Olivia Pepper is an African-American woman aged 30-years old. She is married and has three children, aged eight, six, and two. Even though Pepper is currently unemployed, she is pursuing her master’s degree to increase her chances of securing a better paying job. She is a devout Baptist Christian. In this therapy session, she arrived fifteen minutes late dressed in oversized clothes, which were dirty. Looking at her preliminary reports, I realized that she also had formed a habit of arriving late for her classes or not attending them at all, a move that compelled her instructor to recommend her to this therapy session. She has undergone various traumatic experiences, which have affected her perspectives towards life in her adult phase. For instance, her mother abandoned her when she was fourteen, exposing her to different risks such as peer pressure, which saw her engage in drugs and receive her first Driving Under the Influence (DUI) strike at the age of 16. Currently, the client’s husband is jobless and she reports an increased strain on her abilities as the sole breadwinner. The client’s problems with her husband has exposed her to alcohol abuse, which has distracted her from accomplishing her intended goals in class and outside the learning environment. Even though she has received various treatment regimens, the client has had an and off relationship with alcohol and substance abuse. At one time, she was rescued when she attempted suicide. This therapy session seeks to identify the best approaches that can be used to control her behavior and enable her overcome her traumatic childhood experiences since she has no family to talk to.
The Client’s Demographical Information
Olivia Pepper is a 30-year old African-American woman who is experiencing alcohol and substance abuse problems, which have significantly affected her relationship with her husband, children, and other people in her immediate environment. In the U.S., Black Americans experience challenges navigating the murky waters of racial profiling and ethnic stereotyping, which hinder their interactions with other people. Even though the client is married, her marriage with her husband is on the brink of collapse because of their inability to agree on defining aspects that are supposed to build their relationship. Currently, the client is unemployed after being served with several DUI strikes, which hinder her from driving to work. Pepper has an undergraduate degree but is now pursuing her master’s program, which she is having difficulties attending classes on time and participating in the learning process.
An Analysis of the Client’s Presenting Problem
After missing some classes and attending others late, Pepper was advised by her instructor to visit a counseling facility that would examine her condition and expose her to an enabling environment where she could accomplish her goals and objectives. Given her inability to take care of herself, the instructor believed that exposing her to an environment where she would receive care was critical to her performance in the learning context. Severally, Pepper has attended classes while drunk, demonstrating her vulnerability and inability to adhere to the rules and regulations outlined by the learning institution. She arrived late to our therapy session and seemed agitated by the fact that she had to do it. I noticed that her hair was unkempt and her baggy clothes were dirty. She had neglected self-hygiene but minutes into our interactive session, she opened up and confirmed that she was having a difficult time with her husband who had lost her job and was not staying at home all day long.
The burden of providing for her family had taken a toll on Pepper, compelling her to indulge in alcohol and drug abuse. She contemplates quitting her studies because of the pressure from her educators to perform amidst the things going on in her life. Despite sleeping for long hours, Pepper indicates that she is tired and experiences various moments where she thinks about her worth. Given her family and school baggage, she has developed anger management issues with people who can easily trigger her emotions. During her moments of vulnerability, Pepper quips that she is a victim of gender-based violence and that she finds solace and happiness at the liquor store where she spends time outside her house to avoid her battering husband.
A Description of the Client’s Diagnosis
By using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Pepper’s mental health will be resolved based on her diagnosis, which will dictate the care approach used to resolve her medical condition. By building on Pepper’s symptoms to identify the best care approach, this diagnosis will explore the primary factors that contribute towards her symptoms (American Psychiatric Association’s Online Assessment Measures, 2020). For instance, the diagnosis will extend beyond the normal medical examination and focus on identifying the signs and symptoms that may be intentionally produced. Likewise, the diagnosis will narrow on the signs and symptoms that may be related to substances and those associated with a developmental conflict or childhood experience. By so doing, Pepper’s diagnosis will develop a proactive care approach that addresses the underlying issues, which hinder her from maintaining healthy relationships with other people in her surroundings.
Olivia Pepper’s mental state fits various medical conditions which include major depressive ailment, tenacious depressive ailment, and disruptive mood dysregulation ailment. Her symptoms can also be associated with substance/medically induced depressive condition, which explains her baggy dirty clothes and unkempt hair. In this case, the major depressive condition appears to be the best fit for Pepper’s scenario. Importantly, Pepper demonstrates various symptoms that can be related to clinical depression through her loss of interest in meaningful activities such as employment, school, and even her family (Close, 2020). The lack of interest has caused a significant impairment in her life, exposing her to suicidal thoughts and attempts on two counts. Patients who have been diagnosed with clinical depression manifest anxiety, hopelessness, and loss of pleasure in activities, which were once meaningful to them. Pepper confirmed that she experiences unexpected bouts of sadness and mood swings, which affect her interactions with her children and husband.
