Marcella, a new clinician, tells her supervisor that her efforts to help a client are
going nowhere.
Marcella, who has a frail elderly parent, is focused on the client's
feelings about putting her mother in a nursing home, but the client is actually most
concerned about finding reliable child care. What should the supervisor do?
A. Help Marcella determine who owns the problem.
B. Remind Marcella that she need not have all the answers.
C. Coach Marcella on how to support grieving clients.
D. Work with Marcella to discern the underlying issues.
A
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Briefly describe the following major crime efforts of organized crime: gambling, drug trafficking, loan sharking, infiltrating legitimate businesses, labor racketeering, and prostitution
What will be an ideal response?
Some of the therapeutic strategies of Haley' strategic approach include:
a. Engagement, involvement, disentanglement b. Spontaneity, humor, metaphor c. Intensity, role modeling, encountering d. Directives, homework, interruption of patterns maintaining problems
Do Vlad’s disruptive behaviors seem to arise out of frustration because of his inattention and hyperactivity?
DSM Diagnosis 312.82 Conduct Disorder, Adolescent-Onset Type, Mild 304.30 Cannabis Use Disorder, Severe, in Early Remission, in a Controlled Environment Sinus problems Allergies Rationale The diagnosis of Conduct Disorder was given due to Vlad’s pattern of persistent disregard for authority, rules, and the feelings of others, which started three years ago. Three symptoms are required and Vlad meets the following: 1) Under aggression to people and animals, Vlad has admitted to physically assaulting his girlfriend on two different occasions while under the influence of drugs and alcohol. One of his criminal charges involved Unauthorized Possession of a Fire Arm. 2) Under deceitfulness or theft, Vlad has broken into his neighbor’s house, where he stole money and electronics. 3) Under serious violations of rules, Vlad’s behaviors include disregarding curfew, running away from home, and truancy from school. Vlad’s behavioral disturbance causes significant impairment in his academic functioning. He received failing grades due to skipping class, and eventually had to resort to getting his GED. In addition, his behaviors have resulted in strained family relationships and legal involvement. As a result, Vlad now lives at a residential treatment programs rather than being able to live at home. In addition, his disobedience towards regulations has contributed to his termination from several previous placements. Although the case presentation does not allude to any conduct behaviors within the last six months, as stated by criterion A, Vlad has been placed in a restrictive placement, and therefore, his ability to commit antisocial acts has been curtailed. The “adolescent-onset type” was identified, as the appropriate subtype since Vlad’s conduct problems appeared to start at age 14. “Mild” was specified because Vlad does not demonstrate conduct problems in excess of those required to make the diagnosis, and his behaviors cause only minor harm to others. The diagnosis of a cannabis use disorder was also given. Vlad has shown tolerance for marijuana, evident by increasing the amount to achieve the desired effect and by diminished effect after prolonged use. He also admits to cravings. Further evidence for the appropriateness of the cannabis use disorder is that even when Vlad has attempted to control or limit his use, he has been unable to do so. His relationship with his family, his academic performance, and involvement with basketball have suffered due to his use. The specificer “severe” was added because he meets more than six symptoms of the disorder. The controlled environment specifier was used because his incarceration precludes access to marijuana despite continued cravings for the drug. Additional Information Required In order to rule out an alcohol use disorder, Vlad would be assessed for his tolerance for alcohol, if he had any unsuccessful attempts to quit or cut down, how much time he’d spent seeking out alcohol, drinking, and recovering from its effects. While cannabis is his drug of choice, Vlad consumed alcohol when it is not available and to supplement its effects. Of concern is that he was using alcohol (as well as marijuana) when he hit his ex-girlfriend. Although the information might not be available, it would be interesting to know about Vlad’s early history before he was expelled from his family of origin. What was the pattern of his relationships then? Inquiry about possible PTSD symptoms would also be helpful, especially in terms of the re-experiencing and increased arousal criteria. Information about his past failed placements might be helpful to understand Vlad’s patterns and what might make him vulnerable to being unable to complete the program. In order to improve the relationships within his family, it would be important to understand Vlad’s resentment toward his adoptive mother. What is the source of this resentment? What are his perceptions of her? How often do he and his adoptive siblings now communicate (speak/write) with his mother while she is overseas? Course While there are many risks contributing to the onset of his substance use, most of them related to his early childhood, Vlad has a number of current protective influences that might help his recovery. At the individual level, he is intelligent and can be academically successful when he is motivated. He has educational and occupational goals. He understands his behavior and substance use could prevent him from succeeding in these areas. Risk at the individual level includes his concurrent disorder of conduct disorder. Social protective influences involve the supportiveness of his family and their financial resources. What techniques could be used to elicit additional strengths? 1. Ask Vlad about the resilient qualities he possesses “to make it this far, despite a very difficult early upbringing.” 2. Exception-finding: Identify times he is not experiencing the marijuana cravings or when they are less intense. What is different about those times? What is he doing? Who is he with? What is he saying to himself? 3. Vlad struggles with anger. Identify times he handled his anger appropriately. What did he do differently then? Who was there? How were they helpful? 4. Vlad mentioned that he was able to stop his alcohol use when he wanted to in the past. What motivated to stop? How was he able to do it? How did he deal with any cravings? How can he use these strategies to work on the marijuana problems? 5. Because artwork has been a way for Vlad to express himself, externalizing (times when he is able to control the marijuana use, talk back to the cravings, not let anger tell him what to do) could be drawn. 6. How was he able to apply himself and get his GED so quickly? 7. It is stated that Vlad’s relationship’s with his father has improved. What did Vlad to do to make this happen? 8. What talents does he have to “fix things?” How does he go about solving problems when things are broken? How could he use some of these strategies to approach his current challenges? 9. Vlad’s seems like he’s applying himself to this residential treatment program, in contrast to the other programs in which he was unsuccessful. What was helpful and not helpful about past treatment? What is he doing differently this time? How will he make this program work? 10. Decisional balance: What does Vlad get out of substance use? What does he lose? What does he get out of handling his anger in ways that get him in trouble? What are the disadvantages of this pattern of behaving? Treatment Motivational interviewing should be used initially to enhance Vlad’s motivation to remain abstinent and to control his anger. Next, cognitive-behavioral therapy may help the client to address his substance use problems and the disruptive behaviors that occur with them (feeling identification and management, impulse control, and problem-solving). Family work can help Vlad and his parents to build cohesion, affection, and communication. Vlad’s parents should also be trained on how to set consistent limits on his behavior with clear consequences to follow for infractions. The social worker will also consult with a psychiatrist to determine if medication is appropriate and could be beneficial for Vlad. Finally, the social worker should identify community resources for Vlad, so that he can gain employment experience in mechanical or technical settings and pursue his desire to attend a technical school or community college. Critical Perspective In consideration of the diagnosis of reactive attachment disorder, some of the problems in diagnosing this disorder in teenagers and adults come to light. The DSM identities the disorder as arising in early childhood (before the age of five), and talks about the course as often “continuous.” However, it does not detail how the disorder would evidence itself as the individual grows out of childhood into adolescence and adulthood. The other issue that emerged when diagnosing Vlad was figuring out which disorder to present as primary – conduct disorder or the substance use disorders – and to disentangle how one influences the other. Substance use behaviors could easily be part of the syndrome of conduct disorder, as Vlad’s case illustrates. Indeed, the risk and protective influences for the development of conduct problems and substance use are very similar. Therefore, it is not that one problem causes another but that they co-occur together (Wei, Loeber, & White, 2004).
Describe the objectives of Alcoholics Anonymous. Give reasons why self-help groups are successful
What will be an ideal response?