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In this assessment, you play the role of a developmental psychologist who has been asked to write a report for an adolescent boy, Jacob. You will be required to apply your knowledge of key topics from developmental psychology (i.e. attachment, nature vs nurture) to a case study about Jacob in order to compile a brief psychological report. The case study covers Jacob’s history and current presentation in the form of text. The case study also includes accounts from a clinical psychologist, a teacher, and a school counsellor, who provide additional information about Jacob and his developmental history. As part of the case study, you will be provided with an assessment tool called the Strengths and Difficulties Questionnaire (SDQ) that has been pre-filled by Jacob. You will need to score this questionnaire using the scoring instructions and use the outcomes of the questionnaire to help complete the report. Finally, as part of the case notes for the report, you will be required to construct a genogram and evaluate the influence of nature and nurture on Jacob’s attachment style. The genogram should show Jacob and his family relations (i.e., grandparents, parents) using the standardized symbols.
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1. Sophia’s Childhood
Joe and Rosa gave birth to their only child Sophia on February 12th, 1976.
Both Joe and Rosa had migrated to Australia as children, their parents
seeking a better life as their home country was experiencing economic
hardship and high levels of crime. Joe was born in August 1954 and Rosa
was born in the same month but a year earlier. They had met through
family friends in their youth before getting married on October 8th, 1974.
Now both retired, Joe had owned a moderately successful carpentry
business and Rosa had worked as an accountant at various different
firms.
Sophia remembered the relationship between her parents as close at times
but hostile at others. Arguments were a frequent occurrence in her
household and would sometimes last weeks. Whilst the arguments
seemed to be started over almost anything, she frequently remembered
they took on a pattern where her mother would be quite expressive in her
anger and frustration whilst her father would shut down or walk away and
isolate himself. She had later learned that her father had been diagnosed
with depression. When reflecting on this, she thought back to times when
she was a child and her father had seemed quite distant and low, making
her wonder what role this had played in the conflicts between her parents.
Sophia would describe her childhood as fairly typical and her parents as
firm but fair. She recalled being a fairly independent child with a few
friends. She attributed this independence to her parents who had taught
her to depend on herself as they had done throughout their lives. She
often reminded herself of her parent’s advice, that life was tough and no
matter how difficult it gets, to deal with it and keep going. For example,
in grade 10, Sophia had come home in tears after being picked on by a
group of her peers. It had been happening for months but she had not told
her parents. Sophia had put on a brave face until that evening when it had
all been too much for her to keep her feelings hidden. She remembered
her parents appeared disapproving at seeing her so upset, and had
reminded her how life is hard, that she needed to pick herself up and get
on with it as it would make her into a stronger person.
Sophia had always identified as being a hands on and practical person.
She particularly enjoyed cooking and knew that she wanted to pursue a
career as a chef, even from a young age. Sophia would regularly enter
cooking competitions as she grew up and would win awards for her
creations. Sophia worked at various jobs to do with food preparation in
cafes and restaurants before receiving professional culinary training,
which she excelled at. Tragically, in March 1996 as Sophia was just
beginning her career, her mother Rosa unexpectedly passed away during
a routine surgery. This had devastated both Joe and Sophia, triggering an
episode of depression in Joe. However, Joe and Sophia supported each
other through this time and with the help of family and friends, worked
through their grief.
2. Sophia’s Pregnancy
At the age of 22, Sophia met her current partner John in the local
restaurant where she worked as a professional chef. Sophia was
responsible for preparing the food, whilst John was a professional waiter,
and waited on the tables. John was born on September 20th, 1972 to
parents Stephanie and Brad. John’s parents were a little older than
Sophia’s parents but a similar age to each other, both having been born in
1946, with Stephanie born in August of that year and Brad in December.
They had met and become a couple in February of 1970 and had married
in a small ceremony around 16 years later on July, 16th, 1986. Stephanie
and Brad had a close relationship with each other, and John remembered
a loving childhood. Like Sophia, John was very practical and very
athletic at school. Both enjoyed their jobs and worked well together, with
John’s ability to bustle and Sophia’s passion for cooking making for a
very efficient service. They would take the same shifts frequently,
meaning they would see each other often during work. Over time, they
began seeing each other outside of work hours and their friendship
developed into a romantic relationship. In 2000, soon after Sophia turned
24, she began living with John and they eventually moved away from
their hometown to work at a new restaurant with better prospects that had
just opened in another state. Whilst the move to another state was
exciting for both of them, it was also difficult as it took them quite far
from their parents, about a 40 hour drive away.
