Treatment Plan Case: Bill Treatment Plan Case – Bill Mr.. Bill presented for treatment stating he was experiencing “depression, co- dependency, and a history of chemical abuse. ” He disclosed information on continual failure to maintain healthy relationships, he also stated that he has had sexual relationships with several different partners. During further discussion, he divulged information of a chaotic childhood that consisted of physical and emotional abuse. ADSM-V Diagnosis (DXL) The provisional diagnosis of 302. 9 Other Specified Sexual Dysfunction (Sexual Addiction) is given, due to the client fulfilling three criteria from a list f behavioral patterns in Clinical Management of Sex Addiction for a diagnosis of Sexual Addiction. The three criteria consist of “excessive amounts of time spent obtaining sex, or being sexual, preoccupation with sexual behavior, continuing to take part in the sexual behavior despite knowledge of having recurrent social problems, and psychological problems” (Scares, P & Adams, K. 2002, p. 9). Furthermore, as a child, Mr..
Bill’s mother was a prostitute, which may qualify as another member of his family being sexually addicted, he has a history of crisis because of sexual addiction, and he comes room a disengaged family. Mr.. Bill is also given the following V codes; VI 5. 41 personal past physical abuse during childhood, due to abuse suffered as a child. VI 5. 42 (z. 81 1) personal past history of psychological abuse in childhood, due to psychological abuse suffered as a child. VIA. 29 (Z. 9) problems related to employment, because of the fact that his employment is influencing his sexual addiction.
VIA. 49 (Z. 9) sex counseling, intended for sexual addiction. Differential diagnosis includes the following, listed in order of importance. These are illnesses that are suspected, but a diagnosis cannot e given at this time due to lack of evidence: 350. 90 Unknown Substance Use Disorder; 292. 84 Us absences/ Medication-Induced Depressive Disorder and; 296. 21 Major Depressive Disorder; 309. 81 Postgraduates Stress Disorder. The Unknown substance use disorder will be investigated due to Mr.. Bill’s acknowledging he has a history of substance abuse.
He also assumes he has depression, which could indicate a depressive disorder. Depression can also be caused by chemical addiction, and therefore medication-induced depressive disorder is being investigated. Furthermore, Mr.. Bill disclosed a story of psychological and physical abuse, therefore postgraduates stress disorder will be assessed. Mr.. Bill mentioned co-dependency as a concern, a co-dependent personality trait may have developed due to the nature of his dysfunctional relationships.
According to Scares (2002) creaking can be a manifestation Of codependent controlling behavior (p. 129). Although he demonstrates evidence of impairments in personality function, he does not meet criteria for a dependent personality disorder, nor any other personality disorder. In light of his sexual promiscuity, Mr.. Bill is being referred to a hysteria to attain testing for sexually transmitted disease (STUD) and a human immunodeficiency virus (HIVE). It is recommended that Mr..
Bill abstain from any sexual activity until he has been tested, to remove the probability of developing a Sexually Transmitted Disease (STUD) or infecting another with a Sexually Transmitted Disease (STUD). A full physical exam is recommended in light of a history of chemical abuse. Mr.. Bill is displaying distorted thought patterns. He has a history of chemical abuse, but has not mentioned how far back in history, or if he still continues to use drugs. He has poor problem loving ability, this is suggested of reliance on outside sources to provide him with his own self-identity.
He seems to be a resourceful person due to the fact that he owns several strip clubs, however, the strip clubs have directly contributed to his sexual addiction. He showed poor insight into the extent of his sexual addictions; however, records from a previous a therapy session indicated that he has made some progress by admitting that his unconscious feelings of pain from his past have developed into habits that encourage his sexually acting out (Scares, 2002, p. 33). This is a crucial first step to healing home from his past and present. Mr..
Bill displays several defense mechanisms including codependency, using sexual relationships and work to avert pain and shame of his past and present. He displayed cognitive distortions by following the same faulty pattern with relationships, and used manipulation to gain control Of these relationships, then intentionally sabotaging these relationships. Which is a demonstration of poor developmental skills in relationships, this is an indication of developmental failure with his initial caretaker. Further Assessment Needs Suicidal ideation was not addressed in Mr..
Bill’s initial interview, therefore this will be done the next evaluation. To accurately identify Mr.. Bill’s clinical needs the following assessments will be conducted, he will be administered the Sexual Addiction Screening Test (CAST) (Scares, 2002, p. 1 1). To rule out the differential diagnosis in light of his admittance to a history of Chemical Abuse, he will be administered the CAGE questionnaire (Scares, 2004, p. 222). For further study of drug abuse, the Addiction Severity Index (ASS) taken from the National Institute on Drug Abuse (Scares, 2002, p. 44) will be given. Mr.. Bill discussed the presence of depression if no drug use is shown he will be given Beck Depression Inventory II and, he will be referred for psychiatric evaluation as suggested in Scares, (2002, p. 221 However, if drug use is indicated, Beck Depression Inventory II will be delayed for two weeks into treatment. PETS symptoms will be assessed by the Minnesota Multiphase Personality Inventory 2 (IMP-2) as recommended in The Complete Adult Psychotherapy Treatment Planner (Jogging, A. , & Peterson, M, 2006, p. 231).
