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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 4756
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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A mother attends an intake with her 11 yr old daughter and

Resolved Question:

A mother attends an intake with her 11 yr old daughter and she reports that she has been blessing her with holy water because she believes the spirits have entered her daughter's soul. Her daughter has been sad and listless. What would you initially say to this mother? Why?
Submitted: 11 months ago.
Category: Mental Health
Expert:  Dr. Z replied 11 months ago.

Dr. Z :

Hello I believe I can help you with your concern

Dr. Z :

This is an intriguing situation and obviously involves cultural sensitivity and understanding

Dr. Z :

I would ask her mother why she believes that the spirits have entered her daughter? Specifically looking for outward symptoms that the mother has noticed and for how long she believes that spirits have inhabited her daughter

Dr. Z :

This way I am still acknowledging her mother's spiritual beliefs, but getting information on specific symptoms that may be explained by a mental health disorder

Customer:

I agree that it involves cultural sensitivity, but why would an 11 year old child be tired and listless?

Dr. Z :

Well there could be multiple reasons, I would ask how long the child has been like this, if they are taking an prescription and non-prescription medications, as these can effect a child.

Dr. Z :

Also I would ask if the child has been exposed to any trauma as this can cause these symptoms as well

Dr. Z :

In rare cases, the negative symptoms of a psychotic disorder can cause this, but it is extremely rare for symptoms of a psychotic disorder to show up in a child so young

Customer:

I agree that medications could be the cause as well as trauma. What do you think the most likely cause could be? Psychiatric issue?

Dr. Z :

The most common cause would be severe depression. Listless, sadness, lack of energy, sleep issues, eating issues, hopelessness, etc.. are all symptoms of depression and because the child is so young they do not have the requisite emotional tools to help cope with depression and this is why it hits a child hard and they have these severe symptoms that you describe.

Customer:

I have looked through the DSM 5 to come up with some rational for this problem and I am stumped. My first instinct would be head trauma

Dr. Z :

Head trauma would also cause confusion and memory impairments as well, is that present in the child?

Dr. Z :

It also can be an organic issue like hypothyroidism which can be easily correctable.

Customer:

No. The only information available is what I posted above and they hypethtical office is a counseling one

Customer:

Should I rule out medical issue before I look at a psychiatric issue

Dr. Z :

Typically that is usually the protocol in pediatric cases. For your question I would ask the mother for more symptoms and clarification of the symptoms, because the two symptom that your described can account for many psychiatric disorders. The most likely diagnosis is a depressive disorder based on sadness and listless because that is more common than other psychiatric disorder where those two symptoms are present. In addition, I would ask the mother if she would be comfortable giving her daughter medications (some religions and cultures do not allow it).

Customer:

I would hate to miss a medical cause for this problem. Failure to thrive? However the mother is at a psychotherapist appointment for child. Hypethetically speaking.

Customer:

Is our time up?

Dr. Z :

But like I said sad and listless can account for many psychiatric disorders in children, so this is why getting more information for the mother would be good. But depression is the most common.

Dr. Z :

No there is not time limit here we can discuss this for as long as you need.

Dr. Z :

Hypothyroidism is commonly misdiagnosed as depression because depression is a common symptom of hypothyroidism so a blood test checking thyroid levels would be good and easy.

Dr. Z :

You can also ask about head trauma, this is a common question to ask during intakes.

Customer:

So Initially I would acknowledge the mother, and then ask about more symptoms and then inquire about her beliefs on medications. What if she won't use medications?

Dr. Z :

By the way I am assuming this is for a class assignment.

Customer:

Yes it is and I am stumped

Dr. Z :

Yes you do not want to question the mother's beliefs or this may turn her off to treatment. If the mother is not willing to accept medications, and it turns out the daughter needs medications to survive or have a good quality of life, then it could mean an legal issue in the future where her rights as a parent are taken away. But usually it may not be hard to convince her to accept medications for her child, but to continue using holy water and prayers as well as the mother believes this will her daughter.

Customer:

There is no real patient involved

Dr. Z :

Well for these types of assignments, there are not right answers on the diagnosis, but the professor wants to see how you handle the cultural sensitivity of the issue and what ideas of a diagnosis you come up with because all the diagnoses we talked about are plausible.

Dr. Z :

In addition, acknowledging the mother's religion and talking about it can build rapport and build a more trusting relationship with you, the mother, and daughter.

Customer:

Thank you for encouragement I am a bit of a perfectionist and wanted to make sure I was on the right track. I tried to look up what culture uses holy water to bless the sick, so I could be culturally sensitive, but came up with thousands of answers. Can you recommend a good psychotherapy book? The one we are using is not for insightful.

Dr. Z :

You mean psychotherapy book for cultural sensitivity?

Customer:

yes

Dr. Z :

There are many cultures that use holy water you are right, and that is why you ask about it and take genuine interest in her culture and religion, many patients like this a lot and trust you more because you took the time to show care for her religious beliefs.

Dr. Z :

Sure, I have one that I used in school. Let me get the name of it and I will get you the link. Give me a few minutes.

Customer:

Ok that sounds great. I would also be interested in a good reference book o Theory and practice of counseling and psychotherapy as I will have many more assignments.

Dr. Z :

Sure no problem, I can do that too

Customer:

Thank you for all of your input. You have been extremely helpful. In the future if I have any questions or need some guidance can I ask for you?

Dr. Z :

Yes you can definitely ask for me, all you have to do is put "For DoctorZ only" before you type your question and that way it will come to me

Customer:

Great. I look forward to working with you in the future. Are you going to send me the info on the books to my email?

Dr. Z :

No I am getting them right now, sorry I have many books in my office, so I want to find the right ones for you.

Dr. Z :

These two books are excellent for cultural psychology

Dr. Z :

And give me a minute to get you the therapy and counseling books to

Customer:

So, is it right for me to assume that Counselors from all cultural groups must examine their expectations, attitudes, biases and assumptions about the counseling process and also about persons from diverse groups.

Customer:

So, its extremly important to remember that there is no one size fits all approach to clinical work

Dr. Z :

Yes that is correct, it is important for all therapists and counselors to examine their own cultural and personal beliefs and if they can maintain an objective mind in helping others. Also the therapist must be sensitive and understanding of the patient's cultural and religious background. They do not have to agree with it, but acknowledge it and understand their view point.

Dr. Z :

Exactly, there never is. The best therapist is someone who can adapt and adjust to the client.

Dr. Z :

Here are two good books on counseling and psychotherapy that I have used many times.

Dr. Z :

These are very broad books, I usually practice CBT and DBT therapy more so my focus in on that treatment modalitly, but these books are a good starting point until you decide with therapy modalities you prefer.

Customer:

Thanks again for all of your time. I will surely ask for you again. Can I save this chat so I can access the information on the books or do I have to write it down before I sign off and give you an excellent rating

Dr. Z :

An email with a link to this chat should have been sent to you, so you can always access this chat in the future. Also you can bookmark this page using this link too and you can quickly reference this chat as well.

Customer:

Thank you have a nice night.

Dr. Z :

You as well, best of luck to you on your assignment. My goal is to provide you with excellent service, so if you ever have any further questions or concerns please do not hesitate to contact me at anytime.

Customer:

I will thanks again

Customer:

Dr. Z's answers were extremely thorough and answered all of my questions.

Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 4756
Experience: Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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