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: During the previous session, the client committed to controlled drinking and agreed on a limit of two drinks per night. She admits to having limited success with this goal and concedes to over-indulging when feeling “stressed out.” You learn she ran into a woman from her church who she discovered was a recovering alcoholic. She agreed to meet the woman at an AA meeting, and the client was surprised she could relate to other alcoholics. The client’s affect brightened as she reported that she has had seven days of continuous sobriety. She continues to have a strained relationship with her now ex-husband. Her youngest child is home on spring break, which has helped improve her mood and kept her accountable for staying sober. She is able to use relaxation and mindfulness techniques for insomnia, which have been effective at times at improving her sleep pattern

Question: According to the Transtheoretical Stages of Change model, in which stage would you classify this client?
(A): Precontemplation
(B): Action
(C): Preparation
(D): Contemplation

Correct Answer: Preparation
Explanation: The Transtheoretical Stages of Change (SOC) Model, developed by Miller & Rollnick (2013), outlines the following SOC: precontemplation, contemplation, preparation, action, and maintenance. This client has just entered the preparation stage. Individuals in the preparation stage consider making a change but are unsure exactly how to do so. Like others in this stage, this client has taken significant steps towards sobriety, but there is still unresolved ambivalenceShe has explored AA and is in early sobriety but will need specific behavioral goals and a more solid commitment to reach the action stage. Individuals in the precontemplation stage are not considering a change, while those in the contemplation stage are beginning to consider making a change. Those in the contemplation stage are still drinking but are weighing the pros and cons of cutting back or abstaining. This client was in the contemplation stage when she attempted to cut back to two drinks per night. Individuals in the action stage have a specific behavioral plan and are committed to the process of change. When individuals become more stable in their sobriety, they have reached the maintenance stage. Therefore, the correct answer is (B)
Competency: intake, assessment, and diagnosis