Posted: February 26th, 2023

George’s Case

Instructions attached/Example attached.

COUC 667

COUC 667

Case Presentation Case Conceptualization (CP-CC) Assignment Instructions


This is the second of your Case Presentation assignment that will be due formally in Module 7: Week 7 of the course. This is a formative assignment (draft) in that you will get to “practice” the case conceptualization (CC) process. This is an important step towards the development of an effective treatment plan. It is the middle part of the “golden thread” when working with a client. By offering a sound CC, you are creating focused problem areas (step 2 of inverted pyramid model, IPM) that directly connects to the treatment plan (step 1 of tx plan), theoretical buckets (e.g., cognitive and behavioral maladaptations, if using CBT), and an etiological understanding (e.g., maladaptive core beliefs) which are driving the maladaptive thinking and actions.


For this assignment, you will complete the Case Conceptualization (CC) portion of the case presentation as illustrated in the Case Presentation: Case Conceptualization of Penny. As you work through this assignment, you may “consult” with your clinical team via Microsoft Teams.

This assignment should be 3-6 pages in length in current APA format, which includes headings, subheadings, in-text citations, reference section. The assignment requires at least two citations, e.g., Switzer and Rubin, peer-reviewed journal, other theoretical textbooks. If other sources are used they are to be scholarly articles published within the last five years unless there are considered seminal works in the field of study.

To complete this assignment, do the following:

1) Review the Case Presentation Example – Case Conceptualization of Penny.

2) Review the Case Presentation: Case Conceptualization (CP-CC) Template document. Follow the APA format as provided in the template. It is developed to help you stay in alignment with assignment expectations based on the assignment instructions and grading rubric.

3) Review your textbook and other readings on Case Conceptualization, review theory-specific examples.

4) Create part one of the Inverted Pyramid Model (IPM) based on your case study data. Follow the Case Conceptualization of Penny example on how to format step one of the IPM.

5) Develop part two of the IPM. See p. 90 of Switzer and Rubin for guidance. This is the “atheoretical” grouping of part 1. Make sure to document in the assignment, which ONE of the four thematic groupings approaches was used to develop this step. Again, see Case Conceptualization of Penny for formatting.

6) Next, create IPM step three. In part three, apply your chosen counseling theory (psychodynamic, CBT, etc.). Use
only one theory. As a counselor-in-training, you do not have a solid foundation for more than one theory as it takes years to master. As such, you would be operating unethically and potentially illegally, based on the ACA code of ethics (2014) – core professional value 5; C.2.b; C.2.f; and E.5.b.

7) For part three of the IPM, it is the “natural groupings” based on your theory. For example, CBT has the natural groupings of maladaptive automatic thoughts and maladaptive behaviors. See Case Conceptualization of Penny for formatting.

8) In IPM part four, you will use your chosen theory to determine the deeper theoretical inferences. From a CBT lens, it is the maladaptive core belief (worthless, helpless, or unlovable), from a psychodynamic it is the drives, instincts, unconscious factors that are motivating the themes offered in step three of the model and ultimately the signs and symptoms observed in step one of the IPM.

9) After completing the IPM, it is now time to write up the case conceptualization (CC) narrative. The CC narrative is where you apply your chosen counseling theory to explain (not describe, as you did in the Discussion of Diagnostic Impression) what is going on with the client. You use key theory-based concepts and terms to explain why a client is experiencing their signs, symptoms, problems. When writing the CC narrative, start with step four, the deeper issues, and then connect the deeper issue to the step three theoretical groupings by using the problems identified in steps two and one. For example, from a CBT lens, if a client’s maladaptive core belief is “I am unlovable,” then connect this belief to his maladaptive automatic thoughts (“nobody likes me”), conditional assumptions (if nobody likes me, then I will act out), and maladaptive behaviors using the client problems (sadness, depressed, hyperactivity, problems in school, conflict with sister).

Note: Your assignment will be checked for originality via the Turnitin plagiarism tool.

