I have to answer some questions for a case study for my psychology class.
Case Study: Irma Irma Marroquin is a twenty-five year old woman who came to see you for assessment. Irma had some difficulty getting to your office as she had a cast on her lower right leg and was using crutches. After finally getting to a seat, Irma set her crutches, coat, and backpack next to the chair, looked up at you, and began to cry. She took your offer of a tissue and said, “I’m so embarrassed, I’m sorry. I’ll be okay in a minute.” She is an undergraduate college student studying accounting and marketing. She shares an apartment with a classmate off campus. When asked why she came in, Irma reported that she has grown despondent. “This month has been hell, and I just feel so terrible. I can’t see a way out. I don’t know what to do.” Six weeks ago today, Irma was a passenger on a bus that struck a car. The driver of the car was killed and several bus passengers were injured. Irma’s right tibia and fibula were broken. Irma had been in terrible pain while awaiting the ambulance. When she arrived at the Emergency Department, she was not attended to for some time while staff tried to save the life of the car’s driver. Irma was pleased with the quality of her medical care once she was seen, but was shocked by the cost of the care. Irma has student health insurance but must pay a portion of her emergency care. She has been trying to figure out how to cut expenses to pay her bill. Her leg is healing, but slowly, and her physician has opted to keep the cast on longer than she anticipated. Other than her broken leg, Irma’s health is good. She had pain medications for the first week after her injury, but now takes no medications. Irma reports only itchiness and discomfort with her actual injury now. She reports she has gained a few pounds, but she attributes that to less physical activity since the accident. Now that she has a cast on her leg, she is having problems with mobility. Getting to and from class is a struggle given the snowy weather and her difficulty with stairs. “Just getting to the bus stop on time and getting up the stairs of the bus is a real challenge! And there’s no room for these stupid things,” she said, gesturing at her crutches. Irma reports that she is easily overwhelmed and has opted to miss class when she slipped and fell on the way out of her apartment. “I wasn’t even hurt, I just couldn’t face going out into the snow and mess after that.” Irma does attend most of her classes, however, and either rides the bus or with friends to get around. Irma used to volunteer at a senior center, but has taken a leave due to her injury. “It was a pretty physical job, and I can’t do it with my crutches.” Irma reported that she is overwhelmed by more than coping with her injury, however. She will be graduating in the spring but is not looking forward to it. She was born in a Latin American country that has had political and social unrest in the last few decades. “When I was twelve, my family went to Mexico to escape the violence. My father was able to get a job at a university in Mexico City.” Irma’s parents and two younger sisters continue to live in Mexico City. Irma still is a citizen of the country she was born in, but has permanent residence status in Mexico. She is in the United States on a student visa. Irma is bilingual and has excellent English. After graduation, Irma will need to go back either to her family in Mexico City or to her home country. While things are calmer in her home country, Irma has no real connection to it any more. And Irma does not like Mexico, her family’s adopted home. “Mexico is so corrupt,” she told you. “You have to bribe people to do anything and it still feels unsafe to me.” Irma had always dreamed of coming to the United States, and has had a wonderful college experience, despite her recent problems. “It was hard to adjust to how different America is at first, but I wanted to be here so much and for so long that I just adapted. And watching American movies and television helped.” When Irma said this, she smiled and laughed for a moment, in contrast to her demeanor during the rest of the interview. For the last month, Irma has found it increasingly difficult to motivate herself. She feels tired every day. She often finds herself ruminating about going back to Mexico. “I cry all the time now. I can’t focus on my classes at all. I sit in lecture and I just can’t make myself pay attention. I’ve actually been called on in class and I didn’t even know what the professor was asking me!” This is very unusual for Irma, who has maintained a 3.9 GPA in college. When you asked if there are times she feels better, she replied, “only momentarily.” Irma typically wakes up in the middle of the night, thinking about all she will lose at the end of the school year. She reported that her sleep is generally poor, and estimated she gets three to four hours of sleep a night. She is so tired in the evenings that she falls asleep quickly, but wakes up and has trouble going back to sleep. While lying awake in bed, Irma sometimes thinks it would be better if she had died in the accident so she didn’t have to face finishing school and leaving. Irma denied any intent to harm herself. Irma has several close friends she socializes with, but has stopped spending as much time with them. “We all are very close, we enjoy going to parties and dancing, but with this leg I just can’t do it. But I don’t like to do anything anymore. They’ll want me to go to dinner with them and I just make excuses. Nothing is fun now.” Irma admits that the reason she made the appointment to come in today was because her friends had met with her and told her they were concerned. Irma’s friend Sara drove her to the appointment today and has insisted that they go out to eat after. Irma’s family knows about the accident and her broken leg, but she hasn’t told them any details about her mood or her feelings about graduating. “They’ll just worry. My mom especially. There’s nothing they can do anyway.” She does regularly email, text, and phone her family, especially her mother and sisters. At the end of the interview, Irma said “I’m embarrassed that you’ve seen me as such a whiner. I’ve never felt so bad in my life. I just want to be myself again.” Questions 1. Use the competency-based assessment model diagram as shown on page 23 of the Gray text. Please list the biological/psychological/social considerations appropriately for this client. Include your assessment of competence (strengths and resources) as shown on the diagram. 2. How might the strengths and resources of this client be used in assessing this client? 3. Please provide a diagnosis for this client. List the numerical code followed by the DSM-5 diagnosis. 4. What are possible diagnoses requiring additional information for this client? 5. What information is needed and how might you obtain it? 6. What are the ethical and confidentiality issues in this case? Please explain what the issues are and what your actions would be to address these issues. 7. Are there potential barriers to your ability to develop empathy for this client? If so, what are they, and how might you overcome them? How might you develop or strengthen your working relationship with this client?