Case Vignette for Comprehensive Examination

Psychological Theory and Practice

Part A

Conducting an unstructured interview would be critical in obtaining detailed information concerning the client. During an interview, the psychological professional prepares the appropriate questions that will help provide as much information as possible. Unstructured interviews are a type of informal interviews whereby the researcher may not utilize an interview schedule (Weiner, 2003). Unstructured interviews comprise of open-ended questions that are asked without a specific order. The main advantage in applying unstructured interviews in this case is the fact that these kinds of interviews allow for flexibility since the researcher can alter the questions as the interview progresses. The psychological professional may change the interview questions depending on answers provided by the respondent, Adrianna. Since unstructured interviews utilize open-ended questions, the respondent has room to respond in much detail. This would help in establishing the sense of the respondent in understanding the case against her. Unstructured interviews will also allow for more probing in order to get a deeper understanding of issues raised by the respondent.

Unstructured interviews are valuable in obtaining information from individual with various forms of mental health problems. Unstructured interviews are similar to the free association method, which encourages individuals to provide details of their thought patterns or what they perceive in their mind (Weiner, 2003). Unstructured interviews are mainly client-centered. The key point is to allow the client to talk freely. As the psychology professional, the key role will be to reflect Adrianna’s statement back and to encourage her to talk more about her feelings and thoughts (Weiner, 2003). The open-ended approach has little guidance as to what or how much the client says. This will encourage Adrianna to open up about her thoughts and feelings. Nonetheless, I will still apply focused questions in order to guide the interview process and the course it takes. From the case study, there is need to conduct certain psychological assessments in order to evaluate the mental status of the client. The following assessments will help in reaching a diagnosis for the client.

The Mental Status Examination (MSE) is an important psychometric instrument used in clinical psychology to evaluate the functioning levels of a client with mental health issues. The MSE can help psychology professionals in determining whether a client requires treatment and in evaluating the efficacy of current treatment practices. MSE is critical while conducting the initial interview. The MSE enables the psychology professional to draw important conclusions through observation of the client and data provision by the client. The MSE bears several categories that can help the psychology professional to draw conclusions about the client. The following is an examination of the various categories with regard to client behavior.

Appearance. While conducting the MSE, the psychology professional begins by noting the physical appearance of the client (Haddox, 1999). This may include an evaluation of the dress code, tattoos, general neatness, and unusual marks on the body. It is also important to note whether the client is cooperative or not during the interview. Additional cues to look out for include consciousness levels, posture, apparent age, self-mutilation as evidenced by scars, eye contact, and among others. Posture can help indicate anxiety levels. Eye contact can indicate whether Adrianna is comfortable in answering the interview questions.

Substance use. It is important to establish whether Adrianna has alcohol dependency and drug related problems, which could exacerbate her current situation. People may slip into alcohol dependency in order to ease anxiety or depression. Most individuals with alcohol dependency will deny they have a problem or they do not realize they have an alcohol dependency problem. The psychology professional may apply the CAGE questions set that comprises of four questions about alcohol abuse. These questions include:

  1. Do you ever feel the need to cut down on your drinking?
  2. Do people criticize your drinking to the point that you feel annoyed?
  • Do you have any guilt feelings about your drinking?
  1. Have you ever drunk alcohol in the morning to calm you down? (Haddox, 1999).

From the vignette, Adrianna has started depending on alcohol as a way of getting sleep. This will most likely lead to addiction. When evaluating the history of drug use, the psychology professional must be aware of the terminology revolving around drug use. It is also important to be aware of the phenomenology relating to drug use. Adrianna is susceptible to drug abuse as a way of coping with her depression. It is possible she will start using hard drugs to ease her frustrations.

Suicidal ideation assessment. The risk of suicide may be high judging by the fact that Adrianna had a previous diagnosis of depression. The risk of suicide may occur when there is presence of affective disorders, personality disorders, and cognitive disorders. Affective disorders include a range of psychiatric diseases such as depression, anxiety disorder, and bipolar disorders. Personality disorders include paranoid personality disorder, schizotypal disorder, borderline personality disorder, antisocial personality disorder, and among others. Suicidal thought patterns are common among individuals with personality issues. They can be more complex when personality issues arise from the need for revenge, punishment, and due to anger issues. In assessing the risk of suicide, the psychology professional may ask various questions. For instance, one may ask, “Have you ever thought of sleeping and never seeing another day?”

The Suicide Behaviors Questionnaire-Revised (SBQ-R) is an important scale that can help in assessing suicide risk in individuals. The SBQ-R scale comprises of 4 items each evaluating a particular aspect of suicidality (Farabaugh et al., 2015). Item 1 evaluates the lifetime suicide ideation of the client. Item 2 examines the frequency of suicide attempts over the last one year. Item 3 examines the general suicidality threat by the client. Item 4 provides an overview of future likelihood of suicide ideation. This item comprises of self-reporting of future likelihood. The SBQ-R is a reliable tool for examining the risk of suicide among clients. The scale is easy to answer and is quick to administer since it comprises of only a few items.

Available literature indicates that alcohol abuse increases suicidal behavior among individuals. Studies indicate that there is a high risk of suicide among alcoholics (Mackrill & Hesse, 2012). This risk is higher where an immediate family member has committed suicide. Further, studies indicate that suicide behavior may run in families. A genetic component may explain why suicide may run in families (Mackrill & Hesse, 2012). Since Adrianna’s brother committed suicide, this indicates she could also be at risk of committing suicide. There is also an increased risk of suicide since Adrianna comes from a drug-abusing family. Further, she is depending on alcohol to help her sleep. According to Albanese, Norr, Capron, Zvolensky, and Schmidt (2015), there is high suicide rate among individuals exposed to traumatic events during childhood. This puts Adrianna at high risk of committing suicide due to her traumatic childhood. Due to the above reasons, there is need for Adrianna to complete a suicidal ideation assessment to establish the risk of committing suicide.

It is critical to conduct psychological tests. Psychological testing is akin to medical testing where the major goal is to provide an accurate diagnosis of a particular condition. Similarly, psychological testing evaluates the client’s behavior in order to provide a diagnosis and guide the process of treatment. Psychological tests enable psychology professionals to identify the cause of a particular psychological condition and identify evidence-based practices of dealing with the problem. For instance, conducting psychological tests on Adrianna may help shed light on anger management issues, personality disorders, affective disorders, and other underlying concerns. Psychological tests will thus help in solving the problem or issue.

Certain formal assessment procedures may help in enhancing the understanding of problems and in directing the treatment plans. One of the assessment procedures is the 4-item Primary Care PTSD Screen for evaluating post-traumatic stress disorder. Another tool that can help in evaluating PTSD is the Posttraumatic Diagnostic Scale, which is a self-report PTSD instrument. Another important assessment procedure is the application of the DSM-IV DSM-5 Disorder Matchesand DSM-V in evaluating the case. The Diagnostic and Statistical Manual (DSM) of mental disorders can help in classifying various mental health disorders.

Referrals may occur if the patient does not give a positive response within a period of three months. If the patient remains a threat to others or to self, there might be need for referral to a specialist. This may help in providing a specialist opinion. The referral question may relate to the nature of the metal health disorder affecting the client. Cultural issues may be present in this case study since Adrianna’s family comes from a different cultural background from that of the US. Culture plays a significant role in shaping an individual’s mental health. For instance in some cultures, men may be expected to cope with stress more than women should.

Part B

The Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) is a multiaxial system for diagnosis of various psychological disorders. The DSM-IV manual addresses a person from multiple perspectives (Mash & Wolfe, 2013). The DSM-IV model provides a comprehensive overview by analyzing a complete picture of the entire set of factors relating to the mental health of an individual. The DSM-IV manual has five diagnostic axes that help in providing a comprehensive diagnosis. The following is an overview of the five axes with regard to the vignette.

