CNL 610 Eliza D Case Study Part One Direction Throughout Thi

CNL 610 Eliza D Case Study Part Onedirectionsthroughout This Course

Throughout this course you will be reviewing a case study about Eliza D. The information from the case study will be used to complete several different course assignments. Read part one of Eliza’s case study below for the completion of your Topic 2 and 3 assignments. Using the information provided, create Part One of Biopsychosocial History for Eliza (Topic 2) and Part Two (Topic 3) which includes case conceptualization. This includes identifying stage of change and initial diagnosis.

On what do you base your justification for services upon this part of the assessment? Your client, Eliza, is a Caucasian female with average height and slender build. The client is currently a freshman in college and she is majoring in engineering. The client’s family resides in a small town approximately two hours away. Her family is high-achieving with both of her older brothers having successful careers in engineering, just like their father.

Eliza has ‘mostly B’s’ in her classes but reports a lot of struggles in maintaining her GPA. The client states her coursework is very demanding, and she attends tutorials in the engineering department at least twice per week between classes. She considers her family a support system but is not in daily contact and doesn’t get to go home very often. At the onset of the session in late January, the client came to your office in the university counseling center because of being caught in a campus dorm with alcohol (it is an alcohol-free campus, and the client is underage). She presented as visibly distraught as evidenced by the initial refusal to sit down and pacing in front of your desk for several minutes before finally sitting down in the chair across from your desk.

Eliza was dressed in jeans, tennis shoes, a t-shirt, and zip hoodie. She appeared somewhat disheveled as evidenced by hair that was uncombed and wrinkled clothes. She struggled to make any eye contact during most of the initial session and rubbed her arms and upper legs often when talking. She said she was ‘very tired’ and admitted to sleeping less than five hours per night ‘most days’ and ‘catching up on sleep on Saturdays and Sundays until noon.’ Concerning the incident, the client stated “the RAs were called because my friends were being too loud in my dorm. When they arrived, they saw us with alcohol, and we got in trouble.” She stated that her friends in the dorm were intoxicated but she was not, adding, “I was just buzzed” and that she was drinking “because they were” and “it’s just something to do.” Eliza appears to minimize the severity of the allegations.

Eliza rationalizes drinking to unwind from her stressful course load as an engineering major, and because parties are “a way to mingle and forget about things since her closest friends and family live over two hours away.” The client identified school as a life stressor, adding “things came easy to me in high school, I just figured it would be the same in college.” She reports not being prepared to deal with things not coming easy to her in college, and voices resentment over having to attend tutorials every week to stay caught up. She reports immense pressure to do well in her major since she comes from a family of engineers. Eliza also disclosed in the initial assessment that besides the increased study requirements, she has struggled with making friends, stating, “a lot of my friends from high school have either gone to college somewhere else or are doing other things,” although she denies feeling lonely.

When asked about a support system, the client denies having close friends at school, and could not identify anyone on campus that she fully trusts to talk to about her problems. She says she goes to parties and that is where she mingles with people the most, and usually does not engage with people in her classes beyond the classroom “because she feels embarrassed about going to tutorials.” Eliza became very emotional and agitated when asked about substance use. She denies having a drug or alcohol problem, adding that she tried marijuana once in high school but “I didn’t like how it made me feel” and had not taken it since. The client stated that she was introduced to alcohol in HS when “friends asked me to drink it with them.” She stated that “I sometimes drink on the weekends with friends,” denying drinking in excess or ever suffering symptoms of being hungover.

When asked for more details about the parties she attends, the client replied again about going to parties on weekends and has been doing so since the first week of classes in late August. Although she denies drinking in excess, she admits to mixing drinks such as several beers chased with shots of liquor and engaging in drinking games that require drinking amounts of alcohol very quickly. The client also reports there have been “a couple of times where she’s pretty sure she’s taken some pills” while under the influence but cannot remember what kind or how much. The client says she goes to parties ‘most weekends’ during long semesters, and usually drinks at home when visiting with friends who go to other colleges.

When asked to expand on how many beers and shots on average per party, she finally admitted drinking at least 5-6 beers and 3-4 shots of liquor ‘on average’ per party. Although client denies experiencing hangover, she did say she has a hard time waking up the next day after a party, and usually isn’t able to eat until much later in the day following a night of drinking. When asked specifically to detail how much and how often she drinks, she had to stop and think several times, made some notes and tallies on a sheet of paper, and seemed surprised by the amount once she shared the information. She frequently paused to stop as she counted and appeared confused. The client is going to 2-3 parties ‘most weekends’ and admits drinking in her dorm at least twice per week.

