ISNP2210 Adult Interventions 1

ISNP2210 Adult Interventions 1

Case Formulation

Feedback Sheet

Criteria Mark Comment

Presenting Problem(s)

Comprehensive problem list

Prioritised in terms of impact on functioning and/or client preference

Maximum 5-8 items

Diagnostically appropriate /10 Predisposing Factors

Sound hypotheses about the potential/likely origins of the persons problem(s) or disorder

Well-articulated

Accurately described with reference to relevant psychological theories

The most relevant predisposing factors are described /20 Precipitating Factors

A description of the likely precipitants/stressors/triggers that have activated the current problems/symptoms

Description of link with predisposing factors

Why was this event/experience a precipitant for this person and these symptoms? /20 Perpetuating Factors

A clear description of the cognitive, behavioural, physical and emotional factors that appear to be perpetuating the persons symptoms or problems

Sufficient detail is provided to highlight likely areas for treatment /20 Protective Factors

Evidence-based resilience/protective factors are identified /20 Clear consideration of how these might support the persons therapy/adherence/alliance/outcome Written Expression

Grammar, punctuation, spelling.

Well-articulated

Written expression /10

198635-1069039ISNP2210 Adult Interventions 1 Vignette for Clinical Case Formulation

John

John is a 65-year-old catholic Caucasian male. John is divorced and has two adult daughters, Michelle aged 43 and Stephanie aged 41, who live 1-2 hours away. Both daughters are married with children and visit John several times a year. John also had a son who died when he was 25 years old in a road traffic accident. John and his wife divorced about 10 years ago as a result of John revealing to his family that he is gay, and saying that he has been living a lie his whole life. He also revealed that throughout his marriage he had several affairs with men that his wife did not know about. This has significantly impacted his relationships with his daughters and grandchildren.

John was referred for a mental health assessment by his GP due to concerns that he was depressed. His GP noted that John was experiencing significant interpersonal difficulties including arguing with his daughters and ex-wife. His GP also said John had recently begun spending a lot of time at home on his own and had stopped participating in many of the activities which he previously enjoyed. The referral information reported that John was initially quite sociable and a member of several community groups including a car club and volunteer fire fighter brigade. One of Johns friends from the firefighter brigade, David, was killed around 4 months prior whilst out tending to a fire and since this time John stopped participating in firefighting.

At initial assessment, John described his mood as fed up and said that he has little to live for. He reported feeling bored and said that he doesnt like anyone. He described a history of being wronged by others, starting from when he was a child and a catholic priest told him that he was not gay, and should act as if he was not and the feelings would go away. As a result of this experience John does not attend church, although he still identifies as a catholic. John also said that members of his community have done things on purpose to make his life a misery, such as report him when he was cutting down one of the trees in his garden.

John reported that he wakes very early in the morning, around 2 or 3am, and has difficulty getting back to sleep. He stated that he usually lies in bed staring at the walls until around 6am when he wakes and dresses himself. John denies excessive worry and does not report any fears or symptoms of anxiety and specifically denies any fear of dying. When asked why he doesnt participate in the social groups he used to enjoy or firefight, John said that the activities dont interest him and hed rather be on his own. He said he no longer feels an obligation to be a firefighter for a community that doesnt appreciate him. The only activity John does participate in is a game of chess at the local park once a week. John described reduced appetite over recent weeks with no known loss of weight. He reported that he had not noticed any changes to his concentration and his short- and long-term memory appear to be intact.

When asked why he no longer participates in social activities John also stated whats the point?; I dont enjoy anything anymore everyone is out to get me. When asked about the loss of his friend, David, John was observed to become a little teary and stated I miss him a lot; But thats what happens here, isnt it? People who try and help others get whats coming to them.

John denied any suicidal ideation but did describe a passive desire to not be here anymore. John did not describe any variation in his mood across the day, although did state that he feels at his lowest in the morning. When asked if anything makes him feel a little happier, John reported that he

enjoys playing chess with Paul, and seeing his grandchildren when they visit several times a year although my daughters have been trying to put a stop to that.

John was born in Manchester, England, and moved with his parents and older brother to Melbourne when he was 2 years old. He describes a mostly happy childhood, describing his mother as a warm, loving person and his father as a hard-working man who provided for his family. However, he said his parents struggled to understand why John did not want to be part of the catholic community that his parents frequented. John denied any difficulties at school and reported that he did well academically and made friends easily. After school he trained as a mechanic. When he was around 30 years old he opened his own mechanic business which he owned until he retired at age 60.

John met his wife through mutual friends when he was 21 years old. They later married and had three children. John reported that he regretted not spending more time with his family when the children were young, stating that he worked long hours and would often spend time with friends at the local pub after work before going home. He says his ex-wife was his best friend, but he just never felt the same way about her as he felt about the men he dated. He reports guilt for this behaviour, and also a sense of disappointment in what his life could have been, had he come out earlier. He reported that he believed that he and his wife had a good relationship although he can see now that she was probably lonely due to Johns romantic disinterest and long working hours. John reported having a very close relationship with his son and was heavily involved in his sons sporting activities such as cricket and athletics. He reported being less close with his daughters stating I dont think I knew how to connect with them. They were off doing dancing and playing with their friends.

When John was around 55 years old he said that he had just had enough of living a lie. His wife had also started to become suspicious about his late nights at work when she realised he wasnt always where he said he was. John and his wife made a mutual decision divorce after he was confronted by his wife about the affairs, and he revealed to her that he was gay. John stated that although he knew his wife wasnt entirely happy, he didnt realise she was that unhappy in their relationship. John reported that it all happened so quickly. One minute I was living at home with my wife and the next thing I know Im living in a flat on my own. He said he missed her company.

John reports being completely devastated by the loss of his son. He had his whole life ahead of him.; He was a good man and some drunk bastard kills him. Just like that!. There is no justice in the world. John reported that he never really recovered from the loss of his son. While his ex-wife re-partnered after a few years, John did not. He had a series of short term relationships but these just seemed to not work out. When asked about these relationships John would start ranting about different ways the partners had wronged him.

John reported that after the divorce the distance between him and his daughters increased. They would see each other at Christmas and his birthday and a few other times a year but I was never part of their lives. John reports that he had several friends during his adult years two whom he worked with and would see after work a couple of times a week and several friends from a car club he had been a member of for over 30 years. He reported that he had not had many visitors recently. John reported that he previously enjoyed listening to music but had not done this is some months. Johns brother moved to Sydney with his family some decades prior. They speak on the phone a few times a year.

John is not aware of any family history of depression, anxiety or other mental illness.