Comprehensive Case Study 1: Olivia's Mental Health and Recovery

This comprehensive case study examines Olivia, a 30-year-old African American woman, struggling with depression, anxiety, and severe alcohol use disorder. The case details her history, including early childhood trauma, multiple DUIs, and a suicide attempt. The assessment identifies symptoms of depression, substance-induced depressive disorder, reactive attachment disorder, and severe alcohol use disorder. The document explores therapy options, including in-patient rehabilitation, cognitive processing therapy, family sessions, and play therapy for her daughter. It also discusses the application of solution-focused theory and outlines an intervention plan. The study considers the impact of her husband's job loss and lack of support on her mental state and academic performance. The evaluation and follow-up plans are presented to ensure effective recovery.

Comprehensive Case Study 1
Brittany Donner
Capella University
SWK 5013
Comprehensive Case Study
September 2021

Comprehensive Case Study 2
Abstract
Olivia identifies as a 30 year old African American married woman. She is
currently suffering from bouts of depression, anxiety, and severe alcohol use disorder that
began at the age of sixteen. Her drinking problem has led to many criminal issues such as
multiple DUI’s, and she has had a hospital stay for a suicide attempt. Olivia was admitted
into a hospital for attempted suicide for a drug overdose on her Wellbutrin with alcohol.
She has become very overwhelmed with her personal life, it is taking a toll on her
marriage and interfering with her school. Olivia has been referred to mental health
services for her tardiness in school and her erratic behaviors with outburst of crying.
Table of Contents

Comprehensive Case Study 3
Abstract………………………………………………………………………………...2
Table of
contents……………………………………………………………………….3
Introduction…………………………………………………………………………….4
Identifying Information……………………………………………………….4
Presenting Problem……………………………………………………………5
Therapy………………………………………………………………………………...6
Solution Focused Theory………………………………………………………8
Assessment plan……………………………………………………………………...9
Rule Outs……………………………………………………………………….11
Intervention plan …………………………………………………………………….11
Systems Theory………………………………………………………………...13
Evaluation plan……………………………………………………………………...14
Client follow-up plan ………………………………………………………………..14
Conclusion …………………………………………………………………………..15
References…………………………………………………………………………….16

Comprehensive Case Study 4
Introduction
Olivia identifies as a 30-year-old married African American female with three children
ages 2,6 and 8. Client has a habit of being late for appointments by at least 15 minutes.
Olivia’s professor has referred her to treatment for her erratic behaviors. She has been
reporting to class very agitated and nervous. She is dealing with a lot of stress financially
at home and also receiving some backlash from her spouse who wants her to quit school.
Olivia has a history of severe alcohol use disorder resulting in multiple DUI's. Her
mother left her family when she was 14 years old which led to her alcohol addiction.
Shortly after her mother left, she met a boy who would drink to make himself feel better.
At the age of 16 is when she received her first DUI. Olivia stated she is feeling very
overwhelmed with how things are going with her life at this time and all she wants to do
is sleep.
Identifying Information
Olivia Pepper identifies as a 30-year-old African American married woman with
three children. Olivia is currently a full-time master’s student with a 3.8 GPA. Recently
her grades have started to slip and she is now failing two courses, her attendance is
sporadic and she is often late. Olivia appears to have dark hair with it pulled back in a

Comprehensive Case Study 5
half bun. Her posture is slouched down, she seems anxious, has made no eye contact and
appears to be wearing very oversized clothes. Olivia was referred to treatment by her
college professor due to her recent behaviors.
Presenting Problem
Olivia is experiencing extreme anxiety, severe alcohol use disorder, depression and
erratic behaviors such as crying, arriving late to school, failing classes and excessive
sleeping. One of Olivia’s peers reported that they “smelled alcohol on her more than once
after lunch and that they don’t want to work with her because she wants to meet at the
local bar and she is never engaged in learning and more worried about what is next to
drink.” Olivia stated while crying “Most days I just don’t want to get out of bed and face
my day, I am overwhelmed, everyone needs something, and I just want to sleep.” Olivia’s
husband is not supportive of her continuing school but she wants to continue since she
has made it this far. Her husband yells at her to get out of bed and says that she needs to
stay home to be with him and the kids since he is not working. Olivia is going to school
and then going to the bar afterward so she doesn’t need to go home and be around her
husband. Since she is not going home she is falling behind on her homework.
Therapy

