Term Paper on "Plan a Treatment for a Case for Dual Diagnosis"

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[EXCERPT] . . . .

Treatment Plan

Treatment of Hypothetical Patient Vera P

Vera is an individual in crisis. Though it is likely that she was predisposed to both addiction and depression through genetic inheritance, as both are present in her immediate family, there are a number of environmental stimuli which have exacerbated her underlying conditions. There are a number of critical life events which directly acted upon Vera at crucial developmental stages ultimately resulting in the maladaptive psychopathology present at the time of her interview. These events include both the divorce of her parents, the development of an abusive relationship with her biological father, numerous dangerous and maladaptive behaviors, suicidal ideations, as well as substance abuse. Within this client is perhaps the most succinct description of the interaction between genetics and environment. Had the divorce and subsequent harsh treatment of her father never occurred it is possible that Vera may never have experienced either depressive symptoms or turned to compulsive behaviors such as substance abuse, self-harm, and shopping to alleviate those symptoms. Similarly, had Vera's mother been less supportive or had the relationship with her step father been more strained it is possible that one of her intentional overdoses might have successfully ended her life. It is also likely that she would not have been put in therapy or either of the two rehabilitation programs she completed.

The reason for Vera's interview is currently her addiction and increasing trouble with depression. Her drug habit which includes regular use of marijuana, cocaine, Percoset and more recently Ativan and Xanax has become

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extremely expensive, more than $700.00-month, as well as becoming a constant source of anxiety and worry. Vera indicates that her next drug use is something she thinks about constantly, she feels that she is dependent upon these drugs. She also describes the sensation that her life, everything, is spiraling downward. Though she previously experienced suicidal ideations, she has not self reportedly experienced them in the last year. Beyond the symptoms related to her drug use, Vera experiences panic attacks, cries a lot, and also sleeps more than normal amounts as a means of escaping her symptoms. She has been hospitalized three times for intentional overdose. She is quite impulsive which often results in feelings of guilt, has chronic low self-esteem, and often worries people are talking about her. She has lost interest in things which she used to enjoy, and is quite unmotivated and sad the majority of the time. Despite these problems though, Vera was able to graduate with a bachelor's degree in psychology. Currently though she is unemployed. In the past she has been diagnosed with borderline personality disorder, it appears that that diagnosis with a modifier of discouraged or self-destructive borderline personality disorder would have been more appropriate as her depressive, dependent, and masochistic features are quite prominent.

Vera's immediate family may provide insight into her differential diagnosis as the incidence of related disorders within first order family members greatly increases her likelihood of developing either their disorders or related ones. Vera's maternal grandparents both experienced depressive symptoms and may even have had major depressive disorder which makes her much more likely to experience symptoms of or even major depressive disorder itself at some point in her life. Her father had substance abuse problems (alcohol), and impulse control issues manifested primarily in uncontrollable outbursts of anger. Though not much information is provided about the specifics of her father's condition, it is possible that he actually suffers from borderline personality disorder as well. The presence of such a family history of related psychological disorders indicates that beyond simple intervention and talking strategies, Vera will likely require a pharmacological regimen to support her therapy.

One troubling aspect of this case though is the fact that Vera has been treated professionally for four years as well as having participated in two rehabilitation programs one of which was residential. Though she apparently likes her therapist, her inability to identify what specifically they are currently working on is problematic. Though it says that she and her current therapist are working with medication management no information is provided as to what medication specifically she is taking. This may prove problematic in the functionality of any new treatment plan devised as a result of this interview. However, working on the assumption that such records will be forthcoming, it will be important first to establish the definition of a counselor as well as the role which counselors play in counseling. Finally it will be important to determine a mutually agreed upon treatment plan. It is important at the outset of therapy, to clearly establish goals and effective strategies to achieve those goals. When an individual knows what they are working toward, and that end goal is one which they know will help them lead more effective and rewarding lives, it makes the development of a useful therapeutic relationship much simpler to develop. In the first meeting, though, it is important to establish the ground work for that developing therapeutic relationship. This is accomplished through clearly defining protocols of behavior as well as allowing the client to define those things he/she expects from you. Important though it is to provide a comfortable space, it is equally as important to provide a set of rules and guidelines which are closely adhered to. A sense of stability where achievement is possible and goals are clearly defined is often extremely useful in establishing a successful therapeutic regimen. It also helps an individual develop a schedule in the rest of their lives and effectively adhere to it which is extremely useful when that individual is on medication.