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George Lopez Show’s George Lopez

Introducing the Character

George Lopez is the main character in the George Lopez Show, a sitcom that aired on ABC television

between 2002 and 2007 and that is now in syndication. It is a “slice of life” show featuring a

predominantly Mexican and Mexican American cast. The program features George Lopez, who

manages an airplane parts factory; his wife, Angie, who works in the home; their children, Max and

Carmen; Mr. Lopez’s mother, Benita (Benny); and Angie’s father, Victor (Vic) Palermo. The show is

family-oriented in nature. It centers on the daily struggles of the Lopez family and the dysfunctional

circumstances that bring them together—and the resulting squabbles and frictions within and across

the generations, which are oftentimes humorous, but occasionally serious. The central comedic

tension is between Mr. Lopez and his proud and judgmental father-in-law, Vic, who, is a retired

physician. Dr. Palermo had always hoped that his daughter would achieve better marital and life

status than she did, and thus, George Lopez is forever trying to live up to his father-in-law’s

expectations of him. Similarly, Angie’s mother-in-law, Benny, is forever criticizing her daughter-in-

law’s cooking, housekeeping skills, and ability to be a good-enough wife to her son. The children,

Max and Carmen, struggle with day-to-day adolescent dilemmas and typically provide Mr. Lopez the

opportunity to prove his worth, both as a parent, person, and comedian. The following Basic Case

Summary and Diagnostic Impressions present our portrayal of the George Lopez Show’s main

character at a recent counseling session as a result of increasing clinically significant distresses

related to his complex family life.

Basic Case Summary

Identifying Information. George Lopez is a 48-year-old Mexican American male who resides in a

socioeconomically middle-class household comprising his wife, two children, mother, and father-in-

law. Mr. Lopez identifies himself as Roman Catholic. He manages the warehouse at the Power

Brothers Aviation


Company, where he has progressively advanced through the ranks over his 25-year employment

with them. He presented as notably conscious of his appearance, including his average height and

weight, recently graying hair, and what he described as “my Mexican features.”

Presenting Concern. Mr. Lopez was urged to attend counseling by his wife, Angie, who has become

increasingly concerned with the frequency of her husband’s headaches and episodes of fatigue,

anxiety, and moments of low mood that have bothered her husband since recent changes at work.

These changes include corporate cutbacks that have resulted in ongoing furloughs about 3 months

ago. As a result, Mr. Lopez now has a 1-day furlough without pay per week, along with 1 paid day of

working at home instead of at his office. Further, because the manager’s position may be

permanently cut in the near future, Mr. Lopez feels there is great pressure to compete to “be in the

inner circle.” As a result, he recently has been encouraged to play golf, play tennis, meet for

martinis, and join the Kiwanis Club with his upper-management bosses. He describes this as “like

crossing the border again into a whole new world. How does a g4y like me hang out with guys like


During the intake, Angie noted that her husband, who typically does not talk about his feelings, has

become increasingly irritable, distractible, inattentive at home, and withdrawn from the family,

particularly on weekends when he prefers to retreat to the den to watch sports and drink beer with

his friends from work. When queried, Mr. Lopez admitted that “I have a lot of responsibilities and a

family to support . . . so I like blowing off steam and I get a little cranky once in a while. And okay,

sometimes my mood isn’t so happy.”

Background, Family Information, and Relevant History. George Lopez was born in Tijuana, Mexico,

the youngest of three sons to his father, Hernando, who abandoned the family soon after his birth,

and mother, Benita (Benny), who worked a number of odd jobs in order to keep her family together.

By the time George was 7 years old, his mother began drinking heavily and experienced bouts of


Mr. Lopez attended the Rodrigo Escobar Elementary School in Tijuana where he reports that he was

often chastised by his teachers for inattentiveness, failure to focus on his studies, and his seemingly

insatiable need to be the center of attention. Nevertheless, Mr. Lopez’s memory is that among his

endearing childhood


qualities were his charm, eloquence, and ability to, as he recalled, “play to my audience.” During his



school years at Tijuana Middle School, Mr. Lopez displayed a propensity for comedy and took an

active role in the widely popular school talent shows. It was around that time that he began doing

stand-up comedy routines on the streets of Tijuana, which, to his surprise, provided a relatively

stable income for his family. By the time Mr. Lopez was of high school age, he had become

disinterested in school and recalled that “I was making more money performing on the street than

my teacher who was busting her ass in the classroom.” However, with the encouragement of his

mother, who by that time had been hospitalized several times for the effects of alcoholism, Mr.

Lopez persevered in completing his studies.

