Regene_Best_case_conceptualization_u9a1

docx

School

Egerton University *

*We aren’t endorsed by this school

Course

4002

Subject

Psychology

Date

Nov 24, 2024

Type

docx

Pages

Uploaded by nyakwarokiro

Case Conceptualization Assignment 9 COUN-R5863 Regene Best Mental Health Counseling 1

Case Conceptualization Client Description Name: Rita Age: 32 Presenting Issues Rita is a 32-year-old female with depressive symptoms that she relates to her drinking habits. She is married with children. However, her husband left with the children following a disagreement when she was intoxicated. Her main support frame includes her parents, her husband and children, and her workmates especially her boss and her deceased friend. Rita is socially active but is currently worried about her marriage because she is unable to link up with her family, her husband never returns her calls or messages. She misses them and is worried about their safety since she has no idea where they are at the moment. As much as her parents and other associates are also mentioned in her assessment, it is evident that Rita had the main support system in her family and her longtime friend who is no more. Rita is experiencing mixed reactions that she attributes to alcohol, the fall of her marriage, and the death of her friend. She is unable to come to terms with her friend’s death since she affirms that her friend provided the main emotional support on different occasions. It is imperative to note that her alcoholism has escalated after the demise of her friend. Rita’s responses also revealed a significant magnitude of depression. Her marriage is broken and she can’t relate to her husband or children. Rita is confused and seeks to find a solution to her drinking problem which she believes is the main stressor in her current depressive problems. Her boss noticed her current incompetence and recommended therapy that would help her restore her 2

normal self before losing her job. According to Gold et al. (2020), depression and Alcohol Use Disorder (AUD) co-occur such that 33% and above suffering from AUD also suffer from depression. The complex relationship between the two disorders escalates the symptoms experienced by people who have the two disorders at the same time. based on the mentioned analogy, assessing Rita for further information is imperative before embarking on a more appropriate treatment plan. Assessment Rita is confused. More importantly, her depressive symptoms accrued with time after her friend’s death and the departure of her husband and children after a fight. The mentioned analogy hints at the fact that her drinking habits are not influenced by depressive symptoms. In other words, Rita did not opt for alcohol use as a coping measure. Rather, her consistent use of alcohol resulted in her depressive state because of the pressure and trauma she is going through at the moment. It is imperative to mention her current ineffectiveness at her workplace which has been noticed by her boss. Rita is experiencing mixed reactions that she attributes to alcohol, the fall of her marriage, and the death of her friend. She is unable to come to terms with her friend’s death since she affirms that her friend provided the main emotional support on different occasions. Based on her experiences, a possible diagnosis of Alcohol Use Disorder (AUD) with depressive symptoms is imperative. According to the American Psychological Association (2013), the DSM-5 criteria for Alcohol Use Disorder considers at least two symptoms that cause clinically significant impairment or distress. From Rita’s assessment, she takes alcohol in large amounts since she was a teenager. Secondly, her persistent efforts to control alcoholism are unsuccessful. Additionally, the client reports consistent craving for alcohol making her addiction escalate beyond control. 3

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

She also has problems at the family and job level as indicated by her husband’s departure and the boss’s ultimatum if she needs to retain her job. She persistently used alcohol despite the problems associated with the habit. Lastly, Rita is aware of her current psychological health status. Her boss also noticed her change and ineffectiveness. However, she has continued alcohol use despite being cognizant of the damage alcoholism has in her life. It is imperative to note that Rita showed signs of significant tolerance and withdrawal during her assessment. Other than AUD, Rita showed comorbid symptoms of depression. Therefore, it would be appropriate to consider her complaints of an unsettled mind alongside loneliness. According to Gold et al. (2020), the majority of alcoholic individuals suffer from depression making their conditions worse compared to those without the second condition. The magnitude and frequency of the symptoms are, however, not enough to meet the criteria for major depressive disorder or a similar depressive order that stands alone. Therefore, the DSM-5 criteria associate Rita’s symptoms with a short-duration depressive episode characterized by significant distress or impairment that persists for more than 4 days, but less than 14 days (American Psychological Association, 2013). Several scales are used to assess the severity of AUD and depressive symptoms. The Alcohol Use Disorders Identification Test (AUDIT) will provide comprehensive information about Rita’s level of alcohol use to advise on the best treatment plan. According to Higgins- Biddle et al. (2018), AUDIT is a simple and effective method of screening for unhealthy alcohol use, defined as risky or hazardous consumption or any alcohol use disorder. The counselor will use the 10-item screening tool to outline the best framework for intervention by identifying the drinking behaviors and the associated problems in Rita’s case. Additionally, the counselor will incorporate the Beck Depression Inventory (BDI), a 21-item self-reporting questionnaire, to 4

