practitioner case study establishing rapport

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Dual Diagnosis

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Bleak House, Genogram, A dozen Angry Men, White Noise

Research from Examination:

Honest seemed to consider that there can be a problem and that change could be necessary. Therefore , beginning treatment should be give attention to emphasizing consciousness and environmental reevaluation.

A combination of Cognitive-Behavioral Therapy (CBT) and motivational selecting (MI) may be the recommended treatment.


Frank, a 33-year-old African-American guy, came to the caseworker of record following relating adversely to an first caseworker. His came for treatment because he great attorney hoped it would beneficially influence the judge who consider the truth stemming via Frank’s capturing his partner, who had shocked him out of a restless sleep. Honest claimed that his liquor use has not been relevant. The first caseworker’s probing about alcohol work with prompted Frank’s referral towards the caseworker of record.

The caseworker set up rapport early in the 1st session by simply remarking on Frank’s cowboy boots – which were special in contrast to his plain clothing. When mentioned any problems, Frank labeled his almost constant “traveling partners, ” fear and worry. He also reported restless nights and bad dreams, which will dated via his armed service service in Vietnam.

Frank’s history of behavioral problems included several drunken driving arrests, and while not acknowledged as this kind of they advise alcohol abuse and dependence. The shooting of his wife was the showing problem.

Frank’s family history included a sis with mental problems, a troubled significant other history and weighty drinking and drug use and a heavy-drinking father, who could “handle his liquor. inches

Frank himself had a extended drinking history, from interpersonal drinking in high school to heavy ingesting – 14 bottles of beer every day along with a pint of hard liquor – after relieve from army service. This individual admitted to regular power shutdowns, fear of drawback symptoms in the event he did not drink each day, and morning shakiness, which in turn he combated by adding alcohol to his coffee. He also publicly stated to an increase in alcohol consumption after the shooting. At the time of the firing, he was in probation pertaining to his third drunken driving arrest. He had avoided imprisonment or loss of driver’s license mainly because his legal professional, a specialist in drunken traveling offenses, asserted that Frank was a pickup truck driver simply by occupation.

Frank’s current environment is unsatisfactory, living alone in a motel, drinking, and watching television. Prior to shooting, this individual lived acquainted with his better half and 2-year-old twin children.

He kept home because he feared further injury to his wife, who “he liked to look at mainly because she was so gorgeous. ” Frank did, nevertheless , seemed separate from his daughters and reported that he was more at ease on the road, where there was fewer noise and chaos.

Outspoken did not refer to any outdoor recreation aside from drinking, which he did alone himself. He had no pals, other than with Fiona, and he believed that his wife and family were enough

Frank met conditions required for a diagnosis of alcohol dependence on Axis I: the need to take alcohol with his morning coffee to stop withdrawal symptoms, trying unsuccessfully to cut upon his usage, and elevating his intake “quite a bit” following moving out of the house after the shooting. He likewise met conditions for a associated with PTSD: an initial trauma; re-experiencing the original trauma(s) through flashbacks or disturbing dreams; avoidance of stimuli linked to the trauma and numbing of general responsiveness; increased arousal, as suggested by difficulty falling or perhaps staying in bed and overstated startle response; duration of symptoms more than one month; and significant impairment in social and also other important aspects of functioning caused by the disorder.

Frank likewise had challenges relevant to Axis IV: suffering over firing his better half, irritation with messy, noisy 2-year-old twin daughters, disapproval by wife’s parents, and discord with older sis. He had, during the time of coming to treatment, little if any social support as well as the prospect of job loss and incarceration.

When he made an appearance for treatment, Frank was plainly in the precontemplation stage of change with regard to his ingesting. He noticed no cause to even discuss it. At the end with the second period, he seemed to have relocated to contemplation; i actually. e., this individual seemed to consider that there may be a problem and that change could be necessary. As a result, beginning treatment will give attention to emphasizing understanding and environmental reevaluation.

A variety of Cognitive-Behavioral Therapy (CBT) and motivational meeting with (MI) is definitely the recommended treatment.

Treatment Plan

Your skin therapy plan must collectively address Frank’s diagnoses of PTSD and Alcohol Dependence. Although some practitioners might argue that the client needs to be abstinent by alcohol just before dealing with another psychiatric problem, it seems in Frank’s circumstance too dangerous an approach. All of us can’t be sure that alcohol misuse was a (partial) cause of the PTSD or a way of coping with PTSD, so that removal of the alcohol may not address all of the problems. It could possibly in fact make things more serious; Frank seems to have little when it comes to other dealing mechanisms and support.

