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Comprehensive Case Conceptualization

Lucynda O’Hara

Department of Psychology, Southern New Hampshire

COU-610: Ass & Eval in Counseling

Dr. Eric Jett

August 20, 2023

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Introduction

Amelia Yee-Jones is a 42-year-old cis-lesbian female of multi-racial descent. She is a

Licensed Professional Counselor (LPC) in the American school district. She holds a Master’s

Degree earned in 1999 and shares a 22-year relationship with her wife in their three-bedroom

home. Amelia maintains a close bond with her mother by communicating often and seeing her

twice or thrice a month. Tragically, Amelia lost her father to a work accident at 12, but she

cherishes her relationship with her four siblings. Amelia has a history of counseling starting at 13

but has not attended since 2006. Presently, she only takes medication for her asthma and

allergies. Depression and anxiety run through her family, affecting her mother, one brother, and

one of her sisters. Amelia has faced challenges throughout her life, including dyslexia, enduring

abuse, and being severely bullied during her school years. Despite past struggles, she maintains

her well-being through a stable relationship, although she occasionally struggles to form new

friendships. Although raised Roman Catholic, Amelia is no longer practicing her faith. Despite

her journey, she finds unwavering support from her partners and siblings.

Presenting Concerns

Amelia has reported that she is currently seeking counseling as she is not motivated to

complete daily tasks and is afraid that someone is after her. Some days, she feels she is not

effectively working to her full potential, which may affect her overall well-being. The Client’s

wife has seen the client daze off without being able to bring her back. It is important to note that

the presenting symptoms below may be causing distress and impacting Amelia’s overall quality

of life. Our primary goal is to provide a safe and supportive space for her to explore and address

her concerns. Amelia presents with a wide range of symptoms that could point to a significant

and complex depressive episode.

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Behavioral Symptoms

Behaviorally, she has reported experiencing aggressiveness, struggling to attend work,

and missing a few days. She also says she has symptoms of obsessions/compulsions and

problems with ADLs. Amelia has reported and shared that she has had past experiences with

substance abuse and, for almost three decades, has been using alcohol as a possible coping

mechanism two to three times a week.

Cognitive Symptoms

Cognitively, Amelia has struggled with intrusive and irrational thoughts, racing thoughts,

difficulty concentrating or making decisions, and has been occasionally disorientated with

memory lapses.

Emotional Symptoms

Emotionally, Amelia experiences constant worry, nervousness, and overwhelming

sadness and has lost interest in activities she once enjoyed. She also expresses feelings of

helplessness, guilt, hopelessness, and irritability and has been experiencing panic attacks.

Additionally, she has stated that she has experienced dissociative states, feeling disconnected

from reality in stressful moments. It should be noted that Amelia did tell us nothing has changed

recently in her life but did mention that her dog passed away several months ago.

Physiological Symptoms

Physiologically, her appetite has changed, and she feels fatigued with a lack of energy for

daily activities such as work. Amelia also seems to struggle with sleep disturbances impacting

her overall sleep. Based on her prevalent symptoms, it is recommended that we conduct a more

comprehensive assessment to determine the best-integrated treatment approach to support her as

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we work together to address the depressive symptoms effectively to improve her daily well-

being.

Assessment Results and Relationships

The quantitative assessments reveal significant challenges in various areas of Amelia’s

life. She experiences moderate to severe difficulties in activities of daily living, social

functioning, household tasks, and work-related responsibilities. Their health condition

profoundly impacts their emotional well-being and quality of life. Depressive and anxiety

symptoms are evident alongside physical discomfort, sleep problems, obsessive-compulsive

tendencies, and dissociative experiences. Identity and relationship issues further contribute to

their struggles.

The quantitative and qualitative assessment data relationship is essential to understand

Amelia’s challenges, needs, and well-being comprehensively. Amelia’s assessments reveal

significant challenges related to depression and other symptoms. The quantitative assessment

shows moderate to severe difficulties in daily activities, social functioning, household tasks, and

work responsibilities. The qualitative assessment provides valuable context and specific details

that complement the quantitative findings, supporting the development of a personalized

treatment plan to address her unique struggles and challenges effectively.

Application of Assessments

The assessments above are appropriate and applicable to the client for several reasons.

Giving her informed consent shows we are representing her autonomy and ensuring they are

fully aware of the assessment process, which is essential for those with a history of childhood

trauma, as it helps to create an empowered feeling for them. If we emphasize, confidentiality is

vital, given the sensitive nature of her trauma and mental health concerns, to help build trust in
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the relationship. Cultural sensitivity is essential, considering her multi-racial background and

sexual orientation, to avoid biases and ensure the assessments are respectful and relevant.

Adopting a trauma-informed approach during assessments can help to create a safe environment

while considering her potential triggers and emotional sensitivities.

Reliability and Validity

The internal consistency analysis demonstrated strong reliability for the WHODAS-2.0

sum scale, with results for self-care having good reliability (Holmberg et al., 2021). The scales

for getting around and getting along showed acceptable reliability, and the scales for

understanding and participation in society were close to acceptable (Holmberg et al., 2021).

DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure-Adult was created to assess the

more common mental health symptoms. The validity and reliability are supported through

research, but it is recommended to do further study to determine its applicability across diverse

populations (Mahoney et al., 2020).

Assessment Limitations

Looking at the limitations of the Intake Assessment, WHODAS 2.0, and DSM-5 Self-

Rated Level 1 Cross-Cutting Symptom Measure-Adult, there are a few concerns professionals

should consider. The Intake Assessment has potential time constraints as they are a brief initial

evaluation, limiting our ability to get more comprehensive information on the client. There is a

limited client perspective because we rely on the client to self-report, which can be limited due to

their emotional state, willingness to disclose information, and memory recall. Since there is a

time constraint, we may not see the full complexity of the presenting issues, which would require

further assessments.
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The limitations with WHODAS 2.0 can include how it is focused on how the client

functions, which would not allow us to see the specific challenges with some symptoms or

disorders. WHODAS 2.0 is an assessment with subjective reporting, which again can be

influenced depending on their overall emotional state of mind. It also lacks context, as it may not

give a prominent picture of why certain things occur in the client’s life. The DSM-5 Self-Rated

Level 1 Cross-Cutting Symptom Measure-Adult assessment has three limitations from what I can

tell. Again, this assessment is a subjective assessment done by the client that may not align with

a more clinically objective evaluation, and it also focuses on symptoms that have happened

within the last two weeks. This will not capture the overall status or insights with potential long-

term patterns. It is also more of a screening tool than an assessment diagnostic, which helps

identify potential issues. No clinical judgment is incorporated within this tool, and it should be

used with other tools and assessments.

Ethical Considerations

Working with Amelia requires informed consent before any assessments, explaining the

purpose, potential benefits, and risks to the client. Emphasize the importance of confidentiality,

respecting her cultural beliefs and values, adopting a trauma-informed approach due to her

history of childhood trauma, and being transparent about the assessment's limitations and scope

with Amelia while having competence when using assessments. We need to prioritize her

autonomy and ensure her privacy is safeguarded while providing culturally sensitive feedback to

support them through the process.

Current Triggers

It is essential to be mindful of the current triggers that the client, Amelia, may be

experiencing contributing to her depression. There is evidence of triggers within her behavioral
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patterns. Self-isolation and social withdrawal are pronounced, with her avoiding interactions

with friends and potentially with family. It can lead to loneliness and emotional isolation from

her peers. She has some disinterest in activities she once enjoyed frequently. Amelia also

experiences some disturbances in her sleep quality, which have increased over the past two

weeks, as indicated on the DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure- Adult

Assessment. Additionally, the client has some appetite changes impacting her physical health

and emotional well-being.

The loss of her beloved pet eight months ago may also continue to be a significant

emotional trigger for Amelia. Her grief and sadness stemming from this loss seem to be deeply

felt today, impacting her emotional well-being. With her experiences as a cis-lesbian woman in a

long-term same-sex marriage, Amelia may be more susceptible to rejection and abandonment in

the face of societal challenges and potential prejudices by others. Her emotional turmoil may be

attributed to stressful life events and perceived feelings of failure. Having emotional sensitivity,

Amelia may be more reactive to interpersonal interactions, which can lead to vulnerability and

hurt. However, emotional numbers can cause individuals to disconnect emotionally as a

defensive mechanism to protect themselves from potential pain.

The physiological triggers are evident through her experiences of disturbed sleep

patterns, more so than fatigue and low energy levels. Looking at the DSM-5 Self-Rated Level 1

Cross-Cutting Symptoms Measure- Adult, Amelia said she was not experiencing lower energy

levels due to difficulty engaging in daily activities. She is also experiencing fluctuations in

appetite, affecting her eating habits, potentially causing weight fluctuations, and affecting her

overall self-esteem and image. According to WHODAS 2.0, Amelia struggles to eat at a level 4

severe rating. Aches and pains can be common for clients experiencing depression from
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emotional grief. Amelia’s libido also remains low, with a severe rating on the WHODAS 2.0

assessment. This can cause challenging thoughts and feelings toward her intimate relationship

with her wife.

Reliability and Validity Considerations

The validity and reliability of WHODAS 2.0 have been explored through multiple

studies. It has been used to emphasize the importance of using appropriate tools to assess

disabilities in mental health contexts, and the results provided ample evidence of the validity of

WHODAS 2.0 (Guilera et al., 2012). Extensive validation studies have supported its construct

validity, effectively assessing a client’s ability to engage in daily activities impacted by current

triggers. Similarly, the DSM-5 Self-Rated Level 1 Cross-Cutting Symptoms Measure-Adult has

shown that it has the potential for initial screening tools for depression and other mental health

issues in research settings. (Mahoney, 2020) While demonstrating good convergent validity

against established clinical measures, it serves as a useful screening tool for identifying mental

health symptoms triggered by current stressors and highlights areas for further exploration in a

more comprehensive evaluation.

