Axis I 304. 30 Cannabis Dependence, With Physiological Dependence, Early Full Remission – In a Controlled Environment Substance-Induced Psychotic Disorder, Cannabis, with with Onset during Intoxication 302. 82 292. 11 Delusions Voyeuristic Disorder 302. 4 Exhibitionistic Disorder Axis II 301. 83 Borderline Personality Disorder with Narcissistic features Axis III 71. 9 None Axis IV is currently unemployment, history of substance abuse; familial history of mental illness, attempted suicide, difficulty is maintaining long term relationships, poor impulse control, unstable emotional state, unpredictability, and manipulative GAF = 55 (at time of assessment) and volatile behavior. Axis V Conceptual Formulation There are psychological interventions that can be used with Billy Dee they include motivational interviewing (MI), Narrative Career Counseling, and Good Lives Model (GLM).
The Good Lives Model (GLM) suggests that the reason offenders offend is because their basic needs have not been meet. These offenders lack resources making meeting these needs a challenge, they lack either capacity or are unable to because they are need able to do so, and there is conflict with what they want with what they have (Barrnett, Manderville-Norden, & Rakestrow, 2014). Good Lives Model exercises are based on values and priorities while at the same time offering encouragement in creating goals and achieving them is a pro-socially Barnett et al. , 2014).
GLM aims of treatment include building motivation for a better life, to practice the skills required for achievement of having a better life and the supported needed for a better life; and using action planning for lasting change (Barnett et al. , 2014). Motivational interviewing is considered a non-confrontational approach; it is client-centered, works with the client’s cognitions that offer directions of health-seeking behaviors (van Wormer, 007). Principles of MI include expressing empathy, developing discrepancy, supporting self-efficacy, and rolling with resistance (Chanut, Brown, & Dongier, 2005).
Expressing empathy is done through both verbal and non-verbal listening skills so that that the mental health professional can fully understand the client whereas developing discrepancy refers to understanding where the client is in terms of “readiness” to change their behavior (Chanut et al. , 2005). Supporting self-efficacy refers to having a positive attitude toward the process of treatment so that outcome is successful for example, being open to discussing heir problems because they are taking responsibility for their actions (Chanut et al. , 2005).
Rolling with resistance refers to the professional not confronting the problems as if they were the client rather letting the client confront their problems (Chanut et al. , 2005). Chanut et al (2005) provides strategies that are used during sessions they include: the use of open questions so as to allow active elaboration, affirmation of the patients’ self-efficacy and support, the use of reflecting for example, rephrasing what the client has said; and the use of summarizing which allows rganization of the client’s narratives allowing the promotion of change.
Narrative career counseling refers to emotional, action- oriented, personal approach to career counseling in which client and counselor collaborate to review and create career stories in order to inform career decisions and actions (Mcllveen & Patton, 2007). In order to confront one’s career identity they experience challenges such as having to draw upon their personal feelings, and finding one’s purpose that is different from those around them (Mcllveen & Patton, 2007).
Narrative emphasizes the social processes in creating knowledge, connecting it to the individual f such knowledge, and this mode of thinking and organizes our thoughts. The main principle in relational theories is that these relationships are central to human functioning throughout one’s life (Patton, Mllveen, & Schultheiss, 2012). The language use of this style involves interpersonal relationships for example authenticity, mutual respect, mutuality, embeddedness, relational connections, disconnections, and reconnections (2012).
Stages of narrative exploration are as followed: Stage 1 – negotiating a contract which involves asking question such as how can I be useful, tell me why is this important, indentify opics and related issues; Stage 2: exploring the story which involves asking questions about role models when young, hobbies/free time interest, books, favorite school subjects or disliked subject; and Stage 3 – identified goals, agreeing what action is required for example identifying potential action, evaluating potential action, clarifying the action steps, checking/ asking what has been achieved today (National Guidance Research Forum, 2007).
An assessment tool that was given to Billy Dee that deals with career planning is the Myer-Brigg Type Indicator (MBTI) Personality Test. The MBTI measured a erson’s preference based on personality traits.
The knowledge that is obtained from the MBTI research provides a type of empowerment in that individuals can (a) achieve insight into their sources of energy, information gathering, decision making, and personal lifestyle or orientation; (b) strengthen interpersonal relationships based on an objective view of individuals’ underlying rationales for their reactions to highly charged emotional issues; (c) gain opportunity to consider different ways of meeting objectives; and (d) find encouragement toward more constructive and complementary ses of their preferences and differences.