Pepper is easily agitated, experiences long moments of restlessness despite sleeping between 10 and 12 hours, and embraces social isolation. During our session, she hinted that she finds happiness and solace in the liquor store away from her husband who batters her whenever he feels like doing. Since Pepper is a victim of gender-based violence, social isolation comes in handy as it keeps her away from her moody husband. Pepper spends long hour of sleep and complains about being tired. Her behavior indicates irritability, which contributes largely to her lack of interest in different activities that are supposed to be important in her life (Cooper & Granucci, 2015). In two instances, Pepper has thought and attempted to commit suicide before she was rescued and exposed to a treatment facility. The lack of concentration in her studies is also related to her suicidal thoughts because of the general feeling of hopelessness, which affects her interactions with other people in her surroundings. Pepper exhibits more than five indicators of clinical depression, an aspect that hints she could be in the acute stage of the mental health problem.
The Assessments Used to Approach the Diagnosis
Patient Experiences a Health Problem
Even though Pepper did not attend the therapy session voluntarily, her visitation was arranged by her lecturer who noticed her awkward behavior and irregular class attendance. The university counselling center examined her erratic behavior during the therapy sessions and diagnosed her with clinical depression because of the symptoms and experiences she described (Madsen et al., 2017). Given her alcohol and substance abuse, it was evident that her medical condition was triggered by a set of underlying issues that affected her perspectives towards life. On its part, the university counselling center observed the patient’s behavior and used it to develop a diagnostic report that represented its position on the medical issue.
Patient Engages with Health Care System
Mental health patients are supposed to receive therapy treatment where they can interact with different individuals and overcome scenarios that hinder their ability to respond to underlying problems affecting their general health. The university counselling center acknowledged Pepper’s medical problems and diagnosed her with clinical depression, which would be addressed using the relevant treatment regimens. By observing her behavior during the therapy sessions, the medical practitioners noted her situation and the danger it posed to other people in her environment, especially her children.
Information Integration and Interpretation
Based on the symptoms Pepper indicated she had experienced in the past; the university counselling center also observed her inability to embrace self-care and engage in meaningful activities such as learning and seeking employment. Initially, Pepper had a job but due to her DUI strikes and warning, she lost the employment opportunity and engaged in alcohol abuse, which has affected her learning experience and interactions with other individuals in her immediate environment. The clinical history session reviewed that Pepper has had a history of alcohol abuse since she was fourteen, which was triggered by the decision made by her mother to abandon them. Even though her father took her to treatment facility after her first DUI strike, Pepper relapsed and has failed to control her alcohol intake, which has resulted to a series of problems being witnessed today.
Physical exam results indicated that Pepper was unable to take care of other people and especially her children because of her inability to wash her clothes and dress appropriately. Her unkempt hair denotes traits of hopelessness, which are manifested by her clinical depression condition.
Depression DSM-5 Diagnostic Criteria
According to the DSM-5 diagnostic criteria, Pepper has exceeded the expected standards for clinical depression diagnosis. These symptoms have caused impairment in Pepper’s life, as she is unable to maintain any healthy relations with her children, husband, and any other person in her immediate environment. Even though some of the symptoms experienced by Pepper are induced by the events in her immediate environment, a majority are triggered by her alcohol abuse, which affects her ability to maintain healthy interactions with other people in her surroundings. Considering the treatment approaches that can be used to treat her condition, Pepper is likely to be subjected in a monitored environment where her movements will be altered to overcome her alcohol addiction. Likewise, her immediate family will also be involved in the therapy session because of their influence on Pepper’s perspectives towards life.
Mental Health Theory
Mental health theories enable medical practitioners to administer accurate treatment regimens to patients who demonstrate various symptoms that point towards various mental health problems. Likewise, the theories enable patients to understand their conditions and identify suitable approaches that can be used to improve their interactions with other people in their surroundings (Rohan, Burt, Camuso, Perez, & Meyerhoff, 2020). From this realization, mental health theories create an enabling environment where medical practitioners can derive various aspects that influence their perspectives towards the treatment of different mental health issues. Despite the tendency by mental health professionals to focus on aspects such as spirituality, moral character, and psychological development among others, there is a strong influence of the perspectives maintained by individuals towards life (Kube, Siebers, Herzog, Glombiewski, Doering, & Rief, 2018). Therefore, identifying various stressors that influence the thought process of affected population groups exposes one to an enabling environment where they can overcome issues that contribute towards resolving their situations.
