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A Competency Based Assessment

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Educational Policy (EP), 2015 Educational Policy and Accreditation
Standards discussed in Psychopathology: A Competency-Based Assessment
Model for Social Workers, 4th Edition
Competency 1 Demonstrate Ethical and Professional Behavior
a. Social workers make ethical decisions by applying the See chapter(s):

standards of the NASW Code of Ethics and other relevant 3, 5, 6, 7, 8, 10, 14, and 16
laws, regulations, and models for ethical decision-making,
as appropriate to context
b. Social workers use reflection and self-regulation to manage 1, 2, 3, 4, 5, 13, 15, and 16
personal values and maintain professionalism
c. Social workers demonstrate professional demeanor in behav- 2, 3, 10, 12, 13, and 16
ior, appearance, and oral/written/electronic communication
Competency 2 Engage Diversity and Difference in Practice
a. Social workers apply and communicate understanding of See chapter(s):

the implications of diversity and difference in shaping life 2, 3, 9, 10, 11, 13, and 14
experiences in practice at the micro, mezzo and macro levels
b. Social workers present themselves as learners and engage clients 7, 12, 15, and 16
(and constituencies) as experts of their own experiences
c. Social workers apply self-awareness and self-regulation to 14

manage the influence of personal biases and values in
working with diverse clients (and constituencies)
Competency 4 Engage in Practice-Informed Research and Research-Informed Practice
a. Social workers use practice experience and theory to inform See chapter(s):
scientific inquiry and research 5, 6, 7, 8, and 14
c. Social workers use and translate research evidence to inform 8 and 14

and improve practice and service delivery
Competency 5 Engage in Policy Practice
a. Social workers identify social welfare and economic policies See chapter(s):
at the local, state, and federal levels impact well-being, 2, 7, 13, 14, 15, and 16
service delivery, and access to social services
b. Social workers assess how social welfare and economic 8 and 9

policies impact delivery of and access to social services
c. Social workers apply critical thinking to analyze, formulate, 2, 8, and 14

and advocate for policies that advance human rights, and
social, economic, and environmental justice
(Continued on inside back cover)
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A Competency-Based Assessment Model

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Print Number: 01 Print Year: 2015
To my beloved husband,
Kenneth E. Gray, JD
you are my inspiration.
CONTENTS
PREFACE xvii
ABOUT THE AUTHOR xxv
CHAPTER 1 An Introduction to the Competency-Based Assessment Model 1

Introduction 1
The DSM-5: Approaches to the Assessment 4
The DSM-5 Definition of Mental Illness 6
How the DSM-5 Is Organized 7
A Closer Look at Section II 8
Using the DSM-5 9
Refining the Diagnosis 10
The Competency-Based Assessment Model 12
The Biopsychosocial Framework 12
The Ecological Perspective 19
The Strengths Perspective 20
Systems Theory 21
Understanding the Client 24
Summary 28
Competency Notes 30
CHAPTER 2 Neurodevelopmental Disorders 33

Introduction 33
Intellectual Disability (Intellectual Developmental Disorder) 34
Prevailing Pattern 35
Differential Assessment 35
Other Related Disorders 39
Autism Spectrum Disorder 40
Attention-Deficit/Hyperactivity Disorder 48
Other Neurodevelopmental Disorders 54
Communication Disorders 55
v
vi CONTENTS
Motor Disorders 60
Summary 61
Practitioner s Reflections 62
Activities 62
Competency Notes 63
CHAPTER 3 Schizophrenia Spectrum and Other Psychotic Disorders 66

Introduction 66
Schizophrenia 70
The Role of Dopamine 73
Key Features Defining the Schizophrenia Spectrum 74
Cultural Considerations 78
Catatonia as a Specifier and as a Disorder 89
The Impact of Schizophrenia: Suicide, Depression, and Substance Use 91
Delusional Disorder 92
Brief Psychotic Disorder 96
Schizophreniform Disorder 97
Schizoaffective Disorder 100
Other Disorders of Diagnostic Importance 104
Substance/Medication-Induced Psychotic Disorder 104
Psychotic Disorder Due to Another Medical Condition 104
Other Specified Schizophrenia Spectrum and Other Psychotic Disorder 104
Unspecified Schizophrenia Spectrum and Other Psychotic Disorder 105
Summary 105
Activities 106
Competency Notes 107
CHAPTER 4 Bipolar and Related Disorders 111

Introduction 111
Bipolar Disorders 112
Variations of Bipolar Disorder 114
Bipolar Disorder Specifiers 115
CONTENTS vii
Cyclothymic Disorder 121

Other Bipolar and Related Disorders 123
Substance/Medication-Induced Bipolar and Related Disorder 123
Bipolar and Related Disorder Due to Another Medical Condition 124
Other Specified Bipolar and Related Disorder 124
Unspecified Bipolar and Related Disorder 124
Summary 124
Activities 126
CHAPTER 5 Depressive Disorders 129

Introduction 129
Disruptive Mood Dysregulation Disorder 129
Major Depressive Disorder 133
Persistent Depressive Disorder (Dysthymia) 144
The Minor Depressive Disorders 148
Premenstrual Dysphoric Disorder 148
Substance/Medication-Induced Depressive Disorder 149
Depressive Disorder Due to Another Medical Condition 149
Other Specified and Unspecified Depressive Disorders 150
Complications Associated with Major Depressive Disorders 150
Medications Commonly Associated with the Depressive Disorders 154
Summary 156
Activities 157
CHAPTER 6 Anxiety Disorders 161

Introduction 161
Separation Anxiety Disorder 162
Selective Mutism 166
viii CONTENTS
Specific Phobia 167

Social Anxiety Disorder (Social Phobia) 170
Panic Disorder 173
Agoraphobia 179
Generalized Anxiety Disorder 182
Other Anxiety Disorders 185
Summary 187
Activities 188
CHAPTER 7 Obsessive-Compulsive and Related Disorders 191

Introduction 191
Obsessive-compulsive Disorder 192
Body Dysmorphic Disorder 199
Hoarding Disorder 204
Other Obsessive-compulsive and Related Disorders 207
Summary 209
Activities 210
CHAPTER 8 Trauma- and Stressor-Related Disorders 214

Introduction 214
Reactive Attachment Disorder 215
CONTENTS ix
Disinhibited Social Engagement Disorder 218

Posttraumatic Stress Disorder 221
Acute Stress Disorder 231
Adjustment Disorders 236
Summary 239
Activities 240
CHAPTER 9 Dissociative Disorders 244

Introduction 244
Cultural Perspectives and the Dissociation Experience 248
Dissociative Identity Disorder 251
Dissociative Amnesia 258
Dissociative Amnesia with Dissociative Fugue 262
Depersonalization/Derealization Disorder 263
Summary 266
Activities 267
CHAPTER 10 Somatic Symptom and Related Disorders 270

Introduction 270
Somatic Symptom Disorder 272
Illness Anxiety Disorder 277
x CONTENTS
Conversion Disorder (Functional Neurological Symptom Disorder) 283

Psychological Factors Affecting Other Medical Conditions 287
Factitious Disorder 290
Closing Observations About Nan Finkelhorn 292
Summary 293
Activities 294
CHAPTER 11 Feeding and Eating Disorders 297

Introduction 297
Pica 299
Rumination Disorder 304
Avoidant/Restrictive Food Intake Disorder 308
Anorexia Nervosa 311
Bulimia Nervosa 319
Binge-Eating Disorder 325
Other Feeding or Eating Disorders 331
Other Specified Eating or Feeding Disorder 331
Unspecified Feeding or Eating Disorder 332
The Role of Obesity 332
Summary 333
Activities 335
CONTENTS xi
CHAPTER 12 Elimination Disorders 341

Introduction 341
Enuresis 342
Encopresis 346
Other Related Disorders 349
Summary 349
Activities 350
CHAPTER 13 Disruptive, Impulse-Control, and Conduct Disorders 353

