Comprehensive Case Study
patrifl_14i6
PepperFamilyCaseStudy.docxRunning Head: Pepper Family Case Study 1
Pepper Family Case Study 15
Pepper Family Case Study
Instructor Name
Course
Date
Client's demographical information
Olivia Pepper is a 30-year-old African American woman who is married with three children (ages 2, 6, and 8). Olivia is a Baptist and is receiving several financial need scholarships which allows her to attend school without working. She has two residential treatments, once as an adolescent for alcohol use and the second when she was 24 for depression and alcohol use. She has had two DUI's, one at 16 and the second at 22. Olivia has previously taken Zoloft and Wellbutrin, and has gone to family counseling as a teenager. Olivia is currently pursuing her Master’s degree and has a 3.8 overall GPA. She has been referred to the University Counseling Center from her professor for erratic behaviors, which include failing two classes and having a sporadic attendance, being late, and smelling of alcohol on more than one occasion. Olivia's peers have reported that she wants to meet at the local bar and is never engaged in learning.
Olivia grew up with loving parents who worked hard. Her mother left when she was 14 and that is when she started to drink. She has been in a “funk” on and off her whole life and reports that most days she just doesn’t want to get out of bed and face the day. She is overwhelmed and sleeps 10-12 hours a day, isolates herself from her family, and avoids going to school. She has attempted suicide once with a drug overdose on Wellbutrin with alcohol. Olivia is currently attending AA meetings regularly and reports that church and AA help her get out of bed in the morning. She has started to drink again and sneaks drinks into her lemonade so that her family does not know. Her husband is angry and wants her to quit school, and Olivia is concerned for her 8-year-old daughter who is exhibiting similar behaviors as her.
Olivia's demographic information paints a vivid picture of her life. She has faced many challenges in her life, from her mother leaving when she was 14 to her father passing away two years ago from drinking. She is under a lot of stress with having to care for her three children and still trying to pursue her degree. She has dealt with depression and alcohol use, attempted suicide, and has had two, (DUI's Shenoy,2019). Olivia has had to find different coping mechanisms to get her through her day, and while church and AA have been helpful, she has resorted to drinking again, which is causing her to struggle in her classes. Her family dynamics are strained with her husband wanting her to quit school and her 8-year-old daughter exhibiting similar behaviors. It is clear that Olivia is in need of support and guidance to help her get through the current struggles that she is facing.
Analysis of the Client's presenting problem
Olivia is struggling with depression and alcohol misuse. She is currently failing two of her courses and her attendance has been sporadic. According to her professor, she has been smelling of alcohol after lunch and is not engaged in learning, and instead is more interested in what is next to drink. Her intake paperwork reveals that she has a history of alcohol misuse, two residential treatments for alcohol use and depression, and two DUI's.
Olivia has reported that she feels overwhelmed and exhausted all the time, and has difficulty getting out of bed and facing her day. She is sleeping 10-12 hours a day and is isolating herself from her family. She also reports that her husband was recently fired from his job, which has caused a great deal of stress in the home and has led to him asking her to quit school and work until he finds a new job. She has reported that she has been in a "funk" her entire life and has experienced feelings of worthlessness. She has a history of alcohol misuse, which she began engaging in as a coping mechanism after her mother left when she was 14. She has also attempted suicide in the past due to her depression and alcohol misuse, which has caused her to seek help in the form of attending AA meetings.
Olivia is currently exhibiting a number of signs and symptoms of depression, including feelings of worthlessness, difficulty getting out of bed and facing her day, sleeping 10-12 hours a day, and isolating herself from her family. She has also reported that she is struggling with alcohol misuse, which is likely a maladaptive coping mechanism to deal with her depression. Her two DUI's and two residential treatments for alcohol use and depression are further evidence of her struggles with alcohol. Additionally, her husband's recent job loss has likely exacerbated her depression and alcohol misuse, leading to her current difficulty with her studies.
