ellie describes “always having a job from the time I was 15 years old.” She reported being offered a position at the hospital in administration directly after college. She reported that she has quickly “climbed the ladder,” which is how she got to her current position as a project manager. She describes herself as a “go-getter” at work and that she is “very organized, maybe to a fault.” Ellie reported that despite not wanting to get out of bed, she has been able to continue going to work even though she “doesn’t feel like it” most of the time.
Erikson’s Psychosocial Stages
Ellie is in Erikson’s stage of Intimacy vs. Isolation (McLeod, 2023). When talking about her teenage years, Ellie seems to have established her identity, as it relates to Erikson’s Identity vs. Identity Confusion. This was evidenced by Ellie stating that “I never really cared about what others thought of me. I always had a drive to achieve my own dreams, and I set out to do that. Whoever supported me was welcome to walk with me.” She now seems to be struggling in the current psychosocial stage since learning of her father’s affair because she states that she “doesn’t know if I can have a relationship and expect it to actually last.”
Current Social Support
Ellie reported having a strong social network with some friends from college. She also states that she is close with her community group at church. She feels that she has many good friends, but that she has not had any interest in hanging out with them for the last several months. She reported that her friends have noticed that she’s been “on-edge”, “down”, and “not myself” lately.
Significant Life Events
Ellie reported that learning of her father’s extramarital affair has been significant in her life because it has made her question her security with her father and with her own boyfriend as well. She reported questioning the security she had in her parent’s relationship when she was younger, since it seems that “it could have all been a lie.”
Spiritual Assessment
Spiritual/Religious History
Ellie reported that she was raised Catholic and her family was very strict, going to mass every week (sometimes more than once a week) and following strict rules. She reported that her parents are still practicing Catholicism but that they “are saved.”
Present Spiritual/Religious Beliefs
Client reported that she “believes in God” and attends the same church that she found when she was in college. She reported that she stopped going to her parents’ church because her roommate in college invited her to the campus ministry service which she liked better than the traditional Catholic mass. The client reported that she considers herself very spiritual and believes in God. She reported being non-denominational and attends a local Bible church.
Fowler’s Stages of Faith Development
I believe that Ellie would fit under Fowler’s fourth stage of faith development, called “individuative-reflective faith. Fowler (Armstrong, 2020) describes this stage as a time when the individual makes their faith more personal and can challenge some of their old beliefs. This was evidenced by Ellie describing the change she went through when she left the Catholic church and attended church with her college roommate. She reported that she has learned how to have a more personal relationship with Jesus which has been more spiritually meaningful to her than following the sacraments of the Catholic church.
Integration Assessment
The counselor assessed whether the client wants her spiritual beliefs incorporated into the counseling process. The client stated that she would like her beliefs and spiritual disciplines to be incorporated into counseling, specifically by praying, referencing Scripture, and discussing spiritual things, if applicable.
Client’s Story: Background and Current Concerns
Ellie reported that she always considered herself “a little high-strung” regarding her academic and work performance, but that she never experienced anxiety that was debilitating like it is now. She reported that it seemed to help her get things accomplished in the past, but that it is now making life and her relationships much more difficult. She reported that although she’s still able to work, she would rather stay home and sleep. Ellie reported that she experienced a time where she felt depressed for approximately two months in college (about six years ago), and she recalled barely leaving her dorm during that time, “except to go to class and work.” She reported that she remembers feeling better after going on a Spring break vacation with her friends. She reported that the anxiety has been present for about four months, and the depressive symptoms have been present for the last “month or two.”
Barriers to Treatment/Success
Barriers to treatment include the stigma of mental health treatment. Ellie reported that her parents have always been “do-it-yourself” people and that they rarely seek help from others. She reported that she does not plan to tell her parents that she is in counseling because she doesn’t want to hear any disapproval from them. This current barrier to treatment is low at this point.
Part III: Diagnosis
Primary Diagnosis:
(F43.23) adjustment disorder with mixed anxiety and depressed mood, acute
Differential Diagnosis:
(F41.1) generalized anxiety disorder; (F33.1) major depressive disorder, recurrent episode, mild severity
Diagnosis Rationale
Ellie’s symptoms of sadness, anger, and irritability emerged within days of learning her father had cheated on her mother. This is consistent with Criterion A of adjustment disorder as described in the current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR; American Psychiatric Association [APA], 2022). She also began withdrawing and isolating from others, sleeping more than usual, and being preoccupied with and ruminating about her parents’ relationship. These symptoms are consistent with Criteria B of adjustment disorder. Moreover, her symptoms do not meet the diagnostic criteria of another mental disorder (Criterion C) or bereavement (Criterion D; APA, 2022). Additionally, the consequence of the stressor has not ended (Criterion E; APA, 2022). The specifier “with mixed anxiety and depressed mood” is appropriate as her symptoms include both depression and anxiety, as expressed through her fidgeting, restlessness, irritability, worry, sadness, tearfulness, hypersomnia, and difficulty concentrating. The specifier “Acute” is used since symptoms have been persistent for less than six months (APA, 2022). Ellie’s baseline scores on the PHQ-9 (Kroenke & Spitzer, 2002) indicated mild depression (score of 9), and her scores on the GAD-7 (Spitzer et al., 2006) indicated severe anxiety (score of 16) COUC-693: Benchmark Case Presentation Assignment.