Counseling is a venue for professionally guided self-improvement. It is useful most immediately in instances where maladaptive behaviors or identified disorders are present, but would be useful in most individuals. Counseling is an opportunity to sit with a highly trained professional and review the manner in which an individual actively participates in their life as well as: goals, fears, desires, and the manner in which said individual goes about achieving those things they want and growing out of those things which are holding them back. Counseling provides a consistent safe space free of judgment where a person can take time to really work on internal development and growth. It is a time and a space where the many and varied influential forces, expectations, and commitments of the outside world do not exist. Where those many and varied pressures can be deconstructed and examined and either a plan to navigate them more successfully or a plan to remove them from an individual's life can be developed. Counseling is one of the few situations left in which an individual can be completely vulnerable, without fear or hesitation. That ability to be vulnerable in and of itself is cause enough for the majority of people to partake in some form of counseling at least once in their lives.

In large part, the relative efficacy of treatment is based on the counselor. A counselor must be able to make their client comfortable yet remain professional. Providing them with a venue in which to be completely honest should they choose to be yet being careful not to make them dependent on you. Most simply defined it is the role of a counselor to help an individual develop a more adaptive state of mind as encompasses thoughts, feelings, and motivations. There are a great number of therapeutic strategies, different counselors adopt the strategy or strategies which they best feel will meet the needs of their client. Though some counselors specialize in a specific technique, it is likely that an evolving and adaptable style of counseling will be most effective. Each individual client will respond differently to different techniques. It is the job of the counselor to determine the most efficacious treatment method while preventing any potentially harmful effects of such investigation.

The position of a counselor is a perpetual razor's edge. At all times they must balance comfortable easy interaction with the fact that their client is actually a client and is someone who came to them for assistance. It is the primary function of a counselor to enter a client's life helping the client change their life for the better. Whether this is accomplished through helping the client self-actualize, working to change maladaptive habits and behaviors, ridding them of the burden of addiction, managing medication, or even simply listening to them with the totality of your attention, the purpose is to help. While many counselors turn first to medication, an easy and effective solution to what is often a complex and difficult problem, it is this attitude which has called into question recently the actual benefit of seeking therapy. Generally medication does effectively manage symptoms however there is no change to the root of the problem. Combined therapies incorporating cognitive behavioral therapy as well as medication when appropriate is essential for a client to actually make effective changes in their life as well as ensure that they are not abusing the medications… READ MORE

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Quoted Instructions for "Plan a Treatment for a Case for Dual Diagnosis" Assignment:

“

FOR THE HYPOTHETICAL CASE THAT YOU WILL FINE BELOW YOU NEED TO WRITE A 8 PAGE PAPER THAT THE QUESTIONAIRE BELOW THE CASE WOULD GUIDE YOU.

USE AS A TREATMENT PLAN CBT, PSYCHODYNAMICS, PERSON CENTER THERAPY AND MOTIVATIONAL INTERVIEW THECHNICS.

U CAN USE SOME RESOURCES TO BACK UP YOUR FORMULATION TO TREAT THE CASE.

TRY NOT TO BE TO SOPHISTICATED AS A LANGUAGE, BUT YET THIS IS A SCOLARLY PAPER SO TRY TO AVOID : I THINK, I GUESS, I LIKE LANGUAGES.

Hypothetical case:

Vera P is a 25 year old, never married, white female with the date of birth of Feb. 14, 1984 who currently resides Albuquerque, NM. Vera reported that over the last several months things have been *****"spiraling down.*****" She explained that she approached her mother and told her about her struggles and they decided treatment would be a good idea.

Vera reported that her substances of choice are marijuana, cocaine, and Percocet. She began using marijuana around age 17 and progressed to regular use by 18. She has been using daily for the last six years. She reported that she spends about $700 per month on marijuana. Her last use was March 8, 2010. She began using cocaine around age 19 and it progressed to regular use around that time. She has been using daily since January 2010. She reported that she will snort about a gram throughout the day. Her last use was March 5, 2010. She began using Percocet this year. She reported that she has been using it daily with cocaine since January 2010. She generally takes between two and three, 30 mg. tabs. She did not report her last use of this substance. She began using Xanax and Ativan around age 25. She reported that she uses this sporadically. She will generally use .5 mg. per episode of use. Her last use was about one week ago.

