COUNSELOR EDUCATION

SAINT JOSEPH COLLEGE

Summer 2010

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COUNSELING 544.01 Diagnosis and Treatment Planning -online

Credits: 3

Judith C. Durham, PhD, APRN, NCC, LPC,

Cell: 860 716 7266

e-mail:

Office hours: by appointment:

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Course Description: This course addresses individual diagnosis from a variety of perspectives: biologic, developmental, cultural and interpersonal. It will provide students with a broad theoretical base for understanding psychopathology, from not only an individual, descriptive, symptoms perspective as presented in the DSM-IV-TR, but also from a contextual systemic perspective including developmental hallmarks, familial patterns and socio-cultural contributors. This ability to diagnose will form a beginning foundation for treatment planning associated with various diagnostic categories.


Projected Learning Goals and Objectives: Students will be able to demonstrate their ability to conceptualize and articulate the formation of a clinical case, not only from a description of present behavior and diagnostic formulation as presented in the DSM-IV-TR, but also take into account multiple determinants of behavior including familial patterns, defense mechanisms, developmental hallmarks, etc. This ability to conceptualize material will also provide students with a beginning ability to formulate treatment recommendations associated with the various diagnostic categories.

Course Policies and Methods:

This asynchronous class will be delivered online through the SJC Blackboard System. It is expected that students complete oneClasseach week and posted by the final day for each class week. Each Class has an accompanying Required Reading, Lecture and Discussion posted in the Assignment and Discussionsections of Blackboard. Each student must respond to the professor generated questions/exercises within the Discussion for each class and also respond to other students answers. Professor will monitor Discussion and respond as necessary. The student’s participation in the discussion will be 40% of the final grade. Students should expect to spend several hours each week completing Discussion Board assignments much like one would spend several hours each week in a summer class.

Professor will be ‘in class’, processing emails, and reading the Discussion Board approximately twice a week. Students are encouraged to post all questions in the course Discussion folder under the heading of "Questions to Instructor". This is so that all students may benefit from the answers and information shared just as one would in an actual classroom setting. Please do not email professor with general course questions, but rather put them in the Discussion folder. If you have more personal questions, those may be sent to me directly -

It is recommended that students register for an account (free) at as this will be an invaluable source for diagnostic and treatment information. In conducting web based research for class Assignments and Discussions, it is important that students evaluate the quality of the material on the web sites by addressing questions such as:

Who is responsible for the site? When was it last updated?

Where is it housed? -and, is it a commercial site-- .com or an 'edu' or 'org' web site? or one

that includes an address like"~klonoski" which means it belongs to an individual person.

Is there a web address for asking questions about the information in the site?

How objective is the author(s)?

Grading Requirements: Each student is expected to visit the online class regularly, read the assigned readings as scheduled, and participate in online class discussions. The Case exams are to be submitted (in the Digital Drop Box in Blackboard) on time unless there are extenuating circumstances that must be discussed with the instructor first. All papers must be well written and in APA format. Professor will email Case Exams back to the student via their SJC mail box.

  1. Analysis and multiaxial DSM-IV diagnosis offour case vignettes that will be posted in the Assignments section of Blackboard. The analysis must include a differential medical assessment , discussion of cognitive, affective and behavioralsigns, symptoms and etiologic hallmarks, as well as treatment recommendations. Students should consult outside sourcesfor treatment recommendations and make treatment recommendations specific too the person, not the diagnosis. There is a great deal of information available on the web and through the online data bases of the SJC Library:

Students must be able to clearly articulate why they choose one diagnosis as opposed to other possibilities. Students must integrate their assigned reading in these analyses and cite references. What is important is not so much the correct answer, but the thinking that guided the student in the process, and the attention to all the details of the case. These should be about 5-7 pages in length (per case). Each worth 15% of grade. Due June 2; June 23; July 7; July 21. Papers must be well organized, express concepts in a clear and fluid manner, and develop ideas with enough elaboration and detail to adequately cover the subject. The proper mechanics of writing (i.e. spelling, punctuation, verb tense) is a must.

Worth 60 % of grade; Total Points – 60, 15 for each paper.

15 points: Written using APA style of citations and referencing. Integration of all salient information from ppt’s. and other posted material, text, and information from web based sources.