Introduction 353
Cultural Perspectives 354
Oppositional Defiant Disorder 356
Intermittent Explosive Disorder 360
Conduct Disorder 363
Pyromania and Kleptomania: An Overview 368
Pyromania 368
Kleptomania 369
Summary 369
Activities 370
CHAPTER 14 Substance-Related and Addictive Disorders 373

Introduction 373
The Essential Features of the Substance-Related and Addictive Disorders 379
Substance Use Disorder 380
Severity, Specifiers, and Recording 381
Substance-Induced Disorders 382
Substance Intoxication 382
Substance Withdrawal 382
Substance/Medication-Induced Mental Disorders 384
xii CONTENTS
Other Diagnostic Considerations 386

Alcohol-Related Disorders 387
Alcohol Use Disorder 388
Alcohol Intoxication 389
Alcohol Withdrawal 390
Long-Term Effects of Alcohol Use 395
Caffeine-Related Disorders 396
Caffeine Intoxication 397
Caffeine Withdrawal 397
Cannabis-Related Disorders 398
Cannabis Use Disorder 399
Cannabis Intoxication 400
Cannabis Withdrawal 401
Hallucinogen-Related Disorders 401
The Phencyclidines 401
Phencyclidine Use Disorder 402
Phencyclidine Intoxication 404
The Other Hallucinogens 404
Other Hallucinogen Use Disorder 405
Hallucinogen Intoxication 405
Hallucinogen Persisting Perception Disorder 406
Inhalant-Related Disorders 406
Inhalant Use Disorder 407
Inhalant Intoxication 408
Opioid-Related Disorders 408
Opioid Use Disorder 409
Opioid Intoxication 411
Opioid Withdrawal 411
Sedative-, Hypnotic-, or Anxiolytic-Related Disorders 412
CONTENTS xiii
Sedative, Hypnotic, or Anxiolytic Use Disorders 412

Sedative, Hypnotic, or Anxiolytic Intoxication 414
Sedative, Hypnotic, or Anxiolytic Withdrawal 415
Stimulant-Related Disorders 415
Stimulant Use Disorder 417
Stimulant Intoxication 419
Stimulant Withdrawal 419
Tobacco-Related Disorders 420
Tobacco Use Disorder 422
Tobacco Withdrawal 424
Other (or Unknown) Substance-Related Disorders 424
Other (or Unknown) Substance Use Disorder 425
Other (or Unknown) Substance Intoxication 425
Other (or Unknown) Substance Withdrawal 425
Unspecified Other (or Unknown) Substance-Related Disorder 425
Concluding Case Review 425
Gambling Disorder 430
Summary 434
Activities 435
CHAPTER 15 The Neurocognitive Disorders 443

Introduction 443
Delirium 446
The Neurocognitive Disorders 450
Mild Neurocognitive Disorder (Mild NCD) 456
Major Neurocognitive Disorder 456
Neurocognitive Disorder Due to Alzheimer s Disease 457
Vascular Disease 465
Neurocognitive Disorders Other than Alzheimer s and Vascular Disease 465
Frontotemporal Neurocognitive Disorder 465
Neurocognitive Disorder with Lewy Bodies 466
xiv CONTENTS
Neurocognitive Disorder due to Traumatic Brain Injury 466

Substance/Medication-Induced Neurocognitive Disorder 467
Neurocognitive Disorder Due to HIV Infection 467
Prion Disease 468
Neurocognitive Disorder Due to Parkinson s Disease 468
Neurocognitive Disorder Due to Huntington s Disease 469
Additional Neurocognitive Diseases 469
Summary 469
Activities 471
CHAPTER 16 The Personality Disorders 475

Introduction 475
Cluster A: Odd and Eccentric Personality Disorders 481
Paranoid Personality Disorder 481
Schizoid Personality Disorder 486
Schizotypal Personality Disorder 490
Cluster B: Emotional, Dramatic, or Erratic 496
Antisocial Personality Disorder 496
Borderline Personality Disorder 501
Histrionic Personality Disorder 508
Narcissistic Personality Disorder 512
Cluster C: Anxious, Fearful 517
Avoidant Personality Disorder 518
Dependent Personality Disorder 522
CONTENTS xv
Obsessive-Compulsive Personality Disorder 527

The Proposed Alternative DSM-5 Model for Diagnosing the Personality
Disorders 531
Summary 534
Activities 534
APPENDIX 541
GLOSSARY 562
NAME INDEX 573
SUBJECT INDEX 580
PREFACE
INTRODUCTION
All of us engage in behaviors that we usually do not think a lot about from eating,
to talking, feeling, thinking, remembering, playing, buying things, or even going to
the bathroom, to list a few. However, these behaviors can potentially have a mal-
adaptive component that can be diagnosed as a mental disorder. These dysfunctions
are a source of substantial concern to many different mental health professions
whose members hold differing opinions regarding the etiology, pathology, and
treatment of these disorders. Professionals think in terms of their language, and
in order to be able to meaningfully communicate with one another, it is important
to share a common vocabulary. The Diagnostic and Statistical Manual of Mental
Disorders (DSM) published by the American Psychiatric Association (APA, 2013)
offers an official diagnostic nomenclature, making it a powerful document. It plays
a significant role in how practitioners, their agencies, funding sources, social pro-
grams, and the general public conceptualize and respond to problematic and mal-
adaptive behaviors (Schwartz & Wiggins, 2002).
Among the 500,000 mental health professionals in the United States who use the
DSM-5, the largest group is social workers (U.S. Department of Labor, Bureau of
Labor Statistics, 2010) followed by mental health counselors (American Counseling
Association, 2011), psychologists (American Psychological Association, 2012), and
psychiatrists (APA, 2011). Moreover, social work practice specific to the field of
mental health is the largest subspecialty within the profession (Whitaker, Weismiller,
Clark, & Wilson, 2006). Historically, the use of the psychiatric nomenclature in
social work practice has been controversial and has generated considerable discussion
within the profession (Washburn, 2013). To some extent, mental disorders are the
constructions of practitioners and researchers rather than proven diseases and ill-
nesses (Maddux, Gosselin, & Weinstead, 2008). On the other hand, the diagnoses
found in the DSM are not necessarily lacking credibility or empirical support.
THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL

DISORDERS AND ITS FIFTH EDITION
The publication of the DSM-5 in 2013 is the fifth edition of the DSM, representing
the first major revision to the manual in more than 30 years (APA, 2013). The
DSM has a profound influence on all mental health professions. Certainly there
xvii
xviii PREFACE
have been numerous controversies surrounding the DSM-5 including the overall
reliability of the system, poor research for field trials, its seeming slant toward a
biological approach, the relative lack of participation of professional groups other
than psychiatry, and the inclusion and definition of particular mental disorders
most notably the autism spectrum (First, 2010; Frances, 2012, 2013; Friedman,
2012; Jones, 2012; Pomeroy & Anderson, 2013). Admittedly, the DSM-5 may con-
tain flaws, but for the most part it describes what is reasonably understood by most
practitioners and researchers to be the predominant forms of psychopathology. The
psychiatric diagnosis is primarily a way of communicating and the categories of the
different disorders can be useful without necessarily being the final word about
how people function. The DSM-5 may be imperfect and sometimes biased, but no
one has questioned whether the manual should be used at all or suggested that
there is an alternative way to move forward. Regardless of the criticisms, the reality
is that the DSM remains as the primary classification system across the counseling
professions for diagnosis and reimbursement purposes (Washburn, 2013). If we are
to provide our clients with the best possible services, then the ability to make an
accurate diagnosis is an important step in that direction. Regardless of where you
stand, it is essential to become familiar with the changes in the DSM-5 and its
potential impact on clients. In fact, using the DSM-5 is unavoidable for many clinical
social workers. For instance, the Association of Social Work Boards (ASWB)
includes questions specific to the DSM on its licensing exams, which are required
by almost every state (Frazer, Westhuis, Daley, & Phillips, 2009). Beginning in
July 2015, the licensure test questions shifted to testing knowledge of the DSM-5.
Revising the DSM has been an enormous undertaking and no diagnostic pro-
cess is perfect. Keep in mind that a work of this magnitude will have some errors.
The APA has made every effort to keep up with the listing of errata, and you are
encouraged to check the association s website (http://www.dsm5.org), which posts
corrections to the manual. It is anticipated that minor text edits will be corrected
in later publications.
In the prior edition of this book I shared the experience of one of my students on a
field trip we took to an agency that works with the severely and persistently mentally ill
organized around the clubhouse model. Essentially this student had reservations
around working with those people until she met a real client and had the chance to
get to know him a little better as he proudly showed us around the agency. I still
remember this client s greeting as we approached the front door of the agency. He
had a big smile and proudly announced, Hi, I m Danny and I have schizophrenia.
Welcome to our clubhouse. I can t wait to show you around. I remembered thinking,
who knows more about mental illness than someone who lives with a disorder on a
daily basis? Danny s symptoms may wax and wane, but ultimately they do not go
away. The competency-based approach to the assessment process takes into account a
client s lived experiences with a diagnosis. From this perspective, Danny s diagnosis
becomes but a part of his identity and does not define him. The intent of the compe-
tency-based model is to advance the assessment process to one that recognizes each
person s uniqueness rather than to focus solely on a diagnostic label.
Lacasse and Gomory (2003) analyzed a sample of psychopathology syllabi from
top graduate schools of social work around the country and found that the most fre-
quently required texts were authored by psychiatrists. No course had a stand-alone
PREFACE xix
text authored by a social worker. As social workers, we are familiar with working
from a strengths perspective with our clients, and this orientation somehow becomes
lost in books from other disciplines. This book is written by a social worker for social
workers. Learning about psychopathology and related diagnoses is like learning a
new language. Best to learn this language with a social work accent!
THE BOOK S ORGANIZATION

The changes in the DSM-5 will require practitioners to relearn how to classify and
conceptualize some mental disorders. The aim of this book s fourth edition is to
help readers understand the new features of the DSM-5 to the extent that you can
take this information and, by incorporating the competency-based assessment
model, apply diagnoses correctly. As with prior editions, case studies are provided
to highlight diagnostic criteria and to differentiate among the different diagnoses.
Stigma and misunderstanding of mental illness is pervasive, and many still con-
sider mental health problems to be the result of personal shortcomings. The book is
organized around the competency-based model, which highlights the biological
(including neurological), psychological, and social aspects of a person s life as a part
of the diagnostic process. In this way, understanding psychopathology will not focus
on character flaws or personal weakness but include a strengths-based orientation to
the assessment, which looks to how someone like Danny copes with and rebounds
from the challenges of living with a mental disorder. The diagnosis understands the
individual s biopsychosocial makeup, cultural and political influences, coping meth-
ods, and factors that are a basis for strengths, resiliency, and resources. This orienta-
tion balances psychopathology with a parallel appreciation of factors related to
strengths and resiliency. It goes without saying that using the DSM requires skill in
order to be able to distinguish the client s symptom picture. The competency-based
assessment extends this understanding and looks beyond a review of the client s
symptoms to consider how a disorder is experienced, how it is expressed, and how
symptoms are interpreted by the person and those close to him or her.
INTRODUCTION TO ENHANCED CONTENT

You will find a number of changes in each of the chapters. The DSM-5 definition of
mental illness takes into account the neurological features of mental disorders. In
order to familiarize the social work practitioner with the neurological contributions
to psychopathology, Chapter 1 expands the review of the biopsychosocial frame-
work supporting the competency-based assessment by including content on the
role of the brain and related systems in psychopathology. Subsequent chapters
include a discussion of these influences around particular disorders. A review of
changes to the reorganization of the DSM are also included.
The DSM-5 classification system cuts across all developmental stages, thus elimi-
nating the need for a separate chapter on the disorders of infancy, childhood, and
adolescence as seen in the DSM-IV-TR. From a life-span perspective, disorders spe-
cific to early development are placed in the second chapter on neurodevelopmental
disorders, and a later chapter on neurocognitive disorders addresses late life
xx PREFACE
developments. This approach to DSM reorganization also attempts to better reflect the
relative strength of relationships among disorder groups. For example, although there is
an overlap of symptoms among the anxiety disorders, obsessive-compulsive disorder,
posttraumatic stress disorder, and acute stress disorder, each has a different clinical pre-
sentation and are now included in separate chapters on the basis of overt symptoms in
the DSM-5. However, clients with any one of these closely related disorders can show
comorbid disorders from among this spectrum (Bienvenu et al., 2011).
Consistent with this approach to the DSM classification system, new chapters
have been added; for example, obsessive-compulsive and related disorders, and
trauma- and stressor-related disorders, to list a few. To remain consistent with prior
editions, all of the chapters from 2 through 16 in the book have been ordered around
how they appear in the DSM. You will find a review of the specific disorders fol-
lowed by an updated discussion of prevailing patterns, and the differential diagnosis.
Case vignettes are presented followed by a diagnosis and the competency-based
assessment. An assessment summary reviews possible alternative diagnoses so that
readers can become familiar with the process of distinguishing symptoms and client
competencies in reality-based situations. In this way, readers may learn to take the
client s whole person into account when making a diagnosis of mental illness.
Not every disorder addressed in the DSM-5 appears in the book. The intent is to pro-
vide a more in-depth review of those syndromes social workers will more than likely
encounter in their everyday practice. As before, each chapter is designed to stand
alone. This feature was kept in order to facilitate individual instructor preference
around sequencing the teaching of content about a particular disorder. In addition,
it is easier for readers who might want to re-review a diagnosis.
New case stories have been added throughout the book to illustrate the new
diagnoses included in the DSM-5. For example, you will notice the case of John
Laughlin highlighting disruptive mood dysregulation disorder in the depressive disor-
ders chapter, and Larry Dalton s experiences with gambling disorder in the sub-
stance-related and addictive disorders chapter. There are numerous familiar case
studies from prior editions, but the diagnosis has been updated to reflect the DSM-5
diagnostic criteria. For example, Rudy Rosen still struggles with schizophrenia, but
the way it has been diagnosed is different. To add context to the diagnostic shifts,
each chapter ends with a summary of the changes from the DSM-IV-TR to the
DSM-5. Sometimes a diagnosis that the practitioner will more than likely not see in
the average practice situation was reviewed, and this was done to expand the overall
understanding of the diagnostic categories in the DSM-5. For instance, you will find
Patty Nemeth s story about separation anxiety in the chapter featuring the anxiety
disorders, and Mary Ellen Creamer s struggles with pica in the feeding and eating dis-
orders chapter. The DSM-5 has moved away from a categorical approach to the
diagnosis that is, either you meet criteria for a diagnosis or not and more toward
a dimensional perspective. Reflective of this shift, you will find more listings of diag-
nostic specifiers and severity ratings for each of the diagnoses.
The fourth edition of the book remains a part of the Cengage Learning
Empowerment Series and continues to integrate the Council on Social Work Educa-
tion (CSWE) Educational Policy and Accreditation Standards (EPAS). However, in
March 2015, CSWE approved a new set of standards, referred to as practice com-
petencies. This newly revised set of practice behaviors has been integrated into each
PREFACE xxi
chapter, thus further supporting the book s emphasis on a performance-based ori-