Limitations

The WHODAS 2.0 has limitations concerning current triggers as it lacks a more detailed

context on specific stressors impacting the client’s daily life and may not fully capture the

emotional impact of triggers on her functioning. Additionally, its evaluation period of the past 30

days might miss the acute effects of recent triggers. Similarly, the DSM-5 Self-Rated Level 1

Cross-Cutting Symptoms Measure- Adult has limitations such as relying on self-reporting that

can be influenced by memory recall or emotional state. The specific symptoms may not

encompass all reactions to the triggers, which fails to capture the full complexity of how the
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triggers interact with mental health. The measure’s screening nature prevents definitive

diagnoses and does not offer a complete insight into coping strategies, which is crucial for

creating interventions. Considering these limitations and complementing assessments with

qualitative exploration and clinical interviews will be essential.

Maladaptive Patterns

The client exhibits various emotional maladaptive patterns that intensify her depressive

symptoms. As Amelia struggles to process and experience her emotions fully, it can lead to

emotional numbing and a sense of detachment, and disconnection, as we see from her intake

assessment. Excessive guilt is also another emotional trigger for the client if she does blame

herself for past events and trauma that contribute to her feeling worthless and continues to blame

herself. Amelia could also be experiencing emotional sensitivity that makes her more open to

distress, affecting her ability to cope with minor triggers. Amelia may emotionally avoid certain

situations with this heightened sensitivity and her history of childhood trauma and past substance

abuse. Self-isolation can also contribute to her emotional distress, as she withdraws from her

peers and social interactions, contributing to isolation and loneliness.

With cognitive patterns, Amelia’s increase in social withdrawal within the last two weeks

is evident with avoiding any social interactions, and this could be due to being afraid of

judgment or rejection by her peer group. Apathy and procrastination are present as Amelia lacks

interest and motivation to engage in the activities she once found enjoyable and postpones some

responsibilities and tasks. I do not see self-harm as a potential maladaptive pattern, even based

on the Columbia Suicide Severity Rating Assessment; Amelia has had thoughts of suicide and

wishing to be dead but has not taken any steps or actions towards planning and having intent.

These thoughts are a concern if she does continue to have them.

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Her physiological patterns significantly impact her overall well-being and could

contribute to her depressive symptoms. Sleep disturbances could be affecting Amelia’s cognitive

functioning and emotional regulation. Her Appetite changes can also result from emotional

distress, leading to fluctuations in physical health concerns and eating habits. Given Amelia’s

history of substance abuse, it will be crucial to assess her current usage by monitoring of

drinking habits. This is even with her reporting that she does not drink more than three glasses

weekly. Substance usage can become a maladaptive pattern and coping and could be essential to

explore potential healthier coping choices with emotional distress and triggers.

Reliability and Validity Considerations

Reliability and validity considerations for each assessment concerning maladaptive

patterns are essential for understanding the client’s mental health. The WHODAS 2.0

consistently measures overall functioning over time if her functioning remains stable. The

construct validity makes it effective in assessing functioning across multiple domains (Daza et.

al, 2022).. Similarly, the DSM-5 Self-Rated Level 2 Cross-Cutting Symptoms Measure-Adult

convergent validity makes it a sound screening tool, as mentioned before. However, the

Columbia Suicide Severity Rating Assessment exhibit’s robust reliability and validity. (Posner et.

al, 2011). It displays strong convergent and divergent validity with comparable scales, high

sensitivity and specificity in detecting suicidal behaviors, and responsiveness to changes over

time. The ideation subscale also demonstrates consistent internal reliability (Posner et. al, 2011).

Limitations

Despite the strengths of these assessments and tools, each has limitations in

comprehensively looking at the client’s maladaptive patterns. The WHODAS 2.0 may lack

specificity regarding the specific maladaptive patterns and coping strategies she employs to
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manage her depression and challenges. The DSM-5 Self-Rated Measure does not offer an in-

depth exploration of the particular maladaptive patterns she experiences, which gives the

potential to miss the complexity of her coping mechanisms. Additionally, while the Columbia

Suicide Severity Rating Assessment assesses suicide risk, it may not capture other maladaptive

patterns contributing to her depression and emotional distress.

Literature Impact

Considering these limitations, the findings from various assessments, clinical interviews,

and qualitative exploration are crucial for understanding the client’s experience and maladaptive

patterns. By using a combination of tools, counselors can create a more holistic understanding of

her mental health, identify specific maladaptive patterns contributing to her depressive symptoms

and suicidal thoughts, and tailor interventions to support her well-being effectively. This

approach emphasizes the importance of a comprehensive and client-centered perspective in

understanding and addressing maladaptive patterns and mental health concerns.

