Posted: March 12th, 2023

formulation

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ASSIGNMENT PROMPT

For this assignment you will use the case study of Vlad in Chapter 13 and write a paper that provides a case formulation chart and case formulation narrative. Information and details about writing a case formulation paper are below.

Case formulations are a more in depth type of case study. It is a conceptualization of the client and describes the contextual environment that shaped how they came to be who they are as they present to you. It requires a different skill than diagnosing an illness. It is the application of theory to the biopsychosocial assessment. This is where we strive to uncover the whole picture, as many aspects as possible of the client. This detail conceptualization is rich in specific information about the client’s life and enhances the treatment plan process. It all comes together here! The article, website and powerpoint will give you more information. 

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· You can find background information about case formulations in this article titled  

Formulation for Beginners

  Selzer, R., & Ellen, S. (2014). Australasian Psychiatry, 22(4), 397-401. (click on the link or find it easily located in google scholar)

· Review the Biopsychosocial Model and Case Formulation on the following website
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Case Formulation

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Case formulation Powerpoint.pptx

   Voice Over Slide Presentation about case formulation

DIRECTIONS FOR ASSIGNMENT

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· Read case study of Vlad in Chapter 13 of Corcoran & Walsh course textbook. 

· Create and fill out a 4P Case Formulation chart using the cell titles below.  Don’t forget some factors may overlap and should be listed in multiple cells.  
Use short and brief bullet descriptors as modeled in examples provided on the website.  Do not write full sentences in the chart 

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· Identify a full diagnosis

· Write a narrative of the case study which incorporates the chart components and use the following headings.  Your narrative also identifies and 
applies the theory underlying the clinical statement you are writing to support your case formulation (you may add other sub headings if you desire).

Patient ID:

· Include all applicable diagnosis and specifiers (includes medical dx  for example; diabetic, cancer remission x2 years, eczema etc., )

· Current stressors, plus salient developmental history

Non-psychological factors:

· Genetics, temperament, medical history, substances, medications

Early developmental and pathogenic psychological factors:

· Include application of developmental theories where applicable

Precipitating and perpetuating factors

· Don’t forget these could include personality traits, coping skills, etc. 

Prediction of response to treatment and interventions:

· Be sure to discuss factors that you might include in initiating treatment – like addressing readiness to change (stages of change for specific issues), areas to engage the client, and potentiation targets for change to address in the treatment planning including potential barriers where applicable. 

As you are writing your narrative include the application of theories to your case.  This is your chance to demonstrate you understand how theory links to actual case details.  There is an excerpt paragraph below as an example to help you understand the depth of the assignment expectation regarding applying theory to your case. (
you will not earn full credit if you simply repeat the theories listed on the website)

Insert the chart first and then write the narrative. Don’t forget the full diagnosis.  The narrative portion of your paper should be at least 2 pages. (in-text citations are not required for this paper)

Short Example of how to link theory to the case narrative (theories are in bold font)

Client 1

Multiple theories and frameworks can used to conceptualize Gregory’s case. Using 
a social learning lens Gregory’s alcohol use could be indicative of 
modeling as well as a 
biological link through 
genetics. Gregory’s father abused alcohol while he was in his care, which he witnessed and thereby 
modeled the maladaptive behavior. Additionally, as his mother with Borderline personality disorder diagnosis, genetics could explain his later development of the disorder which has a strong genetic component. From a 
systems perspective it is clear Gregory’s early experiences and interactions within his home and low SES community (victim of domestic violence, witness to interpersonal violence, murder, “ghetto”) presented him with a wide range of maladaptive adult interactions. The extended roots of 
Psychodynamic theory informs us that Gregory’s early childhood neglect and home discord would most likely result in a 
disorganized/disoriented attachment style.