Overall, Olivia is presenting with depression and alcohol misuse. Her current symptoms of depression and alcohol misuse are likely a result of her past experiences, her current situation, and her maladaptive coping strategies which she has employed to deal with her symptoms. Additionally, her husband's recent job loss and the resulting stress it has caused is likely further exacerbating her symptoms.
Client's diagnoses using the DSM-5-TR
Olivia presents with a constellation of symptoms that are consistent with a diagnosis of Major Depressive Disorder, Recurrent, Moderate. According to the DSM-5-TR, this is a mental disorder characterized by five or more of the following symptoms, present during the same two-week period and reflect a change from previous functioning; at least one of the symptoms must be either; depressed mood or loss of interest or pleasure: depressed mood most of the day, nearly every day, markedly diminished interest or pleasure in all, or almost all activities most of the day, nearly every day, significant weight loss when not dieting, or weight gain, or decrease or increase in appetite nearly every day, insomnia or hypersomnia nearly every day, psychomotor agitation or retardation nearly every day, fatigue or loss of energy nearly every day, feelings of worthlessness or excessive or inappropriate guilt nearly every day, diminished ability to think or concentrate, or indecisiveness, nearly every day, recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide, (Himes,2020).
In addition, Olivia meets criteria for Alcohol Use Disorder, Moderate. According to the DSM-5-TR, this is a pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period: Alcohol is often taken in larger amounts or over a longer period than was intended, there is a persistent desire or unsuccessful efforts to cut down or control alcohol use. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects. Craving, or a strong desire or urge to use alcohol. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol (Himes,2020). Important social, occupational, or recreational activities are given up or reduced because of alcohol use. Recurrent alcohol uses in situations in which it is physically hazardous. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
Olivia also meets criteria for Post-Traumatic Stress Disorder, Mild. According to the DSM-5-TR, this is a mental disorder that can occur in people who have experienced or witnessed a traumatic event. It is characterized by avoidance of stimuli associated with the trauma, increased arousal, and negative alterations in cognitions and mood. Symptoms include the following: exposure to traumatic event involving actual or threatened death, serious injury, or sexual violence, persistent re-experiencing of the traumatic event, such as flashbacks or nightmares, avoidance of reminders of the trauma, such as people, places, conversations, or activities, persistent negative alterations in cognitions and mood, such as negative beliefs about oneself or the world, or persistent inability to experience positive emotions, increased arousal, such as difficulty sleeping, hypervigilance, exaggerated startle response, or problems with concentration, (Borlaug,2020).
Assessments used to approach the diagnosis
The first assessment that should be used to approach the diagnosis of Olivia is the Patient Health Questionnaire-9 (PHQ-9). The PHQ-9 is a depression scale that evaluates the severity of depression and can help diagnose major depressive disorder. It is a nine-item self-report that asks questions about the frequency of symptoms experienced over the past two weeks. The score from the PHQ-9 can range from 0-27 and can help to determine the severity of depression, (Borlaug,2020).
The second assessment is the Alcohol Use Disorders Identification Test (AUDIT). This is a 10-item self-report questionnaire that evaluates the severity of alcohol consumption. The AUDIT assesses the quantity and frequency of alcohol consumption, the problems associated with alcohol use, and the alcohol related consequences. The score from the AUDIT can range from 0-40 and can help to diagnose any level of alcohol use disorder (Raskin,2022).
The third assessment is the Attention Deficit Hyperactivity Disorder (ADHD) scale. This is a seven-item self-report questionnaire that evaluates the presence of symptoms associated with ADHD. The score from the ADHD scale can range from 0-14 and can help to diagnose any level of ADHD (Raskin,2022).
In addition to the assessments listed above, it is also important to obtain a thorough family history, a mental status exam, and any other relevant information that can help to provide a better understanding of Olivia's situation. It is also important to note any co-occurring diagnoses such as anxiety or substance use disorders.
The assessments listed above can help to identify any issues Olivia may be facing and can provide a better understanding of her current mental health. It is important to use a combination of assessments to gain a comprehensive understanding of Olivia's situation and to provide the best treatment possible, (Bradley,2022).
