1-2 Journal-Top Three Problems
Tabbie Bozeman
Katie N. is presenting for substance use problems. She is only seeing me because she got
a DWI (driving while intoxicated). It is a condition of her therapy. She feels as if she was
trapped into a DWI, failing to take ownership of her drinking and driving.
The top three problems are;
Substance use- potential for multiple substances
Guilt over her sister’s death when she was nine years old
Self-loathing, possible depression, in need of a mental health evaluation.
In speaking to Katie, her first introduction to substances began at the age of fifteen at a
friend’s house. “That first drink was like, wow! It made feel so happy, and I haven’t felt happy
in a long time.” (case study Katie N.) Further evidence of her substance use is that she has tried
marijuana (no longer uses, made her paranoid) cocaine and ecstasy. She still fantasizes about
using cocaine because “ she feels down a lot’ and wishes she could go back to using cocaine “ to
feel better and get more things done.” (case study Katie N.) She and her husband Joe argue over
her drinking, and she was pre-disposed to substances from her mother drinking alcohol heavily
after her sister died.
Katie blames herself for her sister’s death. When she was nine years old walking to a
friend’s house. She was distracted by a stray cat and did not cross in the walkway at the same
time as her sister Sarah. Sarah was struck and killed in the crosswalk by a driver who was not
paying attention. Katie has guilt, “If she hadn’t been dealing with the cat, she might have been
able to prevent her sister from being hit.” (case study Katie N.) What Katie fails to realize is that
both her and her sister might have died that day because the driver was not paying attention.
There is nothing she could have done to prevent a freak accident.
She appears to be depressed about her lack of success career wise. “Thinks she is a loser
when she looks at her friends from high school who are working in better jobs.” (case study
Katie N.) Talks about being depressed and blames the cops for the situation that she is in.
She will benefit from intense outpatient therapy to help her overcome her substance abuse
issues. She could also benefit from some type of grief therapy regarding her sister’s death. I
would also add group therapy and a mental health evaluation. It is time for Katie to start to deal
with her sister’s death and her guilt surrounding it. This will help her make better, sound
decisions regarding herself and her own worth.
References
Case Study: Katie N.
