Diagnosis in Social Work: The Case of Miranda
Reflection Questions
The social worker in each of the cases answered select additional questions as follows.
Practice
Mental Health Diagnosis in Social Work:
The Case of Miranda
1. What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
I referred the client to a psychiatrist. I used behavioral therapy, relaxation and stress management techniques, and psychodynamic and structural family theories to address underlying issues from childhood.
2. Which theory or theories did you use to guide your practice?
I used psychodynamic and structural family theories to address adult survivors of child abuse in order to help Miranda connect to the effects of her stepfather's maltreatment, regain her sense of self, and recognize the unhealthy functioning in her present relationships and daily living.
3. What were the identified strengths of the client(s)?
Miranda was motivated, identified goals well, and had a supportive husband.
4. What were the identified challenges faced by the client(s)?
Miranda reported a mental health history.
5. What were the agreed-upon goals to be met to address the concern?
The initial goal was to decrease symptoms of anxiety and depression. As therapy progressed, the greater goal became gaining insight into Miranda's childhood to allow for more self-care and stress management.
6. How can evidence-based practice be integrated into this situation?
Miranda's case is a great example of the benefit of a combination of medication and talk therapy for overall improvement of emotional and mental health.
7. Is there any additional information that is important to the case?
It is important to note that prior to seeing me for treatment,Miranda had been to several psychiatrists who misdiagnosed her with borderline personality disorder and bipolar disorder specifically based on the fact that she was female and had a history of abuse. She had been given a series of medications that were ineffective due to misdiagnosis. When Miranda came in for the first session she was very distrusting
of psychotherapy as well as medication.
My ability to create a safe and trusting environment was of the upmost importance in order for Miranda to get well and work with her underlying issues.
8. Describe any additional personal reflections about this case.
Miranda's case is a great example of the need for a thorough mental health history, mental status exam, as well as family history of mental health issues and relationships. With individuals, it is important to ask critical questions that reflect mood and affect presentation as well as history of drug and alcohol use, family dynamics, and any past history of abuse. There is almost always a reason for a patient's mood deregulation.
A proper evaluation session allows for accurate diagnosis and treatment planning as well as letting you, the social worker, know if this is a case that will fit within your practice.
Social Work Supervision: Trauma Within Agencies
What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
This was a difficult tragedy to deal with, and it was difficult to know how to proceed. I had contacted the county (who funded the agency) for help.
The people I contacted at the county did not know what to do and were of little help because, as they stated, they had never dealt with death of a staff member. I turned to my senior staff, and we as a group came up with a plan to notify each client in the most sensitive way possible .