Hypothetical Working Agreement Paper The purpose of this paper is to execute a viable contractual agreement between clinician Hillary Kings and Client Rosemary Hans. As a clinician I have to understand the problem of the client and know what her expectations. The document addresses the hopes expected and comes up with a plan that will help achieve valuable outcomes for the client. The paper uses the essential four steps for a working agreement. The elements are the assessment of the client, prioritizing, contracting, and evaluation. These four parts have the relevant and in-depth information showing how the working agreement is working to help the client. 1. Assessment The assessment part is crucial to determine information about the client. In addition, assessment will provide information that will help know the best design of plan that is best for the client (Murphy, & Dillon, 2003). The information needed from the assessment include the identification of the client, the clients demographic information, information regarding the clients concern, health, and biological factors information just to mention a few. 2.1. Identifying and demographic information
The information below is for the client Rosemary Hans who needs help to see her son diagnosed by schizophrenia go back to college.
Name: Rosemary Hans
Age: 41
Gender: Female
Relationship status: married
Religion: committed Christian
Racial Identities: Africa-American
Employment: High school teacher
Education: university first degree in education 2.2. Presenting problem Rosemary’s son Thomas has been diagnosed by Schizophrenia after she took him for diagnosis immediately he dropped out of the college. He hallucinates, and can not go out of the house to play with friends or attend parties across the street. Rosemary explains further that Thomas spends most of the time in the house, and his performance in the studies has dropped. In addition, Thomas personal hygiene has become poor, he does to care about the way he dress, and also his judgment is poor. He smokes excessively and does it openly in his parents’ premises, a behavior that he is not willing to drop at the moment. Previously, Thomas, a 20 year old college sophomore, was pursuing a college degree in linguistics. In his studies he used to show excellent performances and was even ranked among the best student in the department of languages. Thomas used to participate in different college social events and he could be seen enjoying the company of his friends.
When rosemary asked if he has offered any treatment to Thomas after diagnose, she responded that she had done so. Thomas was given anti-psychotic drugs to help minimize the observable effects of schizophrenia. 2.3. Strength and resources When asked how she was going to cater for the treatment of Thomas, Rosemary proved that she will use the resources from her job, as a high school teacher. In addition, Thomas father is working as an engineer and would also work toward offering finances to help in the treatment process. The college in which Thomas was initially studying had also offered to cater for 20 percent of the treatment that Thomas will receive until he can get back to college. Rosemary hopes that Thomas will be healed from Schizophrenia because according to his religion, Christianity, God is able to heal any kind of sickness. In addition, she has support from other Christian friends who call from time to know how she is fairing on with the situation, and are willing to offer financial assistance. 2.4. Background Understanding the family history was vital to help Rosemary to achieve her goal of seeing Thomas back to college because scientists have associated schizophrenia with heredity attributes. When asked about the traces of schizophrenia in the family history Rosemary gave the following information. In the family Thomas father is schizophrenic, Thomas brothers are not schizophrenic, Thomas’ parents were both schizophrenic, and that Thomas first cousins are also schizophrenic. In the desire to understand how the condition was affecting their family, Rosemary answered that Thomas condition had ruined their relationship, as son and mother, to the extent that she would not carry her normal daily chores peacefully. 2.5. Biopsychosocial factors
The purpose of using this model was to get the information that will help understand the biological factors, psychological factors, and social factors that may have unified to make Thomas suffer from Schizophrenia. When asked what the diagnosis had attributed to be the cause schizophrenia in Thomas, Rosemary responded that the psychiatrist said it began at the early stage of life. It was when Thomas was still 10 years and the environment he was being reared in was stressful. His parents seem to have been harsh and hence interfering with his brain development, which at this age is normally very sensitive leading to brain damage. The damage is exposed later in other stages of life in form of mental illness. In addition, other factors include living in a neighborhood of high level of drug abuse. Therefore, Rosemary associates Thomas Schizophrenia with biological and environmental factors, sensitivity of brain, parents’ harshness, and the neighbors. 2.6. Psychological functioning Rosemary identified some of the psychological functioning characteristics displayed by Thomas. The client indicated that Thomas had poor social relationships demonstrated by his desire to stay alone in the house, and staying a way from his friends. Thomas also does not respect his parents anymore for he smokes even at their presence. In addition, Thomas performance in the school has dropped in comparison to the results in the past years. Last, his personal hygiene is a matter of questioning because he cannot clean his room, and dress neatly. 