“Julia Measuring Up I grew up in a northeastern suburban town, and I’ve lived in the same house for my entire life. My father is a lawyer, and my mother is the assistant principal at our town’s high school. My sister, Holly, is 4 years younger than I am. My parents have been married for almost 20 years. Aside from the usual sort of disagreements, they get along well. In fact, I would say that my entire family gets along well. We’re not particularly touchy-feely: It’s always a little awkward when we have to hug our grandparents on holidays, because we just never do that sort of thing at home. That’s not to say that my parents are uninterested or don’t care about us. Far from it; even though they both have busy work schedules, one of them would almost always make it to my track and cross-country meets and to Holly’s soccer games. My mother, in particular, has always tried to keep on top of what’s going on in our lives. In high school, I took advanced-level classes and earned good grades. I also got along quite well with my teachers, and ended up graduating in the top 10 percent of my class. I know this made my mother really proud, especially since she works at the school. She would get worried that I might not be doing my best and “working to my full potential.” All through high school, she tried to keep on top of my homework assignments and test schedules. She liked to look over my work before I turned it in, and would make sure that I left myself plenty of time to study for tests. Describe the family dynamics and school pressures experienced by Julia. Under what circumstances might such family and school factors become problematic or set the stage for psychological problems? In addition to schoolwork, the track and cross-country teams were a big part of high school for me. I started running in junior high school because my parents wanted me to do something athletic and I was never coordinated enough to be good at sports like soccer. I was always a little bit chubby when I was a kid. I don’t know if I was actually overweight, but everyone used to tease me about my baby fat. Running seemed like a good way to lose that extra weight; it was hard at first, but I gradually got better and by high school I was one of the best runners on the team. Schoolwork and running didn’t leave me much time for anything else. I got along fine with the other kids at school, but I basically hung out with just a few close friends. When I was younger, I used to get teased for being a Goody Two-Shoes, but that had died down by high school. I can’t remember anyone with whom I ever had problems. I did go to the prom, but I didn’t date very much in high school. My parents didn’t like me hanging out with boys unless it was in a group. Besides, the guys I had crushes on were never the ones who asked me out. So any free time was mostly spent with my close girlfriends. We would go shopping or to the movies, and we frequently spent the night at one another’s houses. It was annoying that although I never did anything wrong, I had the earliest curfew of my friends. Also, I was the only one whose parents would text me throughout the night just to check in. I don’t ever remember lying to them about what I was doing or who I was with. Although I felt like they didn’t trust me, I guess they were just worried and wanted to be sure that I was safe. Julia Coping With Stress Now I am 17 years old and in the spring semester of my first year at college. I was awarded a scholar-athlete full scholarship at the state university. I’m not sure of the exact cause of my current problems, but I know a lot of it must have to do with college life. I have never felt so much pressure before. Because my scholarship depends both on my running and on my maintaining a 3.6 grade point average, I’ve been stressed out much of the time. Academic work was never a problem for me in the past, but there’s just so much more expected of you in college. It was pressure from my coach, my teammates, and myself that first led me to dieting. During the first semester, almost all my girlfriends in college experienced the “freshman 15” weight gain—it was a common joke among everyone when we were up late studying and someone ordered a pizza. For some of them it didn’t really matter if they gained any weight, but for me it did. I was having trouble keeping up during cross-country practices. I even had to drop out of a couple of races because I felt so awful and out of shape. I couldn’t catch my breath and I’d get terrible cramps. And my times for the races that I did finish were much worse than my high school times had been. I know that my coach was really disappointed in me. He called me aside about a month into the season. He wanted to know what I was eating, and he told me the weight I had gained was undoubtedly hurting my performance. He said that I should cut out snacks and sweets of any kind, and stick to things like salads to help me lose the extra pounds and get back into shape. He also recommended some additional workouts. I was all for a diet—I hated that my clothes were getting snug. In addition, I was feeling left out of the rest of the team. As a freshman, I didn’t know any of the other runners, and I certainly wasn’t proving myself worthy of being on the team. At that point, I was 5?6? and weighed 145 pounds. When I started college I had weighed 130 pounds. Both of these weights fell into the “normal” body mass index range of 18.5 to 25, but 145 pounds was on the upper end of normal. Was the advice from Julia’s coach out of line, or was it her overreaction to his suggestions that caused later problems? Dieting was surprisingly easy. The dining hall food bordered on inedible anyway, so I didn’t mind sticking to salads, cereal, or yogurt. Occasionally I’d allow myself pasta, but only without sauce. I completely eliminated dessert, except for fruit on occasion. If anyone commented on my small meals, I just told them that I was in training and gearing up for the big meets at the end of the season. I found ways to ignore the urge to snack between meals or late at night when I was studying. I’d go for a quick run, check Facebook and Twitter, take a nap—whatever it took to distract myself. Sometimes I’d drink water or Diet Coke and, if absolutely necessary, I’d munch on a carrot. Many eating disorders follow a period of intense dieting. Is dieting inevitably destructive? Are there safeguards that can be taken during dieting that can head off the development of an eating disorder? Once I started dieting, the incentives to continue were everywhere. My race times improved, so my coach was pleased. I felt more a part of the team and less like an outsider. My clothes were no longer snug; and when they saw me at my meets my parents said I looked great. I even received an invitation to a party given by a fraternity that only invited the most attractive first-year women. After about a month, I was back to my normal weight of 130 pounds. At first, my plan was to get back down to 130 pounds, but it happened so quickly that I didn’t have time to figure out how to change my diet to include some of the things that I had been leaving out. Things were going so well that I figured it couldn’t hurt to stick to the diet a little longer. I was on a roll. I remembered all the people who I had seen on television who couldn’t lose weight even after years of trying. I began to think of my frequent hunger pangs as badges of honor, symbols of my ability to control my bodily urges. I set a new weight goal of 115 pounds. I figured if I hit the gym more often and skipped breakfast altogether, it wouldn’t be hard to reach that weight in another month or so. Of course this made me even hungrier by lunchtime, but I didn’t want to increase my lunch size. I found it easiest to pace myself with something like crackers. I would break them into several pieces and only allow myself to eat one piece every 15 minutes. The few times I did this in the dining hall with friends I got weird looks and comments. I finally started eating lunch alone in my room. I would simply say that I had some readings or a paper to finish before afternoon class. I also made excuses to skip dinner with people. I’d tell my friends that I was eating with my teammates, and tell my teammates that I was meeting my roommate. Then I’d go to a dining hall on the far side of campus that was usually empty, and eat by myself. I remember worrying about how I would handle Thanksgiving. Holidays are a big deal in my family. We get together with my aunts and uncles and grandparents, and of course there is a huge meal. I couldn’t bear the stress of being expected to eat such fattening foods. I felt sick just thinking about the stuffing, gravy, and pies for dessert. I told my mother that there was a team Thanksgiving dinner for those who lived too far away to go home. That much was true, but then I lied and told her that the coach thought it would be good for team morale if we all attended. I know it disappointed her, but I couldn’t deal with trying to stick to my diet with my family all around me, nagging me to eat more. Julia Spiraling Downward I couldn’t believe it when the scale said I was down to 115 pounds. I still felt that I had excess weight to lose. Some of my friends were beginning to mention that I was actually looking too thin, as if that’s possible. I wasn’t sure what they meant—I was still feeling chubby when they said I was too skinny. I didn’t know who was right, but either way I didn’t want people seeing my body. I began dressing in baggy clothes that would hide my physique. I thought about the overweight people my friends and I had snickered about in the past. I couldn’t bear the thought of anyone doing that to me. In addition, even though I was running my best times ever, I knew there was still room there for improvement. Look back at Case 9, Bulimia Nervosa. How are Julia’s symptoms similar to those of the individual in that case? How are her symptoms different? Around this time, I started to get really stressed about my schoolwork.DUE 11/14/19