The presence of negative events in Pepper’s life exposed her to a tragic environment that has had a significant impact on her perspectives towards life. Unlike other scenarios where mental health patients experience symptoms caused by natural triggers, Pepper’s life is described by a wide range of stressors that affect her perspectives towards life. In this regard, the cognitive model of depression asserts that the negative outcomes and other underlying experiences contribute towards the sad mood manifested by Pepper (Rief & Joormann, 2019). Likewise, the cognitive theory posits that amidst the negative events and outcomes, individuals post different behaviors, which affect their ability to accomplish various goals and objectives in their immediate environment. By developing negative perceptions about herself, Pepper’s condition has been largely influenced by the measures taken to cope with the unexpected outcomes in her life. Developing depression was triggered by her excessive alcohol consumption, violent husband, and the piling baggage influenced by his inability to provide for the family. Although Pepper has made numerous attempts to attend classes, she has ended up missing certain sessions or failed to attend the learning sessions at all. Besides, she attended some of the periods while drunk and showed up in baggy and dirty clothes with an unkempt hair.
It should be noted that the cognitive theory was developed in the 1950s by Albert Ellis and Aaron Beck. Importantly, this model of mental health is widely used in the administration of cognitive therapy, which provides patients with a wide range of alternatives that respond to different scenarios affecting individuals in their immediate environment. Unlike other behavioral theories that focus on the environment surrounding a patient, the cognitive model of mental health is strongly influenced by the ability of the mind to influence the behavior of individuals. Notably, when the mind is stressed by different factors, individuals respond differently and fail to acknowledge various aspects that can be introduced to control the behavior manifested by the affected population group (Vujanovic, Meyer, Heads, Stotts, Villarreal, & Schmitz, 2017). Markedly, Pepper’s dysfunctional thought process has exposed her to extreme emotions where she experiences mood swings and other aspects that influence her thought process. For instance, when Pepper attempted to commit suicide, her dysfunctional thought process exposed her to an environment where she could not receive quality care to treat her sudden behavior change. Therefore, using the cognitive theory to understand Pepper’s condition is an important approach that should be used to overcome various issues that hinder her behavior with other people in her immediate environment.
In many instances, clinical depression is treated using antidepressants, therapy sessions, or a combination of the two treatment regimens. Depending on the ability of an individual to respond to the administered treatment regimen, medical professionals examine the outcomes of events and focus on the creation of a viable solution that can be used to overcome various scenarios, which contribute towards the realization of different outcomes. In Pepper’s case, Cognitive Behavioral Therapy (CBT) will be used to overcome scenarios that hinder her from establishing healthy relations with other people in her surroundings (Hayes & Hofmann, 2018). Even though used to treat other mental issues such as anxiety, using CBT on Pepper will focus on her brain functions and its influence on her emotional response to different events. In a way, it will be used to break down various problems affecting Pepper into smaller issues that can be easily handled without any complications.
Client’s Strengths and Weaknesses
The client is willing to continue with her learning program and insists on maintaining her GPA score of 3.8 and even improving it. However, her alcohol abuse may expose her to relapse, which will interfere with the different approaches that can be used to accomplish various issues taking place in her immediate environment.
Client’s Long-term Goal for the Treatment Intervention Plan
Since Pepper is experiencing mild symptoms, which affect her ability to overcome the issues affecting her interactions with other people, she will be exposed to a curative treatment approach, which will foster her healing and repair. Her emotional stability has been badly damaged as she is easily affected by various events.
Client’s Short-Term Goals
Pepper’s short-term goals revolve around gaining her control over time and attending designated classes on time. Besides, she will be introduced to a program that will focus on reducing her alcohol intake with the hope of controlling her urge to abuse the drugs. The treatment will also focus on strengthening her relationship with her children and husband.
Pepper will be introduced to a rigorous treatment regimen that will disrupt her normalcy by exposing her to demanding sessions, which will enable her to regain control over her life. By identifying various underlying health issues that can affect the treatment program, Pepper will be expected to identify any challenges that affect her ability to accomplish the treatment goals and objectives. The treatment timeline will cover 12 weeks and will acknowledge the possibility of remission and the approaches that will be used to prevent the scenario from taking place. If Pepper will not relapse, the treatment plan will be maintained through therapy sessions where she will be required to visit the university counselling center even after the timeline is exhaused.