Developmental Influences

Amelia’s journey from birth to the present has been marked by a series of impactful

experiences that have contributed to developing her current concerns related to depression. The

loss of her father at a young age created an early emotional upheaval, potentially shaping her

emotional landscape and contributing to feelings o grief and abandonment. This foundational

loss could have set the stage for her vulnerability to depressive symptoms later in life. Amelia’s

struggles with dyslexia during her school years likely impacted her self-esteem and self-

perception, potentially fostering negative beliefs about her abilities and worthiness. The

subsequent severe bullying she endured during grade school could have deepened these feelings

of inadequacy, isolation and contributed to her vulnerability to depressive episodes.

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Emotional abuse, beginning at a young age, could have been a means of coping with the

emotional pain stemming from her past traumas. The use of substances as a way to manage

distress can contribute to the exacerbation of depressive symptoms over time. Amelia’s current

relationships, particularly her close bond with her mother and older sister, provide support and

potential triggers. The family history of depression and anxiety and her exposure to these

challenges within her family unit could contribute to developing and maintaining her depressive

symptoms. In 2023, the World Health Organization discovered that depression affects 3.8% of

the global population, with adults comprising 5% of this figure. Moreover, women have a 50%

higher likelihood of experiencing this disorder compared to men (World Health Organization,

2023).

Amelia’s developmental experiences, including early loss, struggles with dyslexia, severe

bullying, emotional abuse, and substance use, have contributed to her presenting concerns related

to depression. These experiences have potentially shaped her cognitive and emotional responses,

highlighting the importance of understanding her developmental history when crafting a

comprehensive therapeutic approach—a study by Ihbour et al. in 2021 found that those who have

dyslexia have more anxiety, depression and “disturbed self-esteem”.

Maladaptive Functioning Patterns

Amelia’s maladaptive function patterns related to depression appear to be influenced by

several developmental factors that have contributed to the persistence of her challenges. The

early loss of her father created a foundational emotional upheaval, potentially impacting her

sense of security and attachment. This loss may have set the stage for difficulties in regulating

her emotions and coping with stressors, often implicated in depressive symptoms. Her severe

bullying during grade school likely significantly shaped her self-esteem and interpersonal
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dynamics. These negative experiences could have contributed to the development of maladaptive

cognitive patterns, such as self-criticism and negative self-perception, standard features of

depression.

Emotional abuse from her father and high school boyfriend during her developmental years

has likely contributed to her internalizing negative beliefs about herself. These early experiences

of emotional invalidation and mistreatment may have perpetuated feelings of worthlessness and

hopelessness, contributing to the maintenance of depressive symptoms. It has been found that

children who experience emotional abuse in childhood have been linked to depression disorders

in adulthood (Telloian, 2022). Amelia’s history of substance abuse, which began during

adolescence, further compounds Amelia’s maladaptive functioning patterns. Using substances to

cope with emotional distress can create a cycle of reliance on unhealthy coping mechanisms,

potentially exacerbating her depressive symptoms. The family history of depression, anxiety, and

ongoing relationships marked by emotional challenges could reinforce maladaptive emotional

patterns. Exposure to these dynamics within her family unit may contribute to her negative self-

perception and emotional sensitivities, both of which are associated with depression.

Adaptive Functioning Patterns

Amelia’s adaptive functioning patterns in the context of her depression can be attributed to

several developmental factors contributing to her ability to cope and navigate challenges. Despite

her adversities, these factors have fostered her resilience and capacity for growth. Amelia’s close

relationship with her mother, sister, and wife has likely given her a strong support network.

These familial bonds may have helped mitigate the impact of early losses and traumas, offering

emotional guidance and a sense of belonging that contributes to her overall well-being.
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Her successful career as a licensed Professional Counselor (LPC) reflects her ability to

channel her experiences into a profession dedicated to helping others. This demonstrates her

adaptive use of her personal challenges to contribute positively to her professional life and

maintain a sense of purpose. Amelia’s decision to discontinue marijuana and limit alcohol

consumption signifies her capacity for self-awareness and willingness to make positive changes

in response to her evolving needs. This adaptive shift indicates her commitment to healthier

coping mechanisms and a proactive approach to managing her well-being.

Her enduring 22-year relationship with her wife showcases her ability to form and sustain

intimate connections, suggesting interpersonal strengths that can enhance her emotional

resilience and provide a source of emotional support. Amelia’s self-awareness about her past

therapy experiences and her openness to seeking understanding and growth reflects her adaptive

capacity for self-reflection and personal development. This willingness to engage in self-

examination is a significant factor in promoting her overall adaptive functioning.

Promoters

The present experiences that influence the maintenance of Amelia’s presenting concern of

depression encompass a range of factors that contribute to the persistence of her emotional

struggles. These factors span from the onset of her challenges to the current moment and play a

significant role in perpetuating her depressive symptoms. Amelia’s ongoing challenges with self-

esteem and emotional regulation can be attributed to her traumatic experiences, including the

loss of her father at a young age and the emotional abuse she endured during her developmental

years. These experiences have likely left enduring emotional scars that continue to impact her

self-perception and emotional well-being.