Vlad is a 17-year-old white male court-mandated to attend a 6-month residential treatment program at a local juvenile detention center for breaking and entering with an unauthorized possession of a firearm. Vlad has unsuccessfully participated in several residential placements in the past few years and has repeatedly had positive urine screens for marijuana use. Vlad is on probation until his 18th birthday for breaking and entering. He entered a neighbor’s house through the window and stole money and electronics. Upon searching his bedroom, police discovered a gun, which resulted in a second charge of unauthorized possession of a firearm. Vlad states that after being threatened, he bought the gun from a friend but had no intention of using it. After he was arrested and charged, his mother paid his restitution. He has yet to repay her. He also underwent urine screens as a condition of his probation, which were repeatedly positive for marijuana use.

Vlad has attended but failed to complete several residential placements in the past several years, including a military school, a private alternative school, and a wilderness program. His disregard of regulations has contributed to his termination from several previous placements. Despite reports of his prior disrespect toward authority figures, Vlad presents as cooperative, bright, and approachable. His posture and eye contact are appropriate, but he displays a somewhat flat affect. He expresses a desire to improve his relationship with his family and to stay out of trouble. He says that the burglary occurred 4 months prior and admits that until he was placed at the residential program he continued to flout the rules his parents had set for him. He recognizes that once he turns 18, the legal repercussions for any crimes he commits will become more severe. Vlad was adopted at age 7 from an orphanage in Russia. His biological parents were alcohol abusers, and his father was physically abusive toward his mother. It is unknown whether Vlad was abused, but his father literally threw him out on the street when he was 5 years old. The Russian police discovered him as he wandered the streets with frostbite due to the extreme cold. Parental custody was rescinded, and Vlad was placed in an orphanage.

Vlad’s two younger biological brothers were adopted by a family in the United States. When this family discovered that the two boys had an older brother still in Russia, a relative of this family adopted Vlad. Prior to his incarceration, Vlad lived with his adoptive parents, Mr. and Mrs. Meyers, and two younger adopted sisters. Vlad also has three much older stepbrothers from Mr. Meyers’s first marriage. Mr. and Mrs. Meyers are officers in the U. S. military. Mr. Meyer is now retired and lives with the two girls; Mrs. Meyers is currently stationed overseas. Despite the physical distance between them, Mr. Meyers claims that he and his wife are close. The family is well off financially, and the parents appear to be invested in their children’s well-being. Mr. Meyers says the family’s main support is their extended family out of state.

Vlad states that his most important relationships are with his adoptive sisters and his biological brothers, all of whom live out of state. However, Mrs. Meyers says that even when given the opportunity to visit with his biological brothers, he has chosen to stay at home. Vlad’s relationship with his adoptive father is beginning to improve, but he expresses an immense amount of anger and resentment toward his adoptive mother. Both his adoptive mother and father state that Vlad does not have close attachments to other people. According to his adoptive parents, Vlad has always preferred to be alone in his room and he shies away from physical affection.

Of his early childhood in Russia, Vlad recalls little, unsure whether his memories are “real or dreams.” Mr. Meyers attends the biweekly family therapy sessions and reports that Vlad was a “wonderful, happy little boy.” Both Vlad and Mr. Meyers deny a history of significant illnesses or injuries and state that Vlad is in excellent physical health. He does have some residual sinus problems and is susceptible to allergies as a result of his early childhood experience. It is unknown whether there is a history of mental illness in Vlad’s biological family other than his parents’ alcoholism.

Vlad has a history of unsuccessfully treated mental health issues. He has received psychological evaluations and counseling at most of his past placements. He says that at age 11, he took Adderall to treat his ADHD, but he is not currently taking any medications. Vlad adamantly denies a history of cruelty toward animals or fire setting. He states that he gets into fights only when antagonized by others.

Vlad has a history of frequent and persistent alcohol and marijuana use beginning at age 11 or 12. Vlad admits to smoking daily “as long as me or my friends had some.” He reports evidence of tolerance to marijuana, both increasing the amount to achieve the desired effect and reduced feelings of intoxication with continued use. Despite a history of negative consequences—criminal involvement, academic problems, and interpersonal conflicts—he has not been successful in controlling or limiting his marijuana use. He says he experiences cravings for marijuana every day and admits that he would still be using if he had access. He says that he used alcohol less frequently (“a few times a week, mostly beer”), but more often when marijuana was not available. He said he was able to control or stop his alcohol consumption “when I tried, although I didn’t usually want to.” He said he does not miss alcohol as much as he does marijuana. He admits that he tried PCP on two occasions but found the effects dysphoric and unpleasant. He denies using any other substances.

