Scholar Practitioner Project Assignment: The Disease Theoretical Model of Addiction

Counseling Session 1

Counseling Session 1
Program Transcript

Welcome to the first day of counseling for Marge, an alcoholic who has just been
admitted to the addictions facility. Please carefully read the paperwork
developed by a support staff member during Marge’s intake process earlier
today. Marge’s husband, Ken, was also briefly interviewed during this time.

After reviewing this information, click the “continue” button to begin Marge’s first
counseling session. Using your cursor, rollover buttons A and B to review your
question options. Click what you think is the best question to ask Marge out of
the two options offered. If you ask an effective counseling question, you will
receive more information from Marge. If you ask an ineffective question, you will
receive an equally unhelpful response. Choose wisely, because the better you
counsel Marge, the better her treatment experience.

*Please keep in mind that the video has been made in a way that gives you a
realistic vantage point from where you would sit and counsel your client in real
life. A close up view of the individual has not been added because you, as a
counselor, will not have varying angles of your client to work with.

Paperwork:
• Marge C.
• 41-year-old female
• Married
• Husband, Ken, works two jobs to make ends meet, so he is not home

much. Husband noted that he didn’t know what else to do about his wife’s
drinking, and that he had brought her to the facility out of desperation.

• Patient has three children, ages 10, 12, and 16
• Patient was a teacher, but she lost job for alcohol-related reasons
• Patient had a one-car, alcohol-related accident three days earlier. She

received minor injuries and was issued a ticket for DUI. Husband, family
members, and friends determined that they needed to intervene to prevent
Marge from harming herself and/or others.

• An intervention occurred earlier today, culminating in her being brought for
treatment.

• Patient will go through a week of detoxification during her first week in
treatment to address the physical withdrawal from alcohol

[Opening scene: Marge’s admission into residential treatment. Her counselor is
meeting with her for the first time and is conducting Marge’s initial assessment.
Marge is disheveled, wears no makeup, and her eyes are red from crying. An
adhesive bandage is on her forehead, and she has a black eye and abrasions
from a one-car accident she had several days ago She was charged with driving
while under the influence, her first such charge.

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Counseling Session 1

Her posture is closed—arms crossed, turned away from counselor, and avoiding
eye contact initially. She is tremulous throughout the interview due to impending
physical withdrawal from alcohol. She tries to control her shakes but is not
successful. Her mood is labile (up and down, unstable). She presents herself at
the first part of the session as if she is the victim of an injustice and blames her
husband. She’s initially defensive. This shell begins to melt quickly as the
session moves forward and ends with a receptive, open Marge who seems to
have surrendered to the fact that she may need help. Her body posture, facial
expressions, and tone of voice reflect this change as it occurs through the
session.]

Question #1:

Option A:

Counselor: Marge, I will be your counselor. I want you to know I’m glad you’re
here. I imagine this has been a hard day for you. Right now, I just want us to
begin get to know each other better. I also want to know more about your
drinking so we can begin to plan your treatment. It’s natural to be anxious and
upset right now. You look like you feel like that now. Are you?

Marge: Yes, of course I am! And furthermore, I don’t want to be here; I don’t
need help.

Option B:

Counselor: Hello, Marge. I will be your counselor. I want you to know I’m glad
you’re here, and I want to help you in any way I can. I imagine this has been a
hard day for you, and I know that you and your husband have already answered
many questions during your admission process. Right now, I just want us to
begin get to know each other better. I also want to know more about your
drinking so we can begin to plan your treatment. It’s natural to be anxious and
upset right now. Tell me your thoughts and feelings right now.

Marge: You’re right, I am anxious, and I’m more than that right now! I’m hurt, I’m
scared, and I’m furious at my husband Ken for dragging me to this place. I want
you to know right now I am not here on my own; I am here only because he and
my so-called friends threatened to have me committed involuntarily for “my own
safety,” as they say, if I didn’t agree to do it myself.

I know I drink too much, but I can handle it myself. I don’t need to be put in this
rehab and hid away from the rest of the world to do it. I’m not like the other
people you have here; they might need help, but I can do it on my own. I don’t
need help.

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Question #2

Option A:

Counselor: You “don’t need help”?

Marge: No. I am strong willed. I know I drink too much, but I have to because of
all the stress. Raising a family, and then when I was teaching…it was double
hard. I have diabetes on top of it all, and I’m unemployed and now this damn DUI
hangs over my head. Then, as if that’s not enough, there’s Roger, my 12-year-
old son; he’s always getting in trouble at home and school. It’s never ending. I
could go on and on.

Yeah, I admit. I drink too much, but I do it to deal with all my problems and my
constant depression. You would too if you were me. No one understands that.
But I can go to AA and go back to that counselor at the community mental health
clinic and stop without all this ridiculous fuss of coming here. I’ve tried it before; I
just didn’t give it all I had.

Option B:

Counselor: I think you’re wrong; I think you do need help, and I want to help you
see that.

Marge: No, I don’t; you’re just like them. No one seems to want to listen to me;
they just jump to their own conclusions about my life. I’ve tried to stop on my own
before; I just didn’t give it all I had. I’ll tell you again for the umpteenth time, I
DON’T NEED HELP!