Soon after the move and quite unexpectedly, Sophia conceived. They had
not planned for a child, and whilst they were happy upon receiving the
news that Sophia was pregnant, they were also worried about how they
might cope financially. Whilst their new jobs had given them both a small
increase in wages, the cost of living was also higher in their new location
making them financially worse off than before the move. Despite this, the
pregnancy was an exciting time for both Sophia and John, and both felt a
bond with the baby whilst in utero. Sophia continued to work throughout
the pregnancy because she enjoyed her job and it helped save money for
when the baby arrived. However, she found the changes in diet and
feelings of fatigue to be challenging during the first trimester, and her
increased sense of smell and feelings of nausea interfered the most with
her role as a chef. Certain smells and preparing particular foods like fish
would trigger her nausea, but Sophia worked around this with the help of
her colleagues by prepping and cooking alternative dishes. In some ways,
Sophia found her heightened senses to be useful, with her better sense of
taste helping to better test the flavour of the food. John also took on extra
responsibilities around the home to support Sophia at this time.
During the second trimester, the nausea and fatigue had reduced
dramatically. There were some occasional aches and pains and swelling
of the ankles, but overall Sophia began to feel a lot more energetic and
joined a prenatal exercise class. She found the classes supportive and
became particularly good friends with Amy, who was also expecting her
first child and was at around the same stage of pregnancy as Sophia. John
and Sophia also began to attend other prenatal classes that Amy had
suggested to them and, over time, they both became quite close with Amy.
During the third and final trimester, Sophia started to find it more
difficult to get comfortable and to fall asleep, but continued on with her
usual activities. Around week 33 of the pregnancy, Sophia was finding it
much more difficult to get around than she had in previous weeks and
was frequently breathless. Sophia went to see her local doctor as she was
concerned about the symptoms of breathlessness and increased swelling
around her ankles, legs, and arms. The doctor found everything appeared
to be normal but her blood pressure was quite high and referred her to a
specialist at the hospital. The specialist had confirmed that the baby was
fine but Sophia’s blood pressure would need to be monitored carefully as
high blood pressure can be dangerous for mother and baby whilst
pregnant. Sophia’s blood pressure continued to increase despite efforts to
lower it and she was hospitalised so that the situation could be closely
monitored and assessed. At 35 weeks, just over a month before baby
Jacob’s due date, Sophia was told that she needed an emergency cesarean
section as her blood pressure was too high, putting the lives of both
Sophia and the baby at risk.
3. Jacob’s Birth and Upbringing
Baby Jacob was born on the 3rd of March, 2002, weighing only 1800g.
Despite the complications and shock of having Jacob arrive much earlier
than expected, Sophia and John were overjoyed to see their baby boy.
However, they saw Jacob only briefly before he had to be moved to the
Special Baby Care Unit as he was a preterm baby and needed to be
placed in an incubator to be tube fed and put on a ventilator. It was a
difficult time both physically and emotionally for the family. Sophia
remained in hospital whilst she recovered and her blood pressure
continued to be treated. John took four weeks of parental leave and was
able to visit often. After four days in hospital, Sophia was discharged but
baby Jacob remained in the care unit. They both found it difficult just to
watch Jacob and not to be able to hold or feed him whilst he was in the
incubator. Fortunately, Jacob gained weight quickly and after only four
weeks, was released from the hospital.
Sophia and John were relieved to finally have Jacob home, but both
parents were exhausted from the ordeal and the hard work continued.
Despite Sophia staying home full-time to care for Jacob, the care
responsibilities for both parents were demanding. Jacob was a poor
sleeper and slept in blocks of no more than 30 minutes during the day and
2 hours at night. This meant John and Sophia would have to wake
frequently during the night to attend to Jacob and found it hard to do
things during the day, which frustrated them both. Jacob would also cry
frequently and loudly, and often for no apparent reason. He was difficult
to settle and It didn’t seem to matter what they read or who they listened
too, nothing seemed to work, which made them question their abilities as
parents.
