Scholar Practitioner Project Assignment: Developing an Addiction Treatment Plan Creating an addiction treatment plan is an individualized, dynamic process that begins at the first meeting

Counseling Session 2

Counseling Session 2 Program Transcript

Welcome to Marge’s second counseling session, where you will ask questions to determine the level of treatment needed to address her addiction and her engagement level with her treatment. Before you begin, please carefully read through the paperwork that contains information obtained from team members.

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. • Sixth day of detoxification treatment • Patient is experiencing residual physical withdrawal symptoms. Patient is

shaky and groggy, has been given a mild sedative to keep her calm during withdrawal

• Patient is cooperative and still open to treatment. Patient expressed feelings of loneliness and concern for her children

• Patient exhibiting signs of depression

[About six days later, Marge is going through detoxification, which means she may be a little groggy from sedatives and slightly shaky due to residual physical withdrawal. Her appearance is plain but more kempt than on her admission; she has no makeup, the bandage is removed, her abrasions are healing, and the black eye is almost gone. She is composed, rather down, but cooperative and still open to treatment.]

Question #1:

Option A:

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Counseling Session 2

Counselor: Marge, when we last met, you expressed resentment toward your family and friends after the intervention they held with you. We left that as unfinished business. Share with me your thoughts and feelings toward them now.

Marge:. Yeah, I was furious, but not so much now. I'm more ashamed than mad and concerned that I let things get that bad. They all had written down examples of some of the things I had done while I was drinking that concerned them, and they read those things out to me.

Ethel, my older sister, said that my sons told her they were embarrassed when I came to their soccer games because I’m always staggering around and falling all over everyone. My best friend, Emma, told me she found me passed out one day in the house when she came by to check on me when I hadn’t answered my phone. You know, I don’t even remember that, but why would she make it up?

Their examples got worse, especially when my husband Ken began reading his. I don’t want to talk about what he said right now; I’m too ashamed and afraid to face the facts right now. I need time and help before I can do that.

I’m glad I’m here now; I just hope I can stop drinking for good and live a normal life. I just hope I can, but I don’t know… And even if I would be able to stop, there’s all the damage I’ve done in my life in the meantime, to all those who care about me and need me, and to myself. If only I could ever get sober and live a normal life like most people, if only…..

Option B:

Counselor: Marge when we last met you expressed resentment toward your family and friends after they held the intervention. We left that as unfinished business. Do you still feel that resentment?

Marge. No, not anymore.

Question #2

Option A:

Counselor: Why do you think you’re here?

Marge: You ask me “why”? You’re making me wonder if I’ve done too much damage to repair. Don’t you think I’m asking myself that same question every minute that I’m here anyway? Or you’re making me feel as if I need to own up to ever other single bad thing in my life before I can get better. Well, we could be here a while!

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Option B:

Counselor: I hear you saying that you think your drinking may have caused too much damage to repair and because of that you won’t be able to stop drinking for good. Tell me more about the damage and how it affects your ability to stop drinking.

Marge. It would take me days to tell you all the damage my drinking has done. For starters, though, there’s my family. My children have done the best they can to carry on without a real mom; I’m never there for them, never pay them any attention. I'm an embarrassment to them. They never bring their friends home. They have their problems like any growing kids, and their dad does the best he can to help them. But he has to moonlight to pay the bills since I got fired from teaching, so he isn’t able to give them the attention they need by himself.

Because I lost my income, our finances are in a mess. Now there’s this DUI facing me when I return home. I’ve totally ignored my health. I'm a diabetic, and my drinking is always causing complications. And on top of all that, I’m so tired and so depressed. I’ve always been depressed, and sometimes it’s like a dark tunnel with no light at the end. I could go on and on, but it just depresses me more.

I don’t know how I can return to all that when I leave here, and how I can stay sober with all that facing me? I realize I’ve got a lot to work to do, the more I talk about it, and the more I know I need to be here.