Axis I: Clinical disorders. Axis I of the DSM-IV manual comprises of clinical disorders. This excludes personality disorders and intellectual disabilities since they are presumed to be stable (Mash & Wolfe, 2013). The various clinical disorders under Axis I include disorders diagnosed during infancy such as ADHD, mental retardation, autism, learning disorders, communication disorders, feeding and eating disorders during infancy, selective mutism, stereotypic movement disorder, and among others (Mash & Wolfe, 2013). The other category includes those not exclusive to children, such as mood disorders (bipolar disorders and depressive disorders), anxiety disorders (PTSD, specific phobia, obsessive-compulsive disorder, social phobia, acute stress disorder, generalized anxiety disorder, and others), sleep disorders (parasomnias and dyssomnias), and eating disorders (bulimia nervosa and anorexia nervosa) (Mash & Wolfe, 2013).

Axis II: Includes personality disorders and mental retardation. This axis helps in giving prominence to the two disorders. Most of the intellectual disabilities are diagnosed during childhood. However, it may be difficult to diagnose personality disorders during childhood (Mash & Wolfe, 2013). These become prominent during adolescence or during early adulthood. Personality disorders are more stable in adulthood. However, there are attempts to diagnose personality disorders even in young children. The various personality disorders include borderline disorder, antisocial disorder, histrionic disorder, schizoid disorder, obsessive-compulsive disorder, narcissistic disorder, schizotypal disorder, avoidant disorder, and dependent disorder (Mash & Wolfe, 2013). Personality disorders share similar characteristics. One of these characteristics is a pervasive pattern of behavior that deviates from societal norms or values. Another characteristic is unusual though patterns and feelings, which contribute to significant distress upon an individual.

Axis III: General medical conditions. This axis requires the identification of related medical conditions. The evaluation of certain medical conditions present in the client may help in getting a clear understanding of the underlying mental health disorder (Mash & Wolfe, 2013). The general medical conditions may not have a sufficient link to the underlying mental disorder. Nonetheless, the general medical conditions may be important to the overall diagnosis and treatment. In addition, the medical condition may bear a direct relationship with the mental disorder in question.

Axis IV: The psychosocial and environmental problems. This axis involves the evaluation of psychosocial and environmental problems that may be contributing to the development of disorders in Axis I and Axis II. These problems include negative life experiences, family problems, major environmental disruptions, occupational problems such as unemployment, deficiencies, incarceration, poverty, and among others (Mash & Wolfe, 2013). This axis mainly focuses on current problems or those that have occurred within the past one year. However, the axis also takes into consideration past events that have contributed to the disorder.

Axis V: global assessment of functioning. This involves examining the overall level of functioning. This axis comprises of a rating scale that ranges from 1 to 100. The psychology professional uses this scale to give the observed level of functioning of the client (Mash & Wolfe, 2013). A lower score indicates that the client has significant mental health problems that call for attention. A higher score such as 100 indicates that there are no symptoms or problems.

The following is the DSM-IV-TR diagnosis and analysis of the axes relating to the vignette.

Axis I              Posttraumatic stress disorder, major depressive disorder

Axis II             Obsessive compulsive disorder

Axis III           Recurrent dreams of the ordeal she faced

Axis IV           Death of Adrianna’s family members including her mother and brother, seeing                              the pimp who killed her mother, abuse she ensured as a child (rape and physical                            abuse by her mother), and family stress (her broken family).

Axis V             GAF score of 10. This indicates that Adrianna poses a significant and persistent    risk of hurting self or others. Adrianna may commit suicide or hurt others unknowingly due the severity of her mental health condition. There is need for an      appropriate medical intervention to ensure that Adrianna does not pose a risk to         self and others.

The diagnosis made is posttraumatic stress disorder (PTSD) and major depressive disorder. Posttraumatic stress disorder occurs to persons who have experienced severe trauma (Hyman, 2013). The diagnosis of PTSD occurs at least one month following the traumatic event. Adrianna has symptoms of PTSD. There are three major symptoms for PTSD. One of the key symptoms for individuals suffering from PTSD is re-experience of the traumatic event often through distressing recollections about the traumatic event (Hyman, 2013). This mainly occurs through nightmares and flashbacks. From the vignette, Adrianna has been having recurring dreams about the night she was sexually assaulted together with her mother, and her brother beaten. The second major symptom is avoidance of places that might rekindle memories of the trauma and emotional numbness (Hyman, 2013). Adrianna manifests these symptoms. First, she refused to go out of the house unless forced to do so by her foster parents. Second, she shot the man who supposedly killed her mother without any tinge of emotion.

Another important symptom under avoidance of places that that rekindle negative images is avoidance of routine or normal activities. Adrianna stopped attending classes after learning of her brother’s death. It was only after her psychiatrist’s intervention that she started attending classes. The third major symptom of PTSD is increased arousal, which may manifest itself in the form of inability to sleep, difficulty in concentration, and irritability (Hyman, 2013). The vignette indicates that Adrianna was unable to sleep, which made her result to taking alcohol in order to sleep. Another symptom indicating increased arousal is hypervigilance. For instance, Adrianna would check whether she locked all windows, doors, and check on her children severally. This occurred after she saw her mother’s former pimp while having dinner at a restaurant. Another symptom relating to increased arousal is reckless behavior. For instance, the shooting of the pimp can be interpreted as a reckless behavior. These symptoms clearly indicate that Adrianna was suffering from PTSD.

Adrianna seems to suffer from major depressive disorder. This means that she suffers from both PTSD and a major depression. Her case is not unique. According to Hyman (2013), major depression may result due to stressful life events. In addition, there is a close link between major depression and PTSD. This means that individuals suffering from PTSD may concurrently be diagnosed with major depressive disorder. Research by Hyman (2013) indicates that there is a co-occurrence level of 56 percent and 95 percent in a lifetime between PTSD and major depressive disorder. The high co-occurrence level of the two disorders indicates that this is not a matter of coincidence. Other possible reasons for the co-occurrence of PTSD and major depressive disorder are similar symptoms, resulting from a common reason, and sequential causation (Hyman, 2013). Sequential causation occurs when PTSD goes untreated for a long time, leading to major depressive disorder.

Adrianna shows symptoms of major depressive disorder. These symptoms include detachment, diminished interest, restricted range of affect, hopelessness, irritability, difficulty sleeping, loss of interest in various activities and hobbies, persistent sadness, and among others. It is worth noting that individuals suffering from major depressive disorder may not suffer from all of the aforementioned symptoms. Rather, they may show a few of these symptoms. Adrianna shows various symptoms. For instance, she has difficulty in sleeping. She also seems to be having episodes of sadness. She has diminished interest in attending classes. This occurred after learning about the death of her brother.

Differential diagnosis will certainly play a key role in making the final diagnosis relating to the patient’s mental health condition. Differential diagnosis involves weighing the possibility of over that of others. In the case of Adriana, she seems to be having PTSD and major depressive disorder. Available literature indicates that there is a high probability of co-occurrence of the two disorders. The rationale for diagnostic decisions involves the forensic psychologist examining the possible disorders and then making a decision about which disorder(s) to settle on. The forensic psychologist will diagnose the disorder (s) that best match the client’s symptoms. There are no significant cultural issues involved in this diagnosis. This is because there is no evidence detailing cultural influence in the development of PTSD and major depressive disorder.

Legal Theory and Application

Part A

As a psychology professional, one may explain the crime presented in the vignette through a psychological dimension. From a psychological perspective, the criminal offender is under the influence of social, biological, and psychological factors. The interplay of these factors may influence a person to commit crime. However, psychology theorists assert that even a single component could influence an individual to commit crime. The identification of the appropriate theory linking an individual to criminal behavior requires the careful examination of various factors such as the individual himself or herself, family, friends, neighborhood, school, life experiences, and among others. This section examines the vignette with regard to existing psychosocial theories. This is an attempt to explain the meaning of crime as presented in the vignette.

