Task 2:
Case Study refer to rubric too Assess the mental health challenges being faced by the client in the case study, justifying your hypothesis with reference to appropriate literature. Formulate a plan for proceeding with this client that includes relevant ethical, legal and Christian worldview considerations. Students are to use the following scenario: History Nancy is a 45-year-old woman who has reported a history of being ‘fearful’ dating back ‘as far as I
can remember.’ She said she was a nervous young girl at school who worried a lot and was very shy. As she grew
up, she experienced ongoing concerns about the health of her parents (worrying that her parents would die, even
though they were in good health) and her school performance (though she was a good student). She remembers
marked fears, including fears of the dark and thunder, most of which she ‘outgrew’ except for a persistent fear of
insects, particularly spiders. These issues became more prominent and persistent after she left home at age 18 and
entered university to study law. She sought assistance at the university health service and received a prescription for
anti-depressants that she used over the next 4 years on an as-needed basis during periods of increased stress such
as examinations. She also met episodically with a therapist at the counselling center. In the spring of her first year,
she experienced her first major relational trauma following a break-up with a boyfriend. She was prescribed
imipramine, which she took for a couple of months but then discontinued because of intolerable side effects (dry
mouth and light-headedness). She gradually improved over the next 6 months. Nancy continued to be plagued by
persistent feelings of worry associated with insomnia, irritability, tension, and fatigue. Over the years, her friends and family chided her for ‘worrying too much,’ and she reported difficulty controlling her reactions over her financial
situation, job security, and her children's safety, despite evidence that none of these were problematic. Her husband reported that he found her persistent issues and ongoing need for reassurance ‘exhausting’ and that he had noticed himself withdrawing from her, which has led to significant tension between them. The high quality of her work at the law firm has been recognised and she is well-compensated financially, yet she continues to worry about her performance and was************ pass************r promotion to team leader because, as one of her annual reviews stated, her ‘constant worrying makes everyone else too nervous.’ In addition, over the last 25 years, she has had 5 or 6 episodes of major depression lasting from 3 to 4 months to over a year. These episodes have sometimes, but not always, been triggered by situational stressors; episodes occurred after the birth of each of her children. Other relevant aspects of her medical and psychiatric history include the fact that her overall health had been generally good, although she had presented numerous times to her General Practitioner with a variety of somatic complaints, including headaches, gastrointestinal disturbance, and muscular aches and pains with no clear aetiology. She has had repeated thyroid testing with normal results. She smokes a pack of cigarettes a day and reports that having a cigarette temporarily makes her feel better. She has attempted to quit smoking several times and noted that the increased tension she experienced during these attempts contributed to her lack of success in these efforts. Although not usually a heavy drinker, Nancy has been plagued by guilt since she drove her car after drinking 4 glasses of wine at a recent social occasion. Despite this occurrence, she has no history of abuse or dependence on alcohol but did say that a glass of wine made her feel more relaxed. She smoked marijuana a few times when at university but it made her feel dysphoric and she had not used it or other illicit drugs since that time. Social and Family History Nancy met her husband when they were both at university. She reported being attracted to his sense of calm and stability. He reported that part of what drew him to her was the sense of how much she seemed to need and depend on him. They were married shortly after graduation and had 2 children over the next 5 years. After the birth of her first child, she developed a postpartum depression that lasted almost a year and for which she didn't seek treatment. She has said that her youngest child ‘is just like I was — she's afraid of her own shadow.’ Nancy grew up in a middle-class home, the second of 3 children. She reported that childhood was ‘generally happy,’ although she reported being a fearful and nervous child. There was no history of physical or sexual abuse. Both parents are still alive, although they have had significant medical conditions and she is worried about their health. She noted that her ******** and father were both ‘nervous’ people, and though never formally diagnosed or treated, her maternal grand******** had a history of depression. Please login to CHC student portal if you like to search for more materials available there… login:************pass******************t*
