Essay 2 – Treatment Plan (2000 words)
Choose one (1) of the client vignettes below, and devise an appropriate treatment plan for that client.
In your treatment plan, be sure to include the following:
Summary of case presentation, with short and medium term goals of therapy clearly identified;
Selection of an evidence-based treatment program to address therapy goals, and a clear rationale as to why that treatment program will work best for this client given their diagnosis and personal circumstances;
Analysis of other factors that may be important given the client’s presentation (e.g., age, gender, background, culture, work history etc), and how these may impact, or need to be factored into the treatment plan. Likely prognosis and factors that may be important/impact this.
APA (6th ed.) formatting; at least ten (10) references selected.
Important: DO NOT query the diagnosis (or in the case of “Andrew” develop one!). This is not a repeat of the first essay. Assume that the diagnosis/information given is true and correct.
Siena is a 16 year old Aboriginal girl with a diagnosis of Borderline Personality Disorder. Siena has an extremely troubling background. She and her sister were removed from their mother when Siena was 3 years old. Her father was a European immigrant and although never prosecuted, was believed by Child Protection workers to have sexually abused Siena and her 18 month old sister. Their Aboriginal mother was a chronic alcoholic who had a history of developing relationships with men who would supply her with alcohol, and in turn she would turn a blind eye to their inappropriate behaviours/relationships with her children.
The sisters displayed sexual acting out; binge-eating and purging; food stealing and a range of other challenging behaviours throughout their care history. Whilst Siena’s sister began to improve in care; Siena’s behaviours continued to be volatile, unpredictable and at times violent towards others.
Siena was moved apart from her sister at 13 years of age for her sister’s safety, and placed in boarding school. Her behaviour continued to deteriorate and she jumped from placement to placement for the next few years.
Siena presents as an extraverted, funny yet chaotic and extremely labile individual. She is a tall and strong girl who has succeeded in sporting competitions but has been expelled from several schools due to her uncontainable behaviour. She has a good sense of humour, but swings from being chatty to angry several times during her interviews. She also has a history of reactive attachment to most of her caregivers/psychologists/treating health professionals. Siena has physically assaulted a previous doctor and psychologist, without warning, and their injuries were not trivial.
Siena has been referred to you post-release from juvenile detention and is currently placed in a residential boarding home with no other young people staffed by 24/7 rostered caregivers. She is currently enrolled in and attending a new school. Devise a treatment plan for Siena.
Mike is a 30 year old male who has self-presented for help with difficulties arising from Cannabis use and withdrawal. Mike works full time as a swim coach and is a part time exercise physiology student. Mike reports a stable, middle-class background up until his long-term partner left him three years ago. At the suggestion of a friend he began smoking marijuana for the first time to “relax” after his traumatic break up. For the first year he reports on average weekly usage with no obvious side effects. However, during the last 2 years Mike reports his tolerance for marijuana escalated and he sought increasing amounts and frequency of the drug to achieve its previous effects. He also reports falling into “recreational” drug use with student friends, and taking MDMA as well as LSD on occasions.
Several months ago Mike moved out of his unit that he shared with another student to a self-described “drug house” with like-minded users. Since then he has been smoking multiple times per day (up to 10 cones); he is running out of money each week; his grades at University are slipping and his employer has expressed concerns about his on the job behaviour. Mike has become uncharacteristically unreliable, and his long-time boss told him that his recent conversations were increasingly “weird”. Mike has developed an interest in the possibility of alien life and a range of supernatural explanations for recent events. Last week Mike’s new girlfriend gave him an ultimatum to quit weed or quit her. Mike moved out of the drug house, in with his girlfriend, went cold-turkey and ended up spending 2 days in hospital with cannabis withdrawal symptoms. He is seeking your assistance to permanently cease all drug use, and get his life back on track. He presents as agitated, anxious and occasionally doesn’t make sense in his speech; but intelligent, understanding of his situation and extremely committed to recovery. Develop a treatment plan for Mike.
Andrew is a 21 year old carpenter with an anger management problem. He has no formal diagnosis or psychological history but reports issues managing his anger all his life. Andrew states his difficulty controlling his temper is a long-time almost legendary joke amongst family and friends; and his parents remain bemused by his antics as his two brothers show no such traits. Although a popular, funny and socially-skilled individual, he has been unable to complete even one sporting season without a match ban and frequently gets into heated arguments and physical altercations on his work site. Andrew reports becoming enraged over typical issues such as his drill not working, or a level going missing. He reports his tradie mates have expressed a mixture of mirth and concern when he starts swearing, throwing objects about and physically shaking in response to such inconveniences. Andrew shows excellent insight and has even developed a couple of adaptive strategies such as “sitting down and eating an apple” when this occurs.
Andrew is not currently partnered but reports a previous long-term girlfriend raised concerns about his ability to control his anger in irritating but otherwise normal scenarios. Andrew has presented at the request of his manager after he got into a physical fight with a builder and punches were thrown between them. Andrew presents as somewhat ambivalent towards treatment as he can also identify many occasions where his anger has proven functionally useful for him; especially on trade sites working with other aggressive or bullying males. However Andrew clearly recognises his anger responses are not normal and acknowledges “toning down” his response would be good for him. Andrew reports “not liking” the way his anger makes him feel at work or in relationships, and he has occasionally frightened himself at his lack of control; although he appears to get a kick out of his anger response whilst playing sports. Devise a treatment plan for Andrew.