Cognitive Behavioral Therapy (CBT) has been advised that it is more beneficial in impeding relapse with depression and alcohol use over the long term (Besenius, Beirne, Grogan & Clark-Carter 2013). CBT goal is to identify the problem and identify the negative behavior with the intent to minimize the problem. The idea is to develop techniques to learn to cope with the negative behavior. Once coping strategies are implemented the therapist can establish a steady baseline to evaluate the fluctuations in behavioral changes when the individual begins to develop substance urges.
Developing relaxing techniques is a way to learn to cope with negative cognitive thoughts that result in negative behaviors. In order to develop and revolve the relaxation techniques to assist in abstinence a person may need to go through systematic desensitization. Systematic desensitization as illustrated by Lewis (2014) is to step by step go through the process of high stressful situation that induces the urge to crave the drug of choice. In the situation with Miguel, the scenario could be the anticipation of the evening coming when he begins thinking about all the bills he has to pay.
This form of technique done in the therapeutic setting can provide the necessary tools that he acquires to reject the desire for alcohol as his crutch. Cultural Considerations It is important to consider the cultural considerations when working with substance use with the diverse population. It has been shown that retention rate is lower with non-white population partly due to the cultural needs have not been met (Windsor, Jemal & Alessi, 2015). It is apparent that additional research needs to be done to determine if CBT is just as effective on different ethnic backgrounds (Windsor, Jemal & Alessi, 2015).
Windsor, Jemal and Alessi (2015) article states that everyones experiences are not the same because of their ethnic and cultural experiences that make them unique. There is a clear stereotype that exists between therapist and client either illustrated by gender, race, ethnicity, cultural, sexual preference or religious beliefs. Kelly & Iwamasa (2005) explained when the therapist is not from the same ethnic background as the clients and therefore, the therapist is believed to be inferior.
The most important aspect when dealing with diversity is to be observant of verbal and nonverbal body language (Kelly & Iwamasa, 2005). The therapist can adjust their approach to ensure the client understand and feels respected. Furthermore, the therapist regardless of their intervention style must be conscious to project a multi-cultural balance. Not doing so can make or break the therapeutic relationship. Golding, Burnam, Benjamin and Wells (1992) explain that one of the reasons Mexican-Americans are at high risk of alcohol abuse is to forget their problems.
Miguel suggests that one of the reason he started to drink was to forget his problems so he could sleep. The therapist would need to present a multicultural sensitivity to the therapeutic relationship. The therapist should consider Miguel’s cultural background, education and financial situation to establish a therapeutic connection to warrant in his abstinence success. As the therapist one way of doing this is to offer a reduced sliding scale fee to make the sessions more affordable to the client.
Another important area would be to suggest Miguel’s wife and or mother to a couple sessions with his permission to add to his support system. However, it is critical for the therapist to be observant of his comfort level and his family. The family may require a translator because of the notion that they just moved to the United States from Mexico. What is imperative that the therapist is constantly observant of the client’s mannerism and family and to check in with them to understand if they need additional resources (Windsor, Jemal, & Alessi, 2015).
Short-Term Goals The objective to administer short term goals for both DSM-5 diagnosis for Alcohol Use Disorder, moderate (F10. 20) and Major Depressive Disorder, moderate would include obtaining a full medical examination and evaluation of the previous listed assessment tools. One of the short term goals would be to obtain a full detailed personal history along with a family history of any known addiction dependency. Furthermore, knowledge of the level of dependency that exists. Moreover, evaluate the current support system that is available to the client.
Additional short term goals for major depressive disorder would be to learn coping skills to deal with the pressure of his family’s financial situation. Another would be to become involved in a hobby that the client enjoys with the benefit to not have the client hyper focus on the situations that are bothersome. Long-Term Goals One of the long term goals would include, to maintain complete abstinence from any substance abuse. Furthermore, to continue with additional support of a 12-step program along with work, family and friends that provide a positive environment.
