Case Study Treatment Plan: Treatment Goals

2/28/2021 Case Study Treatment Plan

media.capella.edu/CourseMedia/COUN6321/CaseStudyTreatmentPlan/transcript.html 1/4

P r i n t

CASE STUDY TREATMENT PLAN

INTRODUCTION For your course project, you will develop a treatment plan for one case study subject that you select from two possible candidates. These potential clients are ethnically diverse and are struggling with psychological disorders, which may require medication.

During the course of this project you will:

Organize and present relevant client information.

Review possible assessment techniques.

O�er a diagnostic impression.

Evaluate e�ective approaches and interventions.

Discuss legal and ethical considerations.

Consider methods for e�ective collaboration with members of treatment teams.

Review the impact of diversity issues in assessment and goal formulation.

Develop a suggested treatment plan for the client.

You will select one of the two case studies presented on the next page of this presentation as your client for this treatment plan project. You will write the sections of your assignments directly into the “Case Study Treatment Plan Template” located in the Resources area of each assignment.

STELLA'S CASE STUDY Stella is a 38 year old woman who has just been assigned to you as a client. You are currently working as a counselor for your county community mental health agency that has a contract to provide continuing treatment for patients who have just been discharged from a local psychiatric facility. Stella was discharged last week after a 7 day hospitalization. You received the following information about her as background and history.

Stella is the only child of a Caucasian couple who are now deceased. She was adopted by this couple as an infant in a closed adoption, so that very little information about her parents has been made available to her beyond a birth record noting her mother was African American and her father was Caucasian; both are listed as being 16 years old.

Stella currently lives in a small city of 150,000 people where she is employed as a book-keeper for the local produce packing plant. She has worked there for 3 years. Her educational background includes an associate's degree in accounting and continuing education in tax preparation. Before working for this plant, she was employed as a tax preparer for a national company. She enjoys her work, saying that numbers are easier to get along with than people.

She has been married to her husband (Doug) for 18 years. They have no children due to medical issues that Stella reports have made it very di�cult to get pregnant and carry a child to term. Her husband is a long distance truck driver. He is often away from home for two weeks at a time. He is then at home for only 4 or 5

C r e d i t s

2/28/2021 Case Study Treatment Plan

media.capella.edu/CourseMedia/COUN6321/CaseStudyTreatmentPlan/transcript.html 2/4

days before he leaves on another trip. Stella reports that she feels “lonely and blue” when her husband is away. She �nds it di�cult to motivate herself to do anything when he is on the road beyond going to work and coming home. She has few friends beyond acquaintances at work and only occasionally participates in activities at her local church.

Stella reported that her problems began when she was in early adolescence. She started sleeping and eating excessively. She missed many days of school because she couldn't get out of bed and gained 25 lbs. over the course of 2 years. Because Stella felt unattractive due to the weight gain she experienced, she obtained some methamphetamines from a friend of hers in school so she could lose the weight quickly. She was able to do so, but found that when she stopped taking the pills she felt even lower than before. She asked her friend for more pills, but her friend refused to provide them. Stella's mood continued to decline; she believed she was a failure, that she would never be successful at anything, and stopped talking to her friends. She stated that she felt "blue" during this time, a word she frequently uses to describe her mood. This episode lasted about one month until school ended for the summer. During the summer, she felt better because she had a summer job as a stocker at the local grocery store where she became involved with a boy from a local school. The following year, she once again became "blue" and this time she took 25 aspirins in a suicide attempt. She panicked and told her mother, who took her to the emergency room to have her stomach pumped. Stella started to see a counselor after this incident, but when she began to feel better, she stopped her counseling.

Stella was able to successfully graduate from high school and earn an associate's degree at the local community college. Her �rst full-time job was back at the grocery store, where she worked in the o�ce preparing bank deposits and reconciling bank statements. She reported that she enjoyed this job and felt better about herself. She reconnected with her previous boyfriend and they married. However, after 3 years, she again experienced depression, this time more severely than ever before. "It felt like my 'blue' had taken over my whole world and I couldn't see anything else. I just wanted to die. That had to be better than how I was feeling." Her suicide attempt this time was more serious; she cut her wrist in the bathroom at work. A co- worker found her and called 911. She spent four days in the hospital and was referred to a psychiatrist for follow-up care. The psychiatrist prescribed an SSRI for the depression and referred Stella to her previous counselor.