The client says she didn’t drink that much at the beginning of the semester, usually a beer or two at parties, but now drinks much more and goes to more parties. She says she drinks 5-6 beers and does 3-4 shots at parties; she also admits to sneaking wine into her dorm and drinking ‘a glass or two’ at night to help her fall asleep. In terms of other addictive behaviors, the client stated that she occasionally plays a multiplayer online game. When asked how often the client played, the client stated “one or two times a week” for approximately “three to five hours” at a time. The client denied gambling or pornography issues.

The client says she is most likely to spend time gaming after tutorials for her classes, where she feels a lot of pressure to do very well, and gaming helps her unwind and forget about the stress of school. Eliza denies hospitalizations, but says she has a history of cutting in high school due to pressure from her family to achieve high grades and secure scholarships. She used to cut with a razor blade she kept hid under her mattress. She said the cutting started near the end of her junior year and became more frequent in her senior year, as often as three times per week.

The client said cutting helped her relieve pressure. As you discuss the incident further with Eliza, she interrupts and states she is cutting again due to the “overwhelming stress” of everything going on but denies suicidal ideation. She voluntarily raises her sleeves where you observe several cuts on her left wrist and arm. Some of the cuts are superficial while others look deeper. The area around the cuts is very red and inflamed.

Eliza discloses cutting 2-3 times per day every day for the last week. She also said her brothers talked about drinking a lot in college to unwind from stressful days in class. She also says her mother has a very controlling attitude, and this caused a lot of stress in their home. She said her mother drinks wine every night to unwind but has never seen her mother intoxicated. The client denied any current or past abuse, although stating in passing that she did experience some teasing in HS, although she denied discussing specifics.

Eliza denies legal history at this time, but says her RA reported the drinking incident to campus police. She hasn’t heard anything from them since the incident was reported. The client stated that she had quality relationships, but added that she felt as though she was, at times, being taken advantage of. When asked for details, the client stated that her friends oftentimes pressure her to complete their homework, as well as often push her to “party in my dorm.” When asked if the client had ever talked with her ‘friends’ about said issues, the client stated that she had not, adding, “it’s not that big of a deal.” Eliza also implies struggle with not being able to go home very often, and her close friends from high school went to college elsewhere, so they are not as close.

The client’s support system is completely different at this time in college compared to what she had at home in high school. During the assessment, Eliza was asked to share more information on what she meant by ‘things not coming as easy in college as they did in high school.’ She was teary-eyed and very emotional talking about her grades. She said she achieved good grades in high school, and all A’s during her senior year, “without having to study too much.” She said she never had to attend extra study sessions or tutoring, and she is embarrassed about having to go to tutorials as a freshman in college. The client said, “it was always expected that she would attend the university and pursue a degree in engineering like her brothers and father” and she “never really felt like she had a choice.” She says she does find the engineering field interesting but stresses out a lot over difficulty of classes.

She said her second semester is “even harder than the first” and really worries about maintaining her GPA as she continues in college. Eliza also elaborated on her family during assessment. She stated that she was the youngest of three children in her family, describing her mother as “kind of controlling” and her father as “a good guy.” She has two older brothers who are successful engineers, and her father is also an engineer. She felt majoring in engineering was a path she felt she did not have much choice in due to her family’s expectations. Her brothers are both single, and her parents have a strained relationship, which she implied affects her family dynamics. While in college, she rarely communicates with her brothers unless she goes home. She identified her religious preference as agnostic and mentioned that her parents are Irish Catholics who mostly only attend church during Christmas and Easter.

In summary, Eliza presents with significant stress related to academic pressures, family expectations, social difficulties, substance use, and self-injury behaviors. She demonstrates emotional distress, marked by tearfulness, agitation, and difficulties managing her emotions. Her recent increase in alcohol and drug use, along with her self-harming behaviors, indicate underlying mental health concerns needing comprehensive intervention.

Paper For Above instruction

Introduction

Eliza D is a college freshman experiencing multifaceted psychosocial stressors that influence her mental health and overall functioning. Her case encapsulates typical challenges faced by young adults transitioning into higher education, compounded by familial expectations, peer pressures, substance use, and mental health struggles. This paper provides a comprehensive biopsychosocial assessment, case conceptualization, initial DSM-5 diagnosis, and formulated treatment goals to guide clinical intervention.

Biopsychosocial History

The biological dimension of Eliza’s case involves her physical health and genetic predispositions. She presents as a slender, average-height Caucasian female with no reported medical comorbidities, although her self-injurious behavior indicates significant emotional distress. Her history of cutting in high school suggests underlying impulsivity and difficulty regulating emotions, which may have a biological component related to her stress response systems. Substance use behaviors—alcohol consumption, experimentation with marijuana, and episodic use of pills—pose risks for physical health complications, including liver issues and potential for substance dependence. Her increased alcohol intake and binge drinking patterns, especially her use of alcohol to facilitate sleep and socialization, suggest developing problematic use requiring close monitoring.

