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Margaret’

S Treatment Plan

1. Identify precipitating problems or symptoms

Margaret is a 52 year old African American woman whom seeks out counseling services for herself.
Margaret’s presenting complaint is to acquire coping skills in dealing with her son’s leaving for college.
Margaret appears to be quite anxious as evident by impulsive movement and jitteriness. Margaret
expressed concern about her son’s leaving causing her to feel depressed as he is her “buddy”.
Margaret identifies some domestic issues in marriage per verbal and physical abuse from her
husband, which could unconsciously account for her precipitating factors to anxiety.

2. Conduct a comprehensive biopsychosocial assessment/history

Biological – Information presented suggest client having some challenges in managing her anxiety as
evident by being prescribed Xanax by her PCP. This is client’s 2nd time in counseling. Client did not
identify any specific symptoms of challenges with her anxiety, yet identified several times the trigger of
her emotions being tied to her son’s leaving for college and it further making her “feel depressed”.
Client’s family history has some inclusion of mental illness as evident by her report of her mother
having reoccurring moments of depression and hypomania. Client identified her mother’s behaviors
went undiagnosed.
Psychological- Client presents in session with anxiety as evident her jittery voice and impulsive
movements. Client appears to struggle with focusing consistently due to her anxious behavior, eyes
looking across the room multiple times as if she is frightened. Client exhibits frequent emotional
periods in expressing her challenges with accepting her son’s leaving for school and at times when her
husband is brought up, yet more of a fearful appearance. Client did not identify concrete symptoms of
her claim to “feeling depressed”, yet claimed that her husband calls her “a stupid c*** for crying so
much”. Client is a victim of physical and emotional abuse in her 32 year marriage and explicitly
identifies events of the abuse. Client’s husband has broken her pinky finger during her attempt to leave
the home over the course of turmoil, and threatened her further to “break her neck” if attempted again.
Client’s relationship with her husband appear to be concrete stressor in her psychological condition as
she is called names such as “lard ass” and identifies her responsibility to be “obedient” to her husband.
Client’s anxiety about her youngest son leaving for school attributes to the fact that she will feel “alone
because he’s [her] buddy”, possibly her aspect of sanity in physically and emotionally violent situation
with her husband. Familial psychiatric conditions include her mother having periods of depression and
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hypomania, yet conditions went undiagnosed.
Social- Client is a stay at home that left the mental health counseling field after 10 years to support her
sons in primary school as they were having behavioral challenges. Client has completed her
bachelor’s and master’s degree. Client has been married for 32 years and has two sons’ one is
preparing for college and the other who is a senior in college. Client experiences some favorable and
unfavorable interactions within her marriage, majority unfavorable. Client admits that she has been
physically abused and emotionally abused since the 2 nd year of marriage. Client contributes that time
to when she miscarried and identifies challenges since then, including physical injury by her husband.
Client is contributing her anxiety to her son’s leaving for college, yet has identified characteristics of
fear in her marriage.

3. Identify individual and relationship functioning

Margaret is an educated and well groomed African American woman. Margaret does not work, yet has
10 years experience in the counseling field, along with bachelor’s and master’s degrees. Margaret left
the field to take care of and support her two sons’ when having challenges in school. Margaret
currently volunteers at the free clinic to keep professional skills sharpened. Client admits that she
struggles with controlling her anxiety to extent of medication being prescribed and now further being
triggered by her son leaving home for college. Client contributes most of her concern about anxiety to
her son, yet identifies multiple issues surrounding her marriage in terms of physical and emotional
abuse from her husband. Client recognizes the concerns, yet concentrates on her focus to help cope
with her son leaving for school. Client attributes some of this abuse to her own fault, categorized by
her own low self-esteem and perception of self. Client’s relationship with her husband is lacking
favorable moments, only characterized by rare tangibles of affection and no intimate aspects. Client
even in these moments finds some positive in her marriage.

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4. Integrate client assessment and observational data to form a conceptualization

Client appears to experience anxiety symptoms due to significant stressors. These symptoms
of both emotional and reluctant fear are evident in session and appear to be attributed to
client’s youngest son leaving for college, but most importantly the relationship with her
husband of 32 years. Client, currently prescribed Xanax by her PCP, exhibits challenges in
dealing with anxious moments and stress-related triggers, especially the physical and
emotional abuse towards her from her significant other. It appears that the anxiety is far more
attributed to the fear of physical abuse from her husband that has been going for 30 years,
inclusive of client’s pinky finger being broken, and several times trying to leave the home.
Client’s behaviors of jitteriness, impulsive movement, and constantly watching around the
room even in session are in relation to the abuse from her husband, in which she is not even
able to bill insurance because of his control of the finances and ability to see her seeking
services.
Margaret appears to be a driven and educated woman as evident by her completion of multiple
degrees and tenure in the mental health field. Margaret although coming from a counseling
background herself, fears the seeking out of effective help because of her husband whom she
fails to identify as the presenting problem in her anxiety. For example, client several times
verbalizes her goal to get help for dealing with her depression over her son leaving for school,
yet unconsciously connects the long years of sadness and lack of appropriate relationship and
affection to her marriage. Client is able to recognize that this abuse has occurred since the 2 nd
year of her marriage, yet has made excuses such as her not being obedient and pleasing her
husband the way he says he wants things completed. Client’s behaviors are attributing to even
further low self-esteem and her seeking refuge in her youngest son, which once he departs she
will be at the mercy of her husband and his physical and emotional abuse. Client mentioned
that she did seek counseling after her pinky being broken by her husband when trying to leave,
yet it is speculated due to reoccurring fear that was let go. Client admits that sessions are all
set up secrecy even in her past due to her fear of her husband. Client’s anxiety is more than
just her son leaving, as a victim in a physical and emotional abuse for 30 years, client’s
depression and anxious behaviors are a domino effect to her experience and still living fear of
her significant other.
Because Margaret has been experiencing symptoms of anxiety, prescribed Xanax, and has a
history of physical and emotional abuse from significant other for some time, she meets
criteria for DX.