Several theories attempt to establish crime causation. Learning theories assert that individuals learn behaviors and gain ideas by interacting with others or from the environment. Once individuals learn new behaviors, they may engage in rule violations. Learning refers to the process of acquiring new habits and knowledge through experience (Vold, Bernard, Snipes, & Gerould, 2016). One of the popular learning theories is the differential association theory by Edwin H. Sutherland. This theory asserts that people acquire social behavior or criminal behavior through their social interactions with other people (Bartol & Bartol, 2012). The messages that people obtain by interacting with others has significant influence on behavior. If an individual receives too much negative messages there is a high possibility of acquiring negative behaviors. Sutherland identified nine key points that define the theory, among them the assertion that learning of negative behaviors occur in interpersonal groups.

Sutherland’s differential association theory can explain the criminal behavior of the three men who assaulted Adrianna’s family. The three men seem to have learned criminal behavior by coping each other, which is why they commit similar crimes and as a group. One of the key limitations of this theory is that fact that not all people who associate with criminal elements ends up acquiring criminal behavior. Moreover, arguments exist that it is possible that delinquent people will select those with similar behavioral traits or values as their friends (Vold et al., 2016). As such, the theory may fail to explain the criminal behavior of the three men. This is because there is a possibility that none of them acquired criminal behavior from another, but just a case of common interests bringing them together. Nonetheless, Sutherland’s differential association theory remains fundamental in understanding crime in the society.

Albert Bandura developed the social learning theory to explain crime. His theory is a refining of Sutherland’s differential association theory. Sutherland asserts that learning occurs in close interpersonal groups. Albert Bandura rejected this as a narrow view in social learning. He propounded the idea that learning can take place through observation of others (without developing interpersonal relationships), through interactions with the environment, and through operant conditioning (Vold et al., 2016). Other learning theorists also propound the idea that learning is not restricted to close social groups. Social learning theory can partly explain the criminal behavior of Adrianna. Sutherland’s differential association theory fails to explain Adrianna’s criminal behavior because it had nothing to do with her friends. According to social learning theory, Adrianna could have acquired the criminal behavior from the environment or through observation. This could have been from TV programs or she could have read somewhere. Learning from the environment gave her an idea of buying a gun.

A significant theory of crime is one propounded by Michael Gottfredson and Travis Hirschi, known as a general theory of crime. This theory purports to evaluate all forms of crime that occur in the society. According to the duo, individuals perpetrate crime because of deficits in self-regulation or self-control (Bartol & Bartol, 2012). Social control is internal in nature to an individual. This theory asserts that early childhood experiences has significant impacts on the individual’s ability maintain self-control (Vold et al., 2016). Social control factors include those events in early childhood that has a significant impact to an individual’s later behavior. The theory asserts that social control among individuals becomes prominent at around 8 years of age. The duo argue that ordinary crimes are simply an attempt by the offender to seek “immediate gratification of desires” but with no lasting benefits (Vold et al., 2016, p. 227). Individuals committing ordinary crimes take little time to plan. In addition, they are often impulsive, shortsighted, and insensitive.

The general theory of crime seems to explain Adrianna’s criminal behavior in the most logical manner. The theory focuses on self-control. Adrianna’s childhood was marked by significant negative experiences. The negative experiences that Adrianna faced in her childhood influenced her self-control negatively. This means that currently, Adrianna has low self-control, which indicates increased tendency to engage in criminal behavior. Due to low self-control, Adrianna is likely to engage in ordinary crimes that offer immediate gratification and short-term thrill. People with low self-control will exude impulsivity and are generally insensitive. Adrianna shows symptoms of impulsivity. She shot the pimp who killed her mother and she appears to have lost her senses while shooting him. According to Vold et al. (2016), people with low self-control may engage in analogous behaviors. Such behaviors include drinking, smoking, drunk driving, skipping classes, and others. Adrianna was already skipping classes and drinking herself to sleep.

The general theory of crime holds that poor parenting techniques contribute to low self-control among individuals. A look at Adrianna’s situation reveals that her mother had poor parenting skills due to the stresses she went through. For instance, she used to take out her anger on Adrianna and was emotionally unavailable. One of the key limitations of this theory is that it is tautological. Another limitation is that the theory claims self-control to be constant from around age 8. This has been controversial with some theorists claiming that self-control is dynamic throughout the lifespan, just like the social factors.

Another key theoretical perspective is the psychoanalytical theory of human behavior proposed by Sigmund Freud. The psychoanalytical theory explains criminal behavior as a function of drives and motives in an individual (Videbeck, 2011). According to Freud, human behavior is the result of interactions of three key components: the id, ego, and the superego. Freud applies two models to explain behavior. These include the economic model and the topographic model. The economic model proposes the ideas that the id, ego, and the superego share a constant amount of psychic energy and that behavior is under the influence of instinctual demands. Under this model, the behavior of individuals is controlled by drives. Further, behavior helps in disposing of instinctual energies in an individual. The topographic model suggests that individuals have three consciousness levels, which include the conscious, the preconscious, and the unconscious.

The conscious mind comprises of those things that are within an individual’s awareness. The preconscious is the things that are not conscious but that can come into awareness through some effort (Videbeck, 2011). The unconscious comprises of things that are not within an individual’s conscious realm. According to Freud, human behavior is motivated by the subconscious thoughts and feelings. This includes those in the preconscious and unconscious levels. Freud’s psychoanalytical theory can help in explaining Adrianna’s behavior. Adrianna’s behavior is the result of preconscious and unconscious thoughts and feelings (Videbeck, 2011). It is worth noting that a person represses traumatic events in his/her life into the subconscious. These subconscious thoughts continue to motivate the behavior of an individual. Freud’s theory faces a major limitation in that there is no empirical research evidence to support its claims about the subconscious memories.

Part B

Various psycholegal standards apply to the vignette including competence to stand trial, duty to warn, and insanity standards.

Competence to stand trial. Competence to stand trial refers to the ability of the defendant to understand or comprehend the nature of the accusations brought against him or her. Competency to stand trial involves the legal determination of an individual to go through a criminal adjudication process (Weiner, 2003). In other words, this is the ability to stand trial. During trial, the testimony regarding mental and physical illness of the defendant goes as far as its influence to the mental functioning of the defendant. There are three critical elements evaluated in competency to stand trial. The first element is the ability to understand charges, the court’s adversary system (the attorney), and the role of the criminal process. The second element is the ability to understand one’s role as a defendant in the justice process. Third, the defendant should be able to understand pertinent information concerning the facts relating to the case. Competency to stand trial is different from insanity defense in that it examines the defendant’s state of the mind during trial proceedings rather than at the time of committing crime (Bartol & Bartol, 2012). This is the key difference between the two.

A landmark U.S. case relating to competency to stand trial involves Dusky v. U.S., which occurred in 1960. The case involved the defendant, Milton Dusky, accused of rape and unlawfully transporting a woman (Mossman et al., 2007). During the pre-trial process, it psychologist professionals diagnosed dusky with schizophrenic reaction. Further, it became apparent that Dusky could not help the counsel in establishing the facts of the case since he seemed delusional. Despite this evidence, the trial court convicted Dusky of rape after deciding that he was competent to stand trial. The U.S. Supreme Court reversed this decision. In the landmark ruling, the U.S. Supreme Court observed that Dusky did not have sufficient mental capacity to engage with his lawyer and neither the rational understanding about the facts of the case (Mossman et al., 2007). The matter was referred back to the lower court to determine if Dusky was competent to stand trial. Forensic mental health professionals are interested in establishing whether an individual has the mental capacity to understand rationally the facts of the case during the trial period.

