Interpretation and Impressions
General Level of Intellectual Functioning
Ms. Sandra’s intellectual level with reference to verbal conceptual and oral skills is at an average level. But this is acceptable and probably can be considered to have bright normal intelligence. Her symptoms could not indicate totally indicate problems to interact with the society members and perform routine tasks. This is in accordance with the scored range of mental abilities (WAIS-IV Full Scale IQ = 132) or the 97th percentile when compared to his age-related peers. Her verbal processes are better organized, circumstantial and frequently dominated by topics about which she has some concerns. The score obtained is generally representative of her superior cognitive functioning. However, the other parameters like perceptual reasoning (picture completion, block design and matrix reasoning) and verbal comprehension (vocabulary, similarities and comprehension) were significantly lower because of her current thought process, divorce and her poor motivation. She has good orientation in all three spheres and manifests no significant mental impairment.
Her saying “I cannot keep myself motivated in activities that I am doing because I keep thinking about my problems and I am distracted”, does not totally mean that she is far from the normal psychophysiological behavior. Hence, there are could not be dysphoria, depression and anxiety, although she complains of poor sleep, loss of energy and lack of motivation. She experiences a kind of ambivalent personality organization with moderate disturbances to her functional adaptation. Hence, it can be understood that there is hardly any decline in the overall cognitive functions or abilities, especially to remember and recall earlier thoughts, motivation to aim for a bright knowledge and wisdom.
Verbal Abilities
Sandra’s obtained a verbal IQ which is equivalent to the Average range (WAIS-IV Verbal Comprehension Index = 112) or the 79th percentile. This has indicated a good perceptual motor performance and is probably a conservative reflection of her intellectual capacity. During the interview, she was able to use good words in dialogue and was able to identify different cultural themes and broad vocabulary terms. Hence, with regard to the vocabulary usage, sentence formation she has no problems especially with word-finding, sentence formation or lengthy descriptions or explanations. She has better ability to make use of knowledge gained from previous experience and solve the problems when she is not under stress. Hence, her verbal abilities are having a fine comprehensive strength. This may not indicate a moderate level of verbal functional impairment. This could represent her strength in verbal comprehension based on her high socio-economic status, educational background.
Non-Verbal Abilities
Ms. Sandra’s obtained a good non-verbal score which is in the Average range. The criteria used for this test was WAIS-IV Perceptual Reasoning Index and the value is 109 equivalent to 73rd percentile. These results are not influenced by the mood disturbances she frequently encountered, She is sensitive to environmental signals of threat and at the least suggestion of emotional arousal engages in cognitive patterns. Her non-verbal skills are not influenced by the emergence of a variety of secondary symptoms.
These may include denial, phobic avoidance in the face of anticipatory cues, self criticism, compartmentalization and somatization. This may indicate that acute stress induced symptoms and phobic behaviors have nothing to do with her non -verbal abilities. She could better good tasks. Her social discomfort could hardly produce difficulties. Therefore, there may be minimum chances of distraction
Processing Speed
Ms. Sandra has a potential of producing processing information at high speed. This in accordance with the criteria of WAIS-IV Processing Speed Index. The value is 132 equivalent to 98th percentile. This may indicate that she has ability to get insightful knowledge. Given the unsustaining nature of her subjective distress she could become abreactive, sensate focused. This helps her to focus on problems interrelated to coping style at both behavioral and insight level. Hence, she may not be confronted with a pattern of superficial compliance and more covert resistance to the directives of help givers.
Attention and Concentration (Working Memory Index)
Similarly, Ms. Sandra obtained a good score in the attention and oncentration. This is in accordance with WAIS-IV Working Memory Index. The value is 122 equivalent to 93rd percentile. Her age related peers have scored low. This has indicated that Ms.Sandra does not have any dominant involving strong needs for memory dependence. She could remember things. Hence, she has better cognitive efficiency and manifests no significant mental impairment. She does not possess notes having always been concerned with the potential loss of memory functions.
Psychiatric
Ms. Sandra obtained a score of 13 on BDI – II test. These reflect the presence of minimal depression. Under MMPI –II category she could have depression. This is in agreement with her personal experiences of social maladjustment. This strengthens the finding that she faced depression interconnected with dysporia, and anxiety. This might have made her to become susceptible to poor sleep loss of energy, and lack of motivation. This is also in agreement with the DSM IV criteria under common axis II disorders. This criteria is worth fittin for the presnt case and strengthens Ms. Sandra’s statement ” “I am not interested in socializing as I was before because I prefer to be alone.” Individuals who fall under this category are believed to have social adjustment problems commonly encountered in some diseases like ADHD (Attention Deficit Hyperactivity Disorder). Here, it is anticipated that Ms. Sandra is having few symptoms resembling ADHD in the adults. Hence the findings are worth fitting with the study questions.
