What would you utilize to assess the client’s behaviors? Melissa was 22 years old whens she reluctantly agreed to interrupt her college education in mid-semester and admit herself for the eighth time to a psychiatric hospital. Her psychologist, Dr. Swenson,
Directions: Read the follow case study and using the provided guidelines and rubric provide an analysis.
Melissa was 22 years old whens she
reluctantly agreed to interrupt her college education in mid-semester and admit herself for the eighth time to a psychiatric hospital. Her psychologist, Dr. Swenson,
and her psychiatrist, Dr. Smythe, believed neither therapy nor medication was currently effective in helping her control her symptoms and that continued outpatient
treatment would be too risky. Of most concern was that Melissa was experiencing brief episodes in which she felt that her body was not real, and, terrified, would
secretly cut herself with a knife in order to feel pain, thereby feeling real. During the first part of the admission interview at the hospital, Melissa angrily denied
that she had done anything self-destructive. She did not sustain this anger, however, and was soon in tears as she recounted her fears that she would fail her mid-term
examinations and be expelled from college. The admitting psychiatrist also noted that, at times, Melissa behaved in a flirtatious manner, asking inappropriate personal
questions such as whether any of the psychiatrist’s girlfriends were in the hospital.
Upon arrival at the inpatient psychiatric unit, Melissa once again became quite angry. She protested loudly, using obscene and abusive language when the nurse-in-
charge searched her luggage for illegal drugs and sharp objects. These impulsive outbursts of anger had become quite characteristic of Melissa over the past several
years. She would often express anger at an intensity level that was out of proportion to the situation. When she became angry, she would actually do or say things that
she later regretted, such as extreme verbal abuse of a close friend, or breaking a prized possession. In spite of the negative consequences of these actions and the
ensuing guilt and regret on Melissa’s part, she seemed unable to stop herself from periodically losing control of her anger.
Over the next two weeks, Melissa seemed to be getting along rather well. Despite some complaints of feeling depressed, she was always very well dressed and groomed, in
contrast to the more psychotic patients. Except for occasional episodes when she became verbally abusive and slammed doors, Melissa appeared and acted like a staff
member. Indeed, Melissa began taking on the “therapist” role with other patients, listening intently to their problems and suggesting solutions. She would observe as a
spokesperson for the more disgruntled patients, expressing their concerns and complaints to the administrators of the treatment unit.
Melissa became particularly attached to several staff members and arranged one-on-one talks with them as often as possible. Melissa used these talks to complain about
alleged inadequacies and unprofessionalism of other staff members. She would also point out to whomever she was talking that he was one of the few who knew her well
enough to be able to help her. There talks usually ended with flattering compliments from Melissa as to how understanding and helpful she found that particular staff
person. These overtures made it difficult for certain of these selected staff members to confront Melissa on issues such as violations of rules of the treatment unit.
By the end of the third week of hospitalization, Melissa no longer appeared to be in acute distress so discussions were begun concerning her discharge form the
hospital. At about this time Melissa began to drop hints in her therapy sessions with Dr. Swenson that she has been withholding some kind of secret. Dr. Swenson
confronted this issue in therapy and encouraged her to be more open and direct if there was something about which she was especially concerned. Melissa then revealed
that since her second day in the hospital, she has been receiving illegal street drugs from two friends who visited her. Besides occasionally using the drugs herself,
Melissa had been giving them to other patients on the unit. The situation was quickly brought to the attention of all the other patients on the unit in a meeting
called by Dr. Swenson; during the meeting Melissa protested that the other patients had “forced” her to bring them drugs, and that she actually had no choice in the
matter. Dr. Swenson interpreted this as meaning that Melissa had found it intolerable to be rejected by other people and was willing to go to any lengths to avoid such
Soon after the incident came to light, Melissa experienced another episode of feeling as if she were unreal, and cut herself a number of times across her wrists with a
soda can she has broken in half. The cuts were deep enough to draw blood but were not really life threatening. In contrast to pervious incidents, she did not try to
keep this hidden and several staff members, therefore, concluded that Melissa was malingering – exaggerating the severity of her problem so she could remain in the
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