Currently, Ellie has some symptoms consistent with major depressive disorder, including a depressed mood, loss of pleasure in activities, hypersomnia, and concentration problems for more than two weeks; however, she does not meet the full criteria of five or more symptoms. Since she is close to meeting five criteria, the counselor will continue to assess to rule out major depressive disorder, recurrent episode, mild severity. The recurrent episode specified would be used if Ellie meets all five criteria because she described a time approximately six years ago where she experienced a 1–2-month episode of depression.
Additionally, Ellie is experiencing some anxiety symptoms that are consistent with generalized anxiety disorder (GAD), which include excessive worry, difficulty controlling the worry, restlessness, easily fatigues, difficulty concentrating, and irritability. However, her symptoms do not meet Criterion A, which states that the anxiety is present for at least six months. Ellie’s anxiety symptoms have been present for four months. Furthermore, her symptoms are better accounted for as an adjustment disorder with the stressor of father’s infidelity. Ongoing assessment is warranted, and diagnoses will be changed if necessary. The following Z-codes were considered but ruled out since the client is an adult: (Z62.820) Parent–Biological Child Relational Problem and (Z62.898) Child Affected by Parental Relationship Distress.
Part IV: Case Conceptualization
Theoretical Orientation
The theoretical orientation of the counselor is Cognitive Behavioral Therapy (CBT, Beck, 2021). The major tenets of CBT focus on how cognitions impact emotions and can lead to maladaptive behavior. Further, it is theorized that patterns in behavior derive from an unhealthy core belief. When using CBT, the counselor educates on the theory and teaches the client how to challenge their thoughts and core belief, leading to adaptive coping behaviors (Beck, 2021). CBT has shown efficacy in treatment of anxiety disorders, including GAD (Borza, 2017; Kaczkurkin & Foa, 2015).
Narrative of the Case Conceptualization
Presentation of the Problem
Ellie reported feeling both anxious and sad, while also lacking the ability to concentrate on most days. While Ellie is stay able to get through her tasks during the day, she sometimes goes into crying spells (twice weekly that last for about 30 minutes each), and she experiences a constant undercurrent of tension and anxiety in her body as she ruminates on what happened with her parents. She does not seek out social activities as she did before this event and spends most weekends alone or excessively sleeping (11 hours in 24 hours, 2-3 times weekly). This event caused deep emotional distress as her father came from an Italian background where “family was everything”, leading Ellie to believe that her father would never hurt his family. Ellie reported being very angry with him, and “can hardly stand to look at him.” This includes thoughts that if he loved her more, he would not hurt Ellie this way, leading to a deeper belief that she is not “enough” for her father. It also appears that she may be transferring her fear of betrayal onto her current boyfriend, as she mentioned that she was beginning to struggle with trusting him lately. Ultimately, she is seeking counseling to help her make sense of her father’s behavior, as well as overcome her anxiety, sadness, and lack of trust in others.
Precipitating/triggering factors
Ellie learned of her father’s infidelity four months ago, which was the onset of the presenting concerns.
Patterns of maladaptive behaviors/coping and functional coping/resiliency
In response to this emotional pain, Ellie sleeps more and reported she lacks motivation to get up in the morning. She also doesn’t have the “energy to go to the gym” or take her dog to the park for a walk. This, in turn, has led to feelings of shame for being “so lazy.” Her boyfriend and friends have all noticed she has been “down” and not herself lately and has withdrawn from doing activities with them. Ellie also reported that her anxiety has caused her to skip several meals throughout the week as her stomach is in knots. Even though she desires to sleep, she also reported times in which she recently has struggled to fall asleep.
Predisposing factors
While most of Ellie’s symptoms seem to be connected to her psychological health and maladaptive beliefs related to social contributions (her father’s affair), biologically, Ellie has discontinued exercising and has a poor diet, which is likely a small contributing factor to her depressed mood and anxiety. Further, Ellie has withdrawn from her faith community, which could be a protective measure against anxiety and depression as well.