Psychological Treatment Plan
It is recommended that students review the e-book The Complete Adult Psychotherapy Treatment Planner (Jongsma, Peterson, & Bruce, 2014) for additional assistance in completing this assignment.
Clinical and counseling psychologists utilize treatment plans to document a client s progress toward short- and long-term goals. The content within psychological treatment plans varies depending on the clinical setting. The clinician s theoretical orientation, evidenced-based practices, and the client s needs are taken into account when developing and implementing a treatment plan. Typically, the client s presenting problem(s), behaviorally defined symptom(s), goals, objectives, and interventions determined by the clinician are included within a treatment plan.
To understand the treatment planning process, students will assume the role of a clinical or counseling psychologist and develop a comprehensive treatment plan based on the same case study utilized for the Psychiatric Diagnosis assignment in PSY645. A minimum of five peer-reviewed resources must be used to support the recommendations made within the plan. The Psychological Treatment Plan must include the headings and content outlined below.
Behaviorally Defined Symptoms

Define the client s presenting problem(s) and provide a diagnostic impression.
Identify how the problem(s) is/are evidenced in the client s behavior.
List the client s cognitive and behavioral symptoms.

Long-Term Goal

Generate a long-term treatment goal that represents the desired outcome for the client.

This goal should be broad and does not need to be measureable.

Short-Term Objectives

Generate a minimum of three short-term objectives for attaining the long-term goal.

Each objective should be stated in behaviorally measureable language. Subjective or vague objectives are not acceptable. For example, it should be stated that the objective will be accomplished by a specific date or that a specific symptom will be reduced by a certain percentage.

Interventions

Identify at least one intervention for achieving each of the short-term objectives.
Compare a minimum of three evidence-based theoretical orientations from which appropriate interventions can be selected for the client.
Explain the connection between the theoretical orientation and corresponding intervention selected.
Provide a rationale for the integration of multiple theoretical orientations within this treatment plan.
Identify two to three treatment modalities (e.g., individual, couple, family, group, etc.) that would be appropriate for use with the client.

It is a best practice to include outside providers (e.g., psychiatrists, medical doctors, nutritionists, social workers, holistic practitioners, etc.) in the intervention planning process to build a support network that will assist the client in the achievement of treatment goals.
Evaluation

List the anticipated outcomes of each proposed treatment intervention based on scholarly literature.

Be sure to take into account the individual s strengths, weaknesses, external stressors, and cultural factors (e.g., gender, age, disability, race, ethnicity, religion, sexual orientation, socioeconomic status, etc.) in the evaluation.

Provide an assessment of the efficacy of evidence-based intervention options.

Ethics

Analyze and describe potential ethical dilemmas that may arise while implementing this treatment plan.
Cite specific ethical principles and any applicable law(s) for resolving the ethical dilemma(s).

The Psychological Treatment Plan

Must be 8 to 10 double-spaced pages in length (not including title and references pages) and formatted according to APA style as outlined in the Ashford Writing Center  (Links to an external site.).
Must include a separate title page with the following:

Title of paper
Student s name
Course name and number
Instructor s name
Date submitted

Must use at least five peer-reviewed sources in addition to the course text.
Must document all sources in APA style as outlined in the Ashford Writing Center.
Must include a separate references page that is formatted according to APA style as outlined in the Ashford Writing Center.