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Her history of substance abuse, although no longer involving marijuana, has evolved into

alcohol consumption to cope with emotional distress. The reliance on alcohol can create a cycle

of maladaptive coping, potentially exacerbating her depressive symptoms. Amelia’s difficulty in

forming new friendships reflects her struggles with social interactions, likely influenced by her

experiences of severe bullying during grade school. This challenge in social engagement may

perpetuate feelings of isolation and reinforce her depressive tendencies.

While her close relationships with her mother, sister, and wife provide emotional support,

they expose her to potential triggers due to her family history of depression and anxiety. These

triggers may exacerbate her emotional struggles and reinforce her presenting concern. Her

previous experiences with counseling and medication, which she found unhelpful, may influence

her reluctance to seek professional help for her current concerns. This reluctance to engage in

therapeutic interventions can hinder her progress toward addressing her depressive symptoms

effectively.

Maladaptive Functioning Patterns

The present factors that promote Amelia’s maladaptive functioning patterns within the

context of her depression encompass a range of elements that contribute to the persistence of her

challenges and negative emotional states. These factors play a role in reinforcing her maladaptive

responses and maintaining her depressive symptoms. Amelia’s ongoing struggles with self-

esteem and negative self-reception are influenced by her history of emotional abuse from her

father and high school boyfriend. These experiences have contributed to the development of

distorted beliefs about herself, fostering a cycle of self-criticism and self-doubt that perpetuate

her depressive thinking patterns.

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Her history of substance abuse, specifically her current consumption of alcohol as a

coping mechanism, serves as a maladaptive strategy for managing emotional distress. This

reliance on substances can contribute to a negative cycle of mood fluctuations, exacerbating her

depressive symptoms. The family history of depression and anxiety and her close relationships

with family members who also experience mental health challenges may contribute to a

reinforcing environment for her negative emotional states. These dynamics can perpetuate

feelings of hopelessness and inadequacy, reinforcing her maladaptive functioning.

Amelia’s challenges in making new friends and forming social connections may limit her

opportunities for positive social interaction and emotional support. This isolation can contribute

to a sense of loneliness and reinforce her negative cognitive patterns associated with depression.

Her reluctance to engage in therapy or seek professional help, influenced by her experiences of

unhelpful counseling and medication, can hinder her ability to access effective interventions and

disrupt her path toward healthier coping strategies.

Adaptive Functioning Patterns

The present factors that promote Amelia’s adaptive functioning patterns within the

context of her depression encompass various elements that contribute to her ability to navigate

challenges and foster positive emotional states. These factors support her resilience and maintain

a more balanced and adaptive functioning. Amelia’s strong support network, including her close

relationships with her mother, sister, and wife, provides her emotional stability and a sense of

belonging. These connections offer her a safe space to express her emotions and seek comfort

during difficult times, promoting her adaptive coping mechanisms.

Her successful career as a Licensed Professional Counselor (LPC) showcases her ability

to channel her experiences into helping others. This professional achievement contributes to her
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sense of purpose and reflects her adaptive use of her personal challenges to benefit her growth

and contribute positively to society. Amelia’s willingness to discontinue marijuana and limit

alcohol consumption demonstrates her proactive approach to managing her emotional well-

being. This adaptive shift reflects her self-awareness and commitment to healthier coping

strategies.

Her 22-year relationship with her wife is a testament to her ability to form and maintain

close bonds. These positive interpersonal dynamics contribute to her emotional resilience and

provide a consistent source of support. Amelia’s openness to seeking therapy and engaging in

personal development despite past challenges with counseling and medication indicates her

capacity for self-reflection and growth. This willingness to invest in her well-being supports her

ongoing adaptive functioning.

Cultural Identity

Amelia encompasses various cultural characteristics that contribute to her unique identity.

At 42 years old, she identifies with the experiences and perspectives of her age group.

Additionally, she faces the challenges of dyslexia, which may impact her learning and daily life,

and she may be experiencing depression, affecting her emotional well-being. Raised as a

Catholic, Amelia has since distanced herself from religion, shaping her beliefs and values. She

embraces her multi-racial identity as Filipino-African American, and often has difficulty

balancing both heritages and feels pigeon hold into celebrating only one part of her cultural

identity.

As a member of the middle class, Amelia’s social background influences her access to

resources and opportunities. Her sexual orientation as a lesbian is a fundamental aspect of her

identity, shaping her relationships and interactions. Amelia’s American national origin and cis-
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female gender identity further contribute to her multifaceted cultural identity. Amelia likely uses

her sexual orientation, ethnicity, and gender identity to define a sense of belonging and to shape

her identity. Her identity as a lesbian may be a significant part of her self-concept and how she

relates to others.

Additionally, her mixed heritage as Filipino-African American may influence her

perspectives and experiences, contributing to her overall sense of identity and belonging.

Amelia’s cultural identity has played a role in influencing her development from birth to the

present. Growing up as a multi-racial individual in a society with diverse cultural norms and

expectations may have contributed to her experiences of dyslexia and difficulties in school.