Duty to warn. Duty to warn concerns the risk of dangerousness. In the current legal environment, courts require mental health professionals to give their views about the defendant’s risk of causing harm to self or others (Bartol & Bartol, 2012). Nonetheless, it has been difficult for mental health professionals to predict the risk of dangerousness among individuals. It is worth noting that the mental health professional has the right to breach confidentiality of client information if he/she learns that the client intends to commit an offense or had earlier committed an offense. The mental health professional has a duty to learn if he/she learns about the client’s intent to cause harm to a third party.

A landmark case demonstrating the duty to warn involves Tarasoff v. Regents of the University of California. In this case, Dr. Thomas Moore, a psychologist at the University of California, attended to a graduate student who confessed to him that he intended to kill his girlfriend (Sheppard, 2015). Dr. Thomas Moore took action by informing the campus police of his client’s intentions. The campus police interviewed the student about his intentions of killing his girlfriend, Tarasoff, and later released him on the promise that he would stay away from her. Dr. Thomas and the campus police did not inform Tarasoff about the threats. A few months later, the student fatally stabbed Tarasoff (Sheppard, 2015). Tarasoff’s parents brought a legal action against the regents of the University of California. The lower courts ruled in favour of the school. However, the Supreme Court of California reversed this decision, citing that Dr. Thomas Moore had a legal duty to warn the victim. Forensic mental health professionals are interested in establishing whether their client poses a danger to others.

Insanity. The insanity standard is about irrationality. The standard argues that the defendant should not be held legally accountable for his actions if the court determines that at the time of committing the offense the defendant had a serious mental issue that affected his/her judgment. This is encapsulated in M’Naghten Rule, which concludes that the defendant cannot be held legally responsible if he or she suffers from a severe mental illness that affects judgment (Bartol & Bartol, 2012). Insanity standards will only apply if there is proof that the defendant had mental incapacitation at the time of committing the crime. A popular landmark case on insanity is Durham v. United States (“Findlaw”, n.d). In this case, Durban was charged with housebreaking. However, the lower courts dismissed the insanity claim without conducting adequate tests for insanity. The Supreme Court recommended that adequate tests be conducted to evaluate whether Durham was of sound mind at the time of committing the offense.

Research and Evaluation

Part A

Competency to stand trial. Competence to stand trial is a critical issue in the criminal justice system. Psychology professionals need to apply competence tests in order to determine whether the defendant understands the facts of the case. Competency tests should evaluate not only the defendant’s understanding of the facts of the case but also help in detecting feigning. A significant number of suspects may try to feign incompetence as a way of escaping trial and incarceration (Ragatz, Vitacco, & Tross, 2015;2014;). It is imperative to conduct competency tests in order to satisfy the requirements of the Daubert standard. In the case law involving Dusky v. United States, the U.S. Supreme Court ruled that the defendant must be able to understand the facts of the case and consult his/her attorney, failure to which the incompetency doctrine applies. The following is an examination of various tests that would help in analysing competency to stand trial.

The MacAuthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA) is one of the key tests applied in evaluating competency to stand trial. The MacCAT-CA comprises of 22 items. The 22 items fall into three scales, which include understanding scale with eight items, reasoning scale with eight items, and appreciation scale with six items (Ragatz, Vitacco, & Tross, 2015;2014;). Six of these items specifically evaluate the case. The MacCAT-CA test addresses the limitations found in the original competency test known as the Competency Assessment Test. The MacCAT-CA helps in measuring the defendant’s ability to understand concepts relating to adjudication or the criminal justice system (Ragatz, Vitacco, & Tross, 2015;2014;). The test also addresses the ability of the defendant to apply logic in the legal matters confronting him or her. The last items evaluate the ability of the defendant to understand the specific issues of the case. Experts recommend that the psychologist professional apply other measures in evaluating malingering behaviour of the defendant.

The MacCAT-CA test would give high results, probably a scale of 5. This is an indication that Adrianna is competent to stand trial. The information provided in the vignette indicates that Adrianna understood the consequences of her actions. Soon after she shot the pimp, Adrianna just stood there in amazement until the cops arrived. Previous history indicates that Adrianna was suffering PTSD and major depressive disorder. However, these disorders may not prevent her from understanding the facts of the case. Adrianna seems aware of what she has done, the reason she stood there until the cops arrived. However, her underlying psychological problems could be the ones that motivated her to commit the murder. This test may not provide details concerning whether there is an aspect of feigning by the defendant (Ragatz, Vitacco, & Tross, 2015;2014;). This calls for the application of other tests to detect malingering.

Another important test is the Evaluation of Competency to Stand Trial-Revised (ECST-R). This test comprises of both competency scales and feigning scales (Ragatz, Vitacco, & Tross, 2015;2014;). The competency scales comprise of 19 items, which include consult with counsel, factual understanding of the facts of the case, and rational understanding of the facts of the case. The feigning scale employs Atypical Presentation. Most of the items on the scale are scored on a scale of five points. The results of this scale would be “questionable clinical significance”, which is the second level indicating competency to stand trial.

Risk of Dangerousness. Many instruments are available for measuring the risk of dangerousness. The common instruments include the Violence Risk Appraisal Guide (VRAG), the Psychopathy Checklist-Revised (PCL-R), and the Historical-clinical-Risk-20 item scale (Jaber & Mahmoud, 2015). The most common instrument in prediction of violence is VRAG. This instrument has high violence prediction capabilities. The initial study was conducted using a sample of 618 men in an incarceration facility (Jaber & Mahmoud, 2015). The instrument comprise of 12 items that examine demographical details of the suspect, history of offending, and psychometric values. Two of the items examine developmental problems such presence of parents up to age 16 and adjustment in school. Four items examine offender details including age, sex, victim injury, and offence history (Jaber & Mahmoud, 2015). The rest examine the client’s personality disorders, alcohol abuse, marital status, and psychopathy.

The anticipated conclusions about Adrianna basing on the vignette is that she is at low risk of dangerousness. Adrianna has faced serious development issues in the past. First, she experienced separation from her mother before the age of 16 and had to live with foster parents. Another development issue is elementary school adjustment. Adrianna had poor elementary school adjustment. Although she successfully completed high school, the vignette indicates that she was unable to keep up with the rest of the students. In addition, her teacher constantly reprimanded her for being inattentive in class. With regard to the second category of items under the VRAG instrument, Adrianna’s score would still be high. Her age would give a factor of -1 since she is 32 years under the VRAG instrument. Adrianna did not have non-violent offenses prior to the major offense. The victim died during the incident, which makes the nature of the offense serious. In the recent past, Adrianna has had alcohol problems. She seems to have PTSD and major depressive disorder. It is worth noting that the shooting was not under the influence of alcohol consumption. Moreover, this was her first offense and that she did not have any prior convictions for minor offenses reduces her chances of committing the crime another time. This reduces her risk of dangerousness within the next 10 years to below 50 percent.

Insanity. The law can declare the defendant not guilty if it becomes evident that at the time of committing the crime, he/she was of unsound mind. This is known as ‘not guilty by reason of insanity’. Psychology professionals can apply several tests to determine whether the defendant takes the plea of insanity defence. The standard test is the Mode Penal Code test, also known as the American Law Institute Test (ALI). The ALI test states that the defendant is not guilty of his actions if at the time of committing the offense he/she could not tell the wrongfulness of the actions or could not be able to restrain himself from conducting the act and because of a mental impairment. The anticipated conclusions in this case is that Adrianna, although aware of the wrongfulness of her actions, was powerless in controlling her actions. Adrianna was aware of her actions during the shooting. She also understood that it was wrong to take the law in her hands. However, she could not control the urge to kill the pimp who murdered her mother and walked free.