To get the Alcoholic beverages Dependence element of the treatment, the writer is going to incorporate some of the goals, objectives and interventions suggested by Wenglinsky and Dziegielewski (2002) and Hanson and El-Bassel (2004). For the PTSD and dual diagnosis factors, the article writer will use materials from the Royal College of Psychiatrists (n. d. ) and Banarjee, Clancy Crome (2002).

The goals to get Frank will be as follows.

Help Frank in seeing just how certain thoughts about his experience in Vietnam trigger stress and make symptoms worse. (Short-term)

Help Outspoken link plan Veteran’s Operations and its solutions. (Short-term)

Help Frank connect to AA gatherings and Dual Disorder group meetings. (Short-term)

Help Frank begin to see the discrepancy between his current behavior and his broader goals. (Short-term)

Help Fiona in working with Frank’s alcohol dependency and PTSD. (Short-term)

Help Outspoken continue to show up at AA and Dual Disorder meetings. (Long-term)

Assist Frank in designing a post treatment plan; e. g., What to do that symptoms return? (Long-term)

Objectives and surgery in service of these goals will be discussed within the next section.

Intervention Planning and Implementation

Because indicated previously, Motivational Interviewing and CBT will both be used with Outspoken. Motivational Interviewing is particularly helpful for those inside the contemplation periods of change, where Frank seems to be. The approach allows the client explore and handle ambivalence as a method of motivating change. The idea will be to encourage Frank to attempt the cycle of change (Rollnick Miller, 1995).

CBT seeks to modify the patterns of thinking and tendencies responsible for a trauma victim’s bad emotions and, thus change the way he feels and acts. In CBT, individuals learn to 1st identify thoughts that make all of them feel affected and change them with much less stressful thoughts. (Wenglinsky Dziegielewski, 2002). Honest seems a good candidate just for this approach.

Aims and interventions in service with the short-term Goals are here and will make use of a combination of both approaches.

1 ) Assist Outspoken in finding how selected thoughts regarding his knowledge in Vietnam cause anxiety and produce symptoms a whole lot worse.

Objective: Honest will go over his Vietnam experiences and exactly how he feels about them.

Input: The caseworker listens, will remind, recapitulates and share feedback. The caseworker also educates Frank on tips for anxiety reduction (e. g., relaxation exercises).

2 . Support Frank hyperlink up with Veteran’s Administration as well as services.

Objective: Frank can contact the Addictions and PTSD personnel at the closest VA Middle.

Intervention: the caseworker can provide contact information and inquire about outcome.

3. Help Outspoken connect with LUKE WEIL meetings and Dual Disorder meetings.

Goal: Frank can discuss his experiences on the meeting, of course, if and how they have helped.

Involvement: Frank can keep a record of these experience.

4. Help Frank begin to see the discrepancy between his current behavior great broader goals.

Objective: Frank will list the favorable things in his life wonderful strengths.

Input: the caseworker will give explanations why this can help and after that prompt and nudge. (It does not appear that Outspoken has had very much practice in seeing good things. )

Objective: Frank will certainly discuss just how his current behavior influences the good items and how he can bring his strengths to bear on virtually any undesirable effects.

Intervention: The caseworker listens, reminds, recapitulates and gives reviews.

5. Help Fiona in dealing with Frank’s liquor dependency and PTSD.

Addresses Fiona’s and daughters’ demands. Encourage Fiona throughout treatment.

Intervention: The caseworker may help Fiona connect with Alanon and other supports and having classes with Fiona alone and also with Outspoken.

Termination, After Care and Follow Up

Goals and surgery in service of the long-term goals are here.

1 . Support Frank always attend SOCIAL MEDIA PACKAGE and Dual Disorder gatherings.

Objective: Outspoken will meet with the caseworker on a significantly less intensive treatment schedule and discuss AA and Dual Disorder getting together with.

Intervention: Caseworker will discuss with Frank how a meetings have got helped and whether and exactly how he “has carried the message” to others with difficulties.

2 . Aid Frank in developing a content treatment plan; electronic. g., What to do it symptoms return?

Objective: Frank will show a written plan that considers what direction to go

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