entation to learning that links theory and action; that is, using real-life case exam-
ples to highlight the assessment process. Competency notes are provided at the end
of each chapter that describe each competence and its relationship to chapter con-
tent. The Appendix contains test questions for each chapter, and they have been
expanded to reflect the revisions to this edition.
While the book targets social workers, it can be used by all mental health profes-
sionals taking courses in psychopathology, human behavior, or direct practice. It is
also a good reference for practitioners who want to review the basics of psychopa-
thology or to prepare for a licensure exam. Supervisors will find it a useful reference
for psychiatric diagnoses. The case studies are drawn from real-life practice experi-
ences, and I hope readers will find the diversity reflective of contemporary practice.
All case stories have been changed to protect anonymity, and some represent a com-
pendium of different client experiences. Any resemblance to a real-life client is acci-
dental and not intentional. The cases can be used by both instructors and
supervisors as a part of a homework assignment, to supplement lectures, or adapted
to provide evidence of students understanding of the assessment process in practice.
INSTRUCTOR SUPPLEMENTS
For this edition of the textbook, the author has crafted a detailed Instructor s Man-
ual to support your use of the new edition. The manual includes chapter summa-
ries, practitioner reflections that can be used as student exercises, suggestions for
further study, and additional online and print resources. There is also a detailed
test bank and a set of classroom PowerPoint slides that accompany the text.
This material can be found at http://www.cengagebrain.com.
ACKNOWLEDGEMENTS
The DSM-5 created the opportunity for making significant changes in the book. It
did not take very long for me to realize that an undertaking like this could be
accomplished only with a lot of help and support. I would especially like to
acknowledge all of the helping hands behind the scenes who worked diligently to
make this edition of the book a reality. Looking back, I find it hard to believe that
15 years have passed since the first edition was published. Back then I could not
have predicted that the competency-based assessment would make such an enduring
contribution to the mental health field. I am always collecting case stories from
my own practice, students, supervisees, and colleagues and continue to be
impressed by the strength and resilience of those who struggle with a mental disor-
der. Thank you to all who have shared their stories with me.
Diagnosing clients is not an easy task. The DSM-5 provided an exciting oppor-
tunity to look at this process through the lens of the values of our profession and
then applying those values in contemporary practice. Over and over again, readers
have shared that this textbook, with its real-life case stories, has helped them to
learn psychopathology in a way that keeps in mind the uniqueness of each person
who struggles with the challenges associated with living with a mental disorder.
xxii PREFACE
Thank you for encouraging me to continue this work. When each client s diagnosis is
individualized through the competency-based assessment, we move in the direction of
a societal culture that encourages a change in the negative perceptions of mental ill-
ness and the stigma that surrounds those who seek help for these challenges.
I would like to thank Gordon Lee, Product Manager Anthropology and Social
Work, who was involved at the outset, and Julie Martinez, Product Manager
Counseling, Human Services, and Social Work, who saw this edition through to its
successful completion. I would also like to acknowledge those who assisted with the
production phase of the book, including Tanya Nigh, Senior Content Project Man-
ager, Jeffrey Hahn, J. L. Hahn Consulting Group, and Valarmathy Munuswamy,
Associate Program Manager, Lumina Datamatics, Inc. I know there are many others
on the Cengage team and I do want to acknowledge their contributions.
As a last step, I wish to thank my husband, Kenneth, whose support has made
all of this possible. As with his experiences with my work on prior editions, there
were many times we would miss meals, eat take out, or have lunch at 3:00 or 4:00
p.m. because I was on the computer and, just need another minute to finish this
thought. He claims not to know anything about social work but somehow man-
ages to provide the right words of encouragement at the right time. His faith in
me is something special!
REFERENCES
American Counseling Association. (2011). 2011 statis- on May 1, 2015 from: http://www.psychology
tics on mental health professions. Alexandria, today.com/blog/dsm5-in-distress/201212/dsm-5-is-
VA: Author. guide-not-bible-ignore-its-ten-worst-changes
American Psychiatric Association. (2011). American Frances, A. J. (2013). Two fatal technical flaws in the
Psychiatric Association. Retrieved on May 1, DSM-5 definition of autism. Huffington Post.
2015 from: http://www.psychiatry.org/ Retrieved on May 1, 2015 from: http://www.huf
American Psychiatric Association (APA). (2013). fingtonpost.com/allen-frances/two-fatal-technical-
Diagnostic and Statistical Manual of Mental Dis- flaws_b_3337009.html
orders (5th ed.). Arlington, VA: Author. Frazer, P., Westhuis, D., Daley, J., & Phillips, I.
American Psychological Association. (2012). Support (2009). How clinical social workers are suing
Center: How many practicing psychologists are the DSM: A national study. Social Work in Mental
there in the United States? Retrieved on May 1, Health, 7, 325 339.
2015 from: http://www.apa.org/support/practice. Friedman, R. A. (2012). Grief, depression, and the
aspx DSM-5. New England Journal of Medicine.
Bienvenu, O. J., Samuels, F. J., Wuyek, A., Liang, Retrieved on May 2, 2015 from: http://www
K-Y., Wang, Y., Grados, M. A., Nestadt, G. .nejm.org/doi/full/10.1056/NEJMp1201794?
(2011). Is obsessive-compulsive disorder an anxi- query=TOC
ety disorder and what, if any, are spectrum con- Jones, K. D. (2012). A critique of the DSM-5 field
ditions? A family study perspective. Psychological trials. Journal of Nervous and Mental Disease,
Medicine, 41(1), 33 40. 200, 517 519.
First, M. B. (2010). Clinical utility in the revision of Lacasse, J. R., & Gomory, T, (2003). Is graduate
the Diagnostic and Statistical Manual of Mental social work education promoting a critical
Disorders (DSM). Professional Psychology: approach to mental health? Journal of Social
Research and Practice, 41, 465 473. Work Education, 39, 383 408.
Frances, A. J. (2012). DSM-5 is guide not bible ignore Pomeroy, E. C., & Anderson, K. (2013). The DSM-5
its ten worst changes. Psychology Today. Retrieved has arrived. Social Work, 58(3), 197 200.
PREFACE xxiii
Schwartz. M. A., & Wiggins, O. P. (2002). The hege- workers. Retrieved on May 1, 2015 from: http://
mony of the DSMs. In J. Sadler (Ed.), Descrip- www.bls.gov/ooh/Community-and-Social-Service/
tions and prescriptions: Values, mental disorders Social-Workers.htm
and the DSM (pp. 199 209). Baltimore, MD: Washburn, M. (2013). Five things social workers
Johns Hopkins University Press. should know about the DSM-5. Social Work,
Maddux, J. E., Gosselin, J. T., & Weinstead, B. A. (2008). 58(5), 373 376.
Conceptions of psychopathology: A social construc- Whitaker, T., Weismiller, T., Clark, E., & Wilson,
tionist perspective. In J. E. Maddux & B. A. M. (2006). Assuring the sufficiency of a front-
Weinstead (Eds.), Psychopathology: Foundations for line workforce: A national study of licensed
a contemporary understanding (2nd ed., pp. 3 18). social workers. Special report: Social work ser-
New York: Routledge/Taylor & Francis Group. vices in behavioral health care settings.
U.S. Department of Labor, Bureau of Labor Statistics. Washington DC: National Association of Social
(2010). Occupational outlook handbook: Social Workers.
ABOUT THE AUTHOR
Susan W. Gray is Professor Emerita at Barry University s Ellen

