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Running head: CASE CONCEPTUALIZATION 1

Case Conceptualization

Avery Enzbrenner

Kansas State University


CASE CONCEPTUALIZATION 2

Introduction

NR is a 21-year-old Caucasian female with ADD and Asperger Syndrome. NR is in her

junior year at Benedictine College and double majors in psychology and theology. NR is also

involved in drum core and choir. NR lives in a dorm with two roommates during the week and

spends her weekends at home with her father, mother, and sister. Her father owns a veterinary

clinic and she works there on weekends. NR comes from a loving and financially stable

environment. Her family is devoted Catholics and NR has attended Catholic school for most of

her life. NR’s faith is an important aspect of her life. Her family is currently in the middle of

moving to a new home, while still keeping their current home. NR is above average height and

is well groomed for our sessions. NR is very polite and has excellent manners. NR is talkative

throughout session and speaks fluently and coherently. Her behavior is appropriate and she is

cooperative and engaged during sessions.

Presenting Problem

NR came to counseling because her stress levels have been high and she is struggling

with using her coping skills for stress. She is struggling to manage her time and is

procrastinating on her homework. This is causing her anxiety and stress as well as tension in her

back and shoulders. NR mentioned that when she gets stressed about homework she tends to

put it off until last minute, but she always ends up getting it done. The procrastination adds to

her stress that she is already experiencing. The stressors in her life include school, drum core,

band, and her band teacher. NR has many coping skills to manage her stress, but does not use

them as much as she needs to. This problem has persisted since NR started college 2.5 years
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ago. At the end of the first session, NR reported that she wanted to manage her stress more

effectively by exercising, going to adoration, and managing her time more efficiently. Later in

the sessions, NR discussed how band was causing her stress, specifically because of the way the

band teacher was managing the band. NR indicated that one of her goals would be to talk to

him and advocate for herself and her other band members. This is a problem that has

presented itself this year and has continued to escalate throughout the year.

Theoretical Components

One theory I used to help address NR’s problems is Behavior theory. Her goals were

based on increasing personal choice and “eliminating maladaptive behaviors and learning more

effective behavior patterns” (Corey, 2017, p. 131). I aimed for helping NR cope with her anxiety

and stress by providing training on progressive muscle relaxation. NR responded well to this

method and indicated that she felt much more relaxed after the experience. Another

behavioral intervention I utilized was self-monitoring and self-contracting. I asked NR to

observe and record her goal behavior (exercising) and rate her stress-level after completing her

goal. This homework allowed her to notice the aspects of her behavior. We also worked

together to create a self-contract to give her a structure to follow and to hold her accountable.

The contract included “terms that are completely acceptable to the client, are very specific, and

reflect short-range goals that are feasible” (Hackney & Bernard, 2017, p.205). We then used

self-reward to reinforce her meeting her goals. These interventions were individually tailored to

NR’s problems she was experiencing, and allowed her to make progress towards her goals and

relieve some of her stress.


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Another theory used was the Solution-Focused theory. The goals for our session were

to establish NR’s goals for counseling, identify her strengths, and implement the change in her

behavior. By working collaboratively and using the miracle question we were able to establish

NR goals. We then identified NR’s strengths and how she could utilize them. Each session, I

would use a scaling question to rate NR’s stress levels and identify the strengths she used over

the week to help meet her goals. If NR was not able to identify strengths, I would help point

them out by using summary feedback. Throughout our sessions, we moved “from problem-talk

to solution-talk” (Corey, 2017, p. 211) and I helped NR recognize “the competencies they

already possess and apply them toward solutions (Corey, 2017, p. 212). We focused on what

was working and doing more of it.

The third theory I worked within was the person-centered theory. At times, I used less

directive techniques and focused on “active listening and hearing, empathic understanding,

presence, reflection of feelings and clarification” (Corey, 2017, p. 102). The client-therapist

relationship is important and being genuine and providing unconditional positive regard can

allow for change to occur.

SMART Goal Statement

NR’s smart goals were developed through collaboration and are meant to help her

utilize her coping skills in order to lower her stress levels. Her first goals states “NR will perform

an exercise of running or Hip-hop dance, three times a week.” Her second goal states “NR will

attend adoration once a week for 30 minutes to an hour.” Each goal is time-bound and taken

week by week. Exercising and attending adoration are both attainable and relevant to her
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coping with stress. NR reports lower stress levels when exercising regularly and attending

adoration regularly. She can easily measure these goals and see if she met them after the week.

NR indicates that these tasks can either prevent stress or help her cope with stress as it is

occurring. These goals are meant to be preventative.