14 points: Written using APA style of citations and referencing. Integration of essential information from ppt’s. text, and web based information.

13 points: Written using APA style of citations and referencing. Paper is basically accurate, although some salient information from text, ppt’s or web based sources is missing.

12 points: Not written using APA Style, or essential information from text, ppt’s or web based sources is missing.

2. Participation in online discussions. Worth 40% of grade. Citations for sources (web, text, etc.) must be included. The grading criteria for the Discussion Board is as follows:

  • 1 point for responding to the question
  • 2 points if your response integrated material from the assigned textsor online sources

including appropriate citations.

  • 3 points if your response integrated information/research from the texts and

web sources including appropriate citations and URL.

  • 4 points—Includes all of the above done exceptionally well.

Evaluation Methods: Students will be evaluated on the quality of their work as well as their preparation for and participation in class discussions. This means that students will need to keep up with the required reading. Written and oral work must reflect the ability to communicate in a professional manner at a graduate level.

Criteria for graduate level papers.

  • Fluidity and clarity of expression.-ideas are expressed in a manner that clearly communicates ideas and provides for smooth reading.
  • Organization-the paper introduces and advances the central ideas in a manner that is organized and provides clear links and transitions form topic areas.
  • Elaboration and detail-the ideas presented are adequately supported and fully developed.
  • Critical thinking-the writer has demonstrated skilled analysis, synthesis and scholarly critique citing credible and appropriate, current sources from the field.
  • Reference-the work uses footnotes and cites references in adherence with APA documentation standards.
  • Language-writer uses college level vocabulary and word choice.
  • Grammar-writer must use standard English with appropriate spelling, punctuation, verb tense, sentence structure etc.

All papers must be double spaced using APA format. I recommend that you consult the American Psychological Association Publication Manual, 6th ed. (2009) (APA).Papers must be well organized, express concepts in a clear and fluid manner, and develop ideas with enough elaboration and detail to adequately cover the subject. The proper mechanics of writing (i.e. spelling, punctuation, verb tense) is a must.


Required Texts:

American Psychiatric Assoc. (2000). Diagnostic and Statistical Manual of Mental Disorders-

IV-TR. (DSM-IV-TR). Washington: DC.

Maddux, J. E. & Winstead, B. A. (2008). Psychopathology: Foundations for

Contemporary Understanding, 2nd ed. New Jersey: Erlbaum Associates.

COOSE ONEOF THE FOLLOWING PERSOANLITY DISORDER TEXTS:

O’Donohue, W., Fowler, K. A., & Lilienfeld, S. O. (2007). Personality Disorders: Toward DSM-V

Los Angeles: Sage Publications.

Millon, T., Millon, C.M., Meagher, S., & Grossman, S. (2004). Personality Disorders in Modern

Life, 2nd edt. New Jersey: John Wiley & Sons, Inc.

Required Articles (posted on BB)

Nestler, E. J. (2002). From neurobiology to treatment: Progress against addiction.

Nature Neuroscience, Vol 5(Suppl), Special issue: Beyond the bench:

The practical promise of neuroscience. pp. 1076-1079.

Nestler, E. J. (2001).Molecular Neurobiology of Addiction.American Journal on Addictions,

Vol. 10, Issue 3, 201-217.

Van der Kolk, B. (2001). The psychobiology and psychopharmacology of PTSD. Human

Psychopharmacology Clinical and Experimental. Jan; Vol 16(Suppl1): S49-S64.

Van der Kolk, B.,Hostetler, A., Herron, N., & Fisler, R. E., (1994). Trauma and the

development of borderline personality disorder. Psychiatric-Clinics-of-North-

America. Dec; Vol 17(4): 715-730.

Van der Kolk, B. A., & Fisler, R. E. (1994). Childhood abuse and neglect and loss of

self-regulation. Bulletin of the Menninger Clinic. Spr; Vol 58(2): 145-168.

Internet Resources

excellent information, current research

very understandable, user friendly, includes numerous videos.

St Joseph College Library:

Course Outline

Class 1 - May 12-19: Introduction to Assessment, Mental Status Exam

Introductions, course overview, Terminology, understanding multiple frames of reference,

e.g. individual and the family, biological, cultural, developmental and socio-political/social

justice issues. Mental Status Exam & fundamentals of assessment.