Part B

The client suffers from post-traumatic stress disorder. This disorder may have contributed to the development of major depressive disorder. The treatment plan that may be most effective for the client is cognitive behavioural therapy (CBT) approach and medications (Foa, Gillihan, & Bryant, 2013). CBT is a type of therapy that focuses on thinking patterns or the cognitive patterns of the client. The aim of the psychological professional in the application of CBT is to alter the cognitive patterns that contribute to mental enslavement with regard to the traumatic event. CBT focuses on the traumatic events with the aim of changing the patient’s cognitive patters. Evidence-based research indicates that CBT is effective in managing PTSD among veterans and other groups of people (Foa, Gillihan, & Bryant, 2013). Medications will be effective in managing depression and anxiety. Medications such as antidepressants can help in improving sleep and concentration. The following part examines the application of the two approaches in managing Adrianna’s condition.

As earlier mentioned, CBT aims at modifying erratic thought patterns that manifest themselves following exposure to a traumatic event. CBT adopts a collaborative approach between the therapist and the patient. The first step often involves informing the patient about CBT. Educating the patients enhances collaboration with the therapist (Foa, Gillihan, & Bryant, 2013). Treatment focuses on avoidant behaviours manifested by the patient. Treatment also focuses on irrational thought patterns exhibited by the patient. Irrational thought patterns and avoidant behaviour helps in maintaining PTSD in the patient. There are three core forms of CBT for treatment of PTSD. These include psychoeducation, exposure, and cognitive restructuring.

Psychoeducation involves providing educations to clients about cognitive behavioural approach in the treatment of PTSD. Psychoeducation enables individuals to have a clear understanding of the rationale being CBT for PTSD (Baddeley & Gros, 2013). This is significant in the therapeutic process because it enables patients to gain knowledge about CBT and thus make the correct decisions. The sharing of knowledge about CBT and PTSD also enhances the relationship between the therapist and the patient. This is critical since CBT builds upon collaboration between the therapist and the patient for the approach to be effective (Baddeley & Gros, 2013). The therapist should engage a persuasive rationale in trying to influence patients to changing their cognitive patterns. Maintaining collaborative relationships enables patients to go through difficulties as they try to overcome their fears.

The second form of treatment using the CBT approach involves exposure to various targets. Exposure aims at encouraging patients to confront their fears (Baddeley & Gros, 2013). For instance, it encourages patients to make contact with the stimuli that elicits fear in them. This ensures that they gradually shed their fear of the particular stimuli. While applying the exposure approach, the patient makes contact with the stimuli for lengthy periods in order to experience a decrease in negative thoughts. The therapist must plan for regularly repeating sessions of stimuli exposure in order to help in reducing fear. The therapist often applies two forms of exposure. In the first one, the patients may simply recount the trauma memories in their minds. The second one involves introducing the live stimuli whereby patients experience similar situations to those that led to trauma (Baddeley & Gros, 2013). Lastly, there is interceptive exposure whereby the psychological professional helps the patients in experiencing bodily sensations relating to the stimuli but in a controlled manner. This may be in concentrated form or in a gradual manner.

The other key element of CBT is cognitive restructuring. Cognitive restructuring aims at helping trauma victims to modify irrational thoughts that may haunt them from time to time (Baddeley & Gros, 2013). The aim is to ensure that trauma victims can fight maladaptive thoughts any time they arise.  Cognitive restructuring also aims at teaching adaptive responses among trauma victims. Cognitive restructuring can enable patients deal with irrational thoughts that express themselves in form of magical thinking, magnification, splitting, emotional reasoning, and over-generalization. Trauma victims can apply various cognitive restructuring methods. For instance, leaning to identify cognitive distortions and focusing on these distortions. A trauma victim who identifies his/her cognitive distortions can then begin to evaluate different ways of thinking in order to avoid the distortions. It is also possible for trauma victims to learn about evaluating the evidence surrounding a particular thought.

Existing literature indicates that CBT is highly effecting for alleviating PTSD symptoms such as sleep disturbances and among others. However, there is little literature available over the treatment of depressive symptoms that often manifest with prolonged PTSD in a trauma victim. A meta-analytical review by Ronconi, Shiner, and Watts (2015) found that there are no established treatments for managing depressive symptoms caused by PTSD. Further, the study indicated that there was a strong correlation between measures that reduced PTSD symptoms and their influence in reducing depressive symptoms. The study concludes that the presence of comorbid depressive symptoms should not impede the choice of a treatment approach (Ronconi, Shiner, & Watts, 2015). Adrianna seems to have strong depressive symptoms. In order to manage these symptoms, medication will also be included as a treatment option. Antidepressants will help in easing the major depressive disorder.

The rationale for CBT lies in its efficacy in managing PTSD symptoms. Evidence from scholarly literature indicates that CBT is highly effective in eliminating PTSD symptoms and related depressive symptoms (Ronconi, Shiner, & Watts, 2015). The psychologist professional should identify the short-term and long-term goals involved in treatment. The following are the short-term goals directed at the client:

  • To go through all psychological tests relating to the symptoms for PTSD and depressive disorder.
  • Adrianna should be able to identify the actual symptoms of PTSD that lead to distress and illogical thoughts.
  • Explain the details of the traumatic events.
  • Relate the feelings she experienced during the traumatic event.
  • Adrianna should be able to tell how the symptoms of PTSD affect her social life and her relationship with her family.
  • Adrianna should be able to accept her alcohol dependence to gain sleep and commit to quitting alcohol dependence.
  • Adrianna should be aware of incidences where she has been unable to control her anger and impulses.
  • Adrianna should be aware of the in vivo stimuli that trigger the PTSD symptoms.

There are a few long-term goals for this form of treatment. The long-term goals mainly relate to elimination of the PTSD symptoms. The following are the long-term goals involved in this treatment plan.

  • The first goal is to reduce the impact of the traumatic event on the normal functioning and return the patient to the level of functioning before the traumatic event occurred.
  • Another goal is to help Adrianna recall the traumatic even without developing negative emotions.
  • The third long-term goal is to help her avoid destructive behaviours that help in promoting denial.
  • Another long-term goal is to equip Adrianna with adequate coping skills that can help her carry on with routine activities and avoid negative thoughts.

It is possible to measure the effectiveness of the treatment approaches using a scientific approach. The symptoms Checklist (SCL-90) is a 90-item scale that can assist clients in self-rating. This scale has a multidimensional profile rating examining a range of items. The client uses the scale to measure his/her mental health over a span of one week. The scale comprises of 90 items categorized into 9 diagnostic subscales and 3 on the general level (Hiltunen, Kocys, & Perrin-Wallqvist, 2013). The 9 subscales include depression, somatization, hostility, psychoticism, paranoid expression, phobic anxiety, obsessive compulsive, anxiety, and interpersonal sensitivity. The three general subscales include a General Severity Index, Positive Symptom Total, and Positive Symptom distress Index. This scale will help in scientifically examining the progress that Adrianna makes in managing the PTSD symptoms and in regaining her former functioning.

The anticipated effectiveness of the CBT approach is that it will bring change within short period. CBT is collaborative and relies mainly on the part of the client to bring about change. Under the CBT approach, there is less reliance on the psychological professional comparing to using other techniques such as psychodynamic therapy. CBT is more timesaving compared with other approaches. A normal session may last for 12-16 weeks, while other approaches may last for up to 6 months or even more. CBT is effective because it teaches clients to be adaptive. This is because it relies on the principle that irrational thoughts lead to criminal behaviour. The CBT approach will likely be effective because CBT therapies transcend beyond cultures. The emphasis of CBT is for clients to get better rather than feel better. CBT focuses on the root-causes of the problems and thus effective.

