Case Study
Patient Demographic: Client Age: 48 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Separated Counseling Setting: Private practice Type of Counseling: Individual Presenting Problem: Alcohol use Diagnosis: Alcohol Use Disorder, Moderate, Provisional (F10.20)
Mental Status Exam: Mental Status Exam: The client’s hands tremble, and she becomes tearful on several occasions. There is mild perspiration on her forehead. She endorses feeling hopeless about the future but denies suicidal ideation. The client shows no signs of intoxication or impairment. She presents as well-dressed with good hygiene. Both affect and mood are dysphoric. She apologizes several times for crying and states she has been “a mess” lately due to not sleeping for the last several days. Her demeanor becomes somewhat defensive when asked about her drinking, and she appears to minimize the impact this has had on her life. Fam
Presenting Problem: You are a counselor working in private practice evaluating a 48-year-old female with a history of alcohol misuse. Three weeks ago, the client was hospitalized due to alcohol poisoning. She explains that she was in a blackout before waking up in the hospital and was told her BAC was 0.26, just over three times the legal limit. This occurred on the evening she discovered that her husband was having an affair. The client briefly attended a drug and alcohol intensive outpatient program (IOP) but felt she was not improving with group therapy and would like to try individual therapy instead. She admits that there are times in her life when she has abused alcohol but does not believe she is an alcoholic. The client experiences frequent anxiety and admits to using alcohol “just to take the edge off” and to help her fall asleep. Her alcohol intake increased nearly six months ago when her youngest child left for college. During this time, her husband of 25 years announced he was leaving and filing for divorce. She struggles with being an “empty nester” and is mourning the loss of the life she and her husband built together.
Other Contexts: The client has arrived 15 minutes late for your scheduled session. When you approach the waiting room, you find her loudly talking on her cell phone. She abruptly ends the call and follows you back to your office. She is visibly shaken and angry. She explains that her soon-to-be ex-husband is a “master manipulator” and is “ruining my life.” She remains confident that she can stop drinking but states she can only do so once her family situation is under control. After all, she states, “You would drink too if you had my problems.” She begins to de-escalate as the session progresses, and she is able to identify and prioritize treatment issues. Her sleep continues to be a concern. Upon further exploration, she indicates she is having nightmares and has been for quite some time. The two of you work together to prioritize treatment plan goals. Her mood and demeanor brighten as the session concludes

Question: Given the client’s history of childhood trauma and continued alcohol use, how would you deliver trauma-informed care for this client in the early stages of treatment?
(A): Provide education on the physiological dangers of treating trauma amid alcohol misuse.
(B): Address the trauma if the client agrees to concurrent, short-term psychopharmacological treatment.
(C): Process the details of the client’s trauma experience or trauma narrative.
(D): Help the client understand symptoms of their trauma and offer appropriate outside supports.

Correct Answer: Help the client understand symptoms of their trauma and offer appropriate outside supports.
Explanation: The principles of trauma-informed care (TIC) are emotional safety, collaboration, choice, empowerment, and transparency. Counselors using a TIC approach help the client understand symptoms of their trauma and offer appropriate outside supports (eg, Seeking Safety groups). When treating AUD and addressing trauma, the goal in the early stages of therapy is to increase emotional safety by minimizing the risk of re-traumatization. Providing the client with an understanding of symptoms rather than exploring their trauma narrative (ie, recalling details of the trauma), helps accomplish this goal. Processing trauma in the early stages of therapy can increase the client’s risk of decompensation before developing adequate coping skills. While there are physiological risks associated with treating both trauma and AUD, the counselor must remain transparent by providing information on the risks, as well as the benefits, of concurrent treatment. Attaining short-term psychopharmacological treatment is not a TIC condition, as it does little to empower clients to make educated choices for their care. Therefore, the correct answer is (B)
Competency: treatment planning