All three of Jacob’s grandparents flew down to visit but could only stay
for a short while given commitments back home, so John and Sophia
were unable to rely on their parents to frequently help out with Jacob as
they lived too far away. In addition, they were unable to afford a carer,
and apart from their friend Amy who was busy looking after her own
child, they didn’t have anyone they could rely on for support in their new
home. The lack of sleep, increase in work for both parents and difficulties
with Jacob also meant Sophia and John began arguing much more
frequently, often over small things. The arguments became less frequent
after John began spending less time at home. John started to take more
shifts and do more overtime to bring more money into the household as
their savings began to dwindle. John would come home late each night
and often worked weekends, and when he was at home, would usually
retreat to bed or relax in front of the television to get some rest before
starting his next shift. This meant John would not see much of Sophia or
Jacob during the week and it became a frequent source of arguments.
Sophia, often exhausted after attending to the needs of Jacob and
household responsibilities, would accuse John of not doing enough to
help and not spending enough time with Jacob. John, in turn, would argue
that he was spending as much time as he could but was often too tired or
absent altogether because of work. The argument would go unresolved
and usually end in John leaving the house for a few hours to go for a
drink and calm down. Before the move interstate and birth of Jacob, John
would drink moderately, around 1-2 alcoholic drinks per day. However,
John began spending increasingly more time drinking at pubs and bars to
avoid the high needs of Jacob and the arguments at home, in addition to
relieving the stress from the long work hours. This meant that John spent
even less time with Sophia and the baby, and when he did return from a
night of drinking, he would often be too inebriated to spend time with
either.
Around six months after Jacob was born, John and Sophia’s relationship
had deteriorated further. John would often sleep on the couch, whilst
Sophia slept in the bed upstairs, next to Jacob’s room. They weren’t
arguing as much as they were previously, but this was due mostly to
tiredness and the little time they spent together. Both parents felt as if
they were just going through the motions. Sophia’s behaviour, in
particular, began to change. Whereas she had always been active and
reasonably sociable, she had become more lethargic and reclusive. She
had kept in contact and continued to do a postnatal exercise class with her
friend Amy, but Amy had noticed that Sophia was progressively
attending fewer and fewer of her usual exercise classes until she
eventually ceased going altogether. Amy would call to find out if Sophia
would be coming but the call would either go through to voicemail or
Sophia would give a short reply, excusing herself because of being busy
or too tired. Concerned, Amy contacted John to ask if he had noticed any
unusual behaviour and if Sophia was okay. John confirmed to Amy that
he had noticed changes in Sophia too. Although John had not recently
spent much time with Sophia or the baby, he had noticed Sophia
becoming more solitary, tired, and less responsive. He noticed Sophia
would often be in bed, sleeping or watching television, and when he had
tried to talk to her she seemed low and would give brief responses.
Although concerned, John thought Sophia’s change in behaviour was
because they were currently in a bad place in their relationship and the
difficulties with Jacob. John thought things would eventually improve
once Jacob became a little older and they managed to get themselves out
of the rut they were in. John was also at a personal low point himself and
often felt too tired to think about anything else but work. This continued
until John came home one day, when Jacob was around 10 months old,
and found Sophia crying uncontrollably in bed. When asked, Sophia
mentioned how she couldn’t cope and that she hadn’t attended to Jacob
all day, and what a bad mother that must make her. John was shocked at
this and began to feel guilty for not noticing earlier how much Sophia
needed help. John booked an appointment to attend their local GP. The
GP had concerns over Sophia’s mental health and referred her on to the
psychiatrist, Dr Amir Dabiri.
4. Phone Call to Psychiatrist
Sophia was referred to me by her GP who had concerns over her
mental health. Her baby, Jacob, was about 10 months old at the time
I began to see Sophia. When she arrived to my consulting room she
was quite teary with reduced affect. She appeared tired and
disheveled. When I asked how she was feeling, she mentioned
feeling overwhelmed, and like she was not able to cope anymore. It
was clear that Sophia had felt a major change in her personality,
whereas once she would describe herself as a ‘get up a go’ type, full
of passion and energy, she now felt like a completely different person.
So Sophia mentioned a lack of energy, a lack of appetite, and a lack
of interest in doing anything, not least things she usually enjoys.