Client Strengths
Ms. Sandra has uprightness and more willing to give up for the desired ones. Her orientation in achieving was good as revealed from her background information. Of course, she is overambitious and well in coping style. She shows restraint in situations, more probably revealed when she was allowed to grow under strict parents. She could handle tasks, solve problems follow directions, inclined to be honest and loyal. She has shown equity in all affairs.
Personality
Ms. Sandra is afraid of being used by people. She has distrust in people and believes that others will lie and cheat just to get ahead. She stated “the only reason some individuals do not cheat of lie is that they are afraid that they will get caught.” She feels discomfort in social gatherings and prefers to stay by herself. She has become withdrawn from society and is not as assertive as she used to be. Due to her unhappy marriage that resulted in divorce she is continuously unhappy. Her family lacked to express to Ms. Sandra that they loved her and this became a major problem for her in her life.
Coping style
Ms. Sandra is fine in her coping style. Frequently, it used to vacillate between primary impulsive and externalizing to being self–critical and internalizing. Although, this pattern of coping suggests a problem at both behavioral and insightful level, she is well in introspecting herself at difficulties.
She is not totally self blaming with her moderate Insight oriented mind. She has married a boyfriend after her first marriage. She realized that she was exploited in a bad sense and later grew psychic. However, a sort of mild to moderate problems is interfering with her life ad evading the chances of achievements or goals.
Interpersonal
Ms. Sandra’s interpersonal skills seem moderate. Although, she preferred to be lonely due to social maladjustment, she had enough skills to develop social interactions. This could be revealed from her personal experience where she developed interaction with a man that went to the stage of marriage.
She could resist conflicts. Her fears and phobias have got aggravated after she was withdraw in the society.
The thematic and dynamic aspects of Sandra’s problem rests with the ability to initiate work that mobilizes her intellectually and reduces anxiety and depression.
Diagnostic Impressions
- AXIS I
- 309.81 Posttraumatic Stress Disorder
- 995. 5 Neglect
- AXIS II
- v 71.09 Diagnosis on AXIS II
- AXIS III
- 300.02 Generalized Anxiety Disorder
- 291.8 Alcohol Withdrawal
- Axis IV
- Abandonment by parents due to conflict
- AXIS V
- Current GAF: 60
- Highest GAF past year: 50
Summary and Recommendations
Ms. Sandra is a 34 year-old female brought up in a family under stringent conditions. The psychological evaluation indicates that: She has academic skills in reading and spelling exceed her measured cognitive abilities. She does not exhibit overt behavioral difficulties although peer interactions have been strained. She is demonstrating and experiencing significant signs of emotional distress. She has potential to score well in cognitive tests
She hardly become disturbed by the feelings of emptiness and loneliness. With moderate preoccupations and with failures and physical unattractiveness, and assertions of guilt and unworthiness she got severely depressed. These contributed to the decline in mental functions. Ms. Sandra’s global cognitive ability score is within the low average range, it is likely an underestimate of her true ability level given her higher expected scores on verbal and non-verbal skills. This could suggest that Ms.Sandra’ may be having bilingualism and moderate performance may have inhibited her ability to demonstrate her optimal cognitive ability on the WISC-III. It is also quite possible that Ms. Sandra’s exposure to early and persistent abuse / neglect may have impeded the development of her optimal cognitive functioning, which is likely to be in the average range.
Ms. Sandra’s experience of multiple events, including the conflicts between the family members and the boyfriend’s family, abandonment, loneliness have further exacerbated her feelings of fear/uncertainty associated with persistent maltreatment by her parents. It is evident that Ms. Sandra’s worries, sadness, difficulty concentrating and recurring nightmares are associated with the psychosocial disturbances. With adults, Ms. Sandra exhibits a strong desire to obtain any type of personal acknowledgement, although negative, in a world that she perceives as largely unsafe and threatening. Ms.Sandra’s ability to acquire new knowledge especially verbal skills and her attempts to initiate relationship with others suggest that she possesses the capability to succeed in academic settings and is receptive to building social support networks outside of her family of origin. Inspite of her current and expected difficulties, Ms.Sandra presents as a likeable youth who desires acceptance from others. There is a need of placing a lovable, consistent and structured home environment that provides unconditional acceptance. This is also likely to improve her cognitive level of functioning
Therefore treatment strategies could be
- Ensure regular technical /arithmetic exercises to improve her mental skills. Providing extra assistance to work with timed tasks would be of great help.
- Provide Ms. Sandra with opportunities to participate in structured community activities of interest to her to promote her sense of self–efficacy and enable her to develop positive peer relationships in natural settings.
- Provide Sandra’s parents a psychological counseling to promote their understanding of Sandra’s needs (e.g., supportive structure, limit setting, explanations, consistency, and acceptance) and use of family affairs.
- Drugs recommended for the ADHD are the better choices.
- In case of severe episodes of depression, drugs recommended may be Dextroamphetamine-amphetamine, Methylphenidate hydrochloride.
References
Groth-Marnat, G 2003 handbook of psychological assessment/ 4th ed. (chapeter 15 pg 664-671).
DSM 1V.