Stella began to feel much happier and energized. She made some new friends who liked to “party” – and was out most nights when her husband was away. She drank excessively at night and then smoked marijuana during the day to “take the edge o� and calm down.” She also spent money on new clothes, until she had maxed out her credit cards and borrowed money from her parents. Her performance at work became erratic and her employer began to suspect that money was missing. He was unable to prove the missing money, but became so uncomfortable with Stella's change in behavior and her deteriorating performance that he let her go. Stella was devastated. When her husband returned home, he took her to her psychiatrist, who made adjustments to her medication regime, adding a mood stabilizer. Stella improved over the next several weeks, but was not fully compliant with taking her medications and continued to smoke marijuana from time to time.

Since that time, Stella has had a series of jobs, most of which she was able to keep for several months and, on one occasion, for over a year, until her mood changed and she either “acted out” or became too “blue” to function e�ectively. She feels very fortunate to have kept her current job for so long. She attributes this to a "kind boss," who has kept her employed through her highs and lows. Her boss has asked her to continue with treatment on a consistent basis and since being employed there, she has managed to stay on her medications. Recently, though, her counselor closed his practice and moved to another city. She was distraught by this and refused to �nd another counselor. Gradually, her behavior and mood became more and more unstable over time.

This most recent hospitalization came after she was found at her work desk, sobbing uncontrollably and saying she wanted to die. The work site placed her on medical leave and required her to get treatment before she could return. Stella admitted herself to the hospital, where she saw a new psychiatrist, who changed her medications. She stayed in the hospital for 7 days until her mood stabilized and she was no longer considered to be a threat to herself. Stella is positive that she will be able to stay on the new medications and that she

2/28/2021 Case Study Treatment Plan

media.capella.edu/CourseMedia/COUN6321/CaseStudyTreatmentPlan/transcript.html 3/4

does not plan to drink or use any drugs. She has asked for a report of her progress to be given to her employer so she can go back to work as soon as possible.

Her husband is very supportive of her getting care and has met with both the new psychiatrist and your agency’s intake case worker. He reported that his sister has volunteered to go walking with Stella each day when he is out of town and will help her manage her medication. His sister has a 5 year old daughter whom Stella adores and he thinks being around the child will cheer her up.

You will now be Stella’s counselor. After reviewing her hospital records and the intake report, you are ready to begin developing a preliminary treatment plan that will address, among other issues, medication and treatment compliance, and stabilization. You have spoken with Stella brie�y by phone and plan to meet with her next week.

OSCAR'S CASE STUDY Oscar is a 19-year-old Hispanic male who is the oldest of 5 children. His family has been successfully farming the same land for 4 generations. Currently they grow vegetables for a regional grocery chain's produce departments. They live in a rural area of the county. Three generations live in two separate houses on their land. They are very independent and have little to do with people in town, although the family itself is extremely close knit.

Oscar is currently a freshman at a 4-year college located 6 hours away. He is the �rst person in his family to attend college and plans to major in agriculture. He has been living away from home for the past 9 months. At �rst, he had a very di�cult time being away from his family; but as the weeks passed he made fewer and fewer phone calls home and gradually stopped returning calls or emails. When he came home for spring break, his parents noticed signi�cant changes in his appearance. He had lost weight, looked haggard, wasn't sleeping and seemed irritable and argumentative. He told his parents that he was not going to return to college after the break. He went on to say that his roommate had placed cameras in the room so he could record everything Oscar did while the roommate was absent and that he believed the roommate was posting embarrassing videos of him on the internet. His grades were poor and he expressed that he believed his instructors were prejudiced against him. This poor performance was in stark contrast to his performance in high school, where he was in the top 10% of his class. Within days of coming home he had stopped showering and began wearing multiple layers of clothes (3 pairs of jeans and 4 t-shirts). He responded to questions with one word answers and not initiating conversation. Oscar seemed unhappy or irritable whenever he encountered a member of his family and began spending all his time in his room. He even refused to talk with his youngest brother, with whom he had always been close. He did not take meals with his family, a long- standing tradition in his family, and left his room only in the middle of the night. He could then be heard opening drawers in the kitchen, wandering around the halls, and leaving the house for long periods of time.

