Case 1D Rosa is a 35-year-old woman who has been brought to the inpatient psychiatric unit by police after being arrested for trespassing on Mr. Bennett’s property. Upon arrival, Rosa is cooperative with the staff but becomes adamant about needing to be released. She states that she was simply entering her husband’s home when she was stopped by the police. Rosa adamantly declares that Mr. Bennett is her husband. She explains to the staff how much the two of them loved each other when they got married, and how she is currently pregnant with his child. She also states that she left her previous husband so that the two could be together. Mr. Bennett reports that he used to be Rosa’s boss, and had fired her because of her inappropriate romantic advances three years prior. He also reports that her amorous advances have continued on a fairly consistent basis since then and that her breaking into his house is the last straw so he called the police. He does intend to pursue legal proceedings on the trespassing charge. Rosa reported to the police that this was nonsense and that he has kidded like this in the past about her breaking in. Rosa goes on to explain that this time the police believed his joke that she was someone who had broken into his house and removed her from the house. Rosa explains to the staff that this scenario of her “pretending” to break into the house is a common role play that she and her “husband” engage in. Rosa shares that she was previously married to another man in Florida, with whom she denies any current relationship, stating that she escaped a loveless relationship with him and moved to California to be with her husband, Mr. Bennett. While Rosa reports that this situation of being arrested and being brought to the inpatient unit has been frustrating she does not report any symptoms of depression or anxiety. In addition, she reports no use of alcohol or substances except to have a glass of wine once or twice a week with Mr. Bennett. A substance abuse test revealed the presence of no drugs in Rosa’s system. In addition, a physical examination confirms that Rosa is not currently pregnant. A thorough psychosocial history reveals that Rosa is currently maintaining employment in a bank and has been employed there for the past two years. It is also discovered that she is maintaining her own residence and is in contact with family members (mother, father, sister) in Florida. When the family members are questioned they reveal that they thought Rosa was in a mutual relationship with Mr. Bennett as this is what she had explained to them. Although they had never met him they were not overly concerned as they do not have the funds to visit Rosa in California and she is too busy with work to make the trip home. Due to not being able to spend time together they had no reason to doubt what Rosa was telling them about her relationship. To be specific, nothing about what she shared seemed out of the ordinary or bizarre. Although Rosa is hesitant at first to engage in treatment at the inpatient unit she reports that she is willing to attend counseling as this may assist with relationship issues that she and Mr. Bennett have been having. QUESTION 2 1. Case 2B Linda is a 36 year old single female who has come for assessment due to feelings of loneliness and a desire to have friendships. Linda reported that she feels inadequate in all social situations and that when she does spend time with her established friends she will often have her feelings hurt by “any little thing they say about me, what I am wearing or how I act.” Linda reported that she currently has two friends, but it took over 10 years of these two women reassuring her that they did like her and did not think badly of her for Linda to agree to socialize with them on a semiregular basis. Linda stated that her feeling uncomfortable around people began at an early age and she was often labeled “shy and quiet” in elementary school. She reported that her parents would tell teachers that she would “grow out” of her shyness, but as she aged, her fear of new situations increased. Linda reported that she has feared criticism and rejection by others “my entire life” which has led to her having few friends, never being married and not being able to maintain a job for longer than six months at a time. Linda reported that she is always tense around anyone besides her two friends and that she will often blush or cry when someone criticizes her. Linda stated that she always feels inadequate and self-conscious when around people, even her friends, and will keep social interactions at a surface level. She is convinced if anyone really knew her they would like her even less than they do when they first meet her. Linda stated that she thinks about being rejected all the time and replays social interactions over and over in her mind daily. Linda reported that she has not been able to keep a job for longer than six months and that she spends the majority of a year unemployed. She will find a job that she thinks she will like and will start work, but the comments and rejection by her co-workers becomes so painful that she will stop going to work. She will not notify her employer of her intention to quit due to being fearful of their “being happy” that she is leaving, so she has few positive past employee references. QUESTION 3 1. Case 3C Diane is a 36 year old female who was referred for assessment and treatment by her place of employment. Diane