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CASE VIGNETTE: Utilize this scenario as the basis for your
responses to the

(listed following the vignette).

Antonia is a single, 42 years-old Puerto Rican-American
female. She has her high school diploma and has worked as a real-estate
agent for the past 8 years. She informs you that she was recently fired
due to, “Disorderly conduct with fellow employees”, and is seeking therapy as a
requirement by her former employer in order for them to reconsider her for
rehire. When asked why she was fired from work she indicates that she
thinks they did not like her because she was so successful and the office
director became sexually interested in her which made the other employees
jealous. She also admits to having difficulty controlling her anger and
“loosing control” when confronted.

Despite earning a good income, Antonia informs you that she
is indebt for about thirty thousand dollars on her credit cards. She
lives by herself and is concerned that soon she will no longer be able to pay
her rent and “have nowhere to go.” She reports having difficulty sleeping
and informs you that she goes through phases when she feels “really down” but
that currently she’s feeling “really good.” She has attended therapy a
couple times in the past for a few sessions each time but she stated that, “It
has never worked because they didn’t know what they were doing and just wanted
to talk about my past.”
Antonia reported she has been arrested on two occasions for
public intoxication and disturbing the peace. She has a long history of
tumultuous dating relationships with men and women but has never been
married. She identifies herself as bisexual. She states that she
has a need for closeness and admits to unsafe and high risk sexual behaviors
with both men and women.
She reported having few friends and primarily getting along
with males. She is estranged from her family consisting of two older
brothers and two parents. They all live locally but she indicated that
she has no desire to contact them or reconnect. She describes her mother
as “a very depressed woman who was always drinking and depressed.” She
described her father as a “dirty and evil man” who sexually abused her between
the ages of 5 and 12 and was physically abusive towards her mother. When
she tried to tell her mother about the sexual abuse, her mother became angry
with her and blamed her, accusing her of trying to seduce her father by wearing
inappropriate clothing around the house. She states that she never felt
understood by her parents because they were from Puerto Rico and could not
relate to her. When asked about her cultural identification she states
that she is “American” and didn’t want anything to do with the “machista”
Puerto Rican culture.

She stated that her parents were strict Catholics but she
denied having any religious affiliation or interests. She denied having
any medical concerns at this time.
Please compose a well-written and organized essay in
response to each of the following questions. When writing your response,

1) Use the most current APA (6th edition) Style,
with 1-inch margin, double-spaced, 12 pt font, with a reference list at the
2) Write clearly and concisely.
3) Cite appropriate and especially current literature
(empirical and/or theoretical).
4) Avoid all sexist idioms and allusions.
5) Remember to demonstrate your multicultural competence where


1. Assessment: What
assessment would you conduct to enhance your understanding of the client’s
problems and how would they direct your diagnostic formation? In
addition, what formal assessment procedures (conducted either by you or by
someone you would refer to) would enhance your understanding of the problems
and direct your treatment planning? Why?

2. Diagnosis: Develop a
differential diagnosis. What are your diagnostic considerations?
Indicate why you are considering these possible diagnoses by providing specific
evidence from the vignette. Be sure to include relevant information from
the vignette to support your answer and give a 5-axis diagnosis (including use
of V codes) at the end of this question. What additional information do
you need for each of the possible diagnoses in order to confirm your diagnoses
and rule out the others?

3. Theory – Theoretical Conceptualization:
a. Using the
diagnosis you developed above, provide ONE theoretically grounded case
conceptualization for the client, based on the theory you choose for your
treatment approach. In other words, offer at least one theoretical
explanation of what has caused the symptoms displayed by your client (why does
your client have these symptoms?).
b. Develop a therapeutic treatment plan for the client based
upon your theoretical conceptualization above. Please make sure you
identify the name of the theory your treatment plan is based on, using
appropriate headings. Provide the empirical evidence with appropriate
citations to support your choice of theory and the treatment plan that you are
recommending for use with this client. Be sure to discuss the
effectiveness and limitations in working with this particular client (including
effectiveness/limitations in working with this particular client’s background
using the above theories and treatment plans).


4. What might be some of the transference and counter
transference issues between you and the client? What are your areas of growth
(what do you need to work on) that will be addressed while working with this


Using an ethical decision making model, answer the

5. What are the ethical and legal dilemmas this vignette
introduced? What would be your immediate steps and why? Please be
specific and make sure that you describe your process of ethical decision
making and the solutions/consequences this process might lead to.

6. Given the client’s ethnicity and background, what factors
or cultural considerations would you take into account in rendering diagnoses,
case conceptualization, and treatment planning? What other cultural
factors may be salient for this client?

7. What are the relevant multicultural theories and/or models
that you would use in working with this client? Discuss how you would
incorporate them in your work.

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