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DSM Code #

Diagnosis

995.81

Spouse or Partner Violence, physical, Confirmed ; initial encounter

300.00

Unspecified anxiety disorder

311

Other Specified Depressive Disorder x/ anxiety features

995.82

Spouse or Partner Abuse, Psychological, Confirmed, subsequent
encounter

DSM Code #
995.81

Justification for Diagnosis
Client is a victim of physical and emotional abuse from her husband. Client
confirmed events of both with her husband inflicting physical injury. Client
has confirmed broken pinky finger as inflicted by husband. Subsequent
encounters suspected as client verbalized “serving o’deurves at her own
funeral” which relate to her son’s going away party in which she will be left
alone with husband.

300.00

Client presents with impulsive eye movement and jitteriness in session. Client
appears to very anxious in response to certain topics such as her marriage
and revelation of the physical and emotional abuse that continues to take
place. Client is very anxious about the fact services are in “secrecy” to extent
of she is paying out of pocket to keep her husband uninformed as he controls
the medical insurance.

311

Client exhibits feelings of depression and prolonged sadness per verbal
report. Client experiences periods of crying spells frequently, even observed
in intake session. Client presents with anxiety features as evident by shaking
and jittery movements of constantly looking around and then putting her head
down when speaking about her husband.

995.82

Client is often ridiculed and emotionally abused about her appearance as
inflicted by husband on multiple occasions. Client has come to believe that
this is her own fault, which is evident in deficits in psychological as she has
been emotionally abused and demanded to be “obedient” for over 30 years.

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ACTION PLAN
Long Term Goal.
Resolve the core conflict that is the source of the anxiety.

CHARACTERISTICS/OBSERVATION/JUSTIFICATION FOR THIS GOAL: Client appears to struggle with her anxiety of her youngest
son leaving for college and being alone with her husband. Client has identified significant events of both physical and emotional abuse
over a period of time from her husband which contributes greatly to her fear and anxiety in the home. Client’s presenting complaint is
that of her son leaving for college, while not accepting this is just the surface issue of her anxiety symptoms.

WHAT (Short Range Goal)

WHO IS RESPONSIBLE

Client will verbalize an understanding of the cognitive, physiological, and
behavioral components of anxiety and its treatment.

Client, Therapist

HOW (Support/Intervention)
1: Discuss how generalized anxiety typically involves various bodily expressions of tension, hyper vigilance, and avoidance
of what is threatening that interact to maintain problem.
2: Help client gain insight into the notion that worry is a from of avoidance of a feared problem and that it creates chronic
tension.
3: Assign the client homework each session in which she practices relaxation exercises daily in effort to help manage anxiety
about son leaving for college.

CHARACTERISTICS/OBSERVATION/JUSTIFICATION FOR THIS GOAL: Client has categorized her challenges with being
related to her son leaving home, as opposed to identifying the significance of the abuse in her marriage. Client has rested on
fear, having made an attempt one time to leave. Client has no applicable resources to her marriage issues at this time, except
her “secret” counseling sessions.

WHAT (Short Range Goal)

WHO IS RESPONSIBLE

Client will learn and implement problem-solving strategies for realistically
addressing worries.

Client

HOW (Support/Intervention)
1: Teach problem-solving strategies involving specifically defining a problem, generating options for addressing it, evaluating
options, implementing a plan, and reevaluating and refining the plan.
2: Assist client in identifying resources to problems by using empowering discussions to rid fear talk.
3: Support client in following through with identified resources and working through anxiety and core of conflict as opposed
to avoiding or escaping them to focus on her panic.

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CLINICAL PRACTICE
Determine and identify other services that could meet the client’s needs
Client would benefit from attending a support group for domestic violence. Client needs to learn the resources in the area to help her
understand the importance of her safety and how to get out. Client and husband would benefit from couples counseling once his
domestic abuse is addressed and identified.

Identify and discuss applicable ethical and legal issues
Therapist needs to be cautious about working too fast where it pushes client into further panic by advising her to leave the marriage,
therefore imposing values. Therapist needs to be clear of confidentiality of information as client may be acquainted with multiple
persons in the program as she once interned there as well. Therapist needs to be careful about avoiding further harm to the
relationship or to client’s condition of anxiety.

Discuss the scope of practice parameters and any foreseen limitations
Therapist having worked with domestic violence victims.

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