evaluate the severity of depression in Rita’s case before proceeding to establish the treatment plan. BDI helps in outlining the severity of any depressive condition (Jackson-Koku, 2016). Ethical and Legal Considerations/Implications Various ethical considerations will be effective in Rita’s case. Based on the fact that the counselor conducted virtual assessments, technology-assisted counseling would be appropriate to consider. According to American Counseling Association (2014), the ACA Code of Ethics section H.4.b. highlights Professional Boundaries in Distance Counseling. This section states that “Counselors understand the necessity of maintaining a professional relationship with their clients. Counselors discuss and establish professional boundaries with clients regarding the appropriate use and/or application of technology and the limitations of its use within the counseling relationship (e.g., lack of confidentiality, times when not appropriate to use)” (ACA, 2014). This ethical guideline compels counselors to apply the relevant tools to avoid misinterpretation and misunderstandings throughout the session. Additionally, when the counselor is unable to create a comprehensive assessment, section A.11.a. of the code of ethics encourages the counselor to address Competence Within Termination and Referral to build rapport with Rita in the process (ACA, 2014). Lastly, the counselors are further encouraged to practice within their professional competence in section C.2.a. to minimize avoidable complex ethical decisions and issues in the long run. The need for an ethical platform in counseling is imperative in every state to embark on acceptable practices that uphold the clients’ welfare. In the state of Virginia, informed consent applies to both physical and virtual counseling scenarios. According to the mentioned analogy, providing informed consent ensures the therapist-client involvement follows the legal process and counseling process highlighted in the Virginia Board of Counseling - Laws & Regs (2022). 5

The board further emphasizes confidentiality and privacy of the client’s information necessary to complete a viable counseling outcome. As a counselor, I will uphold professionalism throughout the sessions after building a therapeutic relationship with Rita. With utmost positive regard and active listening, I will execute the necessary counseling procedures to ensure her problems are well-stated and acted on appropriately. Multicultural Considerations Firstly, the American Counseling Association (2014) outlines in section B.1.a. that “Counselors maintain awareness and sensitivity regarding cultural meanings of confidentiality and privacy. Counselors respect differing views toward the disclosure of information. Counselors hold ongoing discussions with clients as to how, when, and with whom information is to be shared.” As a female Caucasian, observing cultural sensitivity throughout the virtual session is imperative in preventing silent biases. The mentioned analogy is further echoed by Constantine and Ladany (2001) who attribute the dynamics of evaluating multicultural counseling competence to the methods used to measure this construct. As the authors assess multicultural counseling including salient limitations of the methods used to bring authentic multicultural competence, an expanded conceptualization defines the limits a counselor should work to deliver the best therapy for all clients. The background factor strongly shapes the skills and techniques a counselor opts to integrate into any therapeutic platform (Constantine & Ladany, 2001). Therefore, there is a need for future practice, research, and training implications for the development and measurement of multicultural counseling competence because cultural sensitivity is essential for all counselors in their respective counseling spectra. Cultural sensitivity ensures a stronger rapport and trust between therapists and clients are built to sustain their therapeutic engagements. Rita has a reduced self- 6

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

esteem attributed to her excessive alcohol use and sudden depressive symptoms especially after her family decided to leave. Upholding multiculturalism will ensure her problems are not compounded in counseling engagements. Consistent cultural training and exposure to different client backgrounds facilitate my cultural sensitivity. This applies to Rita’s case too because I will consider the culturally sensitive tools to assess and diagnose her problems. By appreciating her color, race, language, and accent, for example, Rita will have more freedom to express her problems effectively. Avoiding negative labeling associated with alcoholic individuals will also reduce possible discrimination that counselors get into subconsciously. Self-Awareness Self-awareness is necessary throughout a counseling engagement to initiate self- protection while upholding the best interest of the client. Ugwuanyi et al. (2020) explore the essence of an effective therapeutic engagement by looking at the outcomes realized based on self-awareness. According to the authors, self-awareness bolsters the counselors' perception of their personalities, strengths, beliefs, thoughts, emotions, and motivation that are embodied in their proficiency gained through training and supervised experience considered before licensing. Therefore, a professional counselor with appropriate skills and standards provides outstanding services to their respective clients in the long run. This analogy applies to Rita’s case where exceptional services will be imperative to avert her drinking problem that co-occurs with depressive symptoms. Personal bias hinders the realization of a perfect therapeutic outcome. Rita is a lady, with a traumatized feeling of separating from her family after losing a friend who died. Her thoughts might be overruled by emotions. As a counselor, observing empathy and active listening will 7