P T SD will be investigated due to the prevalence of P T SD in sexual addicted population. Also, it is indicated due to Mr.. Bill’s history of physical and psychological abuse. Treatment Goals/Outcomes During the first session the client will be assessed fifth test listed above indicate Substance Use Disorder, Major Depressive Disorder, Postgraduates Stress Disorder, or HIVE the goals and interventions may be changed. A goal for treatment is for the client to learn skills to accomplish a sober lifestyle. Abstinence will allow the client time to heal while abstaining from the compulsive sexual dysfunction.
The time without sex will reverse neuron- chemical tolerance, and it will allow the client to learn that sex is not the most important thing in his life (Leaser, 2004). This will be reassessed in 12 weeks on 10/28/15. Other goals are for Mr.. Bill to attain a deeper spiritual and emotional relationship with Christ. This will influence his compulsive behaviors by replacing them with healthy ones. Also it will allow him to find forgiveness and salvation. This will be achieved in the second session by 8/14/15. Another goal is to resolve issues that have prevented him from seeking a more intimate relationship with Christ.
This will help to uncover Mr.. Bill’s Cognitive distortions such as feeling unworthy, and understanding why e uses fantasies for comfort. This will help him identify the compulsive habits he developed in romantic relationships and also in his career choice. Therefore, he will develop healthy nonsexual relationships, gain support from healthy support systems and learn to implement boundaries. This will be attempted in the third session by 8/22/15. During treatment Mr.. Bill will surrender his life to Christ. This will allow him to give Christ control over his emotions.
It will also allow Mr.. Bill to develop skills for affect regulation in order to regulate his emotions (Scares, 2002), thus allowing him to recognize tatters of behavior that help him to manage his emotions. This will be done in the fourth session by 8/29/15. Further, goals are for Mr.. Bill to attain repentance and forgiveness in his relationship with Christ. He will begin to work with pain and shame management due to his past history of abuse, and present sexual addiction, this will help him to become more aware of the reasons why he is acting out sexually.
This will be done in the fifth sessions until 9/4/15. For the final goal Mr.. Bill will make a career choice that is beneficial to his sobriety. This will be attempted by 9/1 1/15 if he accepts a rarer change efforts will be made to help him achieve his career goals. Also During the sixth session Mr.. Bill’s progress will be evaluated and adjustments in therapy will be made. If PETS is diagnosed begin treatment in sixth session, to establish relationship bonding and openness before treatment begins.
This will be accomplished on 9/1 1/15. Treatment Actions/ Interventions In order to address adapting to a sober lifestyle and maintaining sobriety it is recommended that Mr.. Bill sign an abstinence contract, and join a local Sex Addicts Anonymous so that he can begin to build healthy relationships and a lately support System. This will be done two times a week for ten weeks until his last session. He is also given the book Healing the Wounds of Sexual Addiction (Leaser, 2004), in order to educate him on healing of sexual addiction.
It is imperative for him to acknowledge a desire to get well, and be enlightened on the healing that can take place when he seeks God for healing (Leaser, 2004). It is also important to develop an open and honest relationship with his therapist to encourage freedom in communication. In session two Mr.. Bill will acknowledge if he desires to satisfy a deeper spiritual lifestyle (Leaser, 2004). He will be encouraged to seek the grace of God’s forgiveness and salvation. He will also be taught how to identify rituals and understand the basis for their existence.
This will be achieved by identifying and understanding rituals and identifying healthy boundaries that can be emotional, spiritual, physical, sexual, and spiritual in nature (Leaser, 2004). He will determine “spiritual disciplines that he can begin to practice, such as prayer, meditation, church attendance, or bible study’ (Leaser, 2004, p. 156). In session three Mr.. Bill’s cognitive distortions will be analyzed, each time en is recognized during the therapy session, it will be identified. The book Feeling Good by David Burns (1980) will be recommended for reading (Scares, 2002, p. 3) to aid in recognizing cognitive distortions, which includes stopping fantasies that perpetuate his sexual desires. He will be taught thought stopping skills and how to satisfy needs in a healthy way. This will be done in the third session. Also, continuation in Sex Addicts Anonymous will be encouraged two times a week. To develop affect regulation in order to deal with his emotions, it will be explained to him how his affect regulation provides emotional relief through addictive behaviors. Practice healthy behaviors to manage emotions.
Discuss despair and the relief that can be gained by surrendering his will to God, and admitting his powerlessness (Leaser, 2004). Encourage weekly meetings in Sex Addicts Anonymous. This will take place in the fourth session. The client will be lead in a prayer of repentance and forgiveness of his sins. To focus on pain and shame management, the origins of the pain and shame will be discussed. The client will be educated on shame and supported to expose shameful events in his life. Support will be given to face the feelings of shame and, deal with guilt” (Scares, 2002, p. 72).