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Assignment Scenarios: Treatment Approach
Amy is a 53yearold married Caucasian female with two children, ages 15 and 17. Amy is being assessed
for her alcoholism. She reports drinking socially since college where she met her husband. She has a
solid career as a top agent in her field, and she and her husband have provided a financially secure home
for their family. She has not had quality time with her husband due to their and
numerous kids activities.
Amy reports drinking with coworkers several times a week. She says that it is part of the job. She is
finding it increasingly difficult to keep up her schedule at work, parenting, domestic chores, and having
time for life outside of work and parenting.
Amy continues to drink each evening after work and often wakes up on the couch in the middle of the
night after passing out. She finds herself frequently bickering with her husband and believes her children
do not want to spend time with her anymore. Each morning it is more difficult to get up and get ready
Amy also reports struggling with friendships, especially with women. She reports not having anyone to
confide in or feel supported by. Her mother frequently tells her to pray and it makes her angry and
more resentful. Her childhood was challenging and has left her angry at the concept of a God. Wine
has become her best friend and way to cope with the struggles at work, home, and within. She reports
feeling trapped and believes it will not get better.
Bill is a 25yearold single African American male presenting for an assessment for driving under the
influence and possession of cocaine. He was pulled over while speeding and the police officer smelled
alcohol on his breath. The client was defensive and was subsequently arrested for attempting to flee
from the scene. Cocaine was later found in his car. He was booked in the county jail for driving under the
influence, possession of cocaine, and fleeing the scene of a crime.
Bills father left when he was a child. Bill was the oldest of four children and was given much of the
responsibility to care for his siblings while his mother worked. He was also a witness to domestic abuse
by his father. He was often scared for his life when his parents fought. Bill reports being unable to trust
adult men since his father left.
Bill began to drink and smoke marijuana in high school. Consequently, he was arrested as a minor for
possession of marijuana during high school. Bill had been enrolled in firefighter school until he tested
positive for cocaine and was kicked out of the program. He reports having over ten jobs in the last seven
months, always having a story for why his boss did not like him. He was offered a chance to sell
cocaine and make quick and easy money. Because he hadnt been successful finding a job, he agreed
to do it, but only for a month to make some money and then he would quit. That was two years ago.
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Bill feels obligated to support his mother and siblings and gives his mother most of his money from
dealing drugs. He is angry he has to support his family and he partially blames his mother for feeling
forced to sell drugs and now being addicted to cocaine. I did not expect to also get addicted to cocaine.
I was just gonna sell it for money. I usually only drink and smoke marijuana. So now I have no bail
money, nowhere to stay since my mother kicked me out, no career, and now no car. I had a promising
life at one point.
Anna is a 17yearold Latina female who is the middle child of three siblings, 13, 17, and 19. Anna lives
in a very patriarchal religious family system where her father makes all the decisions for the house, her
mother, and her two brothers. At an early age, the client experienced sexual trauma by the abuse of her
uncle. The from the age of six until she was nine years old. She tried to tell her
father and he slapped her, called her a slut, and told her to never speak of such topics again. Her
mother said she supported her but would not stand up to her father and get her the help she needed.
Annas father has stated that no one in this family goes to counseling! Anna watched her mother
being physically and emotionally abused by her father. Her mother refused to get a divorce because it
was against their religious beliefs.
Anna learned a distorted view of how women should be treated by watching her mother suffer as a
victim of her father. She reports being alienated from her family and snuck out of the house frequently
and also stayed after school as long as she could every day. At the age of 12, Anna began having sex with
her 16yearold boyfriend and she started drinking every weekend.
Anna started bringing vodka to school in water bottles. She found if she drank at school and shared with
friends she was in the cool crowd. She did not get any healthy attention from the adults in her life and
was looking for connection in any way she could find it.
Anna reported that she didnt always want to drink or do drugs, but didnt want to be viewed as a
baby. She is now in 12th grade, and was caught drinking and smoking marijuana at her high school by
the school resource officer for the fourth time this school year. She was arrested and brought to juvenile
detention. She is terrified of her fathers reaction and response.
Joe is a 62yearold homosexual white male being assessed for alcohol dependence after being admitted
for detox at the local treatment center. He reports a long history of drinking, which began when he was
16 years old. He has a career as a professor of biology at the college in his town, can support a nice
lifestyle, and has a few close friends. He did not announce he was homosexual officially until both of
his parents passed away when he was 50 years old. Joe was an only child from a religious small town
growing up in an era that had no tolerance and compassion for different types of families. His family
system also condemned lifestyles different than theirs and his parents never understood why he was
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Joe had a secret life partner from the age of 25 to 45. His life partner died from AIDS in the mid80s
before there were successful antiviral medications and other resources. He had to lead a private,
secluded life and had to grieve the death of his life partner in silence because no one knew he was gay
due to his fear of prejudice from his upbringing. Joe led a very lonely life, not being able to be himself at
work or with his family due to fear of ridicule and bias.
Joes alcohol abuse increased significantly after the death of his life partner and his parents a few years
later. He reports drinking alone every evening until he passes out watching television. He no longer
participates in activities in his department at the college or with the few friends he has. He reports going
to work, drinking all night, passing out, and doing it all over again the next day. Joe does not believe he
has much left to live for. He reports being lonely and has lived through everything he wants to
experience. He is seeking treatment because he states if I have to live, I dont want to feel this bad.
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