There may be some limitations in applying the CBT approach. Some people may not appreciate the approach by CBT since they may feel like it downplays their emotions while focusing on logical thought process. There is the problem of patients dropping out, especially those who may not be positively responding to treatment. The focus of CBT is on the client and their ability to bring changes in their thought patterns and in their life. Critics of this approach have argued that this focus is too narrow because it does not take into consideration the emotional problems, the personal histories, and the family life of the client.

There is large empirical support for CBT. The literature available on CBT indicates that this approach is highly effective in the treatment of PTSD. According to Ronconi, Shiner, and Watts (2015), CBT is effective in managing PTSD symptoms as well as depressive symptoms that are characteristic of PTSD. Hiltunen, Kocys, and Perrin-Wallqvist (2013) conclude that CBT is an effective treatment intervention for clients with moderate mental health issues. CBT may not be effective in the treatment of clients with severe mental health issues such as mental retardation. Margolies, Rybarczyk, Vrana, Leszczyszyn, and Lynch (2013) examined the efficacy of CBT and Imagery Rehearsal Therapy (IRT) intervention using 40 combat veterans with PTSD symptoms, lack of sleep and nightmares the findings indicate that those who participated in the CBT/IRT had improved results with reduction in PTSD symptoms and improved sleep. Other studies also indicate that CBT is effective in the treatment of PTSD (Baddeley & Gros, 2013; Foa, Gillihan, & Bryant, 2013; Ronconi, Shiner, & Watts, 2015). CBT is thus an effective intervention in the treatment of moderate mental health issues.

Interpersonal Effectiveness

Part A

Ethnicity. It is important to consider the diversity factors in the treatment of PTSD. Due to increased immigration, therapists are facing an increasingly diverse patient population (Zayfert, 2008). This population comprises of asylum seekers, immigrants, and refugees from different ethnic backgrounds and nationalities. It is worth noting that most treatment interventions for PTSD were developed with regard to the industrialized cultures, yet they are increasingly applied to diverse populations. Cultural context plays a significant role in the understanding and treatment of PTSD (Zayfert, 2008). Various cultures have elaborate ways of dealing with stressful events. In addition, there are cultural expectations that greatly shape the way in which individuals react to problems in their life. For instance, some cultures expect men to be more tolerant towards stress compared to women.

The changing demographical landscape in the United States is challenging psychological professionals to develop new clinical methods for addressing a more culturally diverse population. As globalization continues, more cultures are coming together and exchanging ideologies more than ever. The increasing cultural diversity is forcing psychological professionals to rethink their treatment approaches. There is need for psychological professionals to understand the unique features of their client’s cultures before they choose a particular intervention. This will help in broadening the knowledge of the role of culture in psychosocial functioning. It is important for professional psychologists to develop awareness about the unique features of each cultural or racial group in order to determine the most suitable form of intervention. In the past, some researchers have examined value concepts and the way different cultures perceive them. Zayfert (2008) identifies six value concepts relating to Asians. These include conformity, family recognition, humility, collectivism, emotional control, and filial piety. These values have a significant impact to Asians in the U.S.

Cultural context is very important in the understanding of PTSD and other mental health disorders. One of the reasons why a cultural perspective is critical is that traumatic events are more linked to the specific cultures of the people. CBT that takes into consideration the cultural influences promotes distinctiveness in the treatment methods. For instance, Hwang (2006) established a manual for the treatment of PTSD among Chinese Americans (as cited in Zayfert, 2008). This manual was developed following the realization that the Chinese Americans communicate distress in a different way from Americans. The American Chinese are likely to exhibit passiveness or through bodily symptoms. This is in contrast to other ethnicity groups such as the Caucasianss who are likely to make reports about their emotional status.

Gender. Some researcher have sought to investigate the influence of gender in the rate of suicide among individuals with PTSD. Gradus, Street, Suvak, and Resick (2013) examine the influence of gender using a sample of 2,321 war veterans returning from Iraqi and Afghanistan. The literature indicates that the stressful events that these individuals experience increase their suicidal tendencies with time. The study shows that veterans with PTSD symptoms and have alcohol problems are more likely to attempt suicide. Further, the study shows that women are at a significantly higher risk of committing suicide than men. According to Gradus, Street, Suvak, and Resick (2013), women are up to three times likely to attempt suicide comparing with men. On the other hand, men are four times likely to commit suicide comparing with women. This conforms to the cultural scripts theory, which postulated that the behaviour to engage in suicide follows the gender values held by the society. The society holds suicidal behaviour as feminine while death is more attributed to masculinity.

Age. Available data indicates that age has a strong impact in the development of PTSD among individuals. Age is a strong predictor of PTSD. A study by Fu et al., (2013), indicates that individuals over the age of 12 are at increased risk of developing PTSD than a major depressive disorder following a traumatic event. Further, the study indicates that adolescents and children are at increased risk of developing PTSD compared to adults. In the study, PTSD was observed in 66.7 percent of adolescents compared with a rate of 10.3 percent of the population (Fu et al., 2013). The reason for increased risk of the disease among adolescents and children is that this group is emotionally vulnerable and still in the development period. Children and adolescents have a lower tolerance towards stress and traumatic events in general. Since Adrianna experienced the traumatic event at a relatively younger age, there was a high risk of developing PTSD. The research also indicates that certain post-stressor factors play a critical role in determining the severity of PTSD. These factors include treatment opportunities, recovery environment, and coping methods.

Presence of disability. The presence of disability may significantly affect the PTSD symptom management. Some studies assert that disability leads to self-compassion and an awareness of the pain that an individual is going through. Overall, this may lead to reduced PTSD symptoms. Self-compassion is key variable in lowering the number of negative affective states in an individual. Self-compassion helps veterans in coping with distress resulting from experiencing traumatic event. This may reduce the impact of the traumatic event upon an individual.

Religion. Religion plays a significant role in understanding of PTSD on the client’s side. The psychological professional must consider the role of religion in understanding of the traumatic event. Religion forms a global system of understanding events among millions of people worldwide (Anstasova, 2014). In other words, majority of people understand and interpret events around them from a religious perspective. Religious belief systems may be a fundamental aspect in the understanding of issues relating to a traumatic event. Religion can help the clients to alter their meaning about a stressful event. For instance, the client may lean on religion in order to see the positive aspects of a seemingly stressful situation (Anstasova, 2014). It can also help in making reattributions. However, studies indicate that there is no link between religion and improvement of PTSD symptoms. Studies have shown that there is no significant difference in terms of coping between the religious and non-religious groups.

Sexual orientation. Sexual orientation is a strong predictor of PTSD. Available studies indicate that there is higher prevalence rate of PTSD among young adult lesbians and gay men. Lesbian, gay, and bisexual (LGB) individuals are more likely to commit suicide that their heterosexual counterparts. The differences in the risk of committing suicide among the LGB is evident from the age of 22. Caska-Wallace, Katon, Lehavot,  McGinn, and Simpson (2016) examines the relationship between PTSD symptoms and the quality of relationships among lesbian veteran women. The results indicate that partner support is a significant factor in determining severity of the PTSD symptoms. Among the heterosexual group, there was a significantly lower risk of severe PTSD symptoms. This indicates that PTSD symptoms are more severe in minority groups possibly because of the high discrimination they face from the community.

Race. There exist significant statistical differences in the prevalence rate of PTSD across the racial divide in the U.S. There is also a significant difference in the lifetime prevalence of post-traumatic stress disorder among the races. According to Roberts, Gilman, Breslau, Breslau, and Koenen (2011), African Americans have the highest lifetime prevalence of the disorder, which stands at 8.7 percent. This indicates that African Americans are least likely to seek treatment when they develop the PTSD symptoms. Caucasianss have a lifetime prevalence rate of 7.4 percent, while the Hispanics have a prevalence rate of 7.0 percent. Asians have the lowest PTSD prevalence rates with 4.0 percent. On the other hand, Caucasianss are more likely than any other group to develop PTSD symptoms. These differences are significant in the understanding of PTSD in diverse populations such as the United States. Since Adrianna is Hispanic, she would be willing to participate in the therapy program. African Americans may be averse to seeking treatment due to various problems ranging from cultural beliefs to inadequate finances.