The family (parents and grandparents) became very disturbed and consulted their priest. The priest recommended that the parents take Oscar to see a fellow parishioner who is also a counselor. Oscar reluctantly accompanied them to the meeting. The counselor was disturbed with Oscar's presentation and recommended hospitalization. The family was very reluctant to do this, but eventually agreed. By the time they got to the hospital, Oscar was essentially non-communicative, staring o� into space and only nodding or shaking his head in response to direct questions.

The psychiatrist diagnosed Oscar with major depressive disorder, single episode, severe with psychotic features and prescribed anti-depressants. He was released two weeks later, with some improvement. Within three weeks, he was readmitted, with the same presentation he had at the previous admission. This time, though, his father reported that he had discovered a container with marijuana hidden in the barn, and also discovered several large knives that Oscar had collected from the house and storage shed on the property. When he asked Oscar about them, Oscar denied that the marijuana was his and responded that he needed the knives to protect himself from attacks. When his father asked from whom, Oscar responded that he had

2/28/2021 Case Study Treatment Plan

media.capella.edu/CourseMedia/COUN6321/CaseStudyTreatmentPlan/transcript.html 4/4

seen one of his college professors driving past the house and believed he was spying on him. That same day, Oscar's mother found notes stu�ed under Oscar's mattress in Oscar's handwriting that had drawings of knives and referred to sacri�ces he would need to make in order to keep himself safe. In light of these two events, both parents were afraid for Oscar to remain at the house.

Once Oscar was restabilized at the hospital, he was more forthcoming with his treatment team. Oscar acknowledged that his problems began after a semester of being away from home. He was unable to understand or complete his school work, as he was "consumed" with a buzzing in his head, which soon evolved into whispered words warning him of danger. He tried to keep these voices quiet by buying marijuana from his roommate and smoking on a daily basis. While this helped in the short term, it also made it more di�cult for him to complete any of his school work. He started skipping class and staying in his room most of the time. His roommate and other students on the �oor started making fun of him, which increased his distrust and isolation. By the time of spring break, the voices in his head had begun to change and warned him to trust no one, speak to no one, and arm himself for a possible attack.

The family was brought in for several sessions with Oscar and his therapists and during one meeting they discussed a grandparent on the mother’s side who had exhibited similar symptoms. The family sometimes brought their Priest with them to sessions and requested that prayer be included as an active part of Oscar’s healing.

As Oscar began to show some improvement with continual adjustments to his medication, individual therapy and group therapy, his parents and grandparents wanted to take him home, saying they were in the best position to watch over his care. However, after Oscar experienced a setback where he became increasingly moody and referred to one of the sta� as “a dark force in the building,” they agreed to place him in a residential treatment facility that specializes in working with adolescents and young adults. Although most patients stay in this facility for 6 – 9 months, the family only agreed to a trial of 30 days and said they would still consider taking Oscar home once he had calmed down.

You are working as a counselor at the Residential Treatment facility where Oscar has been placed. He will be there for a minimum of 3 months. Professional sta� at this facility include 3 therapists, an addictions counselor, a social worker who is currently away for an extended leave of absence, a psychologist, and 2 nurses on every shift. Oscar's psychiatrist is also on sta� and will continue to follow his care.

The social worker usually coordinates clients' treatment plans; however since she is currently away, you will be the lead therapist who is coordinating Oscar's treatment during the next 60 days. To prepare for your �rst meeting with Oscar, you will be developing a preliminary treatment plan that summarizes the presenting information, assessments and potential goals.

Subject Matter Expert:

Course Developer:

Interactive Design:

Project Manager:

Image Credits:

CREDITS Thomas, Mary Eskola, Megan

Olson, Lori

Latimer, LaRohnda

© iStockPhoto.com

L i c e n s e d u n d e r a C r e a t i v e C o m m o n s A t t r i b u t i o n 3 . 0 L i c e n s e .