Selection and Initial Interview Essay.
The client case assessment is based on a client named Olivia. She was initially born in the eastern United States and moved around a lot with family. Her mother and father divorced, and soon after, she had a stepfather and stepsister age three. Olivia’s father has been out of the picture most of her life until her mother decided to sue for child support; visitation started after that. Her mother met her stepfather when Olivia was ten years old; she feels torn between the roles of her father and stepfather.
Olivia has several presenting problems that have made life difficult for her. Olivia’s developmental needs will be assessed and cultural considerations considering her blended home. Specific approaches will be used to help and maintain therapeutic relationships between family members and Olivia. In addition, there will also be a set of questions assigned for the first assessment. There will also be assessment techniques through evidence-based practice, specifically for Olivia and her family.
The client Olivia is a 14-year-old Caucasian female. Olivia lives with her mother, stepfather, and stepsister, age 3 (McClain et al., 2019). Olivia’s mother suggested that she attend therapy, and Olivia agreed that it would be useful. Her mother expressed a desire for Olivia to have “someone to talk to,” especially in light of recent life changes (i.e., Olivia’s father reentering her life, her mother and stepfather deciding to pursue reconciliation rather than get a divorce). Her mother works as a store manager while her stepfather works as a janitor (McClain et al., 2019).
Olivia reported feeling anxious, particularly with racing and illogical thoughts, but denied experiencing accompanying or precipitating physiological symptoms. Olivia expressed concerns about her upcoming transition to high school and reported anxiety when at school, including test anxiety and social anxiety (McClain et al., 2019). Olivia described having a voice in her head telling her to worry about things (e.g., failing a test, her father not texting her to make weekend plans). To cope with her anxiety, Olivia would “block [it out] and pretend” that nothing was wrong (McClain et al., 2019).
The evaluation of Olivia’s developmental needs will be accomplished using the Ages & Stages Questionnaires, Third Edition (ASQ‐3) to determine her developmental level. Olivia’s parents deny any developmental problems during childhood, and Olivia reached all milestones on time. The ages and stages questionnaire will be an excellent start to rule out any new developmental problems.Olivia came from a middle-class family and was raised, Christian. Cultural considerations will be exercised because of the family’s religious background. Since the therapist and the family are from the same ethnicity and religion, the therapist must be careful not to assume the client’s culture is the same as the therapist’s culture.
Anxiety can be conceptualized as having a tripartite structure with cognitive, behavioral, and physiological components. Fear and anxiety are a normal and healthy part of the development with anxiety serving a healthy, adaptive, and protective function evolutionarily (McClain et al., 2019) Anxiety disorders come with public health implications due to their impairing nature. For youth, these are often considered gateway disorders because they predict adult psychiatric conditions and can lead to chronic anxiety, depression, suicidal ideation, suicide attempts, and substance abuse if left untreated (Ginsburg et al., 2011).
Olivia will be best served by undergoing cognitive-behavioral therapy (CBT) because of the dynamics of Olivia and the severe social anxiety she faces in multiple settings. The efficacy of CBT for the treatment of childhood anxiety disorders, including SAD, is well established. More than 20 randomized controlled trials (RCTs) of CBT for child and adolescent anxiety disorders suggest that CBT is effective for reducing symptoms of anxiety, functional impairment, and comorbid diagnoses (Compton et al., 2014) For social anxiety disorder (SAD), the 12-month prevalence rate among children and adolescents in the United States is comparable to the estimates for adults (7%) and, generally, females have higher rates of SAD with this sex difference being more pronounced in adolescents (American Psychiatric Association, 2013).