Treatment Plan Billy Dee’s referral was related to the following identified problems: cannabis dependence voyeurism, exhibitionism; substance induced psychosis with delusions; high risk of dangerousness, relationship problems; occupational problem; and Borderline traits. Treatment goals and interventions are evidence-based.
1. Identified Problem: Borderline traits Treatment Goals: Long-term goals include developing a plan of recovery that reduced the impact of borderline traits on abstinence, to develop and be able to demonstrate coping skills o reduced mood swings and control impulses, to understand how borderline traits can cause relapse in addictive behaviors, to reduce any self-damaging behaviors such as suicide ideation, and to terminate dichotomous thinking, unmanaged anger, and/or fear of being abandoned (Perkinson & Jongsma, 2009).
Interventions: Interventions in the treatment of borderline traits include exploring history of abandonment during childhood years, validate distress and difficulties in thoughts and feelings; assess the client’s need for and arrange for a prescription, if appropriate; and use behavioral strategies to teach identified kills, strengthen them, and facilitate incorporation into everyday life (Perkinson & Jongsma, 2009).
Additional interventions include reinforcing the client’s positive, reality- based cognitive messages that enhance self-confidence and increase adaptive action and facilitating the client’s personal growth by helping him choose experiences that strengthen self- awareness, personal values, and appreciation of life (Perkinson & Jongsma, 2009).
2. Identified Problem: Cannabis Dependence Treatment Goals: Interventions: 3. Identified Problem: Voyeurism/Exhibitionism (Sex Offender Treatment) Treatment Goals: The goals include taking esponsibility for their abusive behavior, see how the abuse has effect the victim, increase control over their life by setting positive goals, recognize lapse and relapse so that able to prevent the lapse before it becomes a relapse, recognize the links in the abuse cycle, and identify any high-risk behavioral states or situations that would could reoffending to occur (Barnett et al. , 2014).
Interventions: 4. Identified Problem: Dangerousness Treatment Goals: Long-term goals to reduced risk of dangerousness include terminating all acts that are dangerous to self or others, verbalize the core conflicts that lead to angerous/lethal behaviors, to increase self-esteem, purpose for living, and learn how to help others in recovery; to recognize the first signs of anger and use behavioral techniques to control it, and to maintain appropriate boundaries and setting limits when acting dangerous toward self or others.
Interventions: Interventions to decrease high risk of dangerousness include encouraging the client to participate in exercise for at least 20 minutes each day; monitor implementation, reinforcing success, and redirecting for failure; have a journal where they document their intensity of dangerous feeling which you will teach them ow their inaccurate thinking leads to those feelings of anger which will help in the elimination of the aggression behavior.
Additional interventions include having the client sign a no-harm contract which will deal with not harming self or others and have them promise if they have the urge to harm to tell someone. 5. Identified Problem: Substance-Induced Psychotic Disorder, Cannabis, with Delusions with Onset During Intoxication Treatment Goals: Control or eliminate active psychotic symptoms, such that supervised functioning is positive and medication is taken consistently. Significantly reduce or liminate hallucinations and/or delusions.
Eliminate acute, reactive, psychotic symptoms, and return to normal functioning in affect, thinking, and relating. Stabilize functioning adequate to allow treatment in outpatient setting. Develop adaptive methods to cope with symptoms, and seek treatment when necessary. Terminate the use of cannabis (Perkinson & Jongsma, 2009). Interventions: Administer to the client psychological instruments designed to objectively assess addiction relapse for example, the Substance Abuse Relapse assessment (SARA) and give the client feedback regarding the results of the assessment.
Help the client to understand why is it essential to implement a daily program of recovery to maintain abstinence. Help the client to develop a plan that will increase the rewards obtained at recovery groups. Discuss with the client the distinction between a lapse and relapse, associating a lapse with an initial, temporary, and reversible use of a substance and relapse with the decision to return to a repeated pattern of abuse (Perkinson & Jongsma, 2009). 6. Identified problem: Relationship difficulties Treatment Goals: Interventions: Treatment Summary Ethical and Legal Issues