Background Information

NR was born with Asperger’s and had to have a para-educator with her for most of her

elementary school years. She grew up in a very supportive family and her mother was one of

her biggest advocates for her. NR’s mother helped NR develop the skills she needed to manage

her behaviors associated with Asperger’s syndrome. NR is also very close with her younger

sister and a few friends from high school who are also very supportive people in her life. NR is

currently double-majoring in psychology and theology. NR’s is very religious and reports talking

to God often. Double-majoring while being actively involved in campus activities has caused NR

to experience some anxiety and stress. NR usually waits until the last minute to complete

homework assignments and does not use her coping skills to manage the stress. NR had an

issue with an ex-boyfriend previously but has reported that the situation has been resolved. NR

reported that her ex-boyfriend exhibited stalker-like behaviors, such as leaving a note outside

her door and trying to contact her when it was unwanted. NR attempted to reach out to her

band teacher for help, but he normalized the situation and broke her trust. The situation was

resolved after NR contacted her advisors on campus, but NR continues to have resentful

feelings toward band teacher.


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Client Strengths/Diversity

NR has many strengths including a strong support system from friends and family. NR

also reports that her study skills are a strength. She has many techniques she can use when

studying or doing homework such as setting timers, moving to different study areas, and

prioritizing subjects. NR has a photographic memory and it is helpful when working on class

projects. Another strength that NR reported was having many coping skills to handle stress. NR

identified coping skills such as riding horses, exercising, crafting, gardening, going to adoration,

going to mass, and baking/cooking. NR is very aware when stress and anxiety arises. NR has

many resources at college that she utilizes such as her disability advisor and counselor. NR is

able to advocate for herself in an assertive way and also exhibits high self-esteem.

NR grew up in western culture with her father who is Irish and her mother who is half

Arab. NR’s religious culture has strongly influenced her beliefs in values. She has attended

Catholic school most of her life and her spirituality is extremely important to her. NR’s

spirituality plays a large role in helping her cope with different situations and how she views her

world.

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Systemic Assessment

NR has very strong family supports in place. Her parents are very attentive and caring.

They have provided many opportunities for NR to develop the social skills and coping skills that

result from Asperger’s and ADD. NR goes to either parent for advice and talks highly of her

family. NR benefits from her family environment, which is emotionally and financially stable.

NR’s father owns a veterinary clinic and provides for the family. NR’s autonomy has been
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supported by her family throughout her life and she has become very independent. NR comes

from a functioning family system.

Family Map/Influences

NR’s parents are some of her biggest supporters and have helped her manage her

Asperger’s syndrome and cope with the stressors in her life. NR is not close to her maternal

grandparents because her grandfather was abusive to her mother and her grandmother

allowed the abuse to happen. NR’s maternal grandparents live close to her and her family but

are not present in her life. NR’s paternal grandfather has recently been put in a retirement

home and has been put on bedrest. NR’s father made a trip up to see him and help him cope

with his situation, which NR reported being a current stressor. NR indicated that she was

closest to her paternal grandmother who died of cancer a few years ago. Her biggest influences

are her immediate family and close friends.

Solution Assessment

NR has previously attempted to deal with her stress. When she lived at home she was

able to use animal therapy and regularly ride horses. She is not able to do this while living in the

dorms, but it is a solution that has allowed her to successfully lower her stress level. NR also

reports working and being in a consistent routine helps her manage her stress and anxiety.

Working with animals and sticking to a schedule at her current job has been a successful

solution to coping with her stress. NR has struggled to stay in a routine while at college due to

inconsistent scheduling by band teacher. Going home every weekend has also been a successful

way for her to deal with her stressors as well as seeking help and advice from her parents.

“Squinching” or the squeezing of certain muscles is a good way for her to deal with the tension
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in her body that results from stress. She used this self-made method when she was little.

Progressive-relaxation is a step up from this that she could utilize to help her relieve this

tension. NR has also set timers in the past to help with procrastination. Her mom taught her

this study skill, but she has struggled to use it recently.

Summary

In conclusion, NR is continuing to work on utilizing her stress management skills and

learning new behavioral interventions to help her learn more effective behavior patterns. NR

continues to work on her goals and actively participate in counseling sessions. By focusing on

the solution and not the problem, NR has been able to cope with her stress and reports lower

levels of stress. Using the client-therapist relationship, we will continue working and developing

NR’s goals to help her cope with stress and manage her time.
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References

Corey, G. (2017). Student manual for theory and practice of counseling and

psychotherapy(10thed.). Belmont, CA: Brooks Cole/Thomson Learning. (SM)

Hackney, H., & Bernard, J. (2017). Professional counseling (8th ed.) with the My Counseling Lab

access code. Boston, MA: Pearson.