Human Service
Case#1
Alex is a 25-year-old with a diagnosis of alcoholism who had recently graduated from the university and had received an internship in a big company. For Alex, drinking alcohol has been an issue since he was in the second year on campus, but lately, after securing the job, the intake has increased. He lives with his father and is currently dating, and both parties have identified that his alcohol intake is too much that it is altering his normal functioning. Being his fourth month in the new job, HR has already given him a warning for coming to work drunk. The colleagues complain that it is hard for him to complete simple tasks when asked, and at times, he has inappropriate interactions with them.
Additionally, the biometric system at work has shown that very few times, he has checked in at work on time. The girlfriend reports that of late, Alex has been arrogant when he comes to visit. Besides, he rarely eats even at home, and his health has deteriorated drastically. His father intervened and requested the company to give him a month off so they can take him for rehab sessions to see if he can improve.
In the rehabilitation facility, Alex was assigned a therapist that was to assess him for one month and ensure that the condition improves. The therapist proposed the use of Dialectical Behavioral Therapy (DBT) as the mode of treatment to help Alex reform from his alcoholism. Firstly, the therapist required establishing a collaborative relationship with the patient so that the therapy can work. For Alex, the initiative to come to the rehab was not his, and therefore the therapist needs his trust so that the treatment process can begin. The healthcare provider explained to Alex the importance of living a sober life and why they needed to work together to restore him. The road to a sober life is the long-term goal for Alex and the therapist; however, the care provider aims at working with milestones of short obtainable goals.
The dialectical behavior therapy aims at improving four significant elements of the patient’s life. The areas include; Emotional regulation skills, a mindfulness skills, interpersonal effectiveness, and distress tolerance skill. On the emotional regulation skill, the therapist was able to understand the trigger for his increased alcoholism was due to the death of his mother while he was in the second year. The therapist emphasized and attempted to show the patient how they can channel those emotions to productive things other than drinking. Besides, the therapist explained the importance of being mindful of the present since it is crucial to the past or the future.
Alcoholism was affecting Alex’s relationship with his father and girlfriend and thereby affecting the interpersonal link. Therefore, through DBT, the therapist ensured that the patient understood the importance of living a sober life by viewing the current situation caused by alcoholism. Finally, it was noted that alcohol intake increased once he secured a job, and it was due to the pressure at work. Alcohol gives a relaxing feeling; however, the DBT works in enhancing the patient with distress tolerance skills. The therapist encourages Alex to practice radical acceptance as a way to live in the present and accept everything that is happening instead of resisting causing more stress.
Case#2
A 17-year-old female has school and part-time work pressure. She has SATs to sit for very soon and needs to maintain her work to cover some of her tuition fees. On top of the SATs, she has several other examinations that she needs to sit for that will determine the college acceptance the following year. The parent reports that the patient has a history of being an overachiever and obsession in her studies. She is an all-round student and participates in both extra-curricular activities and academic work. Besides, the patient has social pressure and is popular in her school, which gives her a lot of pressure to maintain the status.
The patient is about 5’4″ and has gained approximately 30 pounds over the last year. Looking at her, she seems overweight and reports that when nervous, she tends to eat, especially at night, when she is alone in her room when she thinks about her responsibilities and the uncertainty of the future. The amount of food she consumes at night is, at times, more than the total amount of food she eats during the day. The patient is suffering from an eating disorder and, in particular, binge eating where the overeating and stretching of her stomach distract her from the stressing thoughts. The mechanism works through the overeating; the patient can temporarily treat the anxiety chemically that is in her brain.
To treat the disorder, the patient is referred to a therapist that suggests the use of Cognitive Behavioral Therapy as the method of treatment. The purpose of the CBT as the mode of treatment involves a physician, psychiatrist, nutritionist, and a therapist. The procedure for the patient will involve three phases; cognitive phase, behavioral phase, and the relapse/maintenance phase. Firstly, the behavioral phase, the patient, and the healthcare provider build trust and rapport, creating a safe space for expression. Typically, the patient is allowed to discuss their problems and learn how to identify the negative patterns in emotions, behaviors, and thinking. From this phase, the patient and the clinician generate an appropriate treatment.
The cognitive phase constitutes the cognitive restructuring method, where the client is encouraged to challenge the internal thought process and recognize the unhealthy thoughts that are interfering with the treatment. The therapy focuses on changing the interpersonal relationships and how the client’s emotions and thoughts affect the communication with others. The last phase is to focus on creating a recovery plan incases of a relapse.
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