Question #3

Option A:

Counselor: Marge, look at me; I’m a recovering alcoholic myself. I took my last drink 15 years ago, and if I can do it, you can do it. So I know exactly what’s going through your mind. Until I admitted I had a problem and needed help, I wasn’t able to get sober. Can you understand that?

Marge: I admire you for that, I really do (she’s sincere). I wish I could do it like you, but I don’t think I have whatever it is you have to be able to do it.

Option B:

Counselor: What changes your mind about needing to be here?

Marge: That darn intervention; whether I liked it at the time or not, the truth is, that’s what changed my mind! I didn’t think so at the time, but it brought reality

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home to me. I needed to hear everything they said to me that day. I realize now my children haven’t had a mother; they’ve had a drunk who hasn’t been there for them.

The DUI helped change my mind, too, I guess. I’ve never even had a speeding ticket, and now I get stopped for drunk driving. My name was in the paper, and I have to go to court, just like a criminal. If I had kept on doing what I was doing, there’s no telling what would have happened.

My family and friends’ intervention pointed out that I’ve hit my rock bottom, I guess you could say, before I hit a worse rock bottom than I want to imagine. I could have never done it on my own. Like I told you, I tried. There are too many triggers to drink and distractions out there in the world to just up and stop drinking on my own. I don’t have the tools inside of me to cope with it all on my own right now; I need someone to help me help myself when I go back out there in the real world again.

I’m tired; I want to live a normal life. I just hope I can do it, I mean really stop…for good…I wonder though.

Question #4 Option A:

Counselor: Marge, I strongly believe that unless you have a sound belief in a higher power or sense of meaning, you will never get sober. People who have faith can do it; people who don’t have it can’t do it. That’s my firm belief. Do you believe in God enough to get sober?

Marge: (starts sobbing). No, I try so hard to believe, but I feel so sinful. No God would have anything to do with me.

Option B:

Counselor: You said you need the “tools.” Let’s start identifying some of those tools for developing goals for your treatment plan. What are a few of those tools and personal goals that come to mind right now?

Marge: It seems like whenever I run up against something unpleasant, I don’t have the inner resources to cope with it, so I reach outside myself to the bottle to take care of it. I want to learn to relax without drinking.

And then there’s anger. I get so mad at the littlest thing and become a bundle of nerves. Another thing I can’t cope with on my own is my lack of self-confidence. I can’t go out in public without a drink; I'm too self-conscious.

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But more than any of that, I think my depression is the main thing that drives me to drink. I’ve been depressed since I was a teenager; I can’t remember a happy moment since my childhood. I can’t imagine me being able to ever stop drinking and live a normal life as long as this depression hangs over me, ever.

If I am stressed, angry, or depressed, I want to drink, and it seems like I am feeling those things almost constantly. I need to learn to recognize when I am experiencing those feelings, and do something besides drinking to relieve them. I used to enjoy running, a long time ago. Maybe if I get outside and walk? That seems like a good way to handle those feelings instead of drinking.

Question #5

Option A:

Counselor: Before we end today’s session, Marge, there’s one question I want to ask you. Are you ready to stop drinking?

Marge: I’m here, aren’t I? I never said I didn’t want to try. I just don’t think you can help me do it. I can do it on my own.

Option B:

Counselor: Marge, several times today you’ve questioned your ability to stop drinking for good and have a normal life. Picture yourself living that normal life when you stop drinking and describe it to me.

Marge. Well, to begin with, I see myself being a good mother and a good wife; that’s the first thing that comes to mind. (Ponders the question a moment longer)

And having a sense of meaning in life, yes, that’s important…a sense of meaning…(displays a hint of pleasant anticipation on her face) I would be in better health, too, so that I feel confident when I go out in public. I would be able to help my kids and Ken instead of relying on them all the time to help me. I would be the adult, you know? Not another kid that Ken has to take care of, but a partner.

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

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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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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