Whiteside McDonnell School of Social Work in Miami Shores,
Florida. She received her PhD in social work from Barry University
with a specialization in licensure and professional regulation, her
EdD concentrating on adult education from Nova Southeastern
University, her MBA from Barry University, and her MSW in
clinical practice from Rutgers the State University. She is a member
Photography by Mazrk Safra
of the National Association of Social Workers, the Academy

of Certified Social Workers, and the Council on Social Work
Education. She has been a member of the faculty since 1980,
teaching a variety of courses across the curriculum, including founda-
tion and advanced clinical social work practice courses specializing in
working with individuals, families and groups, an elective course
in crisis intervention, and a doctoral course in social work education. Among her
accomplishments, Dr. Gray directed the Doctoral Program and spearheaded an
extensive revision of its curriculum.
Dr. Gray is a Licensed Clinical Social Worker and registered clinical supervisor
in Florida, where she also serves as a member of the Probable Cause Panel for the
state licensure board. Dr. Gray holds a wide range of experience in direct clinical
practice with individuals, families, and groups, having worked in a variety of clinical
and community settings, including a half-way house for pregnant adolescents, family
and children outpatient counseling centers, acute care medical settings, inpatient
psychiatric units, and private practice. She also served as a member of the Florida
Board of Clinical Social Work, Mental Health Counseling, and Marriage and Family
Therapy.
Her practice interests include her work in supervision, professional regulation
and licensure, rural practice, bereavement groups, intergenerational family assessment
tools, the brief solution-focused model of practice, methods of classroom teaching,
and aspects of cultural diversity. Dr. Gray s current research interests are in mental
health assessment and practice. She has authored numerous publications, given pre-
sentations at local, state, national, and international social work conferences, and is
also the author of Competency-based Assessments in Mental Health Practice: Cases
and Practical Applications. Dr. Gray is known to be an informative and engaging
speaker and has received numerous awards; most notably, she was honored as a
mentor by the Council on Social Work Education s Council on the Role and Status
of Women in Social Work Education and received the lifetime achievement award
xxv
xxvi ABOUT THE AUTHOR
from the Florida Miami Dade National Association of Social Workers. Dr. Gray s
decision to become a teacher was based on her wish to continue to serve and to pay
forward all of the mentoring and support she received throughout her professional
career. Looking to the new generation of graduating social workers and experienced
practicing social workers, she hopes that this book will set the stage for readers to
find their way to positively influence the profession beginning each client, and one
case at a time.
Another random document with
no related content on Scribd:
"I suppose not," I said. "Well, I'll let you have my decision in a few
days. The rent with the cupboard, you say, is——" And I named the price.
"Yes, with the cupboard."
So that settled the cupboard question.
Settled it so far as it concerned him. For me it was only the beginning.

In the year that followed my eyes were opened, so that I learned at last to
put the right value on a cupboard. I appreciate now the power of the mind
which conceived this thing, the nobility of the great heart which included it
among the fixtures. And I am not ungrateful.
You may tell a newly married man by the way he talks of his garden.
The pretence is that he grows things there—verbenas and hymantifilums
and cinerarias, anything which sounds; but of course one knows that what
he really uses it for is to bury in it things which he doesn't want. Some day I
shall have a garden of my own in which to conduct funerals with the best of
them; until that day I content myself with my cupboard.
It is marvellous how things lie about and accumulate. Until they are
safely in the cupboard we are never quite at ease; they have so much to say
outside, and they put themselves just where you want to step, and
sometimes they fall on you. Yet even when I have them in the cupboard I
am not without moments of regret. For later on I have to open it to
introduce companions, and then the sight of some old friend saddens me
with the thought of what might have been. "Oh, and I did mean to hang you
up over the writing-desk," I say remorsefully.
I am thinking now of a certain picture—a large portrait of my old

headmaster. It lay in a corner for months, waiting to be framed, getting
more dingy and dirty every day. For the first few weeks I said to myself, "I
must clean that before I send it to the shop. A piece of bread will do it."
Later, "It's extraordinary how clever these picture people are. You'd think it
was hopeless now, but I've no doubt, when I take it round to-morrow——"
A month after that somebody trod on it....

Now, then, I ask you—what could I do with it but put it in the
cupboard? You cannot give a large photograph of a headmaster, bent across
the waistcoat, to a housekeeper, and tell her that you have finished with it.
Nor would a dustman make it his business to collect pedagogues along with
the usual cabbage stalks. A married man would have buried it under the
begonia; but having no garden....
That is my difficulty. For a bachelor in chambers who cannot bury, there

should be some other consuming element than fire. In the winter I might
possibly have burnt it is small quantities—Monday the head, Tuesday the
watch-chain—but in the summer what does one do with it? And what does
one do with the thousands of other things which have had their day—the
old magazines, letters, papers, collars, chair legs, broken cups? You may
say that, with the co-operation of my housekeeper, a firmer line could be
adopted towards some of them. Perhaps so; but, alas! she is a willing
accessory to my weakness. I fancy that once, a long time ago, she must
have thrown away a priceless MS. in an old waistcoat; now she takes no
risks with either. In principle it is a virtue; in practice I think I would chance
it.
It is a big cupboard; you wouldn't find many rooms in London with a

cupboard like that; and it is included in the fixtures. Yet in the ordinary way,
I suppose, I could not go on putting things in for ever. One day, however, I
discovered that a family of mice had heard of it too. At first I was horrified.
Then I saw that it was all for the best; they might help me to get rid of
things. In a week they had eaten three pages of a nautical almanac;
interesting pages which would be of real help to a married man at sea who
wished to find the latitude by means of two fixed stars, but which, to a
bachelor on the fourth floor, were valueless.
The housekeeper missed the point. She went so far as to buy me an

extremely patent mousetrap. It was a silly trap, because none of the mice
knew how to work it, although I baited it once with a cold poached egg. It is
not for us to say what our humbler brethren should like and dislike; we can
only discover by trial and error. It occurred to me that, if they did like cold
poached eggs, I should be able to keep on good terms with them, for I
generally had one over of a morning. However, it turned out that they
preferred a vegetable diet—almanacs and such....
The cupboard is nearly full. I don't usually open it to visitors, but

perhaps you would care to look inside for a moment?
That was once a top-hat. What do you do with your old top-hats? Ah,
yes, but then I only have a housekeeper here at present.... That is a really
good pair of boots, only it's too small.... All that paper over there?
Manuscript.... Well, you see it might be valuable one day....
Broken batting glove. Brown paper—I always keep brown paper, it's
useful if you're sending off a parcel. Daily Mail war map. Paint-pot—
doesn't belong to me really, but it was left behind, and I got tired of kicking
it over. Old letters—all the same handwriting, bills probably....
Ah, no, they are not bills, you mustn't look at those. (I didn't know they
were there—I swear I didn't. I thought I had burnt them.) Of course I see
now that she was quite right.... Yes, that was the very sweet one where she
... well, I knew even then that ... I mean I'm not complaining at all, we had a
very jolly time....
Still, if it had been a little different—if that last letter.... Well, I might by
now have had a garden of my own in which to have buried all this rubbish.
THE POST BAG
The other day I received a letter from some very old friends of mine
who live in Queen Victoria Street.
Memo from Messrs Robinson, Cigar Shippers

MY DEAR SIR,—We have been very anxious at not having heard from
you for nearly a year. We trust that you are in good health and that no
illness or bereavement has kept you from writing to us. As you know, it is
our one ambition to satisfy you in the matter of cigars, and your long
silence on the subject has naturally made us apprehensive. Until we hear
from you, however, we shall refuse to believe that the last lot you had from
us were fatal.
Write to us frankly on the subject. How did you like the cigars we sent
you last Christmas? Were they brown enough? Did they smoke to a finish
strongly? One third shipper, who went to Havana especially to select this lot
for you, writes us that in this respect they were fit for an ambassador or (we
may add) an actor manager. What is it, then, that you are keeping back from
us? Perhaps you could not light them? If this was the case you should have
written to us before, and we would either have sent you others of a more
porous quality or forwarded you our special gimlet, with which you could
have brought about the necessary draught. Lay bare your heart to us about
these cigars. Do you mind the green spots?
A connoisseur like yourself will, of course, understand that, though we

guarantee that all the cigars sent out by us can be smoked, yet the quality of
the cigar must necessarily vary with the price. This being so, perhaps you
would care to try a slightly higher-priced cigar this time. We have referred
to our books and we see that last year we had the pleasure of sending you a
box of our famous Flor di Cabajo at 8s. 6d. the hundred. A nicer-coloured
cigar is the Blanco Capello at 9s. 6d.; but we are hoping this Christmas that
you will see your way to giving our celebrated Pompadoros, at £5 the
hundred, a trial. They have all the features of the Cabajo which you
approved, together with a breadth and charm of flavour of their own. May
we send you a box of these?
Our other special lines are:
The I am Coming—a spirited young cigar at 7s. 6d. the hundred, of

