Reference no: EM133725709
Read the case study and answer the following questions in a narrative, paragraph format:
Case Study:
Identifying Data: Emily Petit is a 75-year-old Roman Catholic Caucasian female residing in New Orleans, LA. Emily was born in Bordeaux, France. When she was 21 years old, Emily received the opportunity of a lifetime by acquiring a full scholarship to a university in New Orleans. Emily majored in French Language and French History. By age 28, Emily received her PhD in French Studies and was offered a tenured track academic position in the department of French and Francophone Studies. At the age of 35 years and with the assistance of the university, Emily received her permanent residency status in the USA. Soon after, Emily met Jake Byers, an assistant professor housed in the English Department of the university. After a few dates, Emily and Jake connected and married a year after they met. Emily did not take Jake's last name due to her profession. Emily and Jake have been married for 26 years. Emily does not have any children due to her dedication to the academy. Jake; however, has a 21 year old daughter, Jamie Byers, who was conceived from a long term affair that Jake developed with the Administrative Assistant of the English department. Jamie is estranged from Jake and does not interact with Emily. As of 5 years ago, Emily's colleagues begin to notice a decline in Emily's health. Emily had always been deemed as "sickly" as it was not uncommon for Emily to take a few days of sick leave each month with no explanation to Human Resources. Last year, Emily utilized another sick leave. Human Resources advised Emily that she must present a physician's note if she is to return to work. Jake decided that Human Resources was being too nosey. Jake thought it time for Emily to retire, besides, she was well past retirement age. Therefore, with Jake's prompting, Emily decided to retire from the University. Jake continues his employment with the University as Jake is unable to retire as he is 20 years Emily's junior.
Presenting Problem: Emily has frequented Skilled Nursing Facilities (SNF) on numerous occasions due to multiple bone and hip fractures. As of one week ago, Emily was discharged home with home health care. Two days ago, the home health care nurse presented to Emily and Jake's home. After a few knocks at the door, with no response, the nurse figured that maybe Emily went to an appointment and left the home. A few hours later, Emily presented to the local emergency room via EMS unconscious. Not only was Emily unconscious, she had bruises in differing stages of healing on her back, the back of her legs, the front of her legs, on her torso and face. Emergency room physicians determined that these bruises could not have been sustained by a fall and is most likely not due to any disease process; however, labs were in the process of being run. The attending physician offered a preliminary determination that the bruises were secondary to physical abuse. The lead emergency room physician advised the attending physician that he was acquainted with Emily and that she has a history of "clumsiness" and that she falls all of the time. The lead physician also says the he suspects that Emily "hits the bottle a bit too much" and that the bruises most likely were caused due to one of her "many falls." It is clear that Emily will be hospitalized and most likely will not discharge for at least 3 days post her regaining of consciousness. The attending physician was not so sure that these bruises were from a fall. Therefore, the physician decided to place a social service consult. It is Friday night. The consult will not be attended to until Monday morning.
Family Dynamics: Emily comes from an affluent family. Emily has a younger sister, Belle Petit, who is 64 years old and is a retired cardiologist in Baton Rouge, LA. Emily and Belle's parents died 10 years ago, both from natural causes. Emily and Belle are the sole heirs to their parent's fortune. Jake comes from a working class family in New Orleans, LA. It is well known that although Belle initially approved of Emily's marriage to Jake, she soon disapproved of the union due to Emily sustaining a black eye after her honeymoon night.
Educational History: Emily completed high school in France and completed her undergraduate and graduate education in New Orleans, LA. Although Jake was quite the baseball player in high school, he was not able to acquire scholarships to pay for his education like Emily. Therefore, Jake joined the Army as to pay for his college education. Ironically, many of Jake's baseball buddies were academic scholars in high school with many becoming physicians. Because of the tight knit community of New Orleans, Jake and his physician friends remain very close.
Employment History: Emily was an Associate Professor of French and Francophone Studies for over 30 years. Emily is now retired and lives off of her inheritance, her Social Security Retirement (SSDI) and her university's pension. Emily has not filed for Medicare and receives healthcare through extended COBRA. Emily will be without healthcare at the end of the month. Jake continues to be employed as a full-time English literature professor at the local university.
