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Differential diagnosis : vignettes

VIGNETTE ONE

Session One
Jack is a 28 year old male of American Indian heritage. He grew up on an Arizona reservation. Both parents were alcoholics. Jack moved to a major East Coast city where he attended college. Jack is currently married. He and his wife are expecting their first child.

Jack comes to therapy upon suggestion of his primary care physician due to chronic worry and anticipation of failure and fear that he will not be able to financially care for his wife and new baby, and ruminative thoughts that he is a facade and that, â??people will find out who I really am.â?

1. Formulate a Differential Diagnosis for Jack. What are your diagnostic considerations and why? Support your ideas by discussing what you see in the vignette utilizing your course readings thus far. What information would you need to look for to confirm your diagnostic impression and why?

2. Considering the Models of Abnormality outlined by Comer (2007), choose two theoretical models to explain Jackâ??s clinical presentation. Support your ideas by discussing the Models directly and specifically to Jack.

Session Two
Jack comes in this week and tells you that lately he has gotten dizzy when driving on the freeway and recently experienced the inability to breathe when at the mall with his wife. He also tells you that sometimes when he closes his eyes, he sees his parents â??beating each other up and I can hear them screaming.â? He also discloses that sometimes he wakes up at night with clenched fists and feels like that scared little boy all over again. Lately he has been unable to leave the house without making sure the door is locked several times, finds himself â??counting my thoughtsâ? and admits to you that â??I have this silly notion that if I blink three times the Spirits will take all my troubles away.â?

1. What diagnostic issues arise during your second session with Jack? What assessment and intervention techniques might you consider for him at this point in treatment? What referrals might you consider making for Jack and why?

Solution Preview

VIGNETTE ONE
Session One

Jack is a 28 year old male of American Indian heritage. He grew up on an Arizona reservation. Both parents were alcoholics. Jack moved to a major East Coast city where he attended college. Jack is currently married. He and his wife are expecting their first child.

Jack comes to therapy upon suggestion of his primary care physician due to chronic worry and anticipation of failure and fear that he will not be able to financially care for his wife and new baby, and ruminative thoughts that he is a facade and that, people will find out who I really am.

1. Formulate a Differential Diagnosis for Jack.

Jack seems to have developed irrational fears about not being able to take care of his family. Perhaps, due to his back ground as an American Indian, he feels a sense of insecurity and insufficiency in taking care of the family.

It is not clear that he has a job or not, from the description, but if he does and is earning adequately, then there should not be a cause for him to feel insecure.

What are your diagnostic ...

Solution Summary

Differential diagnosis : case study

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