I need help with a treatment plan for Lisa using Motivational interviewing and CBT with the following objectives in mind:
(Treatment Plan for Lisa)
Current Symptoms or Indicators:
Quick Case Summary
Lisa (32) is a heterosexual-identified Mexican American female. Lisa's case has forensic underpinnings, she is facing the possibility of losing custody of her twin boys (8 years old) because of a violent attack she launched against her live-in boyfriend where she pulled a knife on him and tried to kill him after an alcohol and methamphetamine abuse-fueled night. While she left the house frustrated because she was unable to harm him as he managed to lock himself inside a bedroom - she was arrested for DUI by the police whom her boyfriend called to report her attempt at his life. This events and the uncovering of her history of substance abuse has more than likely led to the welfare and human services agency to question her ability to look after her children. Upon interview, she shares that when she feels rage, she blacks out sometimes for minutes, at times for hours. In these episodes, she hears the voice of her deceased father who was a drug addict and who was abusive to her mother and their entire family. Her father raised her to be 'tough' and bet on her and her cousins when they were 'trained' in the backyard - Lisa would be pitted to fight against her brothers & cousins to 'toughen' her up so that she can, in her father's mind, learn to survive. Growing up in poverty on the west side of San Antonio, she was exposed early to drugs and (marijuana, cocaine, heroin) alcohol from as early as 12. She is unable to correlate her poverty, rage-blackouts and dangerous behavior to her substance abuse. She is seeking counselling help due to the advice of her lawyer to help her out in her child-custody case.
Treatment Plan Note:
In the preceding therapy model discussion described, I suggest the Motivational Interviewing Model as the most effective way to correct her troublesome conduct, and deal with the tragedy of losing parental control and legal custody of her children. The fact that her boyfriend is also using drugs is an added problem. In my opinion, Lisa must remain in a rehabilitation centre where she can be given all proper attention and care, as well as medical intervention, and psychological and psychiatric counseling. Violence and poverty are the greatest problem for Lisa and her kids; all three of them must be isolated from these environment as much as is possible. To achieve an overall positive change in Lisa, she must undergo a complete rehabilitation program, which will help palliate her sufferings during that entire period of intervention. In this interval, her children will be temporarily under the supervision of the welfare agency. During the rehabilitation program, Lisa would be educated about the evils of drug abuse, and exposed to other positive activities which will help rebuild her life. She will be helped to find jobs from which she could earn a living when she completes her treatment, and be able to support herself and her family. After discharge from the rehabilitation center, I would suggest frequent follow-ups, interviews and visits be arranged for her. The whole family should be supervised and counseled for the next few months for the betterment of all 3 of them.
This is also part of my notes that you can also incorporate as well. I copied portions of this from the book but wanted it to be more personalized for the client.......So again use the above listing but incorporate what you feel is necessary
Symptoms/Behavior: DSM criteria: tolerance as defined by a need for markedly increased amounts of the substance to achieve intoxication or desired affect; withdrawal symptoms are relieved by continued use of the substance; there is a persistent desire or unsuccessful efforts to cut down or control substance use; a great deal of time is pent in activities necessary to obtain the substance, and important social, occupational, or recreational activities are given up or reduced because of substance use. Additional indicators include: self-admission of substance dependence; extensive drug history; family/peer influence; related legal problems.
Treatment Goals/Individual Actions: 1.) Understand concept of addiction. Alter life aspects that will lead to drug-free lifestyle, 2.)Gain insight regarding the impact of addiction on self and family relationships and begin the healing process. Reestablish family relationships. 3.) Establish a positively influencing, sobriety-centered support system (4), Abstain from criminal involvement and consequently successfully complete term of residential treatment.
Attain an increased knowledge of addiction/disease concept
Gain and verbalize increased insight regarding the severity and negative impact of addiction on self, family, and society.
Reestablish family relationship
Gain and implement knowledge obtained regarding relapse prevention process.
Learn and verbalize plans to live a chemical-free lifestyle.
Associate with productive and sober persons.
Cease criminal activity and involvement with gang.
Lisa will participate in short-term residential program as directed
Lisa will complete required assignments to increase substance use/abuse knowledge.
Lisa will identify and discuss the things that contributed to substance abuse.
Lisa will identify and list all those that have harmed her by use/abuse substances.
Lisa will identify high-risk behaviors and situations.
Lisa will develop a plan to effectively cope with high-risks behaviors and situations.
Lisa will work to understand the impact substance abuse/ use has had on her family.
Lisa will spend quality time with non-substance-using family members.
Lisa will attend 12-step meetings, including AA/NA, during and after residential treatment.
Lisa will work to amend family relationships with her boys as part of the relationship 12-step program.
