Case Presentation Paper

Counselor: Counselor-in-Training (CIT): Fred Rhodes Date: 3 Oct 2019

Agency: CCU Community Counseling Center Dates Seen: 2 Oct 2019

History of Presenting Problem and Additional Background

Client, Russell, is a twenty-nine (29)-year-old, Caucasian male, who referred to individual

counseling by his wife, of three years due, to concerns regarding episodes of depressive mood
swings; manic episodes not stated. The client, at the age of fourteen years old, diagnosed with
Bipolar Disorder II (BPD) by a psychiatrist; later, at the age of eighteen-years-old, the client re-
diagnosed by another psychiatrist with BPD I and prescribed medications, mindfulness, and CBT
managing exercises. The client affirms continued care in telephone contact with a psychiatrist.
The client stated he distances himself both verbally and physically from his mother, also
diagnosed with BPD I when she is experiencing hypomanic mood because he becomes
“uncomfortable.” The client stated, he continues to take prescription medications but wants to
learn new coping techniques when depressive moods occur at about two days out of seven,
“lasting for about 1 hour or so.”

Enjoys most weekends outdoors when the wife is not working, and have visited, alongside wife,
some sightseeing tourist areas of Colorado Springs. The client is looking forward to celebrating
the wife’s upcoming birthday at a local Bed & Breakfast in the mountain region. The client
stated his wife, an orthopedic therapist, is his primary and most important support system
because [his wife] is “very emphatic.”

The client stated his strengths are working part-time from home as website development, God,
and family. The client said he prefers to stay indoors for at least four out of seven days due to
work at home web projects. Recently, the client moved to Colorado from Utah six months ago,
before leaving California on a motorcycle six years ago, and became a follower of the Christian
faith. The client discussed his spiritual life with this CIT and allowed this CIT to understand
better where he stands spiritually. Clients stated his family “were always “Easter-Christmas
believers” but “never” practice regularly, but he now believes in God. No identifiable weakness
noted or observed.

The client reports additional changes in mood swings “possible” due to life-changing event
stressors of moving to a new state, the expectancy of childbirth, and efforts to secure full-time
employment, citing no loss in hours sleeping or eating. The client stated he had not met many
people since he moved to Colorado; however, as a novel member, meets weekly with a bible
study group. The client also stated his enjoyment of watching cartoons in which the father
character is unconditionally loving the daughter’s character regardless of her mistakes. The client
sees himself as the type of father he would be to his (hopefully) daughter when born.
Behavioral Observations

The client showed for intake sessions promptly, dressed casually with a t-shirt and jeans. The
client has no visible tattoos, wounds, or cuts on his arms, hands, and neck. The client tends to
fidget during the session in tapping leg or moving hands to the top of his head in attempts to
groom hair. The client broadly smiles when talking about the type of father he would be when a
“healthy “child (daughter or son) is born and excited about the upcoming wife’s birthday
celebration at the B&B. The client spoke in a normal conversational voice with a higher pitch
when smiling or laughing. The client could be anxiousness or possibly nervous due to coming to
the session.

Clinical Interpretation
Being the first session of both CIT and client, a sense of building rapport as necessary in the
stages of cognitive-behavioral therapy and individual psychotherapy. Prior diagnosis of onset
and existing BPD I & II stands as a current possible diagnosis until further information is
available, in addition to medical records. The client expresses continued use of medication but
desires for more coping techniques in dealing with mania or depressive moods. Further
investigations and reasons why the client want additional coping exercises to manage current
stressors should discourse. The client has expressed ease and comfort with this CIT and wishes
to continue further sessions as scheduled. The client appears to desire a change of current
perceived condition of resolving low-level moods without any manic episodes. The client and
this CIT have explored the client’s family spiritual and cohesiveness, and the client appears to
accept his brand-new faith of Christianity with comfort. His continued meetings with his bible
study group will perhaps enhance his spiritual growth. This CIT will discuss the deeper meaning
of client’s interpretation of “mindfulness and CBT” as the terms applicable to the client’s
understanding.

Interpretations of Differential Diagnostic (DSM-5)

The client is currently under psychiatric care management for early-onset BPD and related
disorders (Mild, F33.0 [Cyclothymia, minor]) “1) Affective disorder characterized by alternating
and recurring periods of depression and elation, similar to manic depressive disorder but of a less
severe nature. 2) An affective disorder characterized by periods of depression and hypomania.
Episodes may separate by periods of normal mood” (APA, 2013, p.115). BPD requires lifelong
treatment with medications, even during periods when feeling better, according to DSM-5. The
client experience two of four symptoms, as noted in the DSM-5: 1) on edge, 2) worry for minor
cyclothymia as stated depressiveness lasting less than two months (APA, 2013). A possible
update of Beck’s Depression Inventory, as overriding preexisting diagnose, is not practical for
the client’s well-being.

Treatment Plan and Intervention

Second session to agree in maintaining a journal with measurable both low-level and manic
episodes occurring and what environment may trigger depressive-manic events. CBT helps the
connection between emotions, thoughts, and behaviors. This form of therapy helps to identify
negative thought patterns that impact responses. Recognize the irrational thoughts, can replace
with positive ones to change behavior. Interpersonal Therapy address the problems that may
exist within close relationships.
Ethical Dilemmas

The client informed of confidentiality and recordings within-session and how the session is not
shared with others outside the current supervisor’s realm of supervision unless ethically required
under the ethical codes (ACA Code of Ethics, 2014, Standard B.1.d).

Personal Requests

This CIT is seeking an alternatives successful treatment plan that may have been overlooked by
consulting with the supervisor and peers in an effort not interfering with the existing psychiatrist
treatment plan. Second session to agree in maintaining a journal with measurable both low-level
and manic episodes occurring and what environment may trigger depressive-manic episodes.

CBT is helping the connection between emotions, thoughts, and behaviors. This form of therapy
helps to identify negative thought patterns impact behavior. Recognize the irrational thoughts,
can replace with positive ones to change behavior. Interpersonal Therapy address the problems
that you have within the close relationships within your life.

References

American counseling association. (2014). In Code of ethics. Retrieved from

https://www.counseling.org/resources/aca-code-of-ethics.pdf

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders

(5th ed.). http://dx.doi.org/doi.org/10.1176/appi.books.9780890425596.x00Diagnostic

Classification