After reading about Suzanne’s case, it is apparent that Suzanne's understandings about her ability to cope, her self-worth, and her future have a major impact and influence on her substance use and other behaviors
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This includes understanding how she perceives her resilience and problem-solving skills in difficult situations. Show more…
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After reading the case below, please complete the five axes of the DSM-V and highlight your next steps as a clinician: Suzanne Whitfield is a 36-year-old woman who lost her job. Allegedly, she was caught stealing money from her cashier's drawer. She is single and has six children. Earlier this month, Suzanne has been diagnosed with bulimia, post-traumatic stress disorder due to rape, and narcissistic personality disorder. She refuses to take medication, and lately, she has been too depressed to care for her children. Suzanne spends all day lying on a chair and staring out the window. She has not bathed in a week, and the children have not attended school for the last three days. Suzanne received an eviction notice and has $18 to last her until she gets another job or secures a loan. All of her family lives on the west coast, and Suzanne relocated to New Jersey after falling in love with Scott. Scott is in prison because he robbed a local drug store to supply his substance abuse habits. Suzanne is very low and reports that she feels hopeless. Axis 1: - Bulimia - Post-traumatic stress disorder due to rape - Narcissistic personality disorder Axis 2: No information provided Axis 3: - Unemployment - Financial difficulties - Lack of support system Axis 4: - Recent eviction notice - Lack of resources - Unstable living situation - Parental neglect Axis 5: - Severe depression - Feelings of hopelessness Next Steps: As a clinician, the next steps would be to: 1. Assess the immediate safety and well-being of Suzanne and her children. 2. Explore the reasons behind Suzanne's refusal to take medication and address any concerns or barriers she may have. 3. Develop a treatment plan that addresses Suzanne's mental health disorders, including therapy and potential medication options. 4. Connect Suzanne with resources for financial assistance, such as job placement services or loan programs. 5. Coordinate with child protective services to ensure the safety and well-being of Suzanne's children. 6. Explore potential support systems for Suzanne, such as local community organizations or support groups. 7. Monitor Suzanne's progress and adjust the treatment plan as needed.
Supreeta N.
After her birth, Joan was adopted into a wealthy family. Her birth mother had a history of emotional problems, and it is unknown whether she had problems with alcohol/drugs. Joan, now 16 years old, was coming to counseling for an alcohol/drug evaluation. She was drunk at a party at her private high school. The parents described Joan's behavior as erratic, sometimes very loving and sensitive, and at other times explosively angry and out of control. Joan was not adhering to simple boundaries that her parents had established (e.g. ignoring curfew, not calling if she is going to be late). They knew Joan was smoking marijuana but were unable to prevent her from using it. The evaluation revealed that Joan is out of control. She blatantly told her parents that they were awful, and she was not going to listen to anything they said. Joan had a new older boyfriend (a 21-year-old) and she was staying out overnight with him, doing cocaine and drinking alcohol. She had told her parents she was staying with friends. Joan told the counselor her parents can't do anything. Joan did not see herself as having a drug problem, but did admit that she frequently lost her temper. Her grades in school were very good (3.8 GPA). She stated "I just want to do what I want to do, and I am tired of my parents nagging all the time." Using concepts described in Chapter 7 and our supplemental materials, discuss Joan's drug use. Use at least one Psychological explanation (psychoanalytic theory or behaviorism/learning theory). Use at least one Sociological explanation (anomie/strain, differential association, social control, subcultures/deviance, or symbolic interactionism/labeling). Use information from the Szalavitz article (The Addictive Personality Isn't What You Think It Is) to discuss Joan's risk factors for addiction. Also address any protective factors you see as relevant to the case.
SCENARIO: As a 15-year-old, Susan began running away from home but was caught and returned. Her parents were alarmed at the behavior problems that were surfacing. She was getting into fights at school with other girls and had been suspended on two occasions. Up and down the inside of her arms and thighs were self-inflicted burn marks from cigarettes, in addition to cuts from a razor blade. In therapy, she divulged that her brother had molested her when she was younger. Questions: - What led to Susan's decision to run away from home? - How long has Susan been engaging in self-harming behaviors? - Has Susan sought any help or support prior to therapy? - How has Susan's relationship with her brother been affected by the molestation? - Are there any other underlying issues or traumas that Susan may be dealing with? Current concerns: - Susan's behavior problems, such as fighting and suspension, indicate potential emotional distress. - The self-inflicted burn marks and cuts suggest that Susan may be experiencing significant emotional pain. - The disclosure of molestation by her brother raises concerns about her safety and well-being. - Susan's parents may be worried about her overall mental health and the impact of these experiences on her future. Possible intervention: - Individual therapy to address the emotional trauma and provide a safe space for Susan to express her feelings. - Family therapy to help Susan and her parents navigate the aftermath of the molestation and improve communication. - Referral to a support group for survivors of sexual abuse to connect with others who have had similar experiences. - Collaboration with school counselors or social workers to address the behavioral issues and provide additional support at school. - Consultation with a psychiatrist to assess the need for medication to manage any underlying mental health conditions.
Shu N.
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