Mental health theory application
In this case, cognitive theory is one of the mental health theories that could be applied to Olivia’s situation. Cognitive theory focuses on the individual’s thoughts and beliefs and how they affect behavior. According to cognitive theory, Olivia’s thoughts and beliefs about herself, her life, and her abilities are impacting her behavior in a negative way. She believes that she is not capable of completing her degree and is overwhelmed by her current life situation. This is leading her to make poor decisions, such as drinking and isolating herself from family and friends. (Bradley,2022)
The cognitive theory suggests that by changing her thought patterns, Olivia can change her behavior. To do this, she needs to identify her negative thought patterns and replace them with more positive, realistic thoughts. For example, instead of believing that she is incapable of completing her degree, she can focus on her past successes and the progress she has made. She can also focus on the positive aspects of her life, such as her loving family, and create concrete plans to help her achieve her goals.
By using cognitive theory, Olivia can begin to challenge her negative thoughts and develop more positive, healthier beliefs. This will help her to make better decisions and move forward with her life in a more positive direction. With the help of her therapist and other supportive individuals, Olivia can take the steps necessary to make positive changes in her life and move towards her future goals, (Torous,2018).
Treatment interventions
The treatment intervention in this case would be a Cognitive Behavioral Therapy (CBT) approach with a focus on self-regulatory strategies. This approach is designed to help the client identify and modify maladaptive thoughts and behaviors that are associated with her current struggles. The client's strengths include her intelligence, drive, and dedication to her studies. She also has a strong interest in helping those in similar circumstances to her own. Her weaknesses include her self-regulatory abilities, her tendency to isolate herself, and her high stress levels. Her social support systems include her husband, her children, her faith, and her peers at school.
The long-term goal of the treatment intervention is for Olivia to increase her self-regulation skills and to have better control over her emotions and behaviors so that she can successfully complete her studies and achieve her goals. Additionally, she should be able to manage her stress levels and find healthier coping strategies for her negative emotions
The short-term goals and treatment objectives are to identify and modify Olivia's maladaptive thoughts and behaviors that are associated with her current struggles, (Torous,2018). This includes identifying her triggers and helping her develop better coping strategies when faced with them. Additionally, she should learn how to manage her stress levels, control her emotions, and become more engaged in her studies. She should also learn to recognize and regulate her alcohol use. Finally, she should become more social and develop healthier relationships with her peers and family. (Torous,2018)
Treatment Timeline
|
Time |
Description |
|
Week 1. |
Intake assessment Psychoeducation on substance use, depression, anxiety and stress Cognitive Behavioral Therapy to address irrational thoughts Psychoeducation on the importance of sleep hygiene Education on the importance of self-care |
|
Week 2 |
Group therapy for substance use Individual therapy to address depression and anxiety Couples therapy to address marital issues Family therapy to address parenting and family dynamics |
|
Week 3 |
Stress management skills Mindfulness training Relaxation training Assertiveness training |
|
Week 4 |
Continuing individual therapy Continuing couple’s therapy Continuing family therapy Continuing group therapy |
|
Week 5 |
Continuing individual therapy Continuing couple’s therapy Continuing family therapy Continuing group therapy Exploring relapse prevention strategies |
|
Week 6 |
Continuing individual therapy Continuing couple’s therapy Continuing family therapy Continuing group therapy Exploring relapse prevention strategies Discharge planning |
Systems theory perspective
At the micro level, Olivia’s family systems theory includes her husband and children. The primary focus of the treatment should be on the dynamics of the family system and how each member’s role and behavior affects the entire family. Treatment should address the family’s stressors, such as the husband’s unemployment, Olivia’s depression and alcohol use, and the children’s emotional and academic needs (Raskin,2022).
At the mezzo level, Olivia’s extended family and community should be considered. Treatment should include communication between family members, and possibly family therapy. Additionally, the family should be connected to community resources, such as AA, financial assistance, and educational support.
At the macro level, Olivia’s social environment should be considered. Treatment should focus on the larger social issues that may be impacting her and her family, such as poverty, racism, and lack of social support. Additionally, Olivia’s access to health care and mental health services should be addressed.