which we enclose a sample.
The Mañana—prompt and impressive—10s. the hundred. (Note.—This
cigar has a band.)
The There and Back—a good persevering cigar. Only 10s. 6d. Never
comes undone.
However we are quite sure that none of these will appeal to such a
fastidious palate as yours must be by now, and that we may confidently rely
on your order for a box of Pompadoros.
We may say that if you should unfortunately have completely lost your
taste for cigars we shall be happy to send a box to any friend of yours.
Nothing could make a more acceptable present, and nothing would endear
your friend or his relatives to you so completely.
Now please write to us and tell us what you feel about it. We desire to
make friends of our customers; we do not wish our business to be a mere
commercial undertaking. Talk to us as freely as you would to your old
college chum or fellow-clubman. We insist on being of service to you.
Hoping to hear from you within a day or two, we are, etc.,
ROBINSON & Co.
I replied at once:
Memo from Me
DEAR OLD FRIEND,—A thousand thanks for your sympathetic letter,

and the book with the pictures. Upon my word, I don't know which of the
cigars I like best; they all look so jolly. Are they photographs or water-
colours? I mean, are they really as brown as that? I like the tall, well set-up
one on page 7. I see you say that it smokes strongly to a finish. That is all
very well, Oswald, but what I want to know is, Does it hang the beginning
at all? Some of these cigars with a strong finish are very slow forward, you
know.
Many thanks for the sample. Bless you, Rupert, I didn't mind the green
spots. What do they mean? That the cigar isn't quite ripe yet, I suppose. But
I think you overdo the light brown spots. Or are they lucky, like those little
strangers in the tea?
Yes, I think I must have some of your Pompadoros. Send a box at

Christmas to Mr Smithson, of 199 Cornhill, with our love—yours and mine
and the third shipper's. I'll pay. Not at all, Percy, it's a pleasure. He sent me
some last Christmas; as it happened, I left 'em in the train before I had
smoked one; but that wasn't his fault, was it? I'll get some for myself later
on, if I may. You won't mind waiting?
Dear old soul, you make a mistake when you say I had some cigars
from you last year. I assure you I've never heard of your name till to-day.
That was why I didn't write on your birthday. You'll forgive me, won't you?
Now it is your turn to write. Tell me all about yourself, and your
children, and the third shipper, and the light brown spots and everything.
Good-bye! Your very loving college chum.
The correspondence concluded thus:
DEAR SIR,—We have received your esteemed order, which shall be

promptly executed. Though the Pompadoros will not be despatched to your
friend till Christmas, they are now being selected and will be put aside to
cool.
We have referred again to our books and find that a box of our
celebrated young Cabajos was indeed despatched to your address last year,
on the advice of Mr Smithson, of 199 Cornhill. This was why we were so
anxious at your long silence. We are, etc.,
ROBINSON & Co.
DEAR OLD SPORT,—I am afraid you misunderstood my last letter.

The Pompadoros are for myself; it was a hundred I am Comings which I
wanted for my friend Mr Smithson. I must tell you a funny thing about him;
as a friend of both of us you will be interested. He collects cigar bands! I
have no use for them myself; so, if it isn't troubling you, would you send
the Pompadoro bands to him, as the I am Comings haven't any of their
own? You might put them on the cigars to save packing. Ever your devoted
fellow-clubman.
GOING OUT
Alone, I can get through an At Home with a certain amount of credit.

No doubt, I make mistakes; no doubt people look at me and say: "Who is
that person sitting all by himself in the corner, and keeping on eating
muffins?" but at any rate I can make the function a tolerable one. When,
however, I flutter in under the wing of my sister-in-law, with my hair nicely
brushed and my tie pulled straight (she having held a review on the
doorstep), then it is another matter altogether. It is then that I feel how
necessary it is to say the right thing. Beatrice has pretty ears, but they are
long-distance ones. We drifted apart immediately but I was sure she was
listening.
I found myself introduced to a tall, athletic-looking girl.
"There's a great crowd, isn't there?" I said. "Can I find you some tea, or
anything?"
"Oh, please," she said, with a smile.

I noted the smile, and thanked heaven that I had read my Lady Grove.
In the ordinary way I say to strangers: "Will you take a dish of tea with
me?" but just in time Lady Grove had warned me that this was wrong. Left
to myself I hit upon the word "find." "Can I find you some tea?" It gives the
idea of pursuit. And the "or anything" rounds it off well—as much as to say,
"If I should happen to come back with a sardine on toast, don't blame me."
I found some tea after a long struggle, but by that time I had lost the
athlete. It was a pity, because I was going to have talked to her about
Surrey's victory over Kent at ladies' hockey. I don't know anything about
hockey, but it's obvious that Surrey must play Kent some time, and it would
be an even chance that Surrey would win. The good conversationalist takes
risks cheerfully.
Well, the international having disappeared, I was going to drink the tea
myself, when I caught Beatrice's eye on me.
"Will you have some tea?" I said to my neighbour.
"I think a little coffee, thank you."
"Certainly."
I pressed the tea into the hand of a retired colonel, and hurried off. Now
that shows you. Alone, I should have quoted The Lancet on coffee
microbes, and insisted on her having my cup of tea. This would have led us
easily and naturally to a conversation on drinks and modern journalism. We
should have become friends. I should have had an invitation from her
mother to lunch; and I should have smoked two of her father's best cigars.
As it was I said "Certainly," fetched the coffee, coughed, and observed

that there was rather a crowd. She said "Yes" and turned away to somebody
else. Two good cigars thrown away because of Beatrice!
I was slowly recovering from my loss when Beatrice herself came up to

say that she wanted to introduce me to a very nice girl called Jane
something. In the ordinary way, very nice girls aren't called Jane anything,
so here evidently was something exceptional. I buttoned my coat boldly,
and followed her, unbuttoning it nervously on the way.
"Here he is," she said, and left us.
This is what they call introducing.
"How do you do?" I started.
"I've heard such a lot about you," began Jane brightly.
I never know what to say to that. There must be a right answer, if only
Lady Grove would tell us. As it was I said "Thank you."
That felt wrong, so I added, "So have I."
"About you," I explained hurriedly. To myself I said, "You know you're

not really carrying this off well. It's idle to pretend that you are."
"What have you heard, I wonder?" beamed Jane.
Only that her name was Jane something.
"Ah!" I said.
"Oh, you must tell me!"
"I mean, I've heard friends of yours mention your name."
"Oh," she said disappointedly, "I thought you meant——"
"But, of course, everybody has heard of Jane—h'r'r'm—of Miss—er, um

—I think my sister-in-law—yes, thank you, we have a train to catch, oh,
must you really go?—er—good-bye."
I staggered away in pursuit of Beatrice. She dragged me up to an

American girl, as I judged her.
"Here he is," she said, and passed on.

