FOR NICOHWILLIAM ONLY WK 8 ASSIGNMENT

Eliza’s Modified Treatment Plan

PCN 610

Date: August 25, 2019

Eliza’s Modified Treatment Plan

Eliza Doolittle is a Caucasian girl aged eighteen years, and a first-year student in college. Both of her parents live in a nearby town. In her initial visit, Eliza had been sent to see a counselor by the school because she was found in possession of alcoholic drinks in her the school dormitory. In the initial assessment, Eliza demonstrated depressive symptoms such as anxiety and low self-esteem. Although she denied she was intoxicated at the time, she said she had previously abused alcohol in high school. After joining college, she stated that she struggled to make new friends after parting ways with her high school friends who went to different schools. She denied having any traumatic experiences, although she stated both her high school and college friends took advantage of her on several occasions.

Changes in Eliza’s Behavior

In the second visit, Eliza has been brought to the health facility because she was found passed out and smelling alcohol. When questioned by the physician what had happened, she admitted that she had lied in her initial assessment of her drinking behavior. She admits that she has a problem with drinking. Eliza states that she often drinks to raise her level of self-esteem, gain confidence, and overcome from the strained relation of her parents. Eliza stated that she drinks about five times a week and also when she gets an opportunity to. She added that she lied in her previous visit because she feared being suspended from school due to abuse of alcohol in the school premises.

Effectiveness and Validity of the Treatment Plan

In the initial treatment, Eliza was diagnosed with mild depression because the major depressive symptoms presented were anxiety and loss of interest in normal activities. However, she had demonstrated other symptoms such as slight sleeping problems, little enjoyment of social activities, and lack of identity. The physician recommended that the symptoms could go away on their own without any treatment. However, the physician stated that Eliza should undergo cognitive behavioral therapy.

The treatment plan is still valid after the new developments in his behavior, but it would be necessary for Eliza to be referred to a psychiatrist to confirm whether she held come more information about her behavior. According to Regier et al. (2013), the DSM-5 diagnostic criteria for depression states that alcohol abuse should not be a reason for diagnosing depression. Therefore, the physician can rule out alcohol abuse as a cause of depression, but alcohol abuse can be a sign of depression. According to Regier et al. (2013), most depression patients often engage in alcohol abuse.

Treatment Changes 

The initial treatment that was prescribed to Eliza needs to be adjusted to address the new situation. According to Eliza’s previous diagnosis, the physician recommended that she should undertake cognitive behavioral therapy to help improve her symptoms. The treatment goals remain the same as in the initial treatment plan. They include (a) anxiety reduction. (b) Maintaining abstinence from alcohol and marijuana. (c) Reducing her sensitivity to traumatic experiences. (d) Increasing coping skills. (e) Stabilizing and adjusting to new life experiences. (f) Improving self-worth as well as relationships. (g) Mood stabilization. However, the physician will focus more on her alcohol drinking problem, which may affect her recovery process.

Ethical and Legal Justification of the Changes in Eliza’s Treatment 

           Ethical treatment requires physicians to promote the autonomy of patients through psychotherapy, especially cognitive behavioral therapy. According to Biegler (2011), depression occurs when the autonomy of patients is undermined regularly and extensively. It is the moral obligation of the physician to promote Eliza’s autonomy. Although it is legal to use antidepressants in the treatment of depression, a therapeutic process would be recommended to promote Eliza’s autonomy. Eliza seems to be drinking to overcome stress. However, studies show that alcohol consumption may worsen the effects of depression (Biegler, 2011).

Impact of the Changes to the Treatment Plan

           The initial treatment would be affected because Eliza had not shown or stated whether she had a problem with depression. Therefore, in the modified treatment plan, her problem with alcohol abuse would be the main focus for the therapist. Anxiety was the biggest problem that Eliza had demonstrated in her assessment, and little emphasis had been laid on alcohol and substance abuse. However, with the new developments on her behavior, it would be necessary for Eliza to undergo a therapeutic process to help her change her mentality towards alcohol consumption to learn that it makes her condition worse although it gives temporary relief.

