1. Diagnosis: When diagnosing a client, it's important to take into consideration all relevant details regarding the client, client's case and situation. This information can come from multiple sources, including interviews, client's history, and testing. In terms of this client, what are some of the things to consider? What does the client seem to be struggling with? What seems to be the most appropriate diagnosis and how did you come about making this decision? Describe the behaviors that helped you to come to this conclusion.
2. Treatment Approach:

• If you were taking the Biological Approach, what would you need to consider as a clinician
• If you were taking the Behavioral Approach, what would you need to consider as a clinician?
• If you were taking the Cognitive Approach, what would you need to consider as a clinician?

Note: For this section, you will provide a brief analysis on each of these approaches and how you think they would address the client's case.

1. Treatment planning: When planning treatment for a client, it means you will set goals for the work you will do to help the client deal with their difficulties. Treatment goals involve various aspects, including, who will perform it, modality of treatment and theoretical approach of the person. For this case, highlight the important considerations of the client and outline your treatment plan and explain why you chose this particular plan. For instance, it's important to state the reason you chose the type of treatment. Also, would clients need to be involved with the planning or will a clinician do this alone?
2. Additional Questions:

• What cultural forces may be impacting the client's manner of expressing her psychological difficulties?
• What are some stereotypes associated with the person's culture? How might these stereotypes affect the client?
• Who would be the ideal therapist to help this client? Please speak to the potential therapist's theoretical orientation and why you believe that is the best fit for the client and their presenting concern.
• Are there any other relevant concepts related to this client's case that should be addressed.

Case Study: A Woman's Dead Parents Keep Telling Her to Kill Herself

During her initial evaluation, Ms. C, a 38 year old mother of three, has a look of dread on her face. Her hands pick restlessly at the enlarging sores on her arms. For several weeks before this consultation, she has become increasingly withdrawn, and during this interview responds only with grunts and nods. Ms. C's husband, who accompanied her for this visit, is extremely alarmed by his wife's symptoms. He reports that she says she is hearing voices that keep her from communicating with "outsiders." Her mother, who has been dead for 5 years, is insisting that she kill herself so that they can be reunited. Her father is also appearing in visual as well as auditory hallucinations, calling her a "freaking, dumb whore" and threatening to kill her if she doesn't kill herself first. In addition, a medley of unrecognizable and tormenting voices are mocking the patient, voices which she told her husband she could silence only by banging her head sharply against the wall, although she usually doesn't have the energy to do this. Ms. C also believes that she has cancer and that her children are also gravely ill. She told her husband that she feels a mission to kill everyone in her family, so they can all be together after death.

This episode of depression began insidiously with a feeling of increasing despair and emptiness. At night. Ms. C could not fall asleep because of the painful, recurring thoughts that she was a damaged and damaging creature. She blamed herself for her mother's death and felt that she was a witch who deserved burning. After awakening early each morning, she would sit shivering on the bathroom floor so that she would not disturb her husband. She wished that she had the will and courage to kill herself and played listlessly with razor blades. Ms. C felt hopeless about herself, and she was also convinced that nuclear war would soon end all life on the planet. She was retarded in her thoughts and actions and looked like a lifeless shell of a person.

Ms. C. had been hospitalized five times during the previous 9 years. One hospitalization 6 years ago was characterized by symptoms very much like her current ones. Her other hospitalizations were necessitated by severe depression and suicidal thoughts, but were not accompanied by psychotic symptoms. Her previous treatments included electroconvulsive therapy (ECT) (three separate regimens), antidepressants, and a combination of tricyclic antidepressant and antipsychotic medication. Ms. C. generally improved during her hospitalizations and was able to return home within 6-8 weeks.

Ms. C does not function very well between her major episodes, and her functioning before her first episode was also poor. There are only brief periods--days or occasionally weekswhen she finds life worth living and feels that she can approach responsibilities with reasonable energy and confidence. For the most part, she is a withdrawn and despairing person who spends many hours alone, feeling empty and sad. Because she only occasionally feels up to preparing meals and shopping, her husband employs a housekeeper to run the house and care for the children. Ms. C has only one friend, who she sees rarely. The patient loves her children but also avoids them. Close contact with them often infuriates her, and she worries that someday she may lose control and kill them.

Sometimes the patient has transient and self-limited hallucinatory experiences (her parents' voices) that last no longer than a day or two. Sometimes she is able to test their reality and sometimes not. The voices do not seem related to an exacerbation of her depression. The voices appear when Ms. C. feels unusual stressmost commonly after a fight with her husbandand disappear when he has agreed to stay home more or reduce demands on her. Ms. C. finds her husband most concerned and helpful when she is most disturbed. She accuses herself of making up voices to gain his attention.