Question #3

Option A:

Counselor: You say you’ve tried to stop drinking before, Marge. Please tell me
more about that.

Marge: I could do it for a while. I went to AA and that counselor, like I said, and I
went a month or two once. But always things would start piling up, and I’d take a
drink just in the afternoon after 5 like I used to, and then before I knew it I’d be
drinking all day again.

I just didn’t try hard enough. I will now; I know I can do it. I feel guilty because I’ve
been too weak and just never tried hard enough. I know what alcoholism is,
believe me, my father was one, so was my uncle—they went to their graves
drinking. I just need to get strong and build up my willpower to make my mind up

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to stop. I need to stop being such a weakling and an irresponsible mother and
wife. It’s almost immoral the way I’ve been doing, but I can do it now. I just need
a change. I need to go home.

Option B:

Counselor: You said earlier that you’ve tried to stop drinking before but were not
successful. That tells me you need to help. Don’t you agree?

Marge: No.

Question #4

Option A:

Counselor: Marge, let me share something with you that you may not know. We
look at alcoholism and other addictions as a disease. Some people have a
genetic predisposition for it. It’s not a moral issue, Marge, or a matter of lack of
will power. That puts a different light on your situation, doesn’t it, Marge?

Marge: No.

Option B:

Counselor: Marge, I think I hear what you’re saying. You admit you drink too
much, and you seem to think you can stop on your own without coming here for
30 days. You think you just haven’t tried hard enough, and you feel that you’re a
weak and immoral person for that.

Let me share something with you that you may not know. We look at alcoholism
and other addictions as a disease. Some people have a genetic predisposition
for it. People who are genetically predisposed to the disease when faced with the
right combination of conditions can’t handle alcohol. They may start just drinking
socially in a controlled way and then drink to deal with stress or other problems.
Because of their genes, they need more and more and eventually need to drink
just to keep from going into withdrawal. It’s not a moral issue, Marge, or a matter
of lack of willpower. What are your thoughts about what I just said?

Marge: (Marge’s whole demeanor has changed during this last exchange from
the counselor—she begins to make eye contact with the camera/counselor and
relax her defensive, closed posture. She begins to convey a sense of surrender
combined with a touch of desperation).

(After a moment’s silence, reflecting on what the counselor said, then tearfully
begins to talk after a moment of silence) I…………..I never thought of it that way.
Well, I guess I have, but (stammers)…..well…, I…, uh……I can see how that

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could be. ….A disease maybe? It could explain why even though I don’t really
want to be like this I am and that I though I’ve really tried to stop I just haven’t
known how…..(looks down staring at her hands now folded in her lap, the truth
has sunk in).

When we first got married and began to have our children, I would have glass of
wine several times a week with dinner, or maybe even with Ken when we both
got home after a long day at work and the children had gone to bed. Then it was
every day, then in the morning, and then I was hiding my drinking habits and
drinking just to feel normal.

I was teaching, and it got to where I would drink vodka before I went to school. I
thought no one would smell vodka, but it didn’t work. I was fired. My life has
spiraled since then, my children, my marriage, my health, everything. If I don’t
drink now I get horribly ill; you can’t imagine how ill. I start feeling things on my
skin or seeing things; it’s bad. I get crazy, just like my father and uncle used to
get.

I know Ken has tried to protect me all these years. He means well. He would call
the school when I was too drunk to go and tell them I was sick. That’s what he’s
always told the children, “Your mother’s ill, she can’t help it.” Oh help me,
please…

(Marge breaks down at this point, head in hands, sobbing out of control….LONG
SILENCE as Marge’s sobs become more controlled.)

Question #5

Option A:

Counselor: Marge, you just turned the corner, and I’m proud of you. You’ve just
made a giant step today, and you’ve just started on your road to recovery. What
are your thoughts and feelings now as we conclude our first session?

Marge: (Marge has softened; she’s beginning to feel relief that she’s finally
admitted she has a problem and that help is here. She is still hurt and maybe
embarrassed perhaps.)

I guess I just feel grateful that someone is listening to me and understands.
(Wipes her eyes, pauses, takes deep breath)

I feel so embarrassed….my husband has put up with so much, and I know the
kids have needed me and I haven’t been around. I just wanted to take care of it
by myself, do at least one thing without having to rely on someone else for help,

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you know? I should at least do that, since I’ve messed up so much already.
(Deep breath)

I don’t want to leave the kids alone for 30 days, but….I guess I’ve left them alone
anyway. I’m scared, but I am willing to try. If you really think you can help me, I
promise I’ll do my best. I have to make it work…for my kids and for Ken.

Option B:

Counselor: Marge, I know this is hard, but until you admit you have a problem,
your drinking will only continue to get worse and cause you and your family more
problems. I want you to think about that before we meet again, OK?

Marge: Yes, I will. Listen, I know you mean well…..but uh… well…uh…I just don’t
think you or anyone else in my life hears me.

Final Text:
Congratulations. You have now completed your counseling session with Marge.

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