"So glad to make your acquaintance," said the American.
There is no answer to that, I know. I ignored it altogether, and said:
"Have you seen the Budget?"
"No. What's that?"
"Oh, you must see that."
"I will. We'll go to-morrow. Where is it?"
I don't think Americans see as much of Addison Road as they ought to.
I gave the usual guide-book directions for getting there, and was just
beginning to be interested when I saw Beatrice's inquiring look. "Are you
behaving nicely?" it said. I passed on hastily.
I was very lonely for a while after that. Three times I got a plate of
cucumber sandwiches safely into a corner, and three times a sisterly eye
dragged us out again. After the third failure I saw that it was hopeless, so I
wandered about and tried to decide which was the ugliest hat in the room. A
man is the only possible judge in a competition of that sort. A woman lets
herself be prejudiced by such facts as that it is so fashionable, or that she
saw one just like it in Bond Street, my dear, at five guineas.
I had narrowed the competitors down to five, two of which were, on

form, certain for a place, when I turned round and saw, in a corner behind
me—
(I don't know if you will believe me)—
A man with a plate of cucumber sandwiches!
I rubbed my eyes in amazement. A man ... at an At Home ... sitting

down and eating cucum—— Why, where was his sister-in-law?
There was only one thing to be done. The favourite in my competition

(green, pink hoops) was disengaged for the moment. I went up to the man,
took him by the arm, and dragged him away from his corner. He still held
the plate in his hand, and I helped myself to a sandwich. "Must introduce
you," I whispered in his ear. "Famous prize-winner." We pushed our way up
to the lady.
"Here he is," I said.
And I looked round triumphantly for Beatrice.
THE SIDESMAN
(For the Third Day running)
For what seemed weeks, but was the last two days,
I'd pottered up and down that blessed baize—
Sorting out aunts in browns and aunts in greys.
For what seemed always, but was only twice

(Looking, if I may say so, rather nice),
I'd lent a hand with hymn-sheets and with rice.
Once more the dear old bells ring out; once more
I linger, pink but anxious, at the door—
This is the third time. Here she comes! Oh, lor'!
* * * * * * *
Something on these occasions goes and thrills

My fancy waistcoat at the first "I will's";
It can't be hopeless love—it must be chills.
Something—a sinking feeling—round the heart

Clutches me closely from the very start,
And tells me I am fairly in the cart.
Something.... And yet the fiercest unconcern
So masks me that the vergers never learn
How underneath my chest I yearn and yearn.
* * * * * * *
"Wilt thou?" And (there you are!) profoundly stirred,

A gleam of hope strikes through me—wild, absurd ...
"No luck!" I sigh. "He's on it like a bird."
"I, Edward John"—and lonely at the back

I wish my name were Edward; I could hack
Myself that I was never christened Jack.
"I, Amabel (O Amabel!) take thee"—

I groan, and give profoundly at the knee:
"There, but for someone else," I say, "goes Me."
* * * * * * *
Fair friends o' mine, what is it tries to shove

My heart into my watch-chain, as above?
It can't be hopeless chills, it must be love.
Yet not for Amabel. No weight of care

Clogs me as I pursue that happy pair
Into the vestry and admire them there;
Save this: I take the clergyman aside—

"Tell me," I whisper—"you're the third I've tried—
Do I, or do I not, embrace the bride?"
AN AWKWARD CASE
This is one of those really difficult cases (being the seventh of the
quarter) where the editor of The Perfect Lady simply has to ask his readers
what A. should have done. The sort of reply that will be given is; "A. should
have carried it off easily." Remarks like that are unhesitatingly included
among the "Answers adjudged idiotic."
The thing happened in the train, while I was returning to town after a
couple of nights in the country. The scene—an empty carriage, myself in
one corner. On the seat opposite lay my dressing-case. I had unlocked it in
order to take out a book, and was deep in this when we stopped at a wayside
station. The opening of the door woke me suddenly; somebody was daring
to get into my compartment. Luckily one only—a girl.
Women always wish to travel with their backs to the engine; in the
event of an accident you don't have so far to go. She sat down next to my
bag. Naturally I jumped up (full of politeness), seized the handle, and
swung the thing up on to the rack.
That, at least, was the idea. It was carried out literally, but not
figuratively. The bag went up beautifully; only—on its way it opened, and
the contents showered down upon the seats, the floor, and—yes, even upon
her....
The contents....
This story shows upon what small accidents great events turn. If I had
only been going instead of coming back! A couple of clean shirts, a few
snow-white collars, a pair of sky-blue pyjamas perfectly creased, socks and
handkerchiefs neatly folded—one would not have minded all these being
thrown before a stranger; at least, not so much. Going, too, the brushes and
things would have been in their proper compartments; they would have
swung up on to the rack. I feel convinced that, if the thing had happened
going, I should have carried it off all right. We should have laughed
together, we should have told each other of similar accidents which had
happened to friends, and we should have then drifted into a general
conversation about the weather. Going ....
But coming back! It was an early train, and I had packed hurriedly. The
brushes and things had been put in anyhow, and they came out anyhow.
There was an absurd piece of shaving soap wrapped up in one of "An
Englishman's Letters." (I always think that things wrapped up like that look
so horrible.) There was a shaving-brush in a pink piece of Globe lying on
the sky-blue pyjamas (and the pyjamas all anyhow). Then the collars. I do
think a dirty collar ... besides I had screwed them up tightly in order to get
them in.... Of course she wouldn't understand that....
Socks. Now this is too awful. I don't know if I can mention this. Well—
well then, they had two wretched sock-suspenders attached to them. Odd
ones, as I live—black and pink. You see, I had got up in a hurry, and...
Handkerchiefs. They had been shoved into the pumps. I had been
pressed for space, and...
You know, there were about thirty-nine different things that I wanted to
explain to her. In novels the hero is always throwing upon the heroine an
expressive glance, full of meaning. That is what I wanted. There is
probably, if one only knew it, a shrug, a wave of the hand, which really
does express the fact that you were coming and not going, and took in The
Times yourself, and had packed in a hurry, and ...
If I could only have handed a Statement to the Press....
And I have yet to mention the unkindest blow of all. The evening
clothes themselves, the only presentable things, stayed in the bag. If they
had come out too, then I might have done something. I should have left
them to the last—conspicuous upon the floor. Then I should have picked
them up slowly, examined them, and nodded at the braid on the trousers as
if to say, "Hang it, that's the sort of man I am really." I think, if they had
come out too, I could still have carried the thing off....
What should A. do? Should he say to the girl, "Close your eyes and
count twenty, and see what somebody's brought you," and then, while she
was not looking, push the clothes under the seat? Should he be quite calm,
and, stretching in front of her, say, "My sock, I think," or politely, "Perhaps
you would care to look at a piece of The Daily Mail?" Should he disown the
thing altogether? "I'm very sorry. Let me put them back for you." That
would have been a master-stroke.
Or should he, to divert attention, pull the alarm, and pay his five pounds
like a man?
But what did A. do?
Alas! He did nothing heroic. For one moment he stood there; then he
pulled down the bag, fell on his knees, and began throwing the things in
madly. He picked up the bag, locked it, and put it on the rack.
Then he turned to the girl. Now he was going to have spoken to her. An
apology, a laugh—yes, even now he might have carried it off.
Only he happened to look up ... and he saw above her head the cord of
his pyjamas dangling over the edge of the rack.
REVERIE
Dear Amaryllis,—(may I call you that?

Seeing I do not know your proper name;
And if I did, it might be something dull—
Like Madge). I offer you my broken heart,
Knowing that if you do not want the thing
You will not hesitate to mention it:
Dear Amaryllis, will you please be mine?
We met, 'twas at a dance, ten days ago;

And after sundry smiles and bows from me,
And other rather weary smiles from you,
And certain necessary calculations,
We hit at last upon the second extra,
And made an assignation for the same.
"I shall be at this corner here," you said:
And I "Right O" or words to that effect.
But when the dance came round we both were tired,
So sat it out instead beneath a palm
(Which probably was just as well for you,
And since I love you, just as well for me).
We talked, but what about I can't remember—
Save this: that you were rather keen on golf;
That I had never been to Scarborough;
And both of us thought well of Bernard Shaw.
We talked; but all the time I looked at you,

And wondered much what inspiration led
Your nose to tilt at just that perfect angle;
And wondered how on earth you did your hair;
And why your eyes were blue, when it was black;
And why—a hundred other different things.
Until at last, another dance beginning,
You left me lonely; whereupon I went
Back to the supper-room, and filled a glass
And drank, and lit a cigarette, and sighed,
And asked the waiter had he been in love,
And told the waiter, Yes, I am in love,
And gave him twopence, and went home to bed.
Am I in love? Well, no, I hardly think so.

