Sample Case Conceptualization

Client was a 27 y/o single, white, male who was a U.S. Army veteran. He currently resides in a residential rehabilitation program and was referred for services by his mother in order to address his alcohol addiction. He presented with problems which included: trouble falling asleep and waking up with reoccurring nightmares; feelings of anxiety and arousal when hearing loud noise, especially the sound of airplanes passing by; feeling agitated and irritable; having random outbursts of anger; being socially withdrawn, detached and isolated; avoidance of hospitals or other situations that reminded him of the war; avoidance of social gatherings because of loud noise; and avoidance of talking about the time he spent in Afghanistan. Client considered himself to be a "functional alcoholic" for the last few years. He started drinking about 5 years ago after coming back from the Afghanistan where he saw so much death around him. At first he used to drink 3 to 5 beers (12 ounce cans), roughly 5 times a week. However, about 3 months ago he switched to drinking hard liquor (mainly whiskey). He started drinking more and more and was unable to stop (about 1 liter a day, every day for the past 2 months). He tried to cut down but started getting withdrawal symptoms like trouble falling asleep, anxiety and hand tremors. This resulted in the client being fired from his job and having to move back in with his mother since he was unable to pay rent. Client's childhood history was unremarkable. He was born, raised, and lived in Miami his entire life apart from the time he served in Afghanistan. He denied any medical history. He reported no history of head injuries, loss of consciousness, seizures, strokes, or delirium tremors. He also denied any personal or family history of psychiatric complications. Client was recently prescribed Ambien for sleep and Zoloft for his anxiety by a psychiatrist. He completed high school and had no history of academic problems. He worked as a data entry clerk since he came back from the war. He denied any past legal history. He also denied the use of any substance other than alcohol. Client's mental status was unremarkable apart from his anxious mood in some of the sessions. He denied any history of suicidal or homicidal ideation, intent or plan. He was diagnosed with Posttraumatic Stress Disorder, Chronic and Alcohol Dependence W/ Physiological Dependence . I conceptualized this case through Rational Emotive Behavioral Therapy (REBT) by Albert Ellis. REBT is an action oriented psychotherapy that teaches individuals to identify, challenge, and replace their self-defeating thoughts and beliefs with healthier thoughts that promote well being and goal achievement. In my client's case his activating event was the time he spent in Afghanistan where he saw many people die around him. When he came back to Miami from the war he felt irritable, detached, anxious and aroused of certain stimuli. He also had trouble falling asleep and woke up from re-occurring nightmares. These things led to some of his maladaptive beliefs which include: his association of loud noise or the sound of airplanes passing by to bad things happening to him or others; he also believed that drinking would help him relax and fall asleep. He believed that he MUST drink in order to make his problems go away and numb his pain. These maladaptive beliefs led to the consequences of my client drinking more and becoming further isolated. It also led to him getting fired from his job and having to move back in with his mother. In treatment with my client, I first worked on building rapport and therapeutic alliance by keeping eye contact, providing him with a nonjudgmental environment, showing empathy, being genuine, asking open ended questions and reflective listening. Our first goal was to reduce his symptoms of arousal, anxiety and avoidance by first teaching him some progressive muscle relaxation and breathing techniques. I then worked with him using systematic desensitization and lastly doing in-vivo exposure using audio tapes. Our second goal was to help him identify and gradually dispute any maladaptive beliefs and behaviors that he has by using cognitive restructuring, specifically though the use thought logs as well as effective philosophy to track and reduce his cognitive errors. Our third goal was to help him prevent relapse and increase social support by using psycho-education, social skills training and getting him to attends Alcohol Anonymous meetings on a weekly basis. This case was a success based on several factors. I was able to build a strong rapport and a therapeutic alliance with him early on. Having that non-judgmental environment enabled him to speak and share more freely. He gained insight to his alcohol use as well as his PTSD symptoms. He was also able to identify some of his irrational beliefs. His PTSD symptoms were reduced by roughly 70%. He was also in early full remission from his alcohol dependency. By the end of the 12 sessions, he met most of his goals. Towards the end of his residential program he enrolled at a two year college with the interest of acquiring a degree in electrical engineering. He also continues to go to the VA as an outpatient on a weekly basis for continued treatment in relation to his PTSD symptoms.