What was your relationship like with your parents when you were growing up?

 PSY 645 Week 2 Reply to Michelle’s post Initial Assessment

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Question

Details: Examine your colleague’s transcript, and write an evaluation of the prospective patient’s apparent symptoms and presenting problem(s) within the context of at least one theoretical orientation. Theoretical orientations are based on the personality theories you learned about in PSY615 (Personality Theories), and are referred to as “approaches” in Abnormal and Clinical Psychology: An Introductory Textbook (e.g., cognitive, behavioral, humanistic, biological, sociocultural, evolutionary, psychoanalytic, integrative, etc.). NOTE: Be clear that you are writing about a theoretical orientation and using the theoretical orientation to explain the client’s symptoms and presenting problems. Do not use the theoretical orientation to discuss any therapy or treatment approaches. Your application of the theoretical orientation should answer the question: How did this client develop the symptoms and current presenting problems? For example, “Based on the cognitive perspective, how did this client develop the symptoms and current presenting problem?” “Based on the humanistic perspective, how did this client develop the symptoms and current presenting problem?” Etc.
Remember that symptoms may not be explicitly mentioned by the patient, but they may be inferred by the patient’s presenting problem(s). Finally, suggest assessment tools and strategies such as those you learned about in PSY 640 (Psychological Testing and Assessment) that might be used to evaluate this patient. (SEE MICHELLE’S POST BELOW)
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Michelle Medina Post
Case 3: Hoarding Disorder

Diagnosis Questions:

Questions 1 – What was your relationship like with your parents when you were growing up?
Question 2 – How did it make you feel when you had to give your things away?
Question 3 – What is your current home life like right now?

Treatment Plan Questions:
Question 4 – What do you know about hoarding disorder?
Question 5 – How do you what your life to look like in 3 years?
Question 6 – When you think of making these changes, what are some of the pros and cons you feel you might encounter?

Transcript:

Psychologist: Hi Jenny. Thank you for coming in today. How are you feeling?
Jenny: I am feeling upset, confused, sad. I have lost everything I care about and my husband has left and taken my kids away.
Psychologist: That is why am here to help. I was reviewing the information you provided and would like to get a better understanding of your situation and where it began so we can get you back in a good place again. On the form, I noticed that you mentioned you were an only child and lived with both your mother and father, what was your relationship like with your parents when you were growing up?
Jenny: I love my parents very much. I was daddy’s little girl growing up, but he and mom were not around all that much. I had a nanny named Ms. Teresa that would help me when my parents were working. Dad was a photographer that had to travel all the time and mom was a bank manager so I would only see her in the morning when she dropped me off at school. I know that they loved me, but I always seemed to disappoint dad. When I would get in trouble at school dad would take some of my favorite toys and make me donate them to someone else who deserved it more than me. I remember coming home from school and some of my most special things were gone.
Psychologist: That must have been a shock for you. How did it make you feel when you had to give your things away or when they were missing?
Jenny: It really hurt. I cried myself to sleep a lot of the nights. It made me feel like I could lose something at any time no matter how hard I tried to hold on to it. Even if it were valuable and I kept it in perfect condition, I could still lose it. A lot of the things I had I would keep the boxes and original packages so that I could sell them myself on Craigslist or something when I was ready. Most of the things I have are worth a lot or I am going to use them for a project I am doing.
Psychologist: I noticed that you mentioned that you have plans for most of the things you are holding on to. Sometimes the things we hold on to no matter how valuable they seem can impact our lives in unexpected ways. What is your current home life right now?
Jenny: Honestly? It sucks. I had plans to make a lot of money selling stuff on Amazon. I had this great idea that I could double my money by buying stuff on eBay and Craigslist then selling it for more on Amazon. But now that my husband has left with the kids, I can barely make it through the day. I have not really been sleeping much and I spend all my time alone. I do not really like people coming over to the house. My mother came over recently and told me that I will not be able to have my family back if I keep doing things the way I am. That is why I am here. To get my life in order.
Psychologist: I am glad you have taken this next step. I want to ask, what do you know about hoarding disorder?
Jenny: I have seen those shows on TV. Those people having lots of stuff piled up all over the place and the doctors come in and make them throw everything out in big dumpsters. I don’t think I have an issue like that. I don’t keep a lot of junk around. All of the things I don’t need anymore I sell online.
Psychologist: Okay. I want to talk to you about what causes this disorder in people and how it impacts the lives of those people. It seems your life is not where you want it to be right now. How do you want your life to look in 3 years?
Jenny: In 3 years, I want to be living in my happy home with my husband and family. I want my family to be able to invite their friends over for parties during holidays and birthdays. I have always had dreams that me and my family would be able to afford to take nice long vacations together and just be happy being around each other. To have a life that is stress-free. I know I must make a lot of changes in my life to get there.
Psychologist: Those sound like some great plans for your future. When you think of making these changes, what are some of the pros and cons you feel you might encounter?
Jenny: I know that change is hard, but once I do it things will be better. I will feel happy to have my family back. I will have less stress when there are fewer things around me to worry about. I will have more money to travel and do the things I want to do with my family. On the other hand, I will have to get rid of stuff that I might need and end up having to replace it. I might accidentally lose something that has great memories with it and feel guilty. Even the thought of losing some of these things are giving me anxiety. But, if I don’t do this then there is no hope of me having that happy home.

Rationale Behind Questions:

Question 1 – The first question was designed to have the patient provide more in-depth information about her history so the psychologist could get an idea of how and where these issues may have started. By learning about the relationship with the parents, the psychologist is able to determine certain triggers that may be causing the current behavior.
Question 2 – This question is designed to assess the level of attachment and emotions associated with the physical items. If having the items and losing the items trigger a strong emotional response in the patient, then there is a possibility that the patient may have hoarding tendencies.
Questions 3 – This question was used to determine the current situation and provide a diagnosis. Based on the information provided by the previous questions, it was safe to assume that there could be an issue with hoarding. By having the patient explain her current living situation it became apparent that she did have a hoarding disorder and requires an intervention strategy since it is interfering with her life.
Question 4 – Patients with hoarding disorder often lack insight about the issue or are unaware that they have anything wrong with them (Gorenstein & Comer, 2015). This question provides the psychologist the chance to see if the patient is aware that there is an issue so that the correct steps can be taken during treatment. It may be necessary for the patient to be educated about the situation prior to any behavioral therapy takes place.
Question 5 – This question is created so the psychologist can better understand the goals of the patient. This step is necessary when creating a treatment plan because it will allow the psychologist to structure the sessions for the client in a way that will motivate her to continue with her treatment plan.
Question 6 – The purpose of this question was to gauge the patient’s feelings about what she looks forward to and what may interfere with her treatment. By understanding the cons to the process from the perspective of the patient the psychologist is better able to address these accordingly during the treatment session which may require different methods to restructure the responses to the fears or triggers.

References
Gorenstein, E., & Comer, J. (2015). Case studies in abnormal psychology (2nd ed.). New York, NY: Worth Publishers. ISBN: 9780716772736. https://redshelf.com

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