After graduating from high school, Mr. Lopez crossed the border into the United States and began

doing stand-up comedy in local bars, in street festivals, and at local colleges. To his surprise, he

became very popular. When Mr. Lopez met Angie, he was 21 and looking forward to a career in

comedy; however, they soon had their first child, Max, and his wife convinced him that the family

needed him to get a steady job. As a result, he began working in the maintenance department at the

Power Brothers Aviation Company, where he quickly earned the respect of his employers and the

friendship of his coworkers, who found him funny and loyal. Over the next several years, Mr. Lopez

worked diligently at the aviation company while doing occasional evening and weekend stand-up. He

advanced to the position of plant manager.

Around that time, Mr. Lopez and his wife were expecting their second child. Mr. Lopez recalls that

this was a cause of great stress for him because “I could barely support us with one child . . . how

was I going to take care of two children?” Additionally, soon after the birth of the Lopez’s second

child, Mrs. Lopez’s father and his own mother came to live with the family to help out with the child-

rearing. However, (a) the friction between him and his father-in-law, who never thought him a good

enough husband, and (b) his own mother’s constant criticism of his wife have made the household a

highly stressful environment. For some time, Mr.

Lopez has been occasionally drinking and staying out late after work and has been increasingly

irritable when home. He reports having told his wife in the past year that he wanted to quit his job in

order to pursue a full-

time career as a comedian “because at least there I was having fun.” At the same time, until his

recent job


changes, Mr. Lopez appears to have been managing his multiple but normally expected occupational

stresses, culturally appropriate household stresses, and other pressures relatively successfully.

Problem and Counseling History. Mr. Lopez volunteered that he agreed with his wife that he has

been having difficulties adjusting to the results of his job cutbacks and furlough, including (a) being

at home 2 extra days per week; (b) attempting to work in his home and family environment one of

those days per week; and (c)

managing financially with 1 day’s furlough. He agreed that his mood has been notably low at time,

“really nervous” at other times, and increasingly irritable and “moody.” In addition, he volunteered

that he was experiencing problems with his entry into upper-management culture, which he

described as “white country club culture, you know?” As described, he sees this as a new and

challenging social, economic, and cultural transition on which his job future might depend.

At the same time, during the intake interview, Mr. Lopez appeared ambivalent about the need for

counseling and made it quite clear that he was not the problem and that “I just need a little chance

to blow off steam.” He was sarcastic throughout the session, making jokes about his family and his

circumstances asserting that “this therapy would make a funny routine for my stand-up.” He avoided

talking in any greater depth about his past or his recent bouts of irritability and often made

unpleasant remarks about his father-in-law, who “I can’t seem to please no matter what I do,

especially now that I’m furloughed.” He was, nevertheless, oriented in all spheres, articulate albeit

glib, and noted that “if I could only get over this bump, I would be as healthy as a bull.” Toward the

end of the session, Mr. Lopez suggested that his father-in-law and mother should probably get

married and move into their own home “and leave us the hell alone.”

Goals for Counseling and Course of Therapy to Date. Mr. Lopez said he would come to therapy if “it

would make Angie happy,” but that he was just “an average guy doing what an average guy does to

provide for his family and then blow off steam after an average day.” He added that all of his friends

at the factory act like he does; they all had the same ups and downs as he is having, but he is just

having a more difficult time “getting

through it”; and that he loves his family and would “do whatever it takes.” At the conclusion of the

session, Mr.

Lopez did agree to return for short-term counseling with the goal of reducing problematic mood,

anxiety, and


behavioral symptoms. When asked if he believed it would be beneficial for his entire family to come

to counseling, Mr. Lopez said, “Sure, we’re all crazy, so we might as well all have fun together in

here.” The plan is for ongoing brief individual counseling to assist the client to return to previous

level of functioning.


Case Conceptualization (CP-CC) of Penny

John Doe

School of Behavioral Sciences, Liberty University

Author Note

I have no known conflict of interest to disclose.

Correspondence concerning this article should be addressed to John Doe.


Case Conceptualization (CP-CC) of Penny

Case Conceptualization

STEP 1: Identify and List Client Concerns and Any Other Problem Areas

Feeling sad




Parental divorce

Joint custody

Elevated PROMIS Emotional Distress- Depression Score

Low self-worth

Low grade performance

Drop in attendance

Worry about sister

Fear of visiting a friend

High parental conflict

Elevated BDI-II score

Parental conflict

Worry about parents

Feels lonely

Withdrawal from friends

Potential discrimination

A friend in a car accident


Feels “helpless”

STEP 2: Organize Concerns Into Logical Thematic Groupings

Descriptive-Diagnostic Theme Used

F32.1 Major depressive disorder – feeling sad, fatigue, avolition, hypersomnia, low self-worth, avoidance, helpless, false guilt