Fig 1.0 A graphical representation of Pepper’s Treatment Timeline.
The Systems Theory Perspective
The systems theory explores the approaches people can use to maintain quality interactions with individuals in their immediate environment. The theoretical perspective analyzes different scenarios that influence the thought process of individuals and their ability to overcome various challenges that ruin their quality of interactions with people in their surroundings (Stefan, Cristea, Szentagotai Tatar, & David, 2019). In this regard, Pepper’s husband will be incorporated in the treatment therapy because of the need to create an enabling environment where her general mental health can be examined and resolved. Likewise, Pepper’s relationship with her children will also be reinforced to provide her a reason to associate with the young family. By addressing Pepper’s problems using the system’s theory perspective, it will be possible to generate viable solutions that overcome her clinical depression.
Diversity Needs for Client, Family, and Viable Solutions
The client needs a support system that can encourage her to pursue her education and accomplish her learning objectives. Importantly, she also needs to identify a job opportunity and focus on accomplishing various aspects that contribute towards her recovery. In the same vein, her immediate family is supposed to be incorporated in the treatment regimen because of the differences between Pepper and her husband. Given the husband’s mental state after losing his job, he should also be introduced in the therapy session to receive the relevant treatment that can enhance his overall relationship with Pepper and their children.
When resolving Pepper’s mental health problem, the aspect of confidentiality might be affected by introducing multiple relationships with her husband. The therapist should exercise utmost caution to ensure that the two client issues are not mixed up to create a confusion that may interfere with the nature of outcomes. Likewise, when addressing the issues, there is a need to create a favorable approach that can address the different issues affecting individuals in their surroundings.
Evaluating the Client’s Progress
Apart from the regular therapy sessions where the client will be required to highlight her experience after the implementation of the treatment method, the university counselling center will observe return demonstrations of the patient’s response to the administered treatment. Pepper will also be required to restate the approaches that were recommended by the medical practitioner to overcome various issues that hinder her overall medical progress. Including questionnaires will play a significant role in the identification of critical approaches that the medical practitioner can sue to ascertain different issues affecting individuals in their immediate environment. However, observation will be a critical approach that will be used to evaluate the client’s response to the administered treatment module.
American Psychiatric Association’s Online Assessment Measures. (2020). Washington, DC. Retrieved from www.psychiatry.org.
Close, Laura, (2020). Depression and Substance Abuse. American Addiction Center. Retrieved from www.americanaddictioncenter.org
Cooper, M., & Granucci, L, J. (2015). Clinical social work practice: An integrated approach (5th ed.). Boston, MA: Pearson.
Hayes, S. C., & Hofmann, S. G. (Eds.). (2018). Process-based CBT: The science and core clinical competencies of cognitive behavioral therapy. New Harbinger Publications.
Kube, T., Siebers, V. H. A., Herzog, P., Glombiewski, J. A., Doering, B. K., & Rief, W. (2018). Integrating situation-specific dysfunctional expectations and dispositional optimism into the cognitive model of depression–A path-analytic approach. Journal of Affective Disorders, 229, 199-205.
Madsen, I. E., Nyberg, S. T., Hanson, L. M., Ferrie, J. E., Ahola, K., Alfredsson, L., … & Chastang, J. F. (2017). Job strain as a risk factor for clinical depression: systematic review and meta-analysis with additional individual participant data. Psychological medicine, 47(8), 1342-1356.
Rief, W., & Joormann, J. (2019). Revisiting the cognitive model of depression: The role of expectations. Clinical Psychology in Europe, 1(1), 1-19.
Rohan, K. J., Burt, K. B., Camuso, J., Perez, J., & Meyerhoff, J. (2020). Applying experimental therapeutics to examine cognitive and chronological vulnerabilities as mediators of acute outcomes in cognitive-behavioral therapy and light therapy for winter depression. Journal of Consulting and Clinical Psychology, 88(8), 786.
Stefan, S., Cristea, I. A., Szentagotai Tatar, A., & David, D. (2019). Cognitive‐behavioral therapy (CBT) for generalized anxiety disorder: Contrasting various CBT approaches in a randomized clinical trial. Journal of clinical psychology, 75(7), 1188-1202.
Vujanovic, A. A., Meyer, T. D., Heads, A. M., Stotts, A. L., Villarreal, Y. R., & Schmitz, J. M. (2017). Cognitive-behavioral therapies for depression and substance use disorders: An overview of traditional, third-wave, and transdiagnostic approaches. The American journal of drug and alcohol abuse, 43(4), 402-415.