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Use the PCN-535 Treatment Plan Template to design a treatment plan…
Use the PCN-535 Treatment Plan Template to design a treatment plan utilizing the case study of Leigh in the textbook and refer to the table in the chapter for an example.
Make sure your treatment plan includes the following:
Problem areas identified
DSM Diagnosis with specifiers
Goals & Objectives to address each problem area identified
Describe the Treatment Interventions
Client’s strengths and weaknesses (liabilities)
Theoretical model for treatment strategies
Case 3: Leigh
Presenting Problem
Leigh, age 16, has been referred because of problems at school and a shoplifting charge. Leigh and her mother moved to this area about eight months ago. She is currently in 11th grade and is attending a new school this year. She is dressed in black with pierced ears, nose, eyebrow, and lip. Her appearance is disheveled and her hygiene poor. She appears to be overly thin. She has previously admitted to “smoking some dope” every now and then and having a drink or two with her friends. When asked to rate her problem on a scale of 1 to 10 (with 10 being no problem), Leigh replied “9” but said her mom’s problem was a -5. Leigh says the shoplifting charge is a mistake; that she intended to pay for the makeup and just forgot it was in her purse. She doesn’t understand why everyone is making such a “big deal out of it.”
When directly asked about her drug and alcohol use, Leigh admits that she has been smoking, drinking, and using Ecstasy, cocaine, and pot at parties for the past four months. She also implies that some of her friends have a meth connection, and she has “tried meth” on a couple of occasions but denies steady use. She says “maybe” she raids her mother’s medicine cabinet “like all the other kids.” She also admits to multiple sex partners at these parties. She states that she sees nothing wrong with any of this and that she is “tired of everyone trying to tell her what to do.” She says that running away with her friends seems to be the best solution for her.
When asked about why she believes running away is the best solution, she describes a series of losses that she has had over the past 10 years. Leigh’s parents divorced when she was 5 years old. When she was a young child she had a close relationship with her brother, who is two years older, but now they do not speak. Both children lived with their mother after the divorce. Until eight months ago they lived in the same town as their father. Leigh and her brother saw him frequently, although she says he was “always busy with work” and she could never talk to him about much of anything. Leigh states that her mother was also busy but would “sometimes” stop and listen. She reports that her mother has a temper and is stressed all the time about money and work. She also reports that her mom and dad still fight about money and “us kids.” She feels like she is in the middle and is always being asked to choose.
Family History
Leigh’s father and brother have “disappeared from her life.” Although her brother is attending college about one hour from their new home, he infrequently comes to visit. He is moody and withdrawn and either goes out to “party” or sleeps most of the time. Her father now lives about four hours away, and she has not seen him since they moved, although he calls her on occasion.
Leigh’s mother is working as a real estate salesperson at a new office and dating Hank, whom she met in their old town and who moved to be close to her in the new town. Leigh says that Hank is “OK” but that she misses her father and never sees her mother now that she is dating as well as working all the time.
In addition to the changes in her family life, she reports missing her old school and friends. At her previous school she received excellent grades and good conduct reports. She was involved in several extracurricular activities and had many friends. Her grades have dropped significantly this year, and her new friends are “different” from her old friends but “accept her for what she is.” Leigh states that her new friends are more fun than her old friends but that she sometimes misses her old school and friends.
Medical Information
Leigh recently went to the doctor for her school physical and reports that the doctor said she was in good health. She is underweight and her menses have not been regular. She denies any eating disorder but some of her comments reflect that behavior. She discusses her mother’s struggle with weight and how she never wants to be “fat.” She also says she “knows different ways to zone out besides drugs and sex when she needs to do that.” Further, she is taking an antidepressant prescribed by the new doctor two months ago.
Leigh reports that her mother is diabetic and she has lots of mood swings. Sometimes she gets really angry and manic. Leigh is worried about her mother’s health and states that she drinks alcohol with Hank every night. The mother is on an anti-anxiety drug as she is “very stressed” at her new job according to Leigh. Her blood pressure is high and she is “on some drug” for that problem. Leigh expresses worry about where she would live if something happened to her mother.
Trauma, Domestic Violence, Substance Abuse
Leigh says the divorce and moving was a very big trauma and that she did not want to move and that now she never sees her father. When they lived in the previous town, at least she saw him sometimes. She also reports that Mom and Hank fight a lot when they are drinking.
Support Systems
Leigh’s only current support system is her new friends. She does stay in touch (text, email) with one of her best friends from her old school, Kathy. She says Kathy is worried about her but that is “crazy; I’m doing fine.” She wants Kathy to visit. When asked about her mother as a support system, she states, “No way!”
Counseling Goals
Leigh states that her goal is just to “get this done.” We did agree that she will attend at least five more sessions and that we would discuss her grades as well as her drug use.
Include at least four scholarly sources in your treatment plan to include the course readings.
include a description of the problem, goal statements, objectives, and interventions. Remember to incorporate the client’s strengths and support system in the treatment plan.
*** Note: You are required to have a minimum of two overall goals, two objectives for each goal, and one intervention for each objective. If you have more than two overall goals, simply copy and paste the chart below.
Client: Click or tap here to enter text. Date: _______ Age: ________ DOB: ________
ICD-9 (ICD-10) Code: DSM-5 Diagnosis (Include Specifiers and Modifiers):
Description of the Problem:
Goal # 1:
Objective(s):
Intervention(s):
Frequency:
Target Date:
1.
? Weekly ? Bi-Weekly
? Monthly ? other: ____________________
Modality:
? Group ? Individual
?Family
2.
? Weekly ? Bi-Weekly
? Monthly ? other: ____________________
Modality:
? Group ? Individual
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?Family
Description of the Problem:
Goal # 1:
Objective(s):
Intervention(s):
Frequency:
Target Date:
1.
? Weekly ? Bi-Weekly
? Monthly ? other: ____________________
Modality:
? Group ? Individual
?Family
2.
? Weekly ? Bi-Weekly
? Monthly ? other: ____________________
Modality:
? Group ? Individual
?Family