The primary diagnostic criteria for SAD are persistent, excessive, and frequent worry about social situations that may involve scrutiny by others (American Psychiatric Association, 2013). During the initial assessment, the therapist will use assessment tools to help shed light on some of Olivia’s problems regarding anxiety and worry. The first assessment tool will be the Achenbach Youth Self Report (YSR) and the Child Behavior Checklist (CBCL). The CBCL is a parent assessment, and the YSR is a parallel self-report measure of emotional and behavior problems in childhood (Achenbach & Rescorla, 2001). The measures contain 120 items for the CBCL and 112 items for the YSR. Both measures are widely used and have excellent validity and reliability (Achenbach & Rescorla, 2001)
The next assessment tool used will be the Screen for Child Anxiety Related Disorders (SCARED). The SCARED parent and child versions each consist of 41 items. The measure assesses for panic disorder/significant somatic symptoms, generalized anxiety disorder, separation anxiety disorder, SAD, and school avoidance while also providing a total score. The SCARED has been attested to have high internal consistency, moderate to substantial test-retest reliability, and moderate to significant parent-child agreement (McClain et al., 2019)
The last assessment tool for Olivia will be the Revised Children’s Manifest Anxiety Scale–Second Edition (RCMAS-2), a 49-item measure with “yes” and “no” responses, is one of the most widely used assessments for children’s anxiety. It assesses for physiological anxiety, social anxiety, and worry (e.g., nervousness or worrisome thoughts) while also providing total anxiety and defensiveness (e.g., willingness to admit to commonplace imperfections) scores. The RCMAS-2 has updated norms, broader content coverage in the items, and excellent psychometric properties (Lowe, 2015).
During the first assessment, there will be several questions for Olivia and the family. The following are some of the initial questionsbased on Olivia’s case.
- Does Olivia have a hard time adjusting after moving to a new city or school?
- What is it about high school that concerns Olivia most?
- How long have you been experiencing test anxiety?
- Does test anxiety feel different than social anxiety?
- Tell me why you worry about things? What kind of things?
- What is it about knives that makes it hard for you to be in the kitchen?
- Is the attention of parents spread out equally between Olivia and younger stepsister?
- How does Olivia act and feel when her father picks her up for visitation, and how does it change the dynamics of the household when Olivia is away?
- How was the experience of exposure therapy with mom regarding kitchen knives?
- Do you feel normal at school around friends?
- Do you feel like you can be yourself, or do you feel like you have to change based on who you are around?
Olivia takes no medications and reported an unremarkable medical history. She reported sleeping 8 hours nightly and feeling tired in the mornings. Olivia denied past or current drug or alcohol use. Olivia had no history of self-harm and denied suicidal and homicidal ideation (McClain et al., 2019). Olivia attended four different elementary schools (two in the Southeast and two in the Northwest). She described “dreading” school because of the social interactions, strict rules, and “purposeless” lecture-style learning. Olivia was enrolled in Honors classes and earned As and Bs, although she was so frightened about receiving bad grades that she refused to check her report cards. (McClain et al., 2019).
Olivia described herself as introverted and preferred to read or play videogames in her room. Olivia completed extensive chores at home (e.g., cleaning the kitchen, doing laundry). While she reported having a group of friends at school, she never spent time with them outside of school and did not have a best friend. (McClain et al., 2019)
An accurate assessment of Olivia is necessary; a number of things must be taken into consideration including the demographics, developmental needs, presenting problems, cultural considerations, building a rapport with Olivia, and following through with pre-made questions for Olivia and her family.
Achenbach, T. M., & Rescorla, L. (2001). Manual for the ASEBA school-age forms & profiles: An integrated system of multi-informant assessmentAseba Burlington, VT:.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®) American Psychiatric Pub.
Compton, S. N., Peris, T. S., Almirall, D., Birmaher, B., Sherrill, J., Kendall, P. C., . . . Rynn, M. A. (2014). Predictors and moderators of treatment response in childhood anxiety disorders: Results from the CAMS trial. Journal of Consulting and Clinical Psychology, 82(2), 212.
Ginsburg, G. S., Kendall, P. C., Sakolsky, D., Compton, S. N., Piacentini, J., Albano, A. M., . . . March, J. (2011). Remission after acute treatment in children and adolescents with anxiety disorders: Findings from the CAMS. Journal of Consulting and Clinical Psychology, 79(6), 806-813. doi:10.1037/a0025933
Kendall, P. C., Cummings, C. M., Villabø, M. A., Narayanan, M. K., Treadwell, K., Birmaher, B., . . . Walkup, J. (2016). Mediators of change in the child/adolescent anxiety multimodal treatment study. Journal of Consulting and Clinical Psychology, 84(1), 1.
Lowe, P. A. (2015). The revised children’s manifest anxiety scale–second edition short form: Examination of the psychometric properties of a brief measure of general anxiety in a sample of children and adolescents. Journal of Psychoeducational Assessment, 33(8), 719-730.
McClain, C. M., Bolden, J., &Elledge, L. C. (2019). Use of the C.A.T. project for a socially anxious teenager: Lessons learned from manual modification. Clinical Case Studies, 18(6), 432-451. doi:10.1177/1534650119874398