Running head: AUTHENTIC ASSESSMENT 1

Authentic Assessment: Gary

Katherine McCormick
University of Maryland, University College








AUTHENTIC ASSESSMENT 2

Multiaxial Evaluation and Diagnostic Report: Gary
AXIS I: Clinical Disorders
Diagnostic code DSM-IV name
296.21 Major Depressive Disorder (Principal Diagnosis)
327.02 Insomnia Related to Another Mental Disorder

AXIS II: Personality Disorders
Diagnostic code DSM-IV name
V71.09 No diagnosis on Axis II

AXIS III: Relevant General Medical Conditions
ICD-9-CM code ICD-9-CM name
None

AXIS IV: Psychosocial/Environmental Problems
Problems with primary support group
o Wife has deteriorating health (chronic condition)
o Feels marriage is strained due to financial burden on wife
Problems related to the social environment
Educational problems
Occupational problems
o Stressful work hours
o Stress due to late paying clients
Housing problems
Economic problems
o Decline in economy has taken a toll on business, savings and investments
o Way of life impacted due to slow economy
Problems with access to health care services
o Exorbitant health care premium
Problems related to interaction with the legal system
Other psychosocial and environmental problems

AXIS V: Global Assessment of Functioning
Score: GAF = 61
Time frame: current

AUTHENTIC ASSESSMENT 3

Arriving at Diagnosis
Even though Gary is reacting to a stress and at first glance may appear to have
Adjustment Disorder with Depressed Mood, instead Gary receives a primary diagnosis of Major
Depressive Episode (single episode). The diagnosis is such because he is not responding to an
immediate crisis but rather presents with chronic symptoms that have persisted over time. Upon
review of the intake session, it is clear Gary meets the criteria for Major Depressive Episode.
First, he describes himself as moody, anxious and irritable (Criterion A1). For depressed
individuals, mood can sometimes take on these qualities. For example, according to the DSM-
IV-TR, individuals may present as feeling anxious (p.349) or exhibit increased irritability
(p.349).
Gary also reports that he has a decreased libido (Criterion A2). Often, depressed
individuals have a difficult time experiencing pleasure and lose the desire to pursue normal
sexual activity (Comer, 2011, p.195). According to the DSM-IV-TR, some people may
experience a significant reduction from previous levels of sexual interest or desire (p.349).
He states that he has experienced loss of appetite and significant weight gain (Criterion
A3). According to Comer (2011), depressed individuals may eat excessively (p.197), and the
DSM-IV-TR notes that this type of change in dietary habit meets the criterion when appetite
changes are severe (in either direction) . . . [and there is] a significant loss or gain in weight
(pp.349-350). In Garys case, he may be eating without feelings of hunger, a common
occurrence in persons experiencing a Major Depressive Episode (Comer, 2011, p.197).
Gary reports he has insomnia and an interrupted sleep cycle (Criterion A4). Because his
insomnia and disrupted sleep are likely contributing to his mood, I have assigned a secondary
diagnosis of Insomnia Related to Another Mental Disorder. Insomnia is considered to be the
AUTHENTIC ASSESSMENT 4

most common sleep disturbance associated with a Major Depressive Episode (DSM-IV-TR,
p.350).
Significantly, Gary complains of general fatigue (Criterion A6). Fatigue often
accompanies depression as depressed people are usually less active and less productive
(Comer, 2011, p.195). Fatigue may be augmented by problems with sleep and insomnia, from
which Gary reports he suffers.
And importantly, Gary expresses feelings loss of self-esteem and feelings of guilt
(Criterion A7) over the loss of income. Loss of self-esteem is typical in people with depression
as they hold extremely negative views of themselves (Comer, 2011, p.195). Additionally,
Gary blames himself for his economic problems and does not give himself credit for the positive
things he has accomplished. This lack of credit for personal achievements is common in
people with depression (Comer, 2011, p.195).
Also contributing to the diagnosis, Garys symptoms do not indicate a Mixed Episode
(Criterion B) and they are causing him to experience significant impairment in his daily life
(Criterion C). His symptoms are not due to substance use or a medical condition (Criterion D).
And lastly, Garys symptoms are not due to Bereavement (Criterion E).
Treatment Goals
In order to help Gary work through this Major Depressive Episode, treatment will be
approached from a cognitive-behavioral perspective aimed at arriving at solutions on several
levels. The desired effects of therapy will be both short-term in order to relieve Garys
immediate symptoms, and long-term to teach essential life skills that will aid in avoiding a
recurrent episodes. As Detweiler and Whisman (1999) describe, the ultimate goal of therapy is
for the client to learn a strategy that can be applied to differing situations over time (p.267).
AUTHENTIC ASSESSMENT 5