Comprehensive Case Study 6
When assisting Olivia with treatment options in-patient rehabilitation would be a
great start to get the alcohol out of her system and help her clear her mind without her
husband yelling at her. My professional opinion is more people need to look at the
holistic route of healing rather than taking medications; however if she is interested in
medication the rehab would be able to get her started on that as well. If she chose not to
use medication then we could do some talk therapy, yoga, meditation and finding coping
techniques that work for her. Yoga in particular, claimed Aurobindo, could ‘bring down a
divine nature and a divine life into the mental, vital and physical nature
and life of humanity’ (Richert, et al. 2018). Many people are realizing that they do not
need to use medications; they can find natural ways of healing themselves that help and
do not have any lasting side effects. Herbal medicine is estimated to be used by up to four
billion people (80% of the world's population). A number of meta-analyses on St. John's
wort is either in comparison to selective serotonin reuptake inhibitors (SSRI) or placebo
and has found it to be significantly better than placebo and of similar efficacy to many
conventional antidepressant medications (Casteleijn, et al. 2019). Secondly cognitive
processing therapy would benefit her to help her free the thoughts that are pulling her
down from the past causing her the want/need to numb herself by drinking. Alleviation of
self‐ or other‐blame cognitions, or what Cognitive processing therapy (CPT) terms

Comprehensive Case Study 7
“assimilated beliefs,” is prioritized early in treatment, with the focus subsequently
shifting to other problematic cognitions, including those related to issues of safety, trust,
power/control, esteem, and intimacy, or what are referred to as “over‐accommodated
beliefs” (Stayton, et al. 2018)
When working with Olivia and her family there needs to be family sessions to help
them communicate better and understand each other’s feelings appropriately. Having a
strong support system is important in her recovery. If Olivia were to go to rehab for
treatment when she comes home, there needs to be encouragement to not let her drink
again. Her daughter needs to be involved in some one-on-one play therapy and talk
therapy to see why she is struggling in school and having a hard time making
friends. Her daughter could be feeling shy in school and lacking interest because she is
suffering from anxiety relating to her father, oftentimes yelling at her mother or her
mother not being home much because she is at the bar. Given the significant development
of the right brain in infancy, and the fundamental role it plays in preverbal, emotional,
tactual and visual processing of our lived experiences, it is a natural progression that
therapeutic interventions for attachment trauma would focus on these neurological areas

Comprehensive Case Study 8
(Urquhart, et al. 2020). Talk therapy alone is not always the most effective treatment
method to utilize with child and adolescent clients. Many researchers and practitioners
have suggested that incorporating art, sand, and play are developmentally appropriate
therapeutic interventions for youth (Stutey, et al. 2019). Most children enjoy playing with
each other and making friends, so why is she feeling apprehensive about a normal child
interaction.
Solution Focused Theory
Olivia is struggling with a lot of anxiety relating to her husband recently losing his
job which has caused her to stress about the finances for her family. Due to the stress she
is enduring it has put her in a position where she has become depressed, she continues to
drink alcohol and it has begun to take a toll on her college, something she enjoyed.
Solution-Focused Brief Therapy (SFBT) is one such modality rooted in theory
that has been adapted to form Solution-Focused Financial Therapy (SFFT) to be a
strength-based approach to working with clients in a financial setting that may help to
reduce an individual's level of financial anxiety (Archuleta, et al.2020).
Helping Olivia understand what she has in the future will help her reach her goals.
At this current time she is struggling with so many things such as her husband wanting

Comprehensive Case Study 9
her to quit school, he has recently lost his job, her child is not doing well in school, she is
sleeping a lot due to the lack of interest, these are all things that need to be treated
however there needs to be a plan put in place of what will the solution be to overcome
these current struggles. How can we improve these current struggles and heal? If her
husband wants her to quit school what could be an option other than this since school is
something Olivia seems to enjoy? Encouraging Olivia to remain in school is important
and reminding her how far she has come. Maybe an option might be to cut back to part
time for a few semesters to help her focus on her family but still continue to do
something she loves. This will also give her time to get her grades back up and improve
her attendance.
Assessment Plan
Olivia is exhibiting signs of depression, reactive attachment disorder and severe
alcohol use disorder. Client is exhibiting signs of depression. She states that she just
wants to stay in bed, and she is sleeping 10-12 hours a day. Client states "You know what
is crazy that it doesn't matter how much sleep I get, I am just exhausted all the time, and I
just feel worthless". During the assessment she begins to cry when talking about quitting
school. According to DSM-5 a more chronic form of depression,
persistent depressive disorder (dysthymia) 300.4 (F34.1), can be diagnosed when the