Leadership, Consultation, and Ethics

Part A

There is need for a professional team to look into the various problems affecting Adrianna. The vignette indicates that Adrianna has alcohol dependency problem. She suffers from depression and at one time, she received medication to control her depression. Further, the analysis of her symptoms reveals that she is suffering from post-traumatic stress disorder. The professional team will include three members. The first professional is a drug and substance abuse counsellor.  The second professional in the team would be a psychiatrist. The third professional in the team is a general practitioner. Each of the professional team members would have specific roles with regard to managing of various symptoms.

Drug and substance abuse counsellors are critical in helping addicted individuals. Drug and substance abuse counsellors listen to their client’s problems and establish the triggers or what causes the problems. From there, the counsellors work on developing a coping mechanism and implementing various treatment approaches such as the 12-step program. The 12-step program is a comprehensive recovery program for people suffering from alcohol-related problems such as addiction. Drug and substance abuse counsellors often try to adapt the treatment approaches to fit each client’s needs. This is because most clients are different. In addition, each client may have specific triggers that contribute towards the drug problem. Substance abuse counsellors act as their clients’ support system. Their role is to teach the client on ways to modify behaviour and recover from drug addiction. The program is also effective in helping clients recover from behavioural and compulsion problems. The counsellor establishes short-term and long-term goals regarding the client and implements various treatment plans.

Majority of substance abuse counsellors engage in on-going relationships with their clients. This is because the journey to full recovery is a long one for the client. Often, the client may relapse and thus seek the help of the substance abuse counsellor. Following treatment, the client may also need the services of the substance abuse counsellor to control any new behaviours that may replace the addition behaviour. Besides helping the client to quit drug and substance abuse, the counsellor may be of help in other areas. For instance, the substance abuse counsellor may assist the client in looking for a job. The substance abuse counsellor ensures that the client finds support groups, which are key in the recovery process. The counsellor arranges meetings with family members in order to provide guidance and help to resolve contentious issues among family members. The objective is to ensure that the client’s family supports the change. This is vital in the recovery process.

The second professional in the team is a psychiatrist. A psychiatrist is responsible for evaluation of mental health of individuals. The psychiatrist will help in diagnosis of the mental health conditions affecting the client. The psychiatrist can also recommend a treatment program or prescribe medications. Psychiatrists work in a variety of community settings including clinics, hospitals, their own private rooms, private consultation, and in other settings. Psychiatrists are critical in conducting teaching about mental health care to others. They are also responsible for research and in identifying evidence-based guidelines that improve the health outcomes of the clients. This can contribute to improvements in service delivery to clients. It is worth noting that psychiatrists evaluate all forms of mental illness ranging from episodic conditions, abnormal behaviour, emotional disturbances, and life-threatening medical conditions.

Psychiatrists are vital in conducting assessments and recommending appropriate treatment forms. The psychiatrist has critical skills required in conducting psychiatric assessment and providing accurate diagnosis of the mental health condition of the client. The psychiatrist also examines the interaction of the mental health condition and the physical aspects of the client (Oud, Schuling, Slooff, Groenier, Dekker, & Meyboom-de Jong, 2009). The psychiatrist develops the short-term and long-term care needs of the patient and implements them. The long-term care needs may involve psychotherapy sessions. Just like the substance abuse counsellors, the psychiatrist works with the client’s family in order to develop a comprehensive solution to the underlying mental health issue. The psychiatrist determines the various social-cultural factors that influence the client and how they relate with his/her mental health issue. The psychiatrist must listen carefully to the client’s inner feelings and thoughts in order to understand their underlying problems. Lastly, the psychiatrist works with the patient in order to identify the appropriate medications or psychotherapy program.

The professional team will also include a general practitioner. General practitioners can also help in the treatment of mental disorders. However, it is worth noting that they have limited ability to diagnose and provide treatment plans in patients with mental disorders. General practitioners can help in managing common mental disorders. This leaves out serious mental disorders where their knowledge and skills may be limited. Although the general practitioner may not be able to handle serious mental health disorders, they are critical in the treatment plan and recovery of the client. According to Oud et al. (2009), general practitioners provide mental care to about 75 percent of the clients. Majority of clients who have mental health problems manage their symptoms with the help of general practitioners. The psychiatrist may provide diagnosis and a treatment plan for a client, leaving the general practitioner to implement the plan and record progress of the treatment plan.

The general practitioner provides ongoing support to the client. This may occur through shared care, direct care, and even referring the client for specialized care depending on his/her condition. The general practitioner should have a good understanding of the condition affecting the client in order to provide ongoing health care. The mental health team that includes the psychiatrist relies heavily on the general practitioners for providing ongoing care for lengthy periods. For clients with serious mental health issues requiring hospitalization, it is important to engage the general practitioner in order to make the relevant plans involving discharge. The general practitioners are also important in providing case management services to clients in situations where there is no case manager.

Part B

Psychological professionals play various roles while providing their services in mental health. The American Psychological Association identifies these roles as diagnostics, researching, educating, consultation, social interventionism, administrative roles, supervision, expert witness, and among other roles. Psychological professionals are guided by ethical codes of conduct that define the way they ought to carry themselves as they conduct the various roles. While conducting these roles, psychological professionals may face various ethical and legal dilemmas.

One of the possible ethical dilemmas is competence. One of the general principles established under the APA guidelines is competence (“American Psychological Association (APA)”, n.d). This principle requires that therapist and other professionals recognize their potentials or skills level while engaging in practice. Therapists and other professionals should only provide services in areas they are fully competent. The therapist must be aware of the fact that there may be different levels of knowledge required to handle different clients owing to the complexities of their problems. Therapists must carefully weigh their judgment to ensure that the decision they with regard to the client is the best (“APA”, n.d). The ethical dilemma in this case concerns the making of the insanity decision. This analysis concludes that Adrianna is not guilty by reason of insanity. The argument is that although she knew the consequences of her actions, she could not control herself at the sight of the man who killed her mother. This decision may be disastrous especially if Adrianna commits another crime in future. This could occur if certain parameters were overlooked while assessing her mental status.

Another ethical dilemma involves concern over the welfare of others. Psychological professionals should always aim at improving the welfare of those they meet while providing their services. The professionals should learn to assess the welfare of their clients and in addition to their rights while conducting their duties. Conflicts may occur in their life of duty. When conflicts occur, psychological professionals must identify ways of resolving these conflicts in ways that satisfy all parties (“APA”, n.d). The ethical dilemma in this vignette concerns declaring Adrianna as dangerous to the society versus recommending that she may not be a danger to herself or anyone. While one may not wish to separate Adrianna from her family and judging by her history, there is need to ensure that she receives medical treatment. This will involve separating her from her family for a period. My immediate step in this case is to evaluate her dangerousness level and make an appropriate decision for the benefit of all parties.

An ethical and legal dilemma that may emerge while applying a treatment intervention is the risk of harm. There is a slight risk of harm from the medication and the CBT. Although the forensic psychologist may take all necessary action to prevent harm, a small risk of harm remains that may result from unforeseen circumstances (“APA”, n.d). The psychological professional avoids causing harm to the client, whether mental harm or physical harm, and whether intentional or unintentional. As the forensic psychologist, it is important to ensure that are codes of conduct are observed while providing service to a client. This ensures there is no harm resulting from negligence. The consequences of causing harm to the patient may include legal charges to losing the practice license.