Ethical Dilemmas
One potential ethical dilemma in Olivia's case is the issue of her husband wanting her to quit school and work instead. According to the NASW Code of Ethics, social workers should “promote the right of clients to self-determination and assist clients in their efforts to identify and clarify their goals” (2018). By encouraging Olivia to pursue her educational goals, social workers should strive to empower her and help her reach her goals. In addition, social workers should strive to provide a safe and supportive environment for her in which to discuss her goals and make decisions about her future. Finally, social workers should be mindful of the potential power imbalance between Olivia and her husband, and strive to ensure that all decisions are made in Olivia's best interests.
Client’s Diversity Needs
When addressing the diversity needs of Olivia and her family, it is important to use a culturally sensitive and trauma-informed approach. This includes using language that is respectful and understanding of her cultural background and experiences. It is also important to recognize that Olivia and her family may have faced racism, microaggressions, and other forms of oppression (Kelly,2019). The counselor should also be aware of the potential for the family to have experienced generational trauma and should use culturally sensitive approaches when exploring this topic. Finally, the counselor should take into consideration the family's religious background and how this may impact their views on alcohol use and other issues.
Evaluation of the Client’s Progress
When evaluating Olivia's progress, I will use a variety of approaches. I will use a combination of both qualitative and quantitative measures, such as self-report questionnaires, interviews, and observations. I will also use standardized assessments, such as the Beck Depression Inventory, to help measure her progress. Additionally, I will use qualitative measures, such as interviews and observations, to gain a deeper understanding of her progress. I will also use measures such as her academic performance, attendance, and her alcohol use. By using a combination of both qualitative and quantitative measures I will be able to get a more comprehensive picture of Olivia's progress. Furthermore, I will also use self-report questionnaires to more accurately measure her progress. This will allow me to get more detailed feedback from her, which will be invaluable in helping her make progress. Additionally, I will also use family interviews and assessments to gain a better understanding of her family dynamics and how this may be impacting her progress. By using a combination of measures and approaches, I will be able to accurately measure Olivia's progress and make the necessary changes to help her succeed.
References
Shenoy, E. S., Macy, E., Rowe, T., & Blumenthal, K. G. (2019). Evaluation and management of penicillin allergy: a review. Jama, 321(2), 188-199.
Himes, C. P., Ganesh, R., Wight, E. C., Simha, V., & Liebow, M. (2020, December). Perioperative evaluation and management of endocrine disorders. In Mayo Clinic Proceedings (Vol. 95, No. 12, pp. 2760-2774). Elsevier.
Borlaug, B. A. (2020). Evaluation and management of heart failure with preserved ejection fraction. Nature Reviews Cardiology, 17(9), 559-573.
Bradley, L., Noble, N., & Hendricks, B. (2022). DSM-5-TR: Salient Changes. The Family Journal, 10664807221123558.
Raskin, J. D., Maynard, D., & Gayle, M. C. (2022). Psychologist attitudes toward DSM-5 and its alternatives. Professional Psychology: Research and Practice.
Bernet, W., & Baker, A. J. Proposal for Parental Alienation Relational Problem to be Included in “Other Conditions That May Be a Focus of Clinical Attention” in DSM-5-TR.
Torous, J., Nicholas, J., Larsen, M. E., Firth, J., & Christensen, H. (2018). Clinical review of user engagement with mental health smartphone apps: evidence, theory and improvements. Evidence-based mental health, 21(3), 116-119.
Kelly, M., & Coughlan, B. (2019). A theory of youth mental health recovery from a parental perspective. Child and Adolescent Mental Health, 24(2), 161-169.
Levis, B., Benedetti, A., & Thombs, B. D. (2019). Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. bmj, 365.
Costantini, L., Pasquarella, C., Odone, A., Colucci, M. E., Costanza, A., Serafini, G., ... & Amerio, A. (2021). Screening for depression in primary care with Patient Health Questionnaire-9 (PHQ-9): A systematic review. Journal of affective disorders, 279, 473-483.