Her religious upbringing as a Catholic may have influenced her early beliefs and values,

even though she no longer associates with the religion. Her identity as a lesbian and her

experiences as part of the LGBTQ+ community may have shaped her relationships and

interactions with others. Furthermore, her middle-class social background and American national

origin may have influenced her opportunities and access to resources, impacting her

development as an adult.

Ethical Considerations

When using assessments with Amelia, it is crucial to uphold ethical considerations to

ensure her well-being and protect her rights. We must be culturally competent and sensitive to

Amelia’s diverse cultural characteristics, including her multi-racial Identity and sexual

orientation, as we respect her experiences, values, and beliefs (ACA Code of Ethics, Section

A.4.b.). Before giving any assessments, it is crucial that we obtain informed consent that

explains the purpose, procedures, and potential risks or benefits of the assessment (ACA Code of

Ethics, Section A.2.a.). Amelia should clearly understand what the assessment contains and how
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the results may be used. We must ensure fair and equitable services to all clients regardless of

their cultural characteristics (ACA Code of Ethics, Section A.4.a.). We must only use the

assessment results responsibly and solely to inform treatment planning (ACA Code of Ethics,

Section C.2.f.).

Cultural Stressors

Like many other states in the United States, Michigan is considered mainstream American

culture. Various factors influence this culture, including the history of European settlement and

colonization, the English language as the primary language, and the predominance of Christian

beliefs and practices. Additionally, mainstream American culture in Michigan is characterized by

a diverse population with people from various racial, ethnic, and religious backgrounds

coexisting and contributing to the overall culture of the state. It is important to note that

Michigan, like many other states, is also home to several subcultures and ethnic enclaves that

add richness and diversity to the state’s overall cultural landscape.

The client, Amelia Yee-Jones, exhibits similarities and differences between her cultural

identity and the dominant culture. Similarities include her national origin as an American, and

her gender identity as a cis-female, which aligns with the broader societal norms. However, there

are notable differences in her cultural identity, such as her multi-racial background as Filipino-

African American, which diverges from the predominantly European-influenced dominant

culture. Additionally, her sexual orientation as a lesbian and her decision to no longer associate

with the Catholic religion reflect unique aspects of her identity that may differ from the

mainstream cultural norms.

However, many local communities in Michigan, such as Ann Arbor, Ferndale, Royal Oak,

and Birmingham, are very LGBTQ+ friendly. Acknowledging and respecting these similarities
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and differences is essential for providing culturally sensitive and effective counseling support

that validates and honors Amelia’s individuality and lived experiences. The similarities between

the client’s cultural identity and the dominant culture, such as being an American national and

identifying as a cis-female, may have positively impacted Amelia’s psychosocial experiences in

some ways. Shared cultural elements with the dominant culture might have provided her with a

sense of belonging and validation, as these aspects align with broader societal norms.

Additionally, being a cis-female may have granted her access to certain privileges and

opportunities within the dominant culture.

However, it is essential to note that psychosocial experiences are complex and multifaceted,

and the impact of cultural similarities can vary depending on individual factors and life

circumstances. On the other hand, the differences between Amelia’s cultural identity and the

dominant culture, such as her multi-racial background, lesbian sexual orientation, and

disassociation from the Catholic religion, may have contributed to her psychosocial stress. These

differences could have exposed her to unique challenges related to identity acceptance,

discrimination, or marginalization. Amelia’s multi-racial background might have exposed her to

experiences of racial or cultural identity conflicts, and being a lesbian might have subjected her

to potential social stigma or discrimination.

Furthermore, disassociating from the Catholic religion might have affected her relationships

with family or community members who adhere to religious traditions. These differences in

cultural identity can influence Amelia’s self-concept, social interactions, and overall well-being.

The abovementioned factors can significantly impact Amelia’s presenting concerns and current

triggers. The similarities with the dominant culture may have influenced how Amelia perceives

her identity and experiences, potentially shaping her coping mechanisms and attitudes toward
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seeking help. On the other hand, the differences in her cultural identity might contribute to the

complexity and depth of her presenting concerns, such as depression, stress, or feelings of

isolation. Cultural disparities between Amelia’s identity and the dominant culture may trigger

distress, affecting her emotional well-being and adaptive functioning patterns. It is crucial for

counselors to be mindful of these cultural factors while addressing Amelia’s presenting concerns

and providing therapeutic support to ensure a comprehensive and culturally competent treatment

plan.

When utilizing assessments with clients, particularly when addressing sensitive matters

hold significant importance. Prioritizing the client's well-being, autonomy, and cultural

sensitivity, as exemplified in the case of Amelia, is paramount. Informed consent is a

foundational ethical principle, ensuring Amelia comprehends the assessments’ purpose, potential

benefits, and associated risks. Given her history of trauma, adopting a gentle and cautious

approach is imperative to prevent inadvertent distress. Adhering to ethical standards concerning

privacy and confidentiality is paramount to safeguarding Amelia’s personal information.