Objectives:

After completing this unit the student will be able to:

  • Describe multiple frames of reference regarding what contributes to disease,

dysfunction, pathology and/or symptoms.

  • Use basic nomenclature (including defense mechanisms) frequently used in

Diagnosis and Assessment.

  • Describe the basic components of a good assessment interview and Mental

Status Examination.

Since this unit presents is only a brief overview of the multitude of terms that one will encounter in process of understanding psychiatric diagnoses, students might consider purchasing a psychiatric dictionary of terms. There are many available and any one will do. Here is an online glossary of psychiatric terms

Required Reading:

Posted lectures and/or power points (in Course Assignments)

Maddux & Winstead, Chapt 1,2,3,4

O’Donohue, chapt 2 OR Millon, Chapt. 1, 2, 3

DSM Read pp. 819-828 in the DSM IV TR, Glossary of Technical Terms.

Mental status Exams:

Discussion Board Exercises: Please introduce yourself to your classmates in the folder in the Discussion Board section of Black Board.

Exercise # 1.

  1. Discuss how an eating disorder such as anorexia might develop (etiological considerations) being influenced by the following frames of reference: family & developmental influences; biological influences; culture & socio-political influences.

Exercise # 2.

The following are a list of examples that you are to match with the appropriate terms from a psychiatric glossary or dictionary.

  • The hand washing of Lady MacBeth.
  • Laughing at a funeral.
  • A child falls out of a tree and develops a fear of heights.
  • Feeling spiders crawl on ones body during the D.T.’s
  • Going from laughing to crying within seconds.

Exercise # 3: After reading the case posted in the Course documents section of BB (Ms Z.), develop a hypothetical Mental Status (in paragraph form) exam on this woman. You will obviously need to invent many of the case details. Please make your details seemingly consistent with the information that is presented. In addition to the ones listed above, there are numerous online resources for the mental status exam that also provide case examples. (You may work with each other to do this exercise, via email contact. When you post your final MS exam, please list the names of all contributors.)

Class 2: May 19-26:DSM-IV TR--Use of the manual, case examples, multiaxial diagnosing, implications for use/abuse.

Objectives:

Following this learning unit students will:

  • Be able to articulate the history of the DSM and the interface between the DSM and the ICD.
  • Be able to summarize the significant changes proposed for the DSM V.
  • Be able to use the DSM IV TR multiaxial diagnosis system.
  • Be able to locate and use the DSM decision trees for various diagnostic subgroups: substance induced disorders, psychosis, mood, anxiety, and somatoform.
  • Be able to articulate the three differential diagnostic clusters for personality disorders.
  • Understand the Insurance and Managed care implications diagnosing.

Required Reading:

DSM, Introduction, p. XIX-XXXVII, Use of Manual, p. 1-37, 745-759, skim p. 819-828.

Maddux & Winstead, Chapt 5, 6

Posted lectures and/or power points.

Discussion Board Exercise:

Exercise #1

Students are to read the case example (Ms S.) below and discuss (through the Discussion Board) the appropriate strategy for determining an Axis I or Axis II diagnoses ( e.g. use of decision trees or personality clusters or ?? ). Students are to also discuss Axis IV and V and the rationale for their selections. It is expected that students will come to a group consensus about the appropriate diagnostic categories for the case examples and will write this as shown on page 35 of the DSM IV TR.

Questions to consider as you are developing you five axial diagnoses:

1. Which, if any, decision tree would you use?

2. Do you think the primary diagnosis is an Axis I or II ? Why? What is your diagnosis?

3. What factors are you considering in determining your GAF score?

Case Example:

Ms. S is a 28 year old, single operating room nurse who was brought to the ER by her roommate following the ingestion of 15 meprobamate tablets. Her roommate was concerned as she stated that she really wanted to die. Shortly after swallowing the tablets, however, she induced vomiting. Now also after gastric lavage, she states that she feels terrific and wants to go home. She is now treating you, the clinician, with a combination of contempt and seduction.