Taking advantage of the appropriate anti-depressant will enable Gary to better
accomplish these long-term goals
Through continued therapy and therapeutic homework, symptoms of depression will be
reduced and Gary will experience improved self-esteem as well as decrease in negative
feelings towards himself
Gary will learn that he is in control and is able to change the way he feels
Gary will be able to communicate his concerns with his wife and improve marital
relations by reducing anxiety and stress
Gary will add positive and rewarding activities to his schedule in order to improve his
overall sense of well-being
Gary will learn to recognize and challenge negative and self-destructive thoughts,
replacing them with positive, beneficial thoughts
Gary will address the physical aspect of his depression by increasing exercise, improving
diet and improving sleep
Gary will learn to give himself credit for his accomplishments and will learn to stop
blaming himself for conditions and events outside of his control (e.g., his wifes health,
the downturn in the economy)
Gary will learn to apply all strategies and tools to future situations, gaining a life skill that
will help prevent future depressive episodes
Strengths
Gary has many strong areas which will be beneficial when working through his Major
Depressive Episode. First, Gary reports that his marriage of 12 years is intact and relatively
happy. As such, it is essential to focus on the positive aspects of his partnership. Importantly,
the fact that his wife is supportive of him and his business venture illustrates the fact that she
loves and cares for Gary and his happiness. Gary reports that his wife does not complain when
he must work difficult hours to keep his business going. It will be helpful for Gary to begin to
stop negative thinking regarding his guilty feelings towards his wife and focus on the positive
aspects of their relationship. Additionally, Gary and his wife have two children and Gary reports
AUTHENTIC ASSESSMENT 6

that they are healthy, smart, obedient, fun and well-behaved. Although he credits his wife with
taking care of the children, Gary should feel proud of his family and learn to turn to it as a source
of pride. It is imperative to highlight his success as a father in addition to his success as a
husband.
In addition to the strengths in his personal life, Gary has several career-oriented strengths.
First, he was able to obtain his MBA from a reputable university in addition to maintaining his
role as husband and father. In addition, he reports that despite the downturn in the economy, his
list of clients has grown. He is able to run a successful business supporting two employees.
Moreover, his business is progressing and growing so that Gary has been able to move out of his
home office and into a larger space. By helping Gary to focus on the positive aspect of his
professional life and working to highlight them as personal strengths, Gary should be able to
alleviate feelings of doubt and anxiety.
Areas for Improvement
While Gary has many positive areas of strength, he also has several key areas for
improvement. First, Gary must learn to communicate with his wife. Currently, Gary imagines
that his wife resents him and suffers feelings of guilt as a result. However, Gary reports that his
wife has not complained. Instead of allowing his automatic, maladaptive thoughts to control his
relationship with his wife, Gary should work on learning to stop these thoughts and determine
whether or not they are valid. Especially in a close relationship, like a marriage, it is essential
that both partners communicate. Although Garys wife has not complained, it is unclear what her
true feelings are on the matter. It would beneficial for Gary and his wife to discuss their feelings
in an open and caring way.
Next, despite the success of Garys business, he experiences ongoing stress and anxiety
regarding his financial situation. He reports that the downward turn in the economy has taken a
AUTHENTIC ASSESSMENT 7

