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Olivia Pepper is a 30 year old Masters Student who was referred to the University Counseling Center from her professor for erratic behaviors. The referral report from the professor states that Olivia is a bright student with a 3.8 overall GPA in her last semester of school but that she is currently failing two of her courses that her attendance has been sporadic, and she is often late. One of Olivia’s peers reported that they “smelled alcohol on her more than once after lunch and that they don’t want to work with her because she wants to meet at the local bar and she is never engaged in learning and more worried about what is next to drink.”
Olivia’s intake paper work shows that she is African American, married with three children (ages 2, 6, and 8). Her religious affiliation is listed as Baptist. Her records indicate that she is receiving several financial need scholarships and that she is currently not working. Olivia reports that she is currently not on any medication but has previously taken Zoloft and Wellbutrin. Her intake paperwork also lists two residential treatments once as an adolescent for alcohol use and the second when she was 24 for depression and alcohol use. She has had two DUI’s her first when she was 16, and the second when she was 22 years of age. Olivia indicates that she went to family counseling as a teenager.
Upon her first visit Olivia is 15 minutes late for her appointment, she is in baggy clothes that look dirty and her is unkempt, she appears agitated and nervous. When asked why she was there she stated “because my teacher is worried I have fallen off the wagon.” When asked to explain what that meant Olivia shared that she is a great student and she is just having a hard semester so she is not doing as well but that it has nothing to do with her drinking. Olivia continues that her husband was fired from his job so it has created great stress in her house and that he wants her to stop school and work until he can find work again. Olivia starts to cry and states, “I am almost done, how am I supposed to quit, but my family needs me.” “Most days I just don’t want to get out of bed and face my day, I am overwhelmed, everyone needs something, and I just want to sleep.” When asked how many days of the week this happens, Olivia shard that this occurs every day. She reported sleeping 10-12 hours a day, isolating herself from her family, and not going to school because she just doesn’t care. When asked how long this had been occurring she stated it has become worse over the past six months but that she has been in a “funk on and off my whole life.” She continued with, “You know what is crazy that it doesn’t matter how much sleep I get, I am just exhausted all the time, and I just feel worthless”
Olivia reports that she has no reason to be so sad all of the time. She grew up with loving parents who worked hard. Her mother left them when she was 14 and that is when she started to drink. She reported she had a boyfriend and drinking with him would make her feel better. When she received a DUI at the age of 16 her Dad didn’t know what to do so he put her into treatment, which was a waste of time as drinking was not her problem. Olivia shared her second trip to treatment was after the birth of her first child, she just felt guilt all the time for working and not being with her baby so she started to drink again. She stated that he was a cranky baby and it was the only way she could cope. Olivia shared that when she received her second DUI at the age of 22 it was too much to handle as she lost her job because she was not allowed to drive after that. She stated it was a long couple of years and after the birth of her second child it was too much to take and she tried to make it all stop. Olivia stated she was admitted into a hospital for attempted suicide for a drug overdose on her Wellbutrin with alcohol. Olivia stated that scared her and she started to go to AA and started to feel better.
A couple of years ago she decided that she wanted to finish school so that she could help kids like her and maybe help them avoid “this mess I am in.” Olivia stated everything was going ok and that she has not been on medication. She reports that church and AA have been very important to her and they help her get up in the morning. Olivia reports she has no family, that she has not seen her mother since she left her as a child and that her dad passed away two years ago from ‘drinking himself to death.’ Olivia has a sister that moved out of state years ago and they talk on the phone occasionally but that they are not close.
Olivia admitted that she has started to drink and typically when she goes to school during lunch she will have a drink to help her get through the rest of the day. She also reports sneaking drinks into her lemonade at home so that her husband and children do not know she is drinking.
Olivia stated her husband is very angry with her and wants her to quit school and just “yells at me to get out of bed.” She states that her eight year old daughter helps with the two year old, that she watches her so I can do my homework, and gets her ready in the morning. She stated her two year used to go to day care but now stays at home seeing her husband is always home. Olivia states this is part of the problem “so I go to school and don’t want to go home so I go to the bar instead. This is the real problem, if I am not home I don’t do my school work, this is why I am so far behind.” Olivia states her six year old is very quiet and keeps to herself and that she is worried about her the most. That her teachers say that she is not doing well in first grade and has no interest in making friends or doing well in class. Olivia stated “she is just like her mom.”
In this assignment, you will use evidence-based literature and the DSM-5-TR to effectively and appropriately diagnose a client. From there, you will use theory and the DSM-5-TR to effectively develop an intervention plan that is informed by best practices as identified in current literature. Describe a diagnosis appropriate for the client.
Consider all potentially fitting diagnoses, discuss the differential diagnoses, and discuss rule out diagnoses and why.
Justify the diagnosis with reference to specific DSM-5-TR criteria.
Describe the therapy or intervention you would provide this client.
Apply theory to contextualize the appropriateness of your chosen therapy/intervention.
Describe an intervention appropriate for the client’s family or community.
Justify the recommended intervention with reference to specific DSM-5-TR criteria.
Cite peer-reviewed literature within the intervention plan.
Cite at least five peer-reviewed articles published in the past five years.
Describe the content of each cited work, specific to how each one supports the main or supporting points of the intervention plan.