The psychological aspect reflects her emotional and cognitive functioning. Eliza exhibits signs of depression and anxiety, evidenced by her tearfulness, agitation, sleep disturbances, and self-harm behaviors. Her feelings of inadequacy in academic performance, compounded by pressure from her family, foster emotional distress. Her tendency to minimize her substance use and rationalize risky behaviors indicates denial or difficulty accepting the severity of her issues. Her history of self-injury underscores maladaptive coping strategies in managing overwhelming stressors. She reports feeling overwhelmed by academic difficulties, social isolation, and familial discord, which contribute to her mental health challenges.

The social component includes her close family relationships and social networks. Eliza feels disconnected from her family due to geographical distance and strained communication, especially with her mother and brothers. Her support system appears limited on campus, with no close trusted friends to confide in, leading her to seek solace in partying, gaming, and alcohol. Her feelings of alienation, coupled with her expressed pressure to succeed academically and her perceived lack of choice in her career path, exacerbate her stress. Her family’s Irish Catholic background and her identification as agnostic suggest some cultural and religious influences shaping her worldview. Her engagement in social activities such as partying and gaming functions as her primary means of socialization and stress relief, albeit maladaptive.

Case Conceptualization

Based on the gathered data, Eliza’s case reflects key features aligning with depressive and anxiety disorders, as well as substance use disorder and non-suicidal self-injury (NSSI). Her presentation of emotional distress, sleep disturbance, self-harm behaviors, and substance experimentation indicates co-occurring mental health conditions requiring integrated treatment. Her recent escalation in alcohol intake and self-injury suggests her current coping strategies are ineffective and potentially dangerous. Her minimization of her issues and denial of dependence signs point to possible denial or lack of insight, which necessitates therapist’s careful engagement.

Regarding the stage of change, Eliza displays ambivalence toward her problematic behaviors, minimizing their severity while recognizing her distress. She seems to be in the contemplation stage—aware she needs help but hesitant to fully accept the need for change. Her lack of trust and limited social support suggest she may benefit from motivational interviewing techniques aimed at enhancing readiness for change.

The initial diagnosis based on DSM-5 includes:

• Major Depressive Disorder, Moderate (F33.1), given her depressive symptoms, self-injury, and functional impairments.
• Generalized Anxiety Disorder (F41.1), reflected by her pervasive worries, stress related to academic performance, and physical symptoms of anxiety.
• Alcohol Use Disorder, Mild (F10.10), considering her pattern of weekend bingeing, increasing consumption, and use to cope with stress.
• Non-suicidal Self-Injury Disorder, (pending further assessment), based on her frequent cutting behaviors to relieve pressure.

Justification for Services

The justification for therapeutic intervention is rooted in Eliza’s dangerous self-injurious behavior, escalating substance use, emotional distress, and social isolation. Her self-harm indicates significant mood dysregulation and a risk for more severe self-harm or suicidal ideation, necessitating immediate risk assessment and crisis management plans. Her substance use and difficulty managing academic and social stressors impair her functioning and can lead to further deterioration if unaddressed. Conducting individual therapy focusing on emotional regulation, stress management, and cognitive restructuring will be crucial. Incorporating trauma-informed approaches and psychoeducation about healthy coping strategies are essential components of her care plan.

Initial Treatment Goals

Discharge Plan

Once therapeutic goals are achieved, Eliza will be provided with ongoing support through maintenance sessions, community referrals, and psychoeducational resources. Emphasis will be placed on relapse prevention, recognizing early warning signs of emotional escalation, and strengthening her support network. Coordination with campus mental health services and her primary care provider will facilitate continuity of care. The discharge plan aims to equip Eliza with sustainable coping strategies, improve her emotional resilience, and foster healthier social connections to support her ongoing mental health and academic success.

Conclusion

Eliza’s case underscores the complex interplay of psychological, biological, and social factors contributing to her current mental health challenges. A comprehensive biopsychosocial assessment informs a tailored treatment plan addressing her emotional distress, substance use, self-injury behaviors, and social isolation. Early intervention focused on building coping skills, reducing maladaptive behaviors, and enhancing social support is vital for her recovery, academic progress, and overall well-being.

References

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
• Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), 310–357.
• Linehan, M. M. (2014). DBT skills training manual. Guilford Publications.
• Kessler, R