Client Identification
Problem Statement
Client B. C. has been experiencing emotional issues (anxiety and difficulties developing an appropriate coping mechanism) due to the recent loss of his father. The patient, therefore, lacks the ability to manage his emotions and handle the pressure of his new responsibilities. The absence of social support aggravates the problem.
Associated Issues
Low energy, short attention span, anger, self-isolation, and avoidance can be deemed as the primary comorbid issues. Despite the fact that Patient B. C. defined himself as Catholic, religion does not play a significant role in his life. There is also the lack of peer support that makes the problem even bigger. The client has a criminal record (graffiti, shoplifting).
Suggested Actions
It is recommended that the client should develop an efficient symptom management strategy. Particularly, the development of coping skills is crucial. Thus, the foundation for a positive outcome can be built.
Potential Barriers
The lack of cooperation from the client due to anger management problems can be viewed as the primary issue to be expected. Furthermore, the problems with restoring the relationships between the patient and the community may need to be addressed. Finally, the client is not ready to make changes to his life, which is bound to be a significant impediment.
Vignette
The patient (Client B. C.) is a 16-year-old heterosexual Hispanic man who has been suffering from a behavioral disorder and substance (marijuana and alcohol) abuse. Client B. C. has no known allergies, medical issues, or health concerns linked to the family background. There have been no mental health problems registered up until today, either. There have been no suicidal or homicidal tendencies registered.
The client is currently in the 11th grade. Though there are no evident school problems, Client B. C.’s academic score has dropped greatly. Because of the instances of shoplifting and graffiti, Client B. C. has a criminal record at the Juvenile Court. The patient has been sentenced to 50 hours or community service.
Client B. C. has recently lost his father, who also had a substance abuse issue (alcoholism). With his mother and a little sister, he feels the weight of responsibilities, assuming that he currently is the breadwinner of the family. The fact that he has three younger sisters adds to the overall feeling of responsibility that Patient B. C. is experiencing. The following issues have been reported by Client B. C. and his mother: anxiety, short attention span, lack of motivation, low energy, isolates self at times, and abnormal sleeping patterns. Client B. C. is aware of his problems and recognizes the significance of learning.
Core Clinical Hypotheses
Hypothesis A: Avoidance of specific emotions
Patient B.C. tends to hide his despair and pain under the veneer of anger. Furthermore, Patient B. C. seems to resent the very idea of experiencing the said emotions; therefore, he suppresses them, thus, making them brew and evolve into even greater issues. Therefore, the client must learn to confront the issues through which he has been going. Thus, the foundation for a successful management of the subject matter will be built.
Rationale
The fact that the patient still has anger issues and cannot control his emotions properly should be viewed as the primary reason or choosing the said course of actions. Since it is crucial that the patient should be able to reconcile with his emotions so that the further cooperation could become a possibility, it is imperative to allow Patient B. C. to face and confront these emotions successfully. For this purpose, bringing what lurks under the guise of anger into the light and allowing the patient experience raw emotions is crucial (Anshel & Brinthaupt, 2014).
Hypothesis B: drug addiction
Patient B. C. has been struggling with his drug addiction for quite a while, yet there has been little to no success in suppressing the client’s need to use marijuana as the means of relieving his stress, which calls for a more intensive therapy aimed at managing the drug problem from a cognitive behavioral perspective. Particularly, the patient will need to recognize the problem and cooperate with the therapist to develop the strategy that will help reduce the consumption of marijuana and, finally, abandon it.
Rationale
There are strong indications that the client needs an improved drug management framework. Even though Patient B. C. has acknowledged the problem, no willingness to cooperate in managing the issue has been registered so far. Drug abuse, in turn, is another tool that allows the client to avoid confronting his problems. Therefore, until the consumption of marijuana is stopped or, at the very least, reduced to a minimum, no further improvements can be expected. The management of the drug issue, thus, must be viewed as the first step toward addressing the anxiety problem and preventing the patient’s condition from aggravating (Shonin, Van Gordon, & Griffiths, 2014).
Anxiety (Parent Loss) and Drug Abuse: Current State of Knowledge
Treatment Plan: Emotions Avoidance
Strategy
Seeing that the customer needs to build the approach for managing his anger issues, as well as handle his addiction to marijuana, it is crucial to make sure that Patient B. C. should be able to confront his actual emotions, i.e., the grief that he has been experiencing after his father’s death, the fear of being unable to face the new responsibilities which he accepted as his own after his father’s passing away, etc.
For this purpose, it is crucial to provide Patient B. C. with the support and empathy that he needs to open himself to others. Apart from the emotional help that the therapist will provide, the mother will also have to be invited to convince the client that he does not have to fight his battles alone. As a result, Patient B. C. is likely to realize that he does not have to keep his feelings bottled up inside and, instead, should be more open toward the people that care for him. As a result, Patient B. C. is likely to accept the idea of reducing the consumption of marijuana. Furthermore, the premises for abandoning his drug habits can be built. The identified step will become one of the building blocks for the reintegration into the society (Ayers et al., 2014).
Subgoals
Apart from making Patient B. C. deal with his emotions, one will have to accomplish several other nonetheless relevant goals. For instance, it will be imperative to make sure that the mother and the community members should be invited to participate in the intervention process and provide the support that the client needs to overcome the current obstacles (Azami, Doostian, Motamedi, Massah, & Heydari).