was caught stealing oxycodone from the hospital pharmacy where she is currently employed as a registered nurse. Diane was placed under disciplinary action including random drug testing, restricted access to medications at work and mandated therapy. Diane reported that she is embarrassed over the entire situation and wants to remain drug free so she can continue to pursue her dream of becoming a nurse practitioner (NP). If Diane follows the corrective action plan for 12 months she will be returned to “normal” status and will be eligible to apply to the NP program that is associated with her hospital. Diane was involved in an automobile accident two years ago and broke a disc in her back. She had surgery but the pain did not subside. After the accident Diane was prescribed oxycodone for pain. She took the medication as prescribed for 10 months. At the 10 month mark her doctor refused to continue prescribing the medication, so she began going from doctor to doctor to get enough medication to keep the “cravings” at bay. She was taking 3-4 days per month off work for doctor’s appointments and would run out of the medication before the next prescription was available. At one point she was seeing six different doctors monthly and getting a prescription from each one. She attempted twice to cut back but found herself taking more than before the cut back. She also attempted to stop taking the medication four times. Each time she experienced significant symptoms including feeling like she had the flu, nausea, vomiting, diarrhea, shaking, inability to sleep and increased pain. She got two warnings at work for excessive absences due to doctor’s appointments. She also stopped socializing all together for the past six months. Three months ago four of the doctors stopped prescribing for Diane and she had to start buying opiates off the street and stealing them from work. After being caught at work she was sent to detox and has been opiate free for two weeks. She reported a strong desire to begin taking opiates again, even though she knows it can result in the loss of her job and future dreams and desires. QUESTION 4 1. Case 4C Grace is a 61 year old married mother of four, who was referred for assessment by her primary care physician (PCP) after multiple hospitalizations due to severe gastric pain. At no time has any test showed a medical root for the pain. Grace reported that she knows her PCP is tired of her complaints of pain and that most people in her life ignore her distress over her medical concerns. Grace’s PCP reported that she believes Grace is experiencing gastric pain, but since no medical reason can be established, she wanted her assessed for psychological possibilities. Grace has struggled with stomach and intestinal pain for the majority of her adult life, but in the past five years, her symptoms have increased “from bi yearly flair ups to daily pain.” In the past five years, she has never gone more than a week without the pain. Grace is highly anxious about her stomach pain, even when the symptoms are not present, and spends most of all days thinking about the pain. Grace has been in the hospital 12 times in the last five years for pain. She has seen her PCP monthly for the past two years and has seen over 10 specialists. Her PCP has lost track of how many different tests she has run. Grace also struggles with feelings of sadness on a daily basis. She reported that the sadness has been present for three years, with less than a week or two in any given year without the sadness. Her family and friends all verified that Grace has been sad almost every day for the past three years. She will often feel tired after 10 hours of sleep, will eat even when not hungry, resulting in gaining 50 pounds in the last three years, and feels hopeless about her life. She has also struggled with concentration, but thinks the continuous pain may also contribute to her lack of focus. Grace has never had suicidal ideations, a manic episode or severe depressive symptoms. Even though Grace is more concerned with her medical issues, the sadness has resulted in less socialization and not fulfilling all her tasks at home. She had thought about getting a job to help fill her life after all her children left home, but lacked the energy and motivation. She also worried that any job would become ‘irritated with her” due to her medical problems and need to attend doctor’s appointments. Grace reported that all of her children left home six years ago. She has been a stay at home mother and after they left, she struggled with how she saw herself and what she was going to do in the future. She was sad during this time, but not to the extent she is presently. Grace’s husband is a recovering alcoholic. He has been alcohol free for 10 years. Prior to his sobriety, he would physically abuse Grace around two times per year. She never left, and he never abused the children physically. Grace stated that since the children have left, she has been thinking more about the years her husband drank. She would like to resolve the old feelings of anger towards her husband and improve their relationship. QUESTION 5 1. Choose TWO of the four previous cases and develop a treatment plan for each. Use the Treatment Plan Worksheet that was used during your class time. Submit the two treatment plans as one Word document. Be sure to indicate the case number and letter (e.g., 3C) for the cases you are using.
Purchase answer to see full attachment