Assignment 5.1: Case Study: Miriam Rosen
Today you are meeting with Miriam Rosen (she, her, hers), a 16-year-old girl, and her parents, Joel and Sarah. Miriam is 5′ 6″ and 97 pounds. She is well-dressed and well-groomed, but her hair is thinning; she is skinny (somewhat gaunt); and she has poor dentation.
Miriam Transcript
Sarah/Mom: Hello. Thank you for meeting with us today. This is our daughter. Miriam?
Miriam: [shy, quiet, reserved] Hi.
Sarah/Mom: [nervous laughter] Oy vey! As you can see, she’s rather shy! But we’re worried about more than that. Let’s see, [deep sigh] School, Miriam used to be a straight A student, and over the last term, she dropped to all Cs.
Joel/Dad: [Interrupting, harsh] And that is not acceptable in our household.
Sarah/Mom: [sharply] Joel, remember, we’re here to get her help.
Joel/Dad: Okay, okay. I know. But…, [calmer] anyway, we almost never see Miri anymore. She’s always in her room, alone, obviously not doing homework. She’ll come out for dinner, not that she eats much. [with great fondness] And Sarah is such a great cook. Even for Shabbat, Miriam hardly touches her plate. She used to eat half the loaf of challah herself!
Sarah/Mom: I’ve noticed that her clothes are suddenly too big for her. At first, I thought it was nice that she lost some weight, and I even suggested we go shopping together to get some new things. But, well, it’s like she’s too depressed to do anything. I’ve never known her to not want to go shopping.
Joel/Dad: No, she’s never been like this before. Hardly ever sick, rarely did she have to see a regular doctor, certainly never a psych doc like you. And it’s not that she’s tried to hurt herself. She’s not suicidal or anything. I really hope you can help. I want my sweet little Miri back.
Narrator: You speak with Miriam alone.
Miriam: [silence for 5 seconds] Umm, they are sort of right or whatever. I’m not really hungry. It’s fine though, because I need to lose more weight. I skip Mama’s dinner; they have way too many calories. You know, the classic Jewish grandma’s cooking? That’s my Mom! [nervous giggle]
But sometimes I have to eat to get them off my back, you know. So after that I either take a laxative, or puke in the toilet. Either way, it gets them off my back and get to keep losing weight.
Narrator: Have you hurt yourself at all?
Miriam: [deep breath] Um, yeah. Ok so, when it gets too much, I… I gotta let it out, you know? Back before school started, like last summer, I cut myself you know, here and here, on my thighs? But I’m not trying kill myself or anything. I don’t want to… die! But the cuts, the blood, let’s it all out and I don’t feel so icky afterward.
Narrator: Did something happen last summer? Miriam takes a while to respond.
Miriam: You won’t tell my parents? Gotta swear you won’t tell them. [waits for affirmation] Uh, almost a year ago, on prom night… these two boys [gulps, some crying in between the rest]… I’ve never told anyone, not even Rachel my best friend, these… two boys took me to a hotel room, upstairs from where the dance was. I thought it was so cool that they wanted to hang out with me. I felt special. They said there was a little party and Stephen, he was my date, he was going to be there, but he wasn’t. And they forced me to… you know, to have sex. I didn’t want to, but I couldn’t stop them. I felt so dirty and so used you know. How could I be tricked like that?
My parents won’t understand. We’re Jewish, you know, not Orthodox, but still, my parents said I can’t do it until after I get married. Mom will absolutely flip, you know, and and [sniffling] and I’m just so… ashamed. If Dad finds out, I won’t be his sweet little Miri anymore.
So see, I need that release to keep me together, to release the pressure… it’s for them, my mom and dad.
From your perspective as Miriam’s psychiatric nurse practitioner, answer the following questions in a two- to three-page double-spaced paper (not including the reference page) in APA format. Include at least two peer-reviewed, evidence-based references (not including your textbooks).
- Identify what interview questions you would have used to determine the underlying eating disorder, self-mutilation, and rape.
- Using the interpersonal therapy model, identify three specific goals for Miriam’s treatment, and in which phase each goal should be accomplished.
- Sarah, Miriam’s mother, asks why you are choosing interpersonal therapy and how it will be beneficial for Miriam. How do you respond? Compare and contrast it with humanistic-existential or solution-focused psychotherapy.
- What are the legal and ethical implications for you relative to a patient reporting a sexual assault? What is the best way for you to proceed? Reference your state of practice’s laws.
Short PaperCriteriaRatingsPts
Integration of Knowledge
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10 pts
Demonstrates full understanding and application of course concepts integrated into own insights. Shows analysis and synthesis of ideas.
8 pts
Demonstrates that you understand and have applied course concepts for the most part. Shows some analysis and synthesis of ideas.
6 pts
Demonstrates that you understand and have applied course concepts to some extent. Some conclusions are not supported in the paper.
4 pts
Demonstrates that you only partially understand and have applied course concepts. Most conclusions are not supported in the paper.
2 pts
Does not demonstrate that you fully understand and have applied course concepts.
/ 10 pts
Topic Focus
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10 pts
The paper is appropriately focused. A thesis statement provides direction.
8 pts
The paper is mostly focused. A thesis statement provides some direction.
6 pts
The topic is focused but lacks direction.
4 pts
The topic is too broad or too narrow.
2 pts
The topic is not clearly defined.
/ 10 pts
Depth of Discussion
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10 pts
Includes in-depth discussion and elaboration throughout the paper.
8 pts
Includes in-depth discussion and elaboration in most of the paper.
6 pts
Includes in-depth discussion and elaboration in some of the paper.
4 pts
Omits pertinent content or content runs on excessively. Quotations from others outweigh your own ideas excessively.
2 pts
Only contains cursory discussion.
/ 10 pts
Cohesiveness
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10 pts
Ties together information from all sources. Paper flows from one point to the next. Demonstrates an understanding of the relationship among material obtained from all sources.
8 pts
For the most part, ties together information. Paper flows with only some disjointedness. Demonstrates an understanding of the relationship among material.
6 pts
Sometimes ties together information. Paper mostly does not flow and much disjointedness is apparent. Demonstrates only some understanding of the relationship among material.
4 pts
Rarely ties together information. Paper does not flow. Does not demonstrate an understanding of the relationship among material.
2 pts
Does not tie together information. Paper does not flow and appears to be about disparate issues. Does not demonstrate understanding of relationship among material.
/ 10 pts
Writing, Composition, Grammar, Spelling, References, and APA Format
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10 pts
Excellently written and composed. No errors in format, references, spelling, and grammar.
8 pts
Well written and composed. A few minor errors in format, references, spelling, and/or grammar.
6 pts
Somewhat well written and composed. Many minor errors in format, references, spelling, and/or grammar.
4 pts
Poorly written and composed. Major errors in format, references, spelling, and/or grammar, but still understandable.
2 pts
Very poorly written and composed. Major errors in format, references, spelling, and/or grammar make it difficult to understand.
/ 10 pts
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