Josephine is a 20 year old female who is present for an eating disorder not otherwise specified. She currently teaches salsa lessons at the community college and is in her last semester of college. She reports she is living at home and the food her mom prepares is not the healthiest because her mom is from Honduras and her father is from Guatemala, so the food is prepared differently. She indicates she has been thin all her life, but as soon as puberty hit, she has struggled to maintain her weight and since she is a salsa instructor, she has to remain fit. She reports she feels very guilty if she has consumed fried foods during the day, but since that is the way her mom primarily cooks, she feels awful to tell her mom to stop cooking that way. She reports if she does consume too much fried foods or junk food, she will run at least 2-3 miles that day or else force herself to vomit, but all the food does not come out. She reports sometimes if she has a later class, she will not eat dinner or only eat 1 meal per day. She has tried counting calories, but then she gets so mad at herself for having more than 1200 calories it causes her to exercise more, which then leads her to feeling exhausted. She indicates she is on no medication, but does take a multivitamin when she remembers. She indicates she has gone from 110 pounds to 125 pounds over 5 years and wants to be back down to 110 or even less. She also had gone to the doctor and he was quite concerned with her lab values. She has provided you a 24 hour meal record: Breakfast: 1-6” corn tortilla ½ cup fried beans cooked with peppers, onions and oil ½ cup rice 1 cup no sugar added orange juice Lunch: 1 slice of whole wheat bread 2 slices turkey 1 small apple Dinner: 2- 6” tortillas Beef with onions, peppers cooked in oil Tomato, onion, pepper salad (made with oil and lime juice) 2 cups of rice Height: 5’2” Weight: 117 pounds (based on your scale in the office) Labs: Test Result Reference Units Albumin (visceral protein stores) 3.3 g/dL 3.5-4.8 g/dL Sodium 133 mEq/L 136-145 mEq/L Potassium 3.8 mEq/L 3.5-5.2 mEq/L Iron 0.4 mg/dL 0.6-1.1 mg/dL Vitamin B12 185 pg/mL 200-835 pg/mL Questions for Unit 3: 1. What stage of change do you believe Josephine is in? In the above paragraph, what makes you determine she is in that stage of change? 2. For this situation, how would you establish a rapport with the client? 3. What personal boundaries would you establish for this seminar session? 4. What cultural considerations do you have to keep in mind? What other physical or psychosocial questions would you ask this client?