Comprehensive Case Study 10
mood disturbance continues for at least 2 years in adults or 1 year in children (American
Psychiatric Association, 2013). DSM-5 diagnostic criteria shows Olivia to exhibit
depressed mood most of the day, nearly everyday, diminished interest or pleasure in all or
almost all activities most of the day, hypersomnia, agitation, fatigue, and feelings of
worthlessness. Olivia has struggled with depression since the age of fourteen when her
mother left the family. She started treatment at the age of sixteen when she received her
first DUI. After multiple suicide attempts and inpatient stays, Olivia continues to
struggle. She has struggled with depression since she was a teenager due to the feelings
of abandonment and lack of attachment. Another diagnosis that Olivia is exhibiting is
substance/medication-induced depressive disorder 291.89 (F10.24). Olivia has a hard
time coping when her life starts to fall apart resulting in her alcohol use. Reactive
attachment disorder relating back to her as a child when her mother left the family
resulting in her beginning stages of using alcohol to cope. Lastly, Olivia has mentioned
her alcohol use resulting in the diagnosis of severe alcohol use disorder 303.90 (F10.20).
Olivia exhibits severe alcohol use disorder by the criteria of her craving or strong desire
or urge to use alcohol, recurrent alcohol use resulting in failure to fulfill major role
obligations at work, school or home and recurrent alcohol use in situations in which it is
physically hazardous.
Rule Outs
After speaking with Olivia there were many different emotions she seems to be
feeling and exhibiting at this present time, in my opinion due to the lack of support

Comprehensive Case Study 11
when she was first starting to have these concerns at a young age. When reviewing her
medical records and speaking with her she stated that she has had multiple suicide
attempts and have completed a few inpatient stays in which she feels did not help her.
The first diagnosis that was ruled out was PTSD. Although Olivia has experienced many
traumatic events in her life starting when her mother left the family, that was the only
criteria she met under the DSM-5. As PTSD and other fear related disorders are
associated with an array of other adverse mental and physical health outcomes, ongoing
translational and clinical research has focused on elucidating the neurobiological
substrates underlying these conditions in order to inform the development of treatments
and interventions that attenuate and/or prevent their associated adverse outcomes
(Michopoulos, et al. 2017).
Treatment Interventions
Olivia exhibits many strengths relating to herself. She seems very outgoing when
she is able to decompress and not allow her home life stress to take over her life. She
really enjoys school and until recently has maintained a 3.8 GPA. She is a wife and a
mother of three young children. However, Olivia has struggled with addiction for most of
her life when she began drinking at the age of fourteen. Based on what Olivia has
stated it seems that a lot of her current stress stems from her husband. He has recently lost

Comprehensive Case Study 12
his job, and he is very argumentative relating to what he wants her to do even though she
does not want to quit school he thinks that is what will be best for the family.
In my professional opinion I think the best option of treatment for Olivia would be
cognitive behavioral therapy (CBT). This will help her to identify the unhelpful thoughts
she is feeling and learn some coping techniques to help her when those thoughts do come
up. As a professional it is important that Olivia feels comfortable with me and we are able
to establish a therapeutic relationship with one another. As a team we will come up with
attainable goals and ways to reach them together. Working with CBT will consist of
SMART goals over the next nine months. I want to ensure that Olivia is comfortable and
I do not want her to feel rushed at all. We will work at her speed to make sure she feels
like this is helping her. At the end of the nine months when her goals have been
accomplished we will terminate services and if she wants to we can continue therapy
maintenance. Goal one will be for Olivia to find a hobby that she enjoys outside of the
home. This will allow her time to process her thoughts as well as self-care. This goal can
consist of just going to park and walking around, or getting involved in a group but
something that she enjoys. Second goal will be Olivia will acknowledge when she is
feeling overwhelmed or anxious and take a time out. When she is feeling anxious or
overwhelmed she needs to go outside and get some fresh air, go for a walk, journal,