For one, I'm much too happy as I am;
For two, I shall forget you by to-morrow;
For three, I do not care about your friends,
The men you danced with—bounders, all of them;
For four and five and six and all the rest,
I'm fairly sure we shall not meet again.
Not that I mind. No, as I said before,
I'm very much too happy as I am.
Besides, I shall forget you by to-morrow.
Then why this letter? Well, two incidents
Have led me to it. Here you have them both.
First, then, that sitting in my rooms last week,
Sitting and smoking, thinking—not of you,
Not altogether, but of many things,
Politics, football, dinner and tobacco—
Quite suddenly, this thought occurred to me:
"By Jove, I wish I had a little dog,
A terrier, an Irish terrier,
I wonder if the landlord would object."
And thinking thus, I rose and sighed, and bent
To take my boots off. Had a mouse appeared
I could have loved it in my loneliness.
Had but the humblest cockroach shown his head,
I think I would have said "Good-night" to it.
This too (I give it you for what it's worth):

Next morning, passing through St James's Park,
A morning for the gods, all blue and white,
I heard what, strictly, should have been a skylark,
(But, probably, was quite a common bird)
Offering up its very soul to heaven.
Then suddenly I stopped and cried, "Oh, Lord!
Oh, Lord!" I cried, "I wish it were the spring."
* * * * * * *
So there you have it. Now it's off my chest.

Just for one moment you upset me slightly,
Disturbed my usual calm serenity,
Got in my head, and set me vainly wishing
For April, and the country, and one other...
But that is over. I am whole again.
Good-bye! I shall not send this letter now.
I find I have forgotten you already.
RETROSPECT
Looking back on the past year I can see that it has been (as usual) one of
noble endeavour—frequently frustrated, but invariably well meant. In
accordance with the custom of the newspapers I have set down here its
record of achievement in the different provinces of art, bicycling and the
like; and I offer this to the public in full confidence of its sympathy and
appreciation.
ART
We have had our photographs taken for the first time for many years,
and if the result isn't art I don't know what is. The photographer said:
"Would you like them en silhouette or straight-fronted?" We said in French
that we had thought of carte-de-visite. The result is a sort of three-quarter
face with one wing forward, and the man insists that we must have looked
like that once. The only other achievement in the world of art is a moleskin
waistcoat of some distinction. I had no idea that moles were that colour, but
the man swore that when you had taken the feathers out of them you found
quite a different coloured skin underneath. As he has been there and I
haven't, I cannot argue with him. Altogether a good year for art.
BICYCLING
At the beginning of the year our eldest brother sold our bicycle for a
sovereign and gave the sovereign to our second brother. A bad year for
bicycling therefore.
SCIENCE
(I thought for the moment science began with a C, which is why it

comes in here.)
Several important discoveries have been made in the year. For instance,
the small white raspberries in tapioca pudding are meant to be there; you
always thought that they had got in from some other dish, when the cook
wasn't looking. And when your watch gains a foot you don't put the
regulator to A because it is advancing, but to R because you want to retard
it. (Or else the other way round—I have forgotten again. Anyhow, I found
out that I had been doing it wrong.) Another discovery made in the early
part of the year was the meaning of the phrase "Bank Rate Unchanged," but
that is too technical to explain here. A record year for science.
FINANCE
The old system of keeping no accounts and never filling in the

counterfoils of cheques again answered admirably.
GAMES
The past year marks an epoch in the history of games. We have retired
from football and are not the cricketer we were; but, on the other hand, we
have made immense strides in croquet. We improve slowly at billiards. In
November we potted the red rather neatly, and everybody said, "There's no
getting away from that—he must have meant it." As a matter of fact ... but it
would spoil it to explain. In the latter part of the year we could have shown
you a trick or two at tennis. That is all, except that I can no longer jump the
ancestral herbaceous border, as the gardener keeps on discovering.
HYDROSTATICS
Archimedes' Principle—that if a heavy body gets into a cold bath

quickly an equal amount of water gets out on to the mat quickly—was
demonstrated daily, to the complete dissatisfaction of the man on the floor
below, who, however, made a still more important discovery in this
interesting branch of dynamics—viz. that water does not find its own level,
but prefers something about ten feet lower down.
INDIGO
Indigo has maintained its status quo throughout the year. There have
been occasions during this time when we had almost decided to be an
Indigo planter in Assam rather than stick it in this beastly country. On each
occasion the weather cleared just before we had packed the sandwiches.
MUSIC
Space and time alike fail us to tell of our notable triumphs upon the
pianola in the year that has just elapsed. We have played the Sonata
Appassionata and "Shuffling Jasper" with equal verve and chiaroscuro. The
fruitness and nutty flavour of our rendering of Remorse—Valse Tzigane,
No. 1,192,999, kindly return by the end of the month—will never be
forgotten. In July one of the black notes stuck down and refused to budge
for some time; but we got it up at last with a potted-meat opener. I say, I
don't think much of Liszt. He has pace and staying power and is a good

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Empowerment Series Psychopathology

A Competency Based Assessment

Empowerment Series: An Introduction to the Profession

Essentials of Testing and Assessment: A Practical Guide

Program Evaluation for Social Workers: Foundations of

Motivational interviewing : a workbook for social

Phlebotomy: A Competency-Based Approach 5th Edition

Health Assessment for Nursing Practice Susan F. Wilson

SysML for Systems Engineering A Model Based Approach

Structural Competency in Mental Health and Medicine A

Competency 1 Demonstrate Ethical and Professional Behavior

a. Social workers make ethical decisions by applying the See chapter(s):

Competency 2 Engage Diversity and Difference in Practice

a. Social workers apply and communicate understanding of See chapter(s):

c. Social workers apply self-awareness and self-regulation to 14

Competency 4 Engage in Practice-Informed Research and Research-Informed Practice

c. Social workers use and translate research evidence to inform 8 and 14

Competency 5 Engage in Policy Practice

b. Social workers assess how social welfare and economic 8 and 9

c. Social workers apply critical thinking to analyze, formulate, 2, 8, and 14

(Continued on inside back cover)

A Competency-Based Assessment Model

Australia • Brazil • Mexico • Singapore • United Kingdom • United States

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CHAPTER 1 An Introduction to the Competency-Based Assessment Model 1

CHAPTER 2 Neurodevelopmental Disorders 33

CHAPTER 3 Schizophrenia Spectrum and Other Psychotic Disorders 66

CHAPTER 4 Bipolar and Related Disorders 111

Cyclothymic Disorder 121

CHAPTER 5 Depressive Disorders 129

CHAPTER 6 Anxiety Disorders 161

Specific Phobia 167

CHAPTER 7 Obsessive-Compulsive and Related Disorders 191

CHAPTER 8 Trauma- and Stressor-Related Disorders 214

Disinhibited Social Engagement Disorder 218

CHAPTER 9 Dissociative Disorders 244

CHAPTER 10 Somatic Symptom and Related Disorders 270

Conversion Disorder (Functional Neurological Symptom Disorder) 283

CHAPTER 11 Feeding and Eating Disorders 297

CHAPTER 12 Elimination Disorders 341

CHAPTER 13 Disruptive, Impulse-Control, and Conduct Disorders 353

CHAPTER 14 Substance-Related and Addictive Disorders 373

Other Diagnostic Considerations 386

Sedative, Hypnotic, or Anxiolytic Use Disorders 412

CHAPTER 15 The Neurocognitive Disorders 443

Neurocognitive Disorder due to Traumatic Brain Injury 466

CHAPTER 16 The Personality Disorders 475

Obsessive-Compulsive Personality Disorder 527

THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL

THE BOOK S ORGANIZATION

INTRODUCTION TO ENHANCED CONTENT

chapter, thus further supporting the book s emphasis on a performance-based ori-

Susan W. Gray is Professor Emerita at Barry University s Ellen

of the National Association of Social Workers, the Academy

"Yes, with the cupboard."

So that settled the cupboard question.

Settled it so far as it concerned him. For me it was only the beginning.

I am thinking now of a certain picture—a large portrait of my old

A month after that somebody trod on it....

That is my difficulty. For a bachelor in chambers who cannot bury, there