Lisa will abstain from substance related activities
Lisa will report to community supervision officer as required
Lisa will successfully complete residential program
Kinds of Services and Frequency
Daily 1.5 Educational alcohol/drug lecture
Daily recovery dynamics and 12-step work
Weekly individual counseling sessions
Weekly peer group counseling sessions
Weekly office visits with community supervision officer as required
Daily alcoholics anonymous (AA)/Narcotics Anonymous (NA) evening meetings
Submit to weekly breath and urine tests
Weekly big book study
Life skill Training
Family Focus Lesson
Relapse prevention lesson
Anger management lesson
Dear Student, I have provided you with a very comprehensive solution regarding case history and a treatment plan for Lisa (the client you identified). I have included not only case notes, but also a very in-depth analysis of treatment techniques and relapse prevention. If you are happy with my assistance, please consider rating 5/5. If for any reason you are not satisfied with my response, please contact me before submitting your rating. I am here to help you succeed! Good luck with your assignment and thank you for using BrainMass! -Expert #107165
Lisa is a 32 year-old single, heterosexual-identified Mexican American female with two twin children, both boys eight years of age. Lisa is facing the possibility of losing custody of her two children due to a violent household on her part. The police arrested Lisa for a DUI when her boyfriend called to report her attempt to harm him. Lisa has an extensive history of substance abuse to include alcohol and methamphetamine. Because of Lisa's history of substance abuse and violence, the welfare and human services agency is questioning her ability to parent her children. Further, Lisa has presented with "hearing voices" which may be secondary to her substance abuse.
Family and Social History
Upon interview, she shares that when she feels rage, she blacks out sometimes for minutes, at times for hours. In these episodes, she hears the voice of her deceased father who was a drug addict and who was abusive to her mother and their entire family. Her father raised her to be 'tough' and bet on her and her cousins when they were 'trained' in the backyard; Lisa would be pitted to fight against her brothers and cousins to 'toughen' her up so that she can, in her father's mind, learn to survive. Growing up in poverty on the west side of San Antonio, she was exposed early to drugs (marijuana, cocaine, heroin) and alcohol from as early as the age of 12. She is unable to correlate her poverty, rage-blackouts, and dangerous behavior to her substance abuse.
Presenting Problem and Diagnoses
Lisa is seeking counseling help due to the advice of her lawyer to help her out in her child-custody case. Lisa is exhibiting tolerance as defined by a need for markedly increased amounts of the substance to achieve intoxication or desired affect; withdrawal symptoms are relived by continued use of the substance; there is a persistent desire or unsuccessful efforts to cut down or control substance use; a great deal of time is spent on activities necessary to obtain the substance; and important social, occupational, or recreational activities are given up or reduced because of substance use. Additional indicators include: self-admission of substance dependence; extensive drug history; family and peer influence; and related legal problems.
Axis I: 305.00 Alcohol abuse
305.20 Cannabis use
305.60 Cocaine use
R/O Psychotic disorder
Axis II: Deferred
Axis III: None noted
Axis IV: Legal problems; Interpersonal difficulty; Parenting difficulties
The assessment serves many purposes. By giving simple, yet specific questionnaires, the professional can determine whether additional screening or diagnosing is necessary. "Relevant assessment information includes consumption patterns, substance-related problems, expectancies and motives for use, and situational context for use" (Carey & Correia, 1998, p. 736). Three of the best tools or methods include collateral information, biochemical methods, and self-report methods. Although collateral information can be very beneficial in determining an individual's substance use, abuse, or dependence, it is often few and far between due to the fact that those with severe mental illness do not have reliable collateral information, i.e. they are often estranged from family and other networks of information. However, case managers and other treatment professionals are often involved and can provide a first-hand account of the individual's behavior. Biochemical methods include blood, breath, and urine samples to determine "metabolites of abused substances..." (Carey & Correia, 1998, p. 737). Although they are good indicators of a pattern of abuse, they may produce false negatives if the individuals are a "newly" addicted person or if there is a lapse in the use. Self-report methods are a noninvasive approach and can be reliable in some contexts; however, individuals admitted to acute psychiatric settings are often dishonest and misrepresent their addiction. The author recommends combining self-report screening tools with other, more reliable, tools.
Because a plethora of ...
This solution is approximately 2700 words and provides the student with a comprehensive evaluation and treatment plan for Lisa (who has substance abuse issues), including relapse prevention, goals, diagnoses, and more. Nine scholarly references are included.
Substance Abuse Case Study
Steven and Joan are the parents of two children, Jessica (14) and Jeremy (12). Steven and Joan are both recovering substance abusers, and they met while at treatment eighteen years ago. Both had parents who were substance abusers. They attend meetings, and both are active in the recovery community. Steven works as a retail store manager and is under stress from declining sales. He has had to lay off several long-time employees and start doing more of the floor sales himself in addition to the administrative responsibilities.
Joan works as a real estate agent, and while she has been very successful in the past, she has not made a sale in almost a year. She has been looking for other work to supplement their income. They are managing to hold on to their home, but the family budget is very tight. Jessica and Jeremy have had to cut back on extracurricular activities due to the financial strain. Steven and Joan have also started arguing more frequently, as there is disagreement about the family priorities, and Steven is working long hours away from the family. Jeremy is an A student in school and popular with his peers. Jessica struggles to maintain a C average. She has few friends, complains that no one likes her, and tends to isolate herself.
The family has come to see you at a community mental health center because Joan found marijuana in Jessica's room while she was putting away clothes. Steven and Joan blame themselves for not seeing her "addiction" earlier and are concerned that Jeremy is also using, although he denies this and does not see why he has to be in therapy. Jessica blames her parents and does not to talk about it.
Conceptualize how you would engage this family in treatment and what relational issues might be occurring to cause stress within the family system.
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