toll on his savings, investments and way of life. In essence, Gary feels that these things are out
of his control. In order to regain his sense of control, Gary should work on a putting a plan in
place that allows him to take charge of his money. Additionally, Gary reports that clients do not
pay him when he wishes to be paid. Gary should evaluate his method of seeking payment and
revise any contracts or invoices to provide a clear and concise procedure for payment. By
learning to take control of the areas he currently feels are beyond him, Gary will feel some
measure of success.
Lastly, Gary reports that he is fatigued and suffers from insomnia. Making improvements
to his physical health will enable Gary to improve his mental status as well. Gary should ensure
that he is exercising regularly and eating a high-nutrient diet. Although not a cure for insomnia,
strenuous physical exercise will help him sleep as well as aid him in shedding the excess weight
he has gained and elevate his mood.
Homework Assignments
One of the cornerstones of CBT is the utilization of homework assignments. Homework
assignments allow clients to practice theories and methods discussed in therapy, and provide
exercises in self-growth and self-awareness. It is essential that clients work on homework
assignments between sessions in order to benefit from CBT. In the case of CBT, the process is
just as if not more important than the product. Detweiler and Whisman (1999) illustrate this as
they explain that attempting the homework, not perfecting the homework, is the true
assignment (p.268). By working through the assignments, clients gain control and learn life
skills they can use long after the therapy sessions have concluded. For the first intersession
homework assignments, Gary should do the following:
AUTHENTIC ASSESSMENT 8

Assignment one: Antidepressant Gary should visit his primary care doctor and begin to
take an appropriate prescription antidepressant.
Assignment two: Thought journal Because Gary is plagued by thoughts of guilt and
anxiety, as well as concerns over the attitude of his wife, the ultimate goal of therapy will
be to stop negative or maladaptive thoughts and turn them into positive, affirming beliefs.
However, in order to stop these thoughts Gary must first learn to recognize them. As
Gary writes and records each negative thought, he will also record the situation
surrounding the thought, his feelings regarding the thought, his views as to whether or not
the negative thought has any validity, and lastly an alternate healthy thought. The
purpose of the journal is to encourage Gary to begin to challenge negative, automatic
thinking and to replace these thoughts will positive ones.
Assignment three: Schedule It is clear from the intake session that Gary feels
overwhelmed by his current schedule and list of things to do. It is imperative that Gary
learn to schedule his time in a healthier way. While work and his business are essential
aspects of his life, Gary should learn to work at creating a more balanced schedule.
Before the next therapy session, Gary should create a timetable that accurately reflects
the way he currently spends his time by simply recording his time and events. He does
not have to begin to make any changes, but should truthfully and accurately record how
his day is spent. The record will allow us to work on scheduling beneficial activities and
create time for rewarding work in the next session.
Areas to Explore
The next session will provide Gary an opportunity to further explore areas of his life
which need addressing as well as allow for reflection through review of the two homework
AUTHENTIC ASSESSMENT 9

assignments. First, a review of the thought journal will provide areas in which Gary especially
struggles with automated negative thinking and maladaptive patterns of belief. Gary should
practice and model positive replacements to negative thoughts. Second, upon review of the
scheduling assignment, a new and improved timetable will be created to allow Gary to begin to
focus on several of the long-term goals finding time for exercise, improved quality time with
friends and family, etc. In addition, it will be imperative to discover Garys hobbies and interests
outside of work in order to create opportunities for Gary to experience them. By creating rewards
within his everyday life, Gary will begin to experience pleasure again and his mood will be
elevated.
Additionally, the next session will afford the opportunity to investigate Garys long-term
professional and personal goals. It will be imperative to address his relationship with his wife,
and it may be beneficial for her to join in part of the session. At present, it is unclear if Gary feels
emasculated by his wifes success or if he is only worried about her potential resentment. By
improving communication in his marriage, Gary will regain his voice. Moreover, as an
entrepreneur, it is essential to investigate Garys specific business goals. The next session will
provide time to explore his vision of his future and how he defines success. By giving him the
opportunity to express his wishes and dreams, Gary will begin to feel he is back in control of his
life and what happens in it. As Gary progresses through therapy and continues to work on
homework assignments between sessions, Garys mood will improve and he will experience
relief from his symptoms.
AUTHENTIC ASSESSMENT 10

References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
Comer, R. J. (2011). Fundamentals of abnormal psychology (6th ed.). New York, NY: Worth
Publishers.
Detweiler, J. B. & Whisman, M. A. (1999). The role of homework assignments in cognitive
therapy for depression. Clinical Psychology: Science and Practice, 6(3), 267-282. doi:
10.1093/clipsy/6.3.267