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1. Intimidating, but experience makes it easier. Everybody is capable of change, and since they are forced to stay in treatment they are there the full length. Need to learn more skills on how to engage an involuntary client because we are taught a lot about clients that are voluntary.
2. Try to figure out why they are late, and offer them resources if possible. Let them know that them being late takes away from their time because you can't let their appointment run late. If they are a certain amount of time late automatically cancel their appointments. Seeing if there is another issue that is leading them to be late. Late can be a sign of continued use behavior, and might signal that they aren't serious about recovery.
3. Strengths include opening up, strong marriage, his job, loving his family, making decisions in high stress situations- be supportive while he was talking about his trauma, commend him for sharing (show appreciation), reflection. Bring up his strengths, remind him that he is strong.
Weaknesses- His denial, and unwillingness to share about character deficits (feels shame for substance abuse), another weakness was his guilt associated with Vietnam, and acknowledge that he does have guilt and trauma from the war. don't address it until he was ready to come to terms about his alcohol and trauma from military. Lightly skimmed the surface of his substance abuse to get him from comfortable with talking about it. Let the client talk about what he is comfortable talking about.
4. He grew up watching his dad drink, and thought that would be a good coping skill. His older sister is an alcoholic and labeled her and demonized her for being an alcoholic. "We were raised better than that"- kind of saying that alcoholism is a choice.
5. 3.5-4
6. Alcohol Use Disorder severe (F10.20)
Tried to cut down unsuccessfully
Used large amounts or for longer period of time that intended
Continued Use despite social/interpersonal problems
Withdrawl
recurrent use in physical hazardous situation
tolerance
excessive time spent using drug
recurrent use despite physical or psychological problems worsened by use
7. Trauma specialist and somatic therapy for PTSD and VA because they can link him to those services, couples counseling and family counseling, seek medical care for blood work
8. Frank showing up intoxicated, potential bias because of polar opposite views of the war.
9. Would have never worked with him in the first place because doesn't want to work with domestic violence.

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Ask general questions about her weight, the rate of her weight loss, potential eating disorders, etc. Using caution

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Co-morbid disorders such as eating disorders, depression and anxiety

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90 meetings in 90 days would provide adequate amounts of support and structure that could establish accountability for the patient.
If the patient indicated they no longer wanted to attend meetings we would want to have a discussion on the decision and think of possible resolutions.
Alternatives could be offered such as SMART recovery or refugee recovery, anything that still provides support

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Some family issues that would be of concern would be the relationship with her children, husband, parents and potentially in-laws.
To handle the issues we would want to address some outstanding issues such as the verbal and physical abuse she experiences in home.

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We wanted to know more about his marriage with his wife. We also wanted to know more about his substance use history and not holding himself accountable for actions. We talked about how we were proud of him for showing up to sessions because that seems to be something he struggles.

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3.5

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Cocaine Use Disorder-Severe

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We agreed that we would approach the situation, but not push too far and drive Oliver away. We believe that the tension could have been addressed in a gentle manner.
a. We would have challenged the way the couple was approaching the session and tried to teach them a new way.
b. Clients could have been separated.

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sexual addiction
chemical dependency-assessed right away
understanding triggers
coping strategies
grief and loss
family therapy
marital therapy
domestic abuse
parenting issues

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confidentiality
integrity
commitment to clients
supervisor was husbands therapist so unable to seek out assistance on case.

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We all agreed there would not be a potential for counter-transference

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3.5

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Use in larger amounts or for longer period of times than intended. [1]
Unsuccessful efforts to cut down and quit [1]
Recurrent use despite physical and psychological caused by or worsened by use [1]
Recurrent use in physically hazardous situations [1]
Tolerance [1]
Activities/hobbies reduced given use [1]
Withdrawal [1]
Intense Desire/urge for the drug [1]
Excessive time using drug [1]
Continued use despite social/interpersonal problems [1]
Use in larger amounts or for longer period of times than intended. [1]
Unsuccessful efforts to cut down and quit [1]
Recurrent use despite physical and psychological caused by or worsened by use [1]
Recurrent use in physically hazardous situations [1]
Tolerance [1]
Activities/hobbies reduced given use [1]
Withdrawal [1]
Intense Desire/urge for the drug [1]
Excessive time using drug [1]
Continued use despite social/interpersonal problems [1]

Alcohol Use Disorder Severe 303.90 (F10.20)

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We said the wife was enabling because of cultural aspects. His family of origin also contributed. His place of employment because they allowed him to receive benefits although he didn't complete the treatment as directed.

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We thought that there were some ethical dilemmas with Oliver.