Another ethical dilemma that may emerge from the vignette is barter. The APA code of conduct refrain psychological professionals from receiving goods or services from their clients as a war of compensation (“APA”, n.d). The professional psychologist can only receive monetary remuneration from the client. This helps to ensure that the relationship between the two remains professional. Accepting gifts in exchange for services may lead to exploitation and conflicts. This is the main consequence of barter. For instance, family members may use gifts as a way of enticing the psychological professional to write an insanity report or make other false claims that will in one way or another favour the client’s legal position.

The vignette introduced the issue of privacy and confidentiality. Psychological professionals have a legal responsibility to protect the information they obtain about the client (“APA”, n.d). It is the role of the professional to ensure the storing of information in a secure location free from intrusion by unauthorized parties. The psychological professional may take a number of steps to avoid a breach of privacy and confidentiality. First, the professional should discuss with the client or his/her legal representatives (in case of mental incapacitation of the client) about details concerning privacy and confidentiality (“APA”, n.d). Second, the psychological professional should inform the client about the intended uses of all the information that he/she acquires through the interaction. The consequences for failing to maintain privacy and confidentiality are dire. The psychological professional may face legal charges. A guilty verdict would attract heavy fines or jail term. There is also a risk of losing the practice license.


Albanese, B. J., Norr, A. M., Capron, D. W., Zvolensky, M. J., & Schmidt, N. B. (2015). Panic    symptoms and elevated suicidal ideation and behaviors among trauma exposed           individuals: Moderating effects of post-traumatic stress disorder. Comprehensive          Psychiatry, 61, 42-48. doi:10.1016/j.comppsych.2015.05.006

American Psychological Association (APA). (n.d). Ethical Principles of Psychologists and Code of Conduct. Retrieved from

Anstasova, R. A. (2014). Understanding the Role of Religion in Coping after Trauma:      Resilience, Post-traumatic Growth and Difference in Coping Mechanisms. Retrieved           from

Baddeley, J. L., & Gros, D. F. (2013). Cognitive behavioral therapy for insomnia as a       preparatory treatment for exposure therapy for posttraumatic stress disorder. American             Journal of Psychotherapy, 67(2), 203.

Bartol, C. R., & Bartol, A. M. (2012). Criminal behaviour: a psychological approach (10th            edition). Pearson

Caska-Wallace, C. M., Katon, J. G., Lehavot, K., McGinn, M. M., & Simpson, T. L. (2016).             Posttraumatic stress disorder symptom severity and relationship functioning among          partnered heterosexual and lesbian women veterans. LGBT Health, 3(3), 186.

Farabaugh, A., Nyer, M., Holt, D., Baer, L., Petrie, S., DiPierro, M., . . . Mischoulon, D. (2015). Screening for suicide risk in the college population. Journal of Rational – Emotive & Cognitive – Behavior Therapy, 33(1), 78. doi:10.1007/s10942-014-0203-6


Findlaw. (n.d). The “Durham Rule”. Retrieved from            procedure/the-durham-rule.html

Foa, E. B., Gillihan, S. J., & Bryant, R. A. (2013). Challenges and successes in dissemination of evidence-based treatments for posttraumatic stress: Lessons learned from prolonged             exposure therapy for PTSD. Psychological Science in the Public Interest, 14(2), 65-111.             doi:10.1177/1529100612468841

Fu, Y., Chen, Y., Wang, J., Tang, X., He, J., Jiao, M., . . . Li, J. (2013). Analysis of prevalence of             PTSD and its influencing factors among college students after the wenchuan          earthquake. Child and Adolescent Psychiatry and Mental Health, 7(1), 1-1.     doi:10.1186/1753-2000-7-1

Gradus, J. L., Street, A. E., Suvak, M. K., & Resick, P. A. (2013). Predictors of suicidal ideation in a Gender‐Stratified sample of OEF/OIF veterans. Suicide and LifeThreatening         Behavior, 43(5), 574-588. doi:10.1111/sltb.12040

Haddox, J. D. (1999). Pain-focused mental status examination. Current Review of Pain, 3(1), 42- 47. doi:10.1007/s11916-999-0063-4

Hiltunen, A. J., Kocys, E., & Perrin-Wallqvist, R. (2013). Effectiveness of cognitive behavioral   therapy: An evaluation of therapies provided by trainees at a university psychotherapy training center: Effectiveness of CBT performed by trainee therapists. PsyCh             Journal, 2(2), 101-112. doi:10.1002/pchj.23

Hyman, S. (2013). Fear and anxiety: the science of mental health. United Kingdom, UK:             Routledge.

Jaber, F. S., & Mahmoud, K. F. (2015). Risk tools for the prediction of violence: ‘VRAG, HCR‐ 20, PCL‐R’. Journal of Psychiatric and Mental Health Nursing, 22(2), 133-141.      doi:10.1111/jpm.12102

Mackrill, T., & Hesse, M. (2012). Suicide behavior in parents with alcohol abuse problems and    suicide behavior in their offspring-adult offspring and counselor perspectives. Nordic        Journal of Psychiatry, 66(5), 343-348. doi:10.3109/08039488.2011.65019

Margolies, S. O., Rybarczyk, B., Vrana, S. R., Leszczyszyn, D. J., & Lynch, J. (2013). Efficacy   of a Cognitive‐Behavioral treatment for insomnia and nightmares in afghanistan and iraq         veterans with PTSD. Journal of Clinical Psychology, 69(10), 1026-1042. doi:10.1002/jclp.21970

Mash, E. J., & Wolfe, D. A. (2013). Abnormal child psychology. Belmont, Calif: Wadsworth       Cengage Learning.

Mossman, D., Noffsinger, S. G., Ash, P., Frierson, R. L., Gerbasi, J., et al. (2007). AAPL practice guideline for forensic psychiatric evaluation of competence to stand trial. The            Journal of the American Academy of Psychiatry and the Law, 35(4): 1-70.

Oud, M. J., Schuling, J., Slooff, C. J., Groenier, K. H., Dekker, J. H., & Meyboom-de Jong, B.     (2009). Care for patients with severe mental illness: the general practitioner’s role          perspective. BMC Family Practice10, 29.

Ragatz, L., Vitacco, M. J., & Tross, R. (2015;2014;). Competency to proceed to trial evaluations and rational understanding. International Journal of Offender Therapy and Comparative          Criminology, 59(14), 1505-1519. doi:10.1177/0306624X14543768

Roberts, A. L., Gilman, S. E., Breslau, J., Breslau, N., & Koenen, K. C. (2011). Race/ethnic         differences in exposure to traumatic events, development of post-traumatic stress         disorder, and treatment-seeking for post-traumatic stress disorder in the United States.   Psychological Medicine, 41(1), 71–83.

Ronconi, J. M., Shiner, B., & Watts, B. V. (2015). A meta-analysis of depressive symptom           outcomes in randomized, controlled trials for PTSD. The Journal of Nervous and Mental          Disease, 203(7), 522-529. doi:10.1097/NMD.0000000000000322

Sheppard, G. (2015). Notebook on ethics, legal issues, and standards for counsellors. Retrieved    from

Videbeck, S. L. (2011). Psychiatric-mental health nursing. Philadelphia: Wolters Kluwer             Health/Lippincott Williams & Wilkins.

Vold, G. B., Bernard, T. J., Snipes, J. B., & Gerould, A. L. (2016). Vold’s theoretical        criminology. New York, NY: Oxford University Press.

Weiner, I. B. (2003). Handbook of psychology. New York: J. Wiley.

Weiner, I. B. (2003). Handbook of psychology: 11. Hoboken, NJ: Wiley.

Zayfert, C. (2008). Culturally competent treatment of posttraumatic stress disorder in clinical       practice: An ideographic, transcultural approach. Clinical Psychology: Science and        Practice, 15(1), 68-73. doi:10.1111/j.1468-2850.2008.00111.x

Leave a Reply

Your email address will not be published. Required fields are marked *