Vlad does not display empathy for the victims of his crime nor express guilt for the stress he has caused his family. He is aware, however, that the majority of his problems stem from his substance use and involvement with undesirable peers. He admits that he has a problem with substance and that he would probably be using if he had access to drugs and alcohol.

Vlad has had two heterosexual relationships. He reports that he felt a strong attachment to his first girlfriend but believes that his•parents sabotaged the relationship. He admits that on two occasions he hit his last girlfriend during arguments while he was under the influence of alcohol and marijuana. He claims that she sustained no iniuries as a result of his abuse.

Beginning around age 11, Vlad began to associate with a group of undesirable peers. Even after the family relocated to a new neighborhood at age 14, Vlad continued to select unsuitable friends, and his behavior worsened. He repeatedly stayed out past his curfew and on several occasions ran away overnight when his parents attempted to ground him. He started skipping classes at school, and his academic performance began to suffer, although he had received good grades before this time. He was also unable to play basketball, a sport at which he excelled, given the school policy requiring a minimum grade point average to play sports.

Vlad attended school at the detention center and was able to earn his GED with minimal preparation. His father reports that Vlad has always been a talented artist. He initially had some difficulty processing his feelinas verballv and was given the option of using a therapeutic journal and mandala circle drawinas as an outlet for his emotions. Vlad used both outlets effectively and produced some creative works depicting both positive and negative feelings he experienced over the course of therapy. Vlad can be stubborn at times, but because of this trait he tends to work hard at an assignment or proiect until it is satisfactorily completed. For example, he was given an art assignment when he was first placed in the detention center and spent a month working on the drawing. He created a beautiful final br

Add bookmark e was extremely proud.

Vlad expresses interest in attending a trade school or community college where he can study to become a car mechanic or electrician, as he is “good at fixing things.” Mr. Meyers says he will support Vlad in whatever educational and occupational decisions he makes. Vlad is athletic and hopes to resume playing basketball in the future. The Meyers family regularly attends a Catholic church, and Mr. Meyers has a close relationship with the priest. Vlad identifies as Catholic and previously attended a church youth group.

While in the program, Vlad has been sharing living quarters with up to 14 other adolescents and is well liked by his peers. His peers describe him as funny, athletic, competitive, and helpful on the unit. Vlad denies any feelings of depression, sadness, or suicidal intent. He also denies experiencing any manic symptoms or episodes when these were described to him. He says the main feeling he struggles with is anger. He admits that he has difficulty controlling himself when he is mad, and he typically yells and throws things.

Vlad views his biggest problems as his negative relationship with his parents and his marijuana use. He states that he would know his problems were solved when he could communicate with his parents about any problems involving work, friends, or school. Vlad would like to be able to ask his parents questions about his birth family and adoption and hopes to feel close enough to them to have a conversation about his early life.

Once he gets out of the residential treatment program, he would like to start eating dinner with his family on a regular basis and playing basketball with his dad and his sisters.

Vlad hopes that one day he will no longer feel the urge to get high and thinks this will happen when he does not feel so angry all of the time. He recognizes that for his situation to change he would have to stop feeling so angry toward his parents, become more capable of effectively managing his anger, and feel more connected to his family and peers. Rather than reacting to angry feelings by yelling or throwing something, Vlad hopes to be able to walk away from a situation and address whatever made him angry when he calms down. Vlad said that he would know his situation has changed for the better when his parents stop criticizing him for his friends and choices. When asked what he would be doing when his parents accept him, Vlad admitted that he would have to be making better choices. Vlad says that if he is busy with school, work, and other positive activities, he will no longer struggle with boredom, which he identified as a trigger for his drug use.

When asked the miracle question (“What would you experience if you woke up one day and your life was the way you want it to be?”), Vlad states that he would be enrolled in college and getting good grades, working at a part-time job that pays well, have a girlfriend who does not use drugs, and enjoy a close relationship with his family.