Social History: Emily is bilingual, fluent in both French and English. Emily identifies as Catholic and considers religion to be a big part of her life. Emily and Jake live alone in the affluent New Orleans' community of Audubon. Emily's research focus was based upon the analysis of French literature, something very important to her. Emily was known to be a very liberal thinker and loved to travel. If there was a faculty party, Emily was the life of it. However, after her marriage to Jake, Emily became socially isolated and has limited contact with Belle. Emily also lacks a peer network of any kind in her neighborhood and has also isolated herself from long term friends/colleagues at the university.
Medical History: Emily is 5'6 and weighed 125lbs. Medical records reveal that Emily lost 15lbs within the past month. There is no history of eating disorders or dieting efforts. It has been documented in Emily's historical obstetrics chart that she has gravida 5, para 0. There are no substantiations noted for the loss of the 5 pregnancies. Emily has had numerous falls within the past 5 years. These falls have usually resulted in broken bones and on three separate occasions, a fractured hip. Emily has previously reported that she has "dizzy spells" and collapses; however, may of Emily's health care providers find the reason for the falls "suspect." Nonetheless, Emily's healthcare providers have run a battery of labs and tests which were all unfounded and reflects that Emily is overall in very good health.
Emily has been prescribed Oxycodone as to manage her pain as a result of her hip fracture. However, Emily reports that the medications make her "sick." Therefore, she has reported that she prefers to take Ibuprofen as to manage the pain.
Legal History: There has been numerous calls to the New Orleans Police Department (NOPD) as it relates to domestic disturbance calls. Once the police arrives, neighbors state that it is like a "reunion" as Jake was in the military with many of the district officers. Neither Emily nor Jake have ever been arrested and there are no restraining orders on file. As of 5 years ago, there have been no domestic 911 calls to Emily and Jake's home.
Alcohol and Drug Use History: Other than socially drinking an occasional glass of Red wine, Emily has no history of alcohol use. Emily does not use any substances and rarely ingests her pain medications due to her broken hip. Emily does ingest caffeine as she has a 6 cup of coffee a day habit.
Mental Health History: During Emily's last inpatient SNF stay, a general mental health assessment divulged that Emily experiences feelings of sadness and hopelessness nearly every day. According to the assessment, Emily stated that in the past 20 years, she is unable to recall a day that she was not feeling sad. Emily also reported that she had trouble concentrating and thinking which caused her research to suffer. Emily believed that her research no longer mattered anyway as she no longer wanted to travel and did not feel the "zest" for French literature as she used to. Emily also stated that she looks forward to dying because there is "nothing left to live for." The social worker issued the Columbia Suicide Severity Rating Scale (C-SSRS) which showed that, at that time, she was at low-risk for suicide. Emily says that she neither has a plan nor the means to carry out a suicide "at this time." Emily denies taking any anti-depressive or psychotropic medications.
Strengths: Emily is bilingual, well-educated and has access to more financial / medical resources than most. Emily understands how to utilize legal services and has personally never had legal involvement. Emily has recuperated from numerous broken bones and hip fractures. Emily also has financial and emotional support from her sister Belle who loves her and is willing to be her caretaker, that is, if Emily will allow the support
Questions:
1. Describe your therapeutic stance. How do you engage clients and encourage clients to engage?
2. How specifically do you attempt to establish rapport and maintain the therapeutic alliance over time with this particular client (consider diagnosis [Major Depressive Disorder], cultural diversity, treatment approach [Using Narrative therapy], etc.)?
3. How do you address barriers within the therapeutic alliance?
1. Describe how micro, macro, and/or a combination of these strategies could work to address the client's issues and their remediation, prevention, and/or amelioration
2. What policies or resources are important to consider and/or include in this client's treatment? Other clients experiencing similar concerns?
3. Consider the mental health and social issues (chronic feelings of sadness and hopelessness and isolation from sister Belle)
4. Consider client strengths and entire ecosystem
1. Based upon your clinical judgement, decide which assessment tool is the most plausible in stabilizing the client in the case study?