Perpetuating factors of the problem(s)
If this cycle continues, she could end up in a downward spiral of withdrawal, isolation, depression/anxiety, and shame which reinforce her underlying belief of not being good “enough” to be fully loved. Ongoing tension within the family and negative family dynamics also perpetuate the problem.
Protective factors/strengths
Protective factors include having overall good physical health, a close relationship with her mother, as well as supportive grandparents. She is also in a committed relationship with her boyfriend and has a strong social network of friends from college, as well as her community group at church. She has a successful career and has been able to push through and do her work despite feeling anxious and sad. She also believes in God and desires to include spiritual disciplines in her counseling.
Prognosis
Ellie is motivated for change in her life and her protective factors and inner resources are robust, which provides a positive and hopeful prognosis for her regarding her counseling goals.
Applying a theoretical lens
Using a cognitive behavioral lens, Ellie’s core belief of ‘unlovable’ drives her maladaptive thoughts and behaviors resulting in some of her current problems (Beck, 2021). Ellie has expressed sadness after learning of her father’s infidelity, which can be healthy, but much of her sadness, anger, and avoidance are driven by cognitive and prediction errors of reality (Beck, 2021). These cognitive errors, or automatic thoughts (e.g., “I can’t trust anyone. Everyone will betray me”), are motivated by faulty core beliefs or interpretations of the world based on Ellie’s belief that she was “not enough” for her father to be loyal to her mother (Beck, 2021). Ellie uses several cognitive distortions. For example, she engages personalization by taking on the responsibility of her parent’s problems, and she applies control fallacy and overgeneralization to limit her perceived control (Beck, 2021). This may be her rationale for avoiding her boyfriend, family, and friends; she is powerless, so why try. Additionally, the psychosocial stage that Ellie is currently in (intimacy vs. isolation; McLeod, 2023) is threatened due to her maladaptive thoughts about all romantic relationships being mistrustful since her father’s affair. This could lead to future problems for Ellie in later stages of her life.
Further, Ellie attempts to evade triggering her core belief of unlovable by using avoidance behaviors such as withdrawing from relationships (isolation) and sleeping more; the client is using her compensatory behaviors based on her conditional assumptions (e.g., if I avoid, then I am in control, and I will not feel unloved; Beck, 2021). Internal or external reminders of her father elicit worry, feelings of being out of control, mistrust, anger, and irritability. The client may also have perceptions of cultural shame that need to be further investigated.
Part V: Spiritual Integration
Personal Integration Approach
The selected model is based on an “Allies” model, which is based on
Integrative approaches to psychology and Christianity
(Entwistle, 2015). This view supports a biblical worldview as the foundation for counseling, namely that the truth comes from Scripture. The truths that guide this Christian counseling practice are that humans are made in the image of God; sin impacts all of creation; a fallen state of the mind, body of humans exists; that a human is both body and soul; the Holy Spirit works upon nonbelievers and within believers; and that all truth is God’s truth, which includes truths from psychology (Entwistle, 2015).
Implicit Integration
By integrating the truth of God’s works with psychological principles, psychological theories and interventions can be implemented in a manner that aligns with God’s truth, even without explicitly mentioning His name (Entwistle, 2015). As a counselor, it will include prayer before, during, and after each session for the clients. Calling on God not only for the fruit of the Spirit during the session but also for wisdom not of this world (1 Corinthians 2:6) for helping clients grow and heal is a strong part of the theoretical framework. If clients are not believers, then integration will be implicit. It is essential to be intentional about A.4.b. Personal Values, which states “Counselors are aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors” (American Counseling Association [ACA], 2014, p. 5).
Explicit Integration
If the client is a believer, at their consent, the sessions will integrate the spiritual disciplines they wish to be included in their sessions. Christian interventions, such as prayer, scriptural bibliotherapy, meditation, silence, solitude, corporate worship, discussion of Scriptural concepts, and service, may be used. In Ellie’s case, she is very open to discussing spiritual concepts, including Scripture and praying together. These are integrated into the CBT interventions by asking Ellie, “how do your spiritual beliefs impact what is being discussed?” Caution is used when discussing Ellie’s spiritual beliefs so that it remains client-centered without imposing beliefs and values (ACA, 2014).