Along with the 12-step program is to continue to learn and grow by demonstrating self awareness of the addiction. Outpatient programs have shown to be just as effective in substance abuse users using CBT coping skills to help prevent relapse (Burtscheidt, Wolwer, Schwarz, Strauss, Loll, Luthcke, Gaebel, 2001). Additional long term goals would be try and implement the support of his family through group sessions. It is imperative for a substance abuse individual to obtain all the emotional and physical support they need to continue their success with abstinence.
Encouragement from Miguel’s family and friends to continue with treatment, a 12 step program and self care is critical. Continuing education about the abuse will only help facilitate the continued success and appropriate skills to maintain a healthy lifestyle. There has been studies on the positive effects of behavioral couples therapy in continuing abstinence (Vedel, Emmelkamp & Schippers, 2008). Referrals for Additional Resources and Support A referral to a primary medical practitioner if Miguel does not already have one in place to obtain a full medical examination not limited to drug and substance testing.
Additionally, making a suggestion that Miguel speaks to a mental health professional to discuss the elements in his life that he believe is becoming burdensome in his life. Furthermore, depending on the information that the mental health counselor has been received by Miguel and his medical records a recommendation may be in order for him to seek an addition counselor. However, it is important not to over welcome the client with a list of recommendations at once. First, the main concern would be his alcohol use in order for him to maintain his employment. Then evaluating his depression, anxiety and insomnia would be the next steps to discuss.
A limitation between an Early-career Marriage Family Counseling/Therapist may be the focus on what the underlying reason for the alcohol consumption without address the immediate concern head on. The limitation of a Mental Health Counselor or Addiction Counselor may only address the addiction and not what may have caused the addiction. As the progress continues the therapist can suggest the benefits of attending a financial planning seminar to assist him with tips and tools to better manage his families finances to plan for their future without adding additional stress.
Plan for Coordinating Care First, the treatment plan would begin with addressing the alcohol abuse. The prevention plan that the company offers would be the begin step, then it would be for Miguel to attend weekly 12-Step meetings within the community to provide him additional support. This would involve having a sponsor than can be on call when he feels he is having difficulties managing the cravings. As Miguel continues and wraps up his prevention plan through his company successfully then a suggestion for him to continue with his 12-Step program an addictions counselor that can address his addiction in more detail.
Once the addiction therapist feels that after 12 months of successful abstinence he or she may refer him to a Marriage and Family Therapist to strength his communication skills with his wife. Behavioral Couples Counseling has been shown to strength couples and family communication skills more effectively because addicts require all the support they need to main their sobriety (Powers, Vedel & Emmelkamp, 2008) . Continued medical health exams would be beneficial to monitor the effects of Miguel’s health an any effects the alcohol consumption may have had on his body.
Furthermore, evaluation of his blood pressure and any medications that his mental health practitioner may have prescribed. It is the duty of the therapist to ensure that all therapist and client confidentiality is maintained. The American Counseling Association, ACA, (2104) states in B. 1. c. that clinicians are responsible to protect the confidential information of prospective and current clients. Clinicians are to release information only with appropriate consent or with legal or ethical justification. There are exceptions to confidentiality between clinician and client.
These would include harm to oneself or to others, child abuse, orders of the court, and insurance companies can obtain detailed information on therapy sessions if insurance is used to cover services rendered. The American Association for Marriage and Family Therapy, AAMFT (2012), states in 2. 1 of the Code of Ethics, that MFT’s should review with their clients when confidential information may be requested and/or asked for disclosure if legally required. Privileged communication is defined as an understanding that the information divulged between the client to the clinician will be kept confidential.
There are exceptions to this privilege such as, receiving a court order to release information. In the State of California, if a client has not signed a waiver an agreed to release confidential information, then the clinician is to assert their privilege unless they receive a court order (Kaplan, 2005). In other situations where harm or orders of the court is not of concern, the clinician will assert privilege to not release any information. The National Association for Alcoholism and Drug Abuse Counselors, NAADAC (2016), have much the same guidelines as the AAMFT and ACA when it comes to client confidentiality and privileged communication.
