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C7 58 Diagnosis and Treatment Planning

Dr. David Moore Argosy University-Seattle

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Case Formulation Instance

The Dual Disorder CBT Treatment of a Childhood Trauma Survivor

I. Introduction to the Theoretical Model

The arroyo to this client's evaluation and therapy is inside the Behavioral Therapy domain of counseling theory. Inside the behaviorist strand of counseling theory, Cognitive Behavior Therapy (CBT)

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 has been successfully used to treat Anxiety Disorders.

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In this case study, the client has Post Traumatic Stress Disorder [PTSD]; which is one of the well-nigh multi-problem mental health categories in the Anxiety Disorder cluster. The clinician uses CBT methodology. A leading CBT Theorist, Albert Ellis, has developed an enriched CBT model chosen Rational Emotional Behavioral Therapy (REBT)

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 that fit this client's treatment needs. The client's substance utilise disorder, separate but entwined with her PTSD, is the 2nd component of her "dual disorder". REBT is an constructive behavioral therapy model for addressing the developmental history model of addictions treatment; which is more than unremarkably treated from a Psychodynamic Therapy domain of counseling theory. In REBT, similar a Psychodynamic [sometimes called Psychoanalytic] method, the client's historical awareness of her progressive disease and its distortions in thinking [i.e. "problem denial"] is addressed through what Ellis calls the ABC's of irrational thinking.

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 The therapist assists the client with an REBT problem cocky- assessment; which is chosen a "First Step" in Minnesota Model chemical dependency treatment.

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In the example transcript of the third session, used for explanatory purpose, the client brings her daughter to the therapist'due south part which creates an enactment of mother—daughter dynamics. The therapist allows the family unit dyad to derail naturally between the multiple subjects of dysfunction that take existed inside the family addiction and multi-generational trauma. In the session, the therapist uses the framing model of REBT to exhibit the disability of the dyad to resolve hither-and-now decisions due to long-continuing irrational behavior near their relationship.

II. Basic Demographic Customer Information

 Name: Laura Client Age: 42 Race: Bi-racial

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Sex: Female Marital Condition: Single, Divorced Employment: Pedicure, Cosmetology without formal education Referral: Tacoma Indian Center Handling: Outpatient Dispensary, Individual counseling

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 Native American and European American

C7 58 Diagnosis and Treatment Planning

Dr. David Moore Argosy Academy-Seattle

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The cardinal presenting issues are Ms. Customer'southward efforts to develop a sustained addiction recovery that includes the level of behavioral health necessary to parent a 14 year old girl who is on the Washington State early intervention program for truancy and delinquency [i.eastward. the BECCA law].

3. Client Background Summary

3.A. Substance Utilize History

Laura Client was introduced to alcohol utilize by her family when she was in her pre-school years. An anecdotal description told in her family is a joke about when the client was a babe and could "suck downward her bottle of beer"—but had a difficult time drinking her canteen of milk. She remembers the ongoing consumption of alcohol from historic period five when she would drink with her grandmother. Her substance abuse was established in her elementary years and, by the commencement of junior high years, she was consuming marijuana, alcohol and hallucinogens ["LSD"]. Prior to reaching adulthood, dropping out of high school in her senior year, her poly-drug corruption escalated to adding cocaine [including the highly addictive smoked version chosen "crack"] and methamphetamine. Every bit she entered early adulthood years, her memory is clouded by the poly- drug nature of her drug abuse, but she had further added the highly toxic combined employ of heroin and methamphetamine to her addictive behavior.

3.B. Psychological Functioning and History

Forth with childhood neglect through the utilize of alcohol provided by her family, she was verbally and physically driveling past her parents and grandparents. The middle of three children, she was the only adopted child. She perceives this divergence resulted in her parents treating her more poorly than her siblings, not feeling accepted past her parents, and even questioning whether her parents wanted her every bit a child. Her mother is an alcoholic. Bated from her very early on exposure to booze, her mother's alcoholic behavior created an environment that she describes as beingness a "self-medication" reason for her ain teenage and developed alcohol use. At this level, she is able to connect the genetic and ecology influences on her dependence. She has an inaccurate perception that, outside of the substance use, she didn't actually have whatsoever behavioral health problems. She too fails to connect her own mother—daughter narrative to her current state of affairs with her daughter. Once her addictions began to include more expensive and neurochemically addictive drugs [methamphetamine, heroin and cocaine] she began to engage in prostitution and theft to finance her lifestyle. She has also experienced psychotic symptoms in her adult life. She does not hear command voices, but she does hear and see negative auditory and visual hallucinations. An explanatory chestnut provided past Ms. Client was an incident most 3 years ago when she  believed Satan was talking to her through her cheek. Every bit a upshot of this psychotic mirage, she took a pair of scissors and cut out a substantial chunk of her cheek to "remove Satan'due south influence." Currently, she presents with very depression self-esteem, high levels of anxiety, and mood swings which have been diagnosed as a Bipolar disorder. She is now abstemious from substance utilize with

C7 58 Diagnosis and Treatment Planning

Dr. David Moore Argosy University-Seattle

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continuing intendance in support groups; only has a very difficult fourth dimension dealing with anger and frustration that she would historically sedate with one or more than drugs. In developing services for Laura, social and health agencies are assisting her develop life skills when she has picayune or no prior learning. These deficits are farther aggravated by sleeplessness created by dreams similar to the hallucinations noted above. While abstemious from addictive employ of drugs at this fourth dimension, she reports the beginning of compulsive overeating late at dark ["rampage eating"].

3.C. Education

Ms. Client reports to having skillful grades prior to dropping out in 12

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 Class. She reports no history of Special Teaching needs. She plans on farther education to complete her GED and is considering post-GED business concern studies. She reports vocational interests in cosmetology and  pedicure services ["applying brand-up and being a nail creative person]. She has had no formal teaching in either action.

iii.D. Legal History

Ms. Customer has been arrested in the by for prostitution and possession of narcotics. In low-cal of her extensive adult lifestyle of admitted criminal behavior, her fourth dimension of incarceration appears less than might be expected. She was a crime victim with two extensive situations of rape. During the second rape, at historic period 19, she was held captive for 3 days by a man who raped her repeatedly while he put a gun to her head. In other areas of contacts with law enforcement, either as a violator or victim, she cannot remember a lot of her past. She knows that she has had numerous legal interactions, just cannot recall specifics. She identifies her drug of choice for the last xxx years as beingness Methamphetamine, which has extensive connections to the illegal community of drug manufacture and distribution. Information technology also left her, as she notes, in an ongoing "fog." Currently, her major legal bug are in the role of a parent. Her 14 twelvemonth-old daughter, Jericah, is involved with the state truancy organisation [BECCA Bill]. Jericah has stopped attention school and Laura can't figure out how to arbitrate successfully on this beliefs. Jericah has a history of suffering from low and self-injury [cutting] behavior. Customer does believe that a substantial amount of Jericah's emotional pain and behavioral health problems are the result of Laura's drug abuse and her parallel parental absence during Jericah's childhood years.

3.Eastward. Social History

In improver to her drug addiction, she as well reports her overall lifestyle has been influenced by  problem gambling during periods of active substance utilize. She reports the assumption that if she gambled she could get more money for drugs. During the past one year period abstinence from alcohol and drugs, she has not engaged in gambling behavior.

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Source: https://www.scribd.com/doc/31758936/An-Example-Psychological-Case-Formulation-PTSD-Treatment-Using-CBT-C7548

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