Z63.5 Disruption of family by separation or divorce – parental divorce 2 months ago, high conflict, affair, joint custody

Z60.5 Target of (perceived) adverse discrimination and persecution (provisional) – “Black kids can’t get a break”

STEP 3: Theoretical Inferences: Attach thematic groupings to Inferred Areas of Difficulty

Maladaptive thoughts (CBT)

Maladaptive thinking in the following areas: the false guilt of parent’s divorce – “I caused my parent’s divorce,” perceived fear of visiting a hospitalized friend, and poor view of self as “helpless”

Maladaptive behavior (CBT)

Maladaptive behaviors in the following areas: Withdrawing from relationships (isolation), avoiding locations (hospital, school), sleeping more, and not engaging in enjoyable activities.

STEP 4: Narrowed Inferences and Deeper Difficulties

Deepest Negative Distortion

(CBT): I am “helpless”

Case Conceptualization Narrative

Using a CBT lens (Beck Institute, n.d.; Murdock, 2017), Penny’s core maladaptive belief is helplessness which is driving her maladaptive thoughts and behaviors resulting in some of her current problems. Penny has expressed sadness, which can be healthy, but sadness, crying, avoidance as well as other maladaptive activities are driven by cognitive and prediction errors of reality. These cognitive errors or automatic thoughts (“It’s all my fault”) are driven by faulty core beliefs or interpretations of the world based on Penny’s belief she is the one who is the source of her parent’s conflict and divorce and helplessness to change her circumstances. This may be the rationale for the avoidance of her friend and the hospital as well; she is powerless so why try. Penny attempts to evade triggering her core belief of helplessness by using avoidance behaviors such as shunning parents, hospital, school, and engaging in hypersomnia; the client is using her compensatory behaviors based on her conditional assumptions e.g., if I avoid, then I am in control and I will not feel helpless.


Beck, J. (n.d.).
Essentials of CBT: The Beck approach. Course Manual. Beck Institute.

Murdock, H. L. (2017).
Theories of counseling and psychotherapy: A case approach (4th ed.). Pearson.


Case Presentation Case Conceptualization (CP-CC) Template

Student Name

School of Behavioral Sciences, Liberty University

Author Note

I have no known conflict of interest to disclose.

Correspondence concerning this article should be addressed to . Email:

Case Presentation Case Conceptualization (CP-CC) Template

Case Conceptualization

Step 1: Identify and List Client Concerns And Any Other Problem Areas

Offer a “grocery” list of the main concerns, and problems based on the clinical data you collected when completing the Case Presentation: Assessment and Diagnosis (C-PAD). Be as comprehensive as possible. This can include behaviors, thoughts, affect, physiology, life role adjustment, institutional adjustment, family roles, relationships conflicts, work problems, school problems, clinical problems such as self-harm, medical problems, meds, developmental problems, cultural social influences, psychological assessment results, MSE concerns, maintaining factors (anxiety but working from home as a safety behavior).

Step 2: Organize Concerns Into Logical Thematic Groupings

Use ONE of the 4 thematic groupings offered by Switzer and Rubin. These themes are important in that they will be used in the treatment plan as primary problems to craft the treatment plan. This section is atheoretical. Identify which one of the 4 themes you used for clarity to the reader.

Step 3: Theoretical Inferences: Attach thematic groupings to Inferred Areas of Difficulty

Theoretically identify groupings and offer data to support the groupings.

For example, CBT has two primary groupings – maladaptive thoughts and behaviors. For each grouping offer case data to support it, and theoretical constructs such as specific cognitive distortions (e.g., all or nothing, mental filter, etc).

Step 4: Narrowed Inferences and Deeper Difficulties

Offer the deeper core issue using your counseling theory that is driving step 3 groupings and client concerns, and problems identified.

Case Conceptualization Narrative

Use the key terms and constructs of your chosen counseling theory to explain (not describe as the DSM-5 does) the clinical problems and maintaining factors. This section needs to be rich in theory as well as clinical data from your case study. As noted in the week’s reading, reference and apply other sources for application of theory such as counseling theories books, journal articles, etc. Start by offering the “deeper issues” in step 4, then connect the deeper issues to step 3 groupings by using the problems identified in steps 1 and 2 along with additional case study data.


Offer at least two references in APA format which could include your course textbooks, readings, and other sources.

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