Comprehensive Case Study 13
something that will help her to get her thoughts out. When she is feeling this way she will
not go to sleep. Last goal will be that Olivia will set a sleep
schedule and stick to it. She will go to bed by 10 pm and wake up no later than 8 am. She
will create a routine to keep her active throughout the day to prevent her from sleeping
10-12 hours.
Systems Theory
The systems theory relates to how the family functions as a “system”. In Olivia's
family there is not much functioning happening at the micro level due to the stress
everyone is currently feeling. The stress has caused Olivia to sleep 10-12 hours a day, fail
her classes, have poor attendance and not even want to come home at night. As a family
this is also affecting her children at this point. Whereas at a macro level Olivia is drinking
to keep herself from feeling the anxiousness and depression. Drinking has always been an
issue for her however she does not want to come home and her daughter is struggling in
school as is she. Olivia has been referred due to her actions at school that relate to her
home life but she is unsure of how to cope.
Evaluating Progress
To ensure that Olivia is getting the best treatment I will go over her goals with her
every few months to make sure we are still on the right track and none of her goals needs

Comprehensive Case Study 14
to be changed. We will also practice coping techniques to help her feel like she is able to
overcome the feelings and emotions during the moment rather than bottling them up.
Making sure that she can see and feel a difference in herself is the most important part of
treatment. Relating to Olivia’s treatment goals if she is unable to attend sessions in person
there would be the telehealth option for her and she could also reach out to me using
email. As a mental health professional it is important to always be respectful and practice
HIPPA when using any form of technology or social media to communicate with clients.
Social workers should not discuss confidential information, electronically or in person, in
any setting unless privacy can be ensured. Social workers should not discuss confidential
information in public or semi-public areas such as hallways, waiting rooms, elevators,
and restaurants (NASW, 2005).
Follow up plan
The follow up plan for Olivia will be to remain in treatment for at least six months
starting with weekly therapy sessions gradually going to bi weekly and eventually
monthly. Olivia needs to work on treatment techniques that will work for her when she is
feeling upset. For the first few months treatment will be in person to establish a strong
relationship and gain comfort. Every few months Olivia will have the opportunity to go
over her goals to remain on track for success. Allowing Olivia to be present in her

Comprehensive Case Study 15
treatment is important to make her feel heard and able to reach the goals she sets for
herself.
Conclusion
In conclusion, Olivia has many great attributes she can offer, however right now
she feels like her world is crumbling down on top of her. With strong coping techniques
in place and consistent treatments Olivia will be able to overcome these fears she is
experiencing and get back to doing the things she loves. Encouragement to continue to do
what she enjoys such as school will help her to make the right choice. Allowing her to
seek treatment with other programs for her alcohol addiction will only help encourage her
recovery and show her that everything will be okay.

Comprehensive Case Study 16
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Arlington, VA: Author
Archuleta, K. L., Mielitz, K. S., Jayne, D., & Le, V. (2020). Financial goal setting,
financial anxiety, and solution-focused financial therapy (SFFT): A quasi-
experimental outcome study. Contemporary Family Therapy, 42(1), 68-76.
Casteleijn, D., Steel, A., Bowman, D., Lauche, R., & Wardle, J. (2019). A naturalistic
study of herbal medicine for self-reported depression and/or anxiety protocol.
Integrative medicine research, 8(2), 123–128.
Michopoulos, V., Powers, A., Gillespie, C. F., Ressler, K. J., & Jovanovic, T.

Comprehensive Case Study 17
(2017;2016;). Inflammation in fear- and anxiety-based disorders: PTSD, GAD,
and beyond. Neuropsychopharmacology (New York, N.Y.), 42(1), 254-270.
National Association of Social Work. (2005). NASW standards for clinical social work
in social work practice [PDF]. Available from http://www.socialworkers.org/
Richert, L., & DeCloedt, M. (2018). Supple bodies, healthy minds: Yoga, psychedelics
and American mental health. Medical Humanities, 44(3), 193.
doi:http://dx.doi.org.library.capella.edu/10.1136/medhum-2017-011422
Stayton, L. E., Dickstein, B. D., & Chard, K. M. (2018). Impact of Self-Blame on
Cognitive Processing Therapy: A Comparison of Treatment Outcomes. Journal of
Traumatic Stress, 31(3), 419–426.
Stutey, D. M., Klein, D. E., Wubbolding, R. E., & Dunnigan, N. (2019). Therapists’
perceptions of the reality play therapy model. International Journal of Play
Therapy, 28(2), 69–78.
Urquhart, M., Gardner, F., Frederico, M., & Sanders, R. (2020). Right brain to right brain
therapy: How tactile, expressive arts therapy emulates attachment. Children
Australia, 45(2), 91-96.