Other relevant history is that since the age of 12, Ms S has been intermittently preoccupied with suicidal thoughts, but this is her first attempt. Her state of mind preceding the attempt was one of extreme anger and despair. This incident was precipitated by her boyfriend storming out of the house, as he was fed up with her constant demands and moodiness. She states that her boyfriend will pay for the way he treated her by storming out.

Exercise #2: medscape.com has a great deal of information on this topic, as well as

  1. When is DSM V scheduled to be released?
  2. What are the major proposed changes?

Class 3: May 26-June 2:Common Disorders of Childhood— Externalizing Disorders: Biological framework for childhood disorders, family dysfunction, ADHD, ODD,

Conduct disorder, Fetal Alcohol Syndrome.

Objectives: Following this learning unit students will:

1. Be able to describe the major features and etiology of ADHD.

2. Be able to describe the major symptoms of Tourettes Syndrome.

  1. Be able to describe the major features and etiology of ODD & Conduct Disorder.
  2. Be able to describe the major features and etiology of Fetal Alcohol Syndrome.

First Case analysis due

Required Reading:

DSM, p. 39-134.

Maddux & Winstead, Chapt 16, 18

ADHD-

Conduct Disorder:

Tourettes

Fetal Alcohol Syndrome:

Posted lectures and/or powerpoints

Discussion Excerises

Excerise # 1

1. Articulate the dynamic commonality and differences between ADD, ODD, &Conduct Disorder, including the differences in boys and girls. (This does not mean just list the symptoms as presented in the DSM)

2. Locate and share with your classmates (on Discussion Board) websites that are helpful in providing an in depth understanding of these diagnoses and associated treatment strategies.

Exercise # 2

  1. Describe and discuss the FAS spectrum of disorders. What is the critical time in utero for its development? How much alcohol does it take?

Exercise # 3

1. Locate websites that are helpful in your understanding of Tourettes and discuss etiological and treatment information about this disorder.

Class 4: June 2-9 Common Disorders of Childhood – Internalizing Disorders

School phobia, Separation Anxiety, overanxious disorder, reactive attachment disorder, Asperger’s, and Autism.

Objectives

Following this learning unit students will:

1. Be able to describe the major features and etiology of school phobia.

2. Be able to describe the major features and etiology of separation anxiety disorder.

3. Be able to describe the major features and etiology of over anxious disorder of childhood.

4. Be able to describe the major features and etiology reactive attachment disorder.

5. Be able to describe the major features contributing to resilience.

6. Be able to describe and differentiate between the sx. of Aspergers & Autism.

Required Reading

Posted lectures and/or powerpoints

Fraiburg, Ghosts in the Nursery

(watch these 6 short videos)

Maddux & Winstead, Chapt 17

Resilience-

Autism: watch video-

Discussion Board Exercises:

Exercise # 1

1. Asperger's and Autism are now thought of as a ‘spectrum disorder’. What does this mean? Describe the differences and commonality of symptoms and treatment recommendations.

Exercise # 2

2.Using Internet Resources find information and discuss the primary different presentations of Reactive Attachment Disorder and scenarios which might give rise to these different presentations of this disorder. What are suggested treatment strategies?

Exercise # 3

3. What is the essential point in the Ghosts in the Nursery Article?

Class 5: June 9-16: Adolescent Disorders and Family Dysfunction

Common disorders including eating disorders & systemic issues.

Objectives: Following this learning unit students will:

  • Be able to articulate how dysfunction develops as a composite of the developmental tasks of the adolescent and the systemic family context .
  • Be able to describe the common disorders of adolescence, including eating disorders.
  • Be able to describe treatment strategies.

Required Reading

DSM- p. 583-596.

Posted lectures and/or powerpoints

Maddux & Winstead, Chapt 12

Discussion Board Exercises:

Exercise # 1

Using Internet Resources find information on the following and respond:

  1. Describe the different types of eating disorders. Do they have different etiologies? Family dynamics?
  2. What is the co-morbidity (for the individual and family) between eating disorders and other disorders?
  3. Cognitive-behavioral therapy (CBT) for eating disorders. What is the efficacy? How is it done? What does it include?
  4. Family Treatment for eating disorders: What is the purpose? How is it done? What does it include?
  5. What is the incidence of sexual abuse in individuals who develop eating disorders?

Exercise # 2