Part VI: Treatment Plan
Treatment Plan
Problems
1. F43.23 adjustment disorder, with mixed anxiety and depressed mood, Acute – Learning of father’s infidelity, sadness, unhappy, anger, irritability, worry, withdraw, isolation, hypersomnia, rumination
Goals for Change
1. F43.23 adjustment disorder, with anxiety and depressed mood, Acute (Jongsma et al., 2014)
A. Recognize current maladaptive thoughts and behaviors contributing to depressive and anxiety symptoms.
B. Decrease maladaptive thoughts of self, others, and world.
C. Alleviate depressive symptoms and return to previous level of effective functioning.
D. Alleviate anxiety symptoms and return to previous level of effective functioning.
E. Increase engagement in adaptive coping activities to reduce avoidance behaviors.
Objectives & Therapeutic Interventions
The client will engage in 10 to 12 weekly, individual sessions of CBT (Beck, 2021; Jongsma et al., 2014).
1. F43.23 adjustment disorder, with mixed anxiety and depressed mood, Acute
Goal(s):
A. Recognize current maladaptive thoughts and behaviors contributing to depressive and anxiety symptoms.
B. Decrease maladaptive thoughts of self, others, and world.
Objective
– Client will learn about Cognitive Behavioral Therapy.
·
Intervention:
Counselor will provide psychoeducation on CBT.
·
Intervention:
Counselor will provide psychoeducation about the relationship between negative self-talk, avoidance behaviors, and mood.
Objective
– Client will practice challenging maladaptive automatic thoughts and core beliefs, incorporating spiritual beliefs when appropriate.
·
Intervention:
Counselor will teach the client how to complete a thought record.
·
Intervention:
Counselor will introduce coping cards.
·
Intervention:
Counselor will use downward arrow technique to identify core belief.
Goal(s):
C. Alleviate depressive symptoms and return to previous level of effective functioning.
D. Alleviate anxiety symptoms and return to previous level of effective functioning.
Objective
– Client will learn and practice adaptive coping behaviors,
·
Intervention:
Counselor will provide psychoeducation on coping skills COUC-693: Benchmark Case Presentation Assignment
Objective
– Client will identify and engage in good sleep hygiene.
·
Intervention:
Counselor will provide psychoeducation on good sleep hygiene.
Objective
– Client will identify and meditate on Scripture that combats core belief.
·
Intervention:
Counselor will use guided meditations to teach the client how to meditate.
Goal:
E. Increase engagement in adaptive coping activities to reduce avoidance behaviors.
Objective
– Client will engage in activity scheduling (e.g., self-care, exercise, and social events every week).
·
Intervention:
Counselor will provide psychoeducation on the benefits of self-care, exercise, and social support to mental health.
Objective
– Client will identify and engage in actions to prevent relapse.
·
Intervention:
Counselor will provide booster sessions as needed.
Outcome Measures of Change
Improved self-worth, improved mood, increased engagement adaptive coping responses, and increased support seeking.
· Self-report reduced maladaptive thoughts and behaviors along with increase in adaptive coping.
· Counselor observed improvements in mood via signs, symptoms reduction, and change talk around automatic thoughts, assumptions, and core beliefs.
· Pre-post measures on the GAD-7
· Pre-post measures on the PHQ-9
References
American Counseling Association. (2014).
ACA code of ethics.
Author.
American Psychiatric Association. (2022).
Diagnostic and statistical manual of mental disorders
(5
th
ed., text rev.). Author.
Armstrong, T. (2020, June 12). The stages of faith according to James W. Fowler.
American Institute for Learning and Human Development.
https://www.institute4learning.com/2020/06/12/the-stages-of-faith-according-to-james-w-fowler/
Beck, J. (2021).
Cognitive behavior therapy basics and beyond
(3rd ed.). The Guilford Press.
Borza, L. (2017). Cognitive-behavioral therapy for generalized anxiety.
Dialogues in Clinical Neuroscience, 19,
203-207.
https://doi.org/10.31887/DCNS.2017.19.2/lborza
Entwistle, D. N. (2015).
Integrative approaches to psychology and Christianity
(3
rd
ed.). Wipf and Stock Publisher
Jongsma, A. E., Peterson, L. M., & Bruce, T. J. (2014).
The complete adult psychotherapy treatment planner
(5th ed.). Wiley.
Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive-behavioral therapy for anxiety disorders: An update on the empirical evidence.
Dialogues in Clinical Neuroscience, 17
, 337-346.
https://doi.org/10.31887/DCNS.2015.17.3/akaczkurkin
Kroenke, K. & Spitzer, R.L. (2002). The PHQ-9: A new depression and diagnostic severity measure.
Psychiatric Annals, 32
, 509-521.
McLeod, S. (2023, April 25). Erik Erikson’s 8 stages of psychosocial development.
Simply Psychology.
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). Generalized anxiety disorder 7 (GAD-7) [Database record]. PsycTESTS. COUC-693: Benchmark Case Presentation Assignment