help avoid misinterpretation of her problems in any assessment. When exposed to tough counseling encounters, section I.2.c. encourages counselors to consult other professionals to avoid compounding the uncertainties involved. Professional consultations and possible referrals are imperative in reducing the pressure associated with a given counseling process. Interventions Rita’s intervention will be Rational Emotive Behavior Therapy (REBT) which imparts a change in clients within a short period by identifying irrational beliefs and replacing them with more productive and healthy ones as reported by Ellis (2021). Therefore, based on the principles of activating events, beliefs, and consequences (ABCs), REBT will provide a guide to the interventions for Rita’s AUD and depression. Firstly, REBT will help Rita deal with her alcoholism by considering it as irrational behavior that is impacting her life negatively. By engaging herself in the battle of interest to outline how her irrational beliefs would influence irrational behavior, Rita will gain from the various skills and techniques that reflect directly into her drinking problem based on the ABCs principles. Under the A category, the counselor applies problem-solving techniques such as assertiveness, conflict resolution skills, social skills, problem-solving skills, and decision-making skills as stipulated by Ellis (2021). On the other hand, the B category comprises Cognitive restructuring techniques including disputing irrational beliefs, guided imagery and visualization, humor and irony, and reframing while category C helps manage the emotional consequences through techniques such as hypnosis, relaxation, and meditation (Ellis, 2021). Associated tools include REBT Problem Formulation, REBT Consequences Analysis Form, and a Dysfunctional Thought Record (Ellis, 2021). The highlighted tools will establish consistency while handling both AUD and depression. REBT will 8

tach Rita coping skills and stress management techniques to change the thoughts that cause a desire to drink (Ellis, 2021). Another individual intervention would be through the use of medications for AUD and depression. According to Hyman (2023), FDA approves three medications including disulfiram, acamprosate, and naltrexone. On the other hand, selective serotonin reuptake inhibitors (SSRIs) are first-line antidepressants that will bolster the role of REBT in combating Rita’s depression. Examples of SSRIs include fluvoxamine and escitalopram (Currie & MacLeod, 2020). Group treatment bolsters individual treatment thereby accelerating a client’s recovery process. Attaching Rita to a group setting such as Alcoholics Anonymous (AA) will help her establish a collaborative approach to handling her drinking problems that have induced depressive symptoms. According to Kaskutas (2009), AA believes that people struggling with addiction likely cannot moderate their drinking and need to stop altogether. The program adopts a collaborative approach to abstinence from alcohol and collective recovery support to minimize excessive alcohol use. When Rita’s drinking habits change positively, she will also reduce her depressive symptoms. At the community level, various activists recommend the increase of alcohol taxes as a way to tame the expenditures on them. Other interventions include enhancing enforcement laws prohibiting sales to minors and regulating alcohol outlet density (Hyman, 2023). Engaging in school-level interventions also facilitates recovery. However, Rita does not belong to the Individuals with Disabilities Education Act (IDEA) because she did not present any disability. The counselor will not consider the various School-level interventions such as programs, classroom guidance, and interventions. Otherwise, I would further collaborate with Rita’s parents, her husband, and her boss to digest her problem comprehensively. 9

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

Conclusion This paper focused on the case of Rita, a client suffering from AUD with comorbid depressive symptoms. Her drinking spree impacted her family causing the breakage of her marriage. Various assessment tools such as the AUDIT and BDI were incorporated to help establish the severity of her condition. Additionally, appropriate interventions were used to create a treatment plan, including individual therapies, group therapies, and community interventions were applicable. The counselor considered REBT for individual therapy alongside medications while group therapy upheld the AA proceedings. The counselor also explored the ethical, legal, and cultural framework to avoid jeopardizing the counseling process. 10

References American Counseling Association. (n.d.). 2014 ACA code of ethics [PDF]. https://www.counseling.org Constantine, M. G., & Ladany, N. (2001). New visions for defining and assessing multicultural counseling competence. Currie, J. M., & MacLeod, W. B. (2020). Understanding doctor decision making: The case of depression treatment. Econometrica, 88(3), 847-878. Ellis, D. J. (2021). Rational emotive behavior therapy. American Psychological Association. Gold, S. M., Köhler-Forsberg, O., Moss-Morris, R., Mehnert, A., Miranda, J. J., Bullinger, M., ... & Otte, C. (2020). Comorbid depression in medical diseases. Nature Reviews Disease Primers, 6(1), 69. Higgins-Biddle, J. C., & Babor, T. F. (2018). A review of the Alcohol Use Disorders Identification Test (AUDIT), AUDIT-C, and USAUDIT for screening in the United States: Past issues and future directions. The American journal of drug and alcohol abuse, 44(6), 578-586. Hyman, Z. (2023). Medically Assisted Treatment for Alcohol Use Disorder Unfortunately Has Its Limitations. The Journal for Nurse Practitioners, 19(4). Jackson-Koku, G. (2016). Beck depression inventory. Occupational Medicine, 66(2), 174-175. Kaskutas, L. A. (2009). Alcoholics Anonymous effectiveness: Faith meets science. Journal of addictive diseases, 28(2), 145-157. Ugwuanyi, C. S., Okeke, C. I., Agboeze, M. U., Igwe, N. J., Eya, N. M., Ejimonye, J. C., ... & Ugwuanyi, C. K. (2020). Impacts of cognitive behavior therapy on occupational stress among science and social science education facilitators in open and distance learning 11

centers and its implications for community development: A randomized trial group. Medicine, 99(41). Virginia board of counseling - Laws & Regs. (2022). Virginia Department of Health Professions. https://www.dhp.virginia.gov/counseling/counseling_laws_regs.htm 12

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

Regene_Best_case_conceptualization_u9a1

Related Documents