Evaluation of Available Resources for making a Referral

           According to Boden & Fergusson (2011), psychotherapy is an effective tool for dealing with alcoholism. Eliza was reported to have a problem. A combination of psychotherapy and antidepressants have been recommended for depressed patients. However, since Eliza’s depressive symptoms show that she is slightly depressed, a psychotherapeutic process should be sufficient to help her regain her autonomy. Cognitive-behavioral therapy is the most recommended method of treating mental illnesses, although antidepressants may be added to the process in severe cases.

The Need for Referral

           The quality of physician-patient communication is key to the treatment of depression. Effective communication would be critical in determining the treatment outcome. The physician must make Eliza accept that she needs help before the conversation about referrals is made. The physician should use a language that is easily understood by Eliza, which should possibly be her native language. Since the counselor cannot provide therapeutic care, there would be a need for the Eliza to be referred to a psychotherapist. Binge drinking can be a hindrance to her recovery. The counselor can use a behavioral activation or a collaborative motivation technique to assure Eliza that the psychotherapist would help her overcome the problems she is experiencing.

Referrals 

Eliza’s drinking problem would require the counselor to seek the services of a specialist who deals with people with drinking problems. The counselor would, therefore, refer Eliza to an intensive outpatient program where her drinking problem would be assessed. The intensive outpatient program would be recommended for Eliza because her problem with alcohol abuse do not meet the diagnostic criteria for inpatient substance abuse treatment. Eliza would be required to attend a minimum of 9 hours of therapeutic care in a week. This service would be a minimum of three 3-hour sessions, depending on the severity of her condition. Eliza would not be attending the intensive outpatient program from school, which would help her improve adjustment to new life experiences.

Instruments used in the assessment  

Eliza’s assessment was done using a biopsychosocial assessment tool. Biopsychosocial assessment is conducted by a counselor to assess the condition of a patient. The technique helps the counselor to assess the social, psychological, and biological factors that might have contributed to the problems facing Eliza. It is a holistic evaluation that looks at Eliza’s condition from different levels. The counselor engaged Eliza in a biopsychosocial interview to identify the various issues that have affected her behavior. It is not enough for the counselor to just look at Eliza, but it is important to look at her environment. A biopsychosocial assessment is critical in assessing possible root causes of the problems facing Eliza. The biological factors to consider are her family history, traumatic family experiences, use of drugs, medical conditions, and personal life history. Psychological factors include self-worthiness, self-esteem, and previous diagnostic assessments, whereas social factors include her relationship with friends.

Conclusion 

           The intensive outpatient program would the major change in Eliza’s initial treatment program to assess her problem with alcohol consumption. However, her condition doesn’t warrant a residential therapeutic process. The therapist would help Eliza overcome the depressive symptoms that she has been experiencing. Studies show that alcohol can worsen the symptoms of depression or make it recur. Therefore, it would be essential for Eliza’s use of alcohol to handle. The therapists would help improve her coping skills, which are critical for her recovery.

References

Biegler, P. (2011). The ethical treatment of depression: autonomy through psychotherapy. Cambridge, UK: MIT Press.

Boden, J. M., & Fergusson, D. M. (2011). Alcohol and depression. Addiction, 106(5), 906-914. doi: org/10.1111/j.1360-0443.2010.03351.x

Regier, D. A., Kuhl, E. A., & Kupfer, D. J. (2013). The DSM‐5: Classification and criteria changes. World Psychiatry, 12(2), 92-98. doi: org/10.1002/wps.20050

Ritschel, L. A., Cheavens, J. S., & Nelson, J. (2012). Dialectical behavior therapy in an intensive outpatient program with a mixed‐diagnostic sample. Journal of clinical psychology, 68(3), 221-235. doi: org/10.1002/jclp.20863