What seemed to worry Sophia the most however, was her lack of
desire to interact with Jacob. And when she did interact with him, she
also expressed doubt about what to do and whether she was doing the
‘right thing’, and this would often mean that most interactions she
had with Jacob were just to meet his biological needs. These can all
be indicators of postnatal depression and, where Sophia felt quite
abnormal in her experiences, this was all completely common for
someone suffering from postnatal depression.
Sophia was not breastfeeding at the time so I prescribed the
antidepressant Zoloft whilst I commenced talking therapy in one hour
sessions, twice a week. We worked through her feelings of guilt
coming from not being able to ‘just snap out of it’, and feelings of
hatred toward herself at not being the parent she wanted to be for
Jacob. Through therapy Sophia gained hope that with the right
treatment she would recover and it helped her realise that she is a
good mother and not to blame for the illness. John would also be part
of some sessions so we could discuss the issues in their relationship
and ways in which both parents could better support each other and
care for Jacob. John was also seeing a therapist separately to discuss
how better to manage his stressors and emotions without relying on
alcohol.
After two months it was decided to cease therapy after Sophia
reported a significant reduction in symptoms and improvements in
her relationships with both Jacob and John.
5. After Psychological Support
With psychological support Sophia began to get better. She felt her
passion for cooking return and had decided to go back to her job as a chef.
A new restaurant opened up in the state where they had grown up as
children. John’s parents no longer lived there as they had retired overseas
but Sophia’s father still lived in the same house, about half an hour drive
away from the new restaurant. The timing was perfect to move back to
their hometown as their rental contract was finishing and the manager of
the new restaurant had sounded impressed with their experience and was
willing to give them a trial with the possibility of a more permanent
position. Given their experience, the owner had offered them a generous
wage too. This income combined with the lower cost of living and the
support they could receive from Sophia’s father if they were to go back to
their hometown resulted in John and Sophia deciding to make the
move.
Jacob was one year and two months old when they moved back to their
hometown. Stephanie and Brad would interact with Jacob regularly via
video call and occasionally visit from overseas but it was Sophia’s father,
Joe, who saw Jacob much more frequently now given his proximity. As
Joe was within one hour driving distance, he was able and willing to help
out with babysitting Jacob and would come around whenever John and
Sophia were both working. This would happen quite often given their
similar work schedules. Joe pitched in with household chores and had
become a vital source of support for John and Sophia, who both felt the
benefits that the reduction in workload had on them. This arrangement
seemed beneficial to Joe too, as Sophia commented on how looking after
Jacob appeared to give him a new lease on life. Joe would spend up to 50
hours per week (or more on occasion) looking after Jacob and was quite
clearly infatuated with him. Joe would often give advice on raising
children that was passed down by his own parents when raising Sophia.
For example, one night, Sophia had come home early from a shift and Joe,
who was caring for Jacob that night, had just put him to bed. As they
were talking, Jacob had begun to cry. Sophia stood up to attend to Jacob,
but Joe insisted that if she attended to him, that would only make him into
a fussy baby. Joe recounted that when Sophia was young, his parents had
told him the same thing, and that giving a crying baby attention only
encourages fussy behaviour. If she went in now, it would reinforce his
crying and he would never learn to go to sleep on his own, but if she let
him cry he will eventually fall to sleep. Sophia had some doubts about
this but accepted it given Joe’s years of experience.
As the years went by, Sophia and John managed to get enough money
together to purchase their own cafe, where they ran the business as
co-owners. They stayed in the same area but moved to a bigger house as
word had spread about their cafe and they began to do quite well. Jacob
grew into a healthy teenager with a passion for keeping active and dreams
of travel. He attended weekly swimming lessons and Karate classes, and
won awards for each. Jacob was living at home with his parents and
attended Spring Hill High School. Overall, Jacob was an average
performing student but in grade 11 at the age of 16, there were reports
from some of his teachers that he began handing in his work late or not at
all in some cases, despite his teacher’s best efforts to encourage
engagement. His home room teacher, Ms. Sarah Agius, had concerns
over Jacob falling behind and set up a session between Jacob and the
school counsellor to see if the counsellor could find out more about the
issues that were causing this change in Jacob’s academic behaviour.
Ms. Eesha Varma, the school counsellor, had a …
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