2.7. Health and biological Factors There was need to understand the health, and biological factors affecting Thomas health. Looking at Thomas he is weak in physical appearance, a situation his mother associates with increased depression. Thomas has a partial hearing impairment, which requires a person to raise his voice when speaking to him but in most of the time he uses hearing aid devices. In using medications, Thomas likes to smoke and is not ready to evacuate the habit, and before he became schizophrenic he used to drink alcohol. Last, before he developed schizophrenia symptoms, Thomas used to play football at the college, and used to go for aerobics to maintain his body weight. 2.8. Test Results Intelligence test, neuropsychological, and psychological test were carried out on Thomas. Thomas intelligence test showed that his intelligent quotient lies between 115 and 130 characterizing that he is averagely gifted. The Neuropsychological results indicated that Thomas’ brain is affected in the frontal lobe section. This can lead to a reduction in the size of the brain when schizophrenia becomes acute. Last, the psychological tests, testing cognitive and emotional functions, reveals that Thomas has developed a personality disorder, and depression disorder. 2.9. DSM IV-TR diagnosis (all five axes) The client reports that according to this classification using this diagnosis, Thomas is classified in the category of the code 31-40. This code means that he has disability in several reality tastings. According to this classification, he is affected in school functions, interpersonal relationships, good judgment, way of thinking, and mood. 2.10. Formulation Thomas has shown a set of medical conditions that medical experts categorize as mental disorders. In this case the disorder is known as schizophrenia, which results in damage of some or differences in brain structures, and is hereditary or caused by some environment factors like depression (McGrath, & Lawlor, 2011). This in turn interferes with the process of thinking and responding to an individual’s environment characterized by hallucination, paranoid, providing meaningless speeches at acute stages. In addition, the affected person shows symptoms of social withdrawal, poor dressing codes, poor judgment, poor hygiene, and sometimes the person may remain mute. Perhaps these symptoms explain why Thomas has dropped out of school.
Thomas has portrayed these symptoms, which relates to schizophrenia. This condition is caused by a combination of biological factors, social, and psychological factors. Thomas condition is caused by a combination of biological and social factors.
Thomas experience with this condition is what has made him to drop out of school because he cannot think properly and relate with other students. Last, when he smokes in his parent house is because he cannot make right judgments. 2. Specific goals for the client In helping Rosemary to fulfill her hope of seeing Thomas go back to school the following goals were set to help the process easier. I. Rosemary should take Thomas to a psychiatrist to be administered with an anti-psychotic drug to minimize the positive symptoms between 7-14 days of administration II. The family members of Thomas should receive a family therapy for a period of one month to help reduce the rate of hospitalization. III. Rosemary should give Thomas three months as she administers the behavior modification techniques to help him stop smoking in the parents’ house. IV. By the end of 2013, Thomas should go back to the college. V. By the mid 2012 Thomas DSM IV-TR diagnosis code should reduce to 1- 10. 3.11. Prioritizing The following are Thomas goals in form of priority: I. Adhere to the psychiatrist medication for his son to help reduce the symptoms of schizophrenia, and prevent it from becoming acute. II. Find a good therapist to offer family therapy education to her family. III. Learn how to use behavior modification techniques. IV. Invest some money for Thomas education V. Follow all the therapeutic guidelines 3. Contracting I Rosemary agree with the information in this document provided by clinician, and am legible to the penalty as a result of my failure. That the goals set are: take Thomas to a psychiatrist, provide family therapy education for may family, use behavior modification techniques, take Thomas back to college, and Thomas DSM IV-TR diagnosis code should reduce to 1- 10. I will give my moral support for the advice from the clinician. In addition, I understand the duration of meeting with the professional will be between 35 to 40 minutes, each session will cost $25, it will be once in a week, and I will contact the professional 12 hours in advance if I will bound to fail meeting the appointment. I understand the purpose of this treatment is to help me see my son, Thomas, go back to college. The focus of the treatment is to help Thomas get out of his schizophrenia situation, and get back to school. I am free to terminate the contract when the ways employed do not help me achieve my goals. 4. Evaluation The best way in evaluating Thomas progress will be how he shows improvement in speech, relate with family members, friends, and the way he continues with his smoke behavior.
To see if Thomas can get back to school in the specified time he will be taken for the intelligence test after every three month to see how he is improving. Rosemary will also give reports after observing Thomas on how he relates with friends, and family members. In addition, Rosemary will tell if Thomas can start making right judgments when he starts smoking out of the parents’ house. Last, the effect of behavior modification techniques, and family therapy education will be realized when the family members are free to relate with Thomas and assist her with the healing process. At the end of the process, re-evaluation will be necessary to determine the achievement of the objectives. Rosemary should be happy that her son, Thomas can get back to college and study.

References
McGrath, J. J., Lawlor, D. A. (2011). The search for modifiable risk factors for schizophrenia. The American Journal of Psychiatry, 168 (12): 1235–8.
Murphy, B. C., & Dillon, C. (2003). Interviewing in action: Relationship, process, and change, (2nd ed.). Pacific Grove, CA: Brooks/Cole Thomson Learning.