ABSTRACT
This chapter highlights Monisha, an 18-year-old African-American woman college student referred due to academic pressures that have increased her migraine headaches. How clearly and comprehensively a diagnosis of Adjustment Disorder fits her, in comparison to other DSM-V-TRTM Diagnoses, and if there is an appropriate ICD-10-CM code for her, are considered. Diagnostic exercises will challenge clinical reasoning about whether her symptoms might be a realistic response to environmental issues, including racism or the impact of violence and trauma, during development rather than reflecting personal or family dynamics. In addition, exercises will challenge clinical thinking as to whether diagnostic choices accurately reflect a balance between client resilience and/or factors supporting resilience in addition to the factors supporting risk in the client’s life. The interviewing skills highlighted in the chapter include commenting on nonverbal behavior, empathetic comments, open-ended and closed questions, and summarizing. Thought questions challenge professionals to consider their own and their clients’ possible thoughts, feelings, and actions when they first meet, and what steps they must take to develop the most effective working relationship with the client. Thought issues for building clinical reasoning skills using this client include academic concerns, bereavement, health issues or physical symptoms, and racism and/or harassment.