Acknowledging her multi-racial and LGBTQ+ identities underscores the need for cultural

competence to avoid biases and ensure that the assessments remain culturally sensitive and

appropriate (ACA Code of Ethics, Section B.1.a.). Applying trauma-informed practices and

language is indispensable to mitigate any potential traumatization.

Ethical interpretation entails embedding assessment results within the context of her

cultural framework to sidestep misinterpretation and facilitate a profound understanding of her

distinctive experiences (ACA Code of Ethics, Section E.5.b.). Valuing her autonomy and

refraining from assumptions rooted in her background are pivotal ethical aspects. Guided by a

compassionate, culturally sensitive, and trauma-informed approach, the overarching objective is

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to create a secure therapeutic space that facilitates Amelia’s journey toward healing. This

approach safeguards her autonomy, privacy, and cultural identity throughout the assessment

process, ultimately fortifying her care's ethical and effective provision.

Cultural Influencers

Amelia’s perspective reflects a nuanced understanding of the complexity of her distress.

While she acknowledges the presence of past negative experiences, she seems to resist

attributing her current challenges solely to those events. This suggests that she recognizes the

impact of external factors on her well-being, implying that her difficulties are not limited to her

personal history. By considering external influences, she underscores the importance of

addressing her present circumstances and potential stressors.

Amelia’s exploration of various coping mechanisms and interventions, including

medication and behavioral strategies, demonstrates her proactive approach to managing her

distress. Her willingness to try different approaches showcases her commitment to finding

practical solutions. However, her mention of not finding significant relief from these attempts

implies a sense of frustration and perhaps a growing sense of helplessness in the face of her

ongoing challenges. This aligns with her broader perspective that her difficulties are influenced

by external factors beyond her past experiences.

Amelia’s belief reveals her openness to considering a range of factors contributing to her

distress rather than attributing it solely to her history. This nuanced perspective will be valuable

in shaping the therapeutic process, as it encourages a holistic exploration of her experiences and

challenges. By building on her recognition of her external influences and willingness to try

different strategies, therapy can address her past and present circumstances to facilitate more

comprehensive and effective healing.

23

Closing relationships in Amelia’s life hold various beliefs concerning the origins of her

distress. Notably, her mother and some siblings share a viewpoint that her struggles could be

connected to her sexual orientation as a lesbian, as mentioned in the Cultural Formation

Interview. This perspective might arise from their cultural or societal perspectives on LGBTQ+

identities and their potential associated challenges. Their belief could reflect a concern for her

well-being within the context of her identity and the societal dynamics that intersect with it.

On the other hand, Amelia’s partner holds a distinct belief that attributes her distress to

work-related factors. Specifically, her partner suggests that the demanding nature of her job and

potential overexertion might primarily contribute to her current difficulties. This perspective

underscores the significance of work-related stressors and the potential impact of her

professional responsibilities on her mental and emotional state. Her partner’s viewpoint may be

influenced by a desire to contextualize her struggles within a tangible and identifiable aspect of

her life.

The diversity of beliefs held by Amelia’s close relationships regarding the origins of her

distress illustrates the complex nature of her challenges. It highlights the intricate interplay

between personal, relational, and societal factors that could potentially contribute to her

experiences. These differing perspectives could impact her own understanding of her struggles

and her sense of support from her loved ones. Addressing these varied beliefs in therapy may

involve exploring how they intersect with her own perceptions, ultimately leading to a more

holistic comprehension of the factors shaping her distress.

These beliefs will impact the conceptualization of the presenting concerns and treatment

goals by highlighting the complexity of factors contributing to Amelia’s distress. While she

doesn’t solely attribute her difficulties to her background, it is evident that her identity and past
24

experiences play a role. Acknowledging and respecting her multifaceted beliefs about the origins

of her distress will be crucial in developing a comprehensive treatment approach. Ensuring that

treatment goals are aligned with Amelia’s understanding and perspectives will facilitate a

collaborative therapeutic relationship and increase the likelihood of successful outcomes.

Addressing the diverse beliefs held by her close relationships will also e essential in fostering a

supportive environment that enhances her healing process.

When using assessments with a client like Amelia, it is crucial to prioritize her well-

being, confidentiality, and cultural sensitivity. Obtaining informed consent, considering her

history of trauma, and approaching the assessments with sensitivity is key. Respecting her

autonomy and safeguarding her privacy, following ethical guidelines from organizations like the

American Counseling Association, is essential. Cultural competence is vital, given her multi-

racial and LGBTQ+ identities, to prevent biases and ensure cultural sensitivity. Given her trauma

history, assessments should be trauma-informed and non-retraumatizing. Results should be

interpreted considering her unique cultural background and personal experiences to avoid

misinterpretation. Ultimately, ethical considerations aim to create a safe and empowering

assessment environment for Amelia’s open sharing, respecting her autonomy and well-being.

