Question

Rebecca is a 38-year-old mother of two who is currently in the middle of a contentious legal battle for custody of her children. About 6 months ago, Rebecca’s husband told her that he wanted a divorce because the relationship had grown “too complicated” and because he felt that she was no longer able to care for the family as she had once done. Rebecca agrees with her husband and noted that she is not nearly as “put together” as she was 2 years ago when her youngest son started kindergarten. At that time, she said that she was a good mother and wife even though she tended to worry all the time. Rebecca notes that she would frequently worry about her children and their health as well as finances and how they would pay the bills. She often felt tired and irritable and had difficulty falling and staying asleep. She tried to find ways to worry less, and was unsuccessful until she started smoking marijuana. She tried it for the first time based on a recommendation from one of her friends, and she reported that when she was high, she felt relaxed and calm. Because of this, she continued to smoke approximately 2-3 times per week in the evenings after the children went to bed. Rebecca noted that the worries would come back when she wasn’t high, and her husband disapproved of her smoking, but she found that she was not able to quit. She soon found that she was smoking more and more often, and a year a half ago, Rebecca hit another car while high. She seriously injured her back and soon found that she could only take care of the children if she was also taking Codeine for her pain. Her husband was OK with this for a while, but when Rebecca kept smoking pot, even while taking the Codeine, they began to argue about her drug use. Despite feeling like she still needs the Codeine and pot to control her pain and worries, Rebecca has tried numerous times over the past year to wean herself off both substances. She has been unsuccessful. About a month ago, her last refill of the Codeine ran out, and after starting to feel physically ill, Rebecca tried heroin for the first time.

1.Using the DSM-5 system, give Rebecca a diagnosis.

2.In no more than 5 sentences, describe how a cognitive behavioral therapist would treat Rebecca.

Answer 1

1. The diagnosis for Rebecca will be she is suffering from Substance Related and Addictive Disorders (481).
2. The Cognitive Behavioral Therapist first needs to focus on the negative thought, automatic in nature that trigger a feeling of negativity and depression in Rebecca. Then the focus should be on replacing these thoughts with positive thoughts. She needs to be given howmework to focus and try to relive the positive memories she experienced earlier. She should focus on positive thoughts and should be alert to break the cognitive triad which is the result of automatic negative thoughts.