Vera reported that she was admitted to inpatient treatment when she was 21. She stayed there for one month. She completed the program. Additionally, she went to an outpatient around age 17. She participated in this program daily for about two weeks.

Vera reported that she believes that she is addicted. She explained that she thinks about using drugs all of the time, craves them, and cannot stop even when she wants too. Vera reported that her use started because of her depression and anxiety but then symptoms would increase due to her use. She described withdrawal and thinking about her substance use all of the time as primary consequences. Additionally, she has experienced financial problems associated with her use.

Vera reported that she was raised by her biological parents until she was 10 years old when they divorced. She has always been much closer to her mother. Her mother remarried when she was 16. She liked her stepfather. In terms of her relationship with her father, she reported that it was not regular until December 2009. She explained that her father has more recently been very nice, calling her a lot, and trying to be a part of her life. She is not sure what changed. Vera reported she has a 17-year-old brother. She did not provide any great detail about the nature of this relationship.

Vera reported that she experienced some emotional abuse from her father growing up. She reported that her father has problems with alcohol. Vera reported that her father has never been diagnosed but she believes that he has a behavioral problem, primarily anger outbursts. Additionally, she reported that her maternal great grandmother and a maternal uncle had problems with depression.

Vera was living with her mother and stepfather prior to treatment. Vera self identifies as heterosexual. She has been dating her current boyfriend for about nine months. She explained that he smokes marijuana. She*****'s had approximately 40 sexual partners and four were significant relationships. She reported that she generally does not practice safe sex and is interested in being tested while in treatment.

Vera reported that she is a high school graduate. She recently completed her Bachelor*****'s Degree in psychology in January 2010. She said that she is currently unemployed.

Vera reported that she does not have any active legal problems. She explained that in 1994 she was charged with underage drinking but the charge was expunged after she completed community service.

Vera reported that she started in therapy around age 12. She has been working with the same psychiatrist for about four years. She explained that the psychiatrist does talk therapy, as well as medication management. When asked what they are working on, she said, *****"Nothing in particular.*****" She likes working with her psychiatrist. She has been hospitalized on three separate occasions for intentional overdoses.

Vera reported that she has struggled with depression since age 12. She explained that most of the time she feels sad, unmotivated, loss of energy, loss of interest in activities she previously enjoyed, and sleeps too much. She described having problems with attention and concentration. She reported that she has problems feeling worthless and hopeless. She has felt little resolution to these symptoms. Vera reported that she is not currently suicidal. She explained that she has had thoughts of wanting to disappear in the past. She feels that things would have been easier if she did not exist. However, she has not had these thoughts within the last year.

Vera reported that she has really bad anxiety. She explained that it is present all of the time. She reported that her heart beats rapidly, she cries a lot, sleeps to avoid, and experiences muscle tension. She explained that anything and everything can produce these symptoms. However, there are shorter periods of time where she will feel and exacerbation of physiological symptoms.

Vera reported that she struggles with over shopping. She explained that shopping can be used as a release from any problems in her life. She generally shops daily. She experiences a lot of guilt around her shopping behavior.

Vera reported that about five years ago she was diagnosed with borderline personality disorder. She explained she has a chronic sense of emptiness, low self-esteem, and feels as though people are often talking about her or do not like her. She can be rather impulsive and engages in highly maladaptive means of coping, including substance use, self-injury, shopping, and sexual activity.

1. The purpose of this assignment is to help you clarify your views of counseling and psychotherapy.

2. Drawing upon the contents presented in course, write 10 page paper which:

a) Describe how you combine ideas and techniques from various theories covered in this course.:

COMBINE (INTEGRATE) CBT, MOTIVATIONAL INTERVIEW, SOME PSYCHODYNAMICS AND CLIENT CENTER THERAPY

b) Demonstrate how you would treat the client described *****the hypothetical case***** that you will use.

3. Your paper should address the fallowing issues:

a) What is your view of human nature?

b) What is your definition of counseling?

c) -How do u define your role as a counselor?

-What are the most important functions of a counselor or therapist?

d) What are your vies on therapeutic relationship between therapist and client?

e) How important is the relationship as a factor for change?

f) Which theory or theories come closest to your way of viewing counseling?

g) Which aspect(s) of those theories are most appealing to you or why?

h) In showing how you would apply this (these) theory (ies) to the hypothetical case, be sure to be specific in describing how you would influence your therapeutic decisions.

I) Describe some of the techniques that you would employ.

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