Rationale for focusing on emotions
As stressed above, the inability to control his emotions, particularly, the anger issue, can be viewed as one of the primary impediments of Patient B. C. on his way to recovery. It is essential to convince the patient that they should be open about their emotional experiences so that the patient’s fears could be addressed, and that the appropriate emotion management framework could be used. Arguably, the introduction of an appropriate anger management approach will help address another problem faced by the client, i.e., his drug abuse.
Strength and limitations
Both advantages and disadvantages of the selected approach come from the fact that it requires the client’s acceptance of the treatment and the social/family support. On the one hand, by promoting a conscious approach toward managing the problem, a therapist builds the foundation for a faster and a more efficient treatment process. On the other hand, the stage at which the patient accepts the treatment and starts cooperating willingly with the therapist may take very long to reach, especially given the anger issues and the fact that patient B. C. has been keeping his emotions bottled up and, thus, is rather hard to reach.
Furthermore, relying on the support of peers extensively may not be as reliable as the therapy needs to be at present. Once the patient experiences social ostracism once again, the chances for a successful intervention will be minimized. That being said, the support of peers and especially family members is bound to provide a powerful boost for Patient B. C.’s confidence and, thus, compel him to accept the suggested treatment methods.
Treatment Plan: Drug Addiction
Strategy
The problems associated with the management of the patient’s drug issue are aggravated by the fact that the client displays both chemical and psychological dependence on drugs. Particularly, marijuana serves as the tool for distracting from the problems that the patient is experiencing, yet its consistent consumption must have had its toll on Patient B. C.’s physical state as well. Therefore, it is crucial that a gradual transfer from the current behaviors to the desirable ones should occur. Therefore, the focus on substituting the stimulant with a different tool for managing the emotional issues that the patient is currently facing should be considered the most reasonable step to be taken (Earle, 2016).
Subgoals
In order to address the issue of substance abuse, one should consider using the social support as the foundation for building the strength and resilience that Patient B. C. needs to accomplish the task. Particularly, the significance of family support needs to be explained to the mother and, possibly, the patient’s younger sisters. As a result, the client is likely to receive a powerful impetus for managing his drug addiction and focusing on the development of a different coping mechanism. The function of the social support, in this case, is vital to the success of the treatment outcomes.
Rationale for focusing on drug management
Patient B. C. has been having emotional issues, including problems with controlling his anger. The propensity toward aggressive outbursts, as well as the consumption of drugs, needs to be addressed so that the patient could develop an appropriate coping mechanism that would replace the current destructive behavior. Thus, the foundation for a recovery can be created.
Strength and limitations
The framework suggested above has a potential since it allows the client to recognize the problem and deal with it in a conscious manner. Therefore, the patient is provided with the independence that he needs in order to build enough confidence to become self-sufficient. The identified quality is bound to help him regain faith in himself and, thus, be certain that he will be able to handle the problems that his family is currently facing. Which is even more important, Patient B. C. will finally be able to reconcile with his grief for his deceased father, thus, putting his past behind him and being able to live his life.
However, the treatment plan also has several limitations. For instance, the success thereof hinges on the patient’s willingness to change his behavior and accept the new one that will ultimately help him recover. As long as Patient B. C.’s enthusiasm is maintained at the required high level, the success is guaranteed. However, as soon as the motivation levels drop, the threat a relapse will grow exponentially.
Client Diversity Factors
When approaching the case, one should also bear in mind that the customer comes from a specific cultural background. Therefore, there is a strong need to take the essential characteristics of the Hispanic culture into account. Some of them, such as the significance of family and the relationships between the community members, can be considered very useful in implementing the required treatment strategy. The possible issues associated with the acculturation of the family and the socioeconomic status thereof will also have to be taken into account as essential diversity factors that are likely to influence the outcome of the treatment plan implementation. Therefore, as long as the therapist keeps in mind that the patient’s family is affected by a range of socioeconomic and sociocultural issues, the efficacy of the intervention is bound to remain high.
References
Anshel, M. H., & Brinthaupt, T. M. (2014). An exploratory study on the effect of an approach-avoidance coping program on perceived stress and physical energy among police officers. Psychology, 5(7), Article ID:46163. Web.
Ayers, T. S., Wolchik, S. A., Sandler, I. N., Twohey, J. L., Weyer, J. L., Padgett-Jones, S.,… Kriege, G. (2014). The Family Bereavement Program: Description of a theory-based prevention program for parentally-bereaved children and adolescents. Omega (Westport), 68(4), 293–314.
Azami, Y., Doostian, Y., Motamedi, A., Massah, O., & Heydari, N. (2016). Dysfunctional attitudes and coping strategies in substance dependent and healthy individuals. Iranian Rehabilitation Journal, 13(23), 49-53.
Earle, T. (2016). The use of hypnosis as an adjunct to cognitive–behavioural therapy in treatment of problem gambling developed as stress management following a workplace injury. Australian Journal of Clinical and Experimental Hypnosis, 41(1), 84-99.
Ingram, B. L. (2011). Clinical case formulations: Matching the integrative treatment plan to the client (2nd ed.). New York, NY: Wiley.
Shonin, E., Van Gordon, W. & Griffiths, M.D. (2014). Cognitive behavioral therapy (CBT) and meditation awareness training (MAT) for the treatment of co-occurring schizophrenia and pathological gambling: A case study. International Journal of Mental Health and Addiction, 12(2), 181-196.