Personality Patterns Summary

Amelia’s general personality reveals a nuanced blend of traits contributing to her unique

identity. Her moderate openness to experience reflects a balanced inclination toward curiosity

and creativity. This suggests that while she is open to exploring novel ideas and perspectives, she

also values stability and familiar routines. This trait may enable her to engage with diverse

viewpoints while still grounding herself in cultural identity and personal values.
25

In terms of conscientiousness, Amelia demonstrates a moderate level of organization and

work ethic. This implies that she possesses a structured approach to her responsibilities and

tasks, which could serve her well in managing her demanding role as a Licensed Professional

Counselor. Her ability to balance meticulousness and flexibility may contribute to her adaptive

functioning, especially in environments that require structure and adaptability.

While Amelia’s extraversion leans more towards introversion, indicating a preference for

solitude and introspection, she also maintains sociability and enthusiasm. This suggests that

while she may find solace and renewal in moments of introspection, she remains socially

engaged and capable of enthusiastic interactions when the situation demands. This dynamic

could play a role in how she manages her professional and personal relationships, allowing her to

navigate between moments of connection and personal reflection.

Amelia’s moderate level of agreeableness indicates her capacity to blend friendliness

with firmness, creating a balanced approach to interpersonal interactions. This trait may

contribute to her ability to maintain healthy boundaries and advocate for herself, particularly in

contexts where her cultural identity or personal beliefs may be challenged. Emotionally, Amelia’s

moderately high level of stability points to a notable degree of calmness and tranquility. While

she may experience fluctuations in mood like any individual, her overall emotional resilience

suggests that she possesses coping mechanisms that help her manage stressors effectively. This

emotional stability could provide a foundation for her to navigate the complexities of her cultural

identity and its intersections with her personality characteristics.

Adaptive and Maladaptive Functioning Patterns

The interaction between Amelia’s general personality characteristics and her cultural

identity significantly shapes her adaptive and potentially maladaptive functioning patterns.
26

Amelia’s moderate level of openness to experience, coupled with her multi-racial and LGBTQ+

identity, creates a powerful synergy. This allows her to approach situations with curiosity,

flexibility, and an inclination to embrace diverse viewpoints. Her ability to navigate different

social contexts with empathy and understanding is reinforced by her openness, contributing to

her adaptability and resilience.

Furthermore, her conscientiousness, manifested through effective work management as

an LPC, becomes even more impactful when seen through the lens of her cultural identity.

Guided by the American Counseling Association (ACA) Code of Ethics principles, Amelia’s

commitment to her responsibilities aligns harmoniously with her diverse cultural background.

This alignment underscores her dedication to her profession and reflects her adherence to the

values inherent in her multi-racial and LGBTQ+ identity (ACA Code, Section A.4.b). Her

conscientious approach ensures that she upholds the highest ethical standards while providing

counseling services, respecting her client's unique needs and backgrounds.

Amelia’s moderate agreeableness plays a pivotal role in her relationships, allowing her to

establish positive connections across a spectrum of cultural backgrounds. This trait enhances her

capacity to communicate effectively, resolve conflicts, and forge meaningful connections,

contributing to her adaptive functioning across a spectrum of cultural backgrounds (ACA Code,

Section A.4.a.). By adhering to the ACA’s non-discrimination mandate and respect for diversity,

Amelia’s agreeableness enhances her ability to communicate effectively, mediate conflicts, and

cultivate rapport with clients from various cultural contexts.

However, the interplay between Amelia’s personality and cultural identity can also foster

maladaptive patterns. Her introverted tendencies, while often reflective and contemplative, may

inadvertently lead to isolation during distress. These moments of solitude could hinder her from
27

seeking the support she needs, potentially intensifying her unease. To address this, ethical

practice (ACA Code A.4.d.) involves creating a therapeutic atmosphere that encourages open

communication and empowers Amelia to seek support when needed.

Moreover, her moderate emotional stability might impact her coping strategies. Adhering

to the ACA’s commitment to the client’s well-being and avoiding harm (ACA Code, Section

A.4.C.), it is crucial to ensure that her coping mechanisms do not result in avoidance behaviors

that hinder her from directly addressing challenges associated with her cultural identity. While

she may typically exhibit calmness and tranquility, this trait could also result in avoidance

behaviors, preventing her from directly confronting challenges associated with her cultural

identity. Balancing her openness to diverse experiences with her unique cultural background

might intermittently generate internal conflicts, causing stress or confusion in navigating her

identity.

In conclusion, Amelia’s general personality characteristics interact with her cultural

identity to promote adaptive functional patterns and resilience and contribute to potential

maladaptive functioning patterns. Recognizing these interactions is crucial in tailoring

therapeutic interventions that leverage her strengths while addressing challenges to support her

well-being. As the process proceeds with Amelia’s therapeutic journey, the aim will be to harness

the positive aspects of her personality and cultural identity, bolstering her adaptive functional

patterns and resilience. Simultaneously, the collaboration between Amelia and her counselor will

recognize and address potential maladaptive tendencies, ensuring a comprehensive approach that

embraces the richness of your personality and cultural heritage.

28

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