Case Study: Client Description.

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[. . .] In order to get more in-depth information regarding the client's progress the client's parents can also be interviewed regarding their perception of their son's progress.

Post-intervention the client can be contacted at four weeks, eight weeks, six months, and one year and given a standard clinical interview along with the Beck Anxiety Inventory in order to determine how well he has been able to manage his issues.

G. Definition of Practice of Effectiveness.

Since this is a qualitative study the measurement of how effective the interventions work will rely heavily on the self-report of the individual. However, interviews with the parents can provide more objective information. With respect to the client's drinking, the definition of effectiveness can rely on the clients self-report regarding the number of drinks consumed and a reevaluation of his substance abuse at the completion of treatment, six months post-treatment, and one-year post-treatment using DSM -- IV -- TR criteria for substance abuse and the SCID-1 if needed.

Information regarding the change in anxiety levels can also be directly taken from the BAI administered at specific intervals. The definition of effectiveness can depend on the categorical level of anxiety the client demonstrates on the BAI (e.g., dropping from moderate levels of anxiety to mild levels of anxiety and remaining at the mild level for several consecutive weeks). The categories of anxiety severity based on BAI scores are (Beck et al., 1988):

0-7: minimal level of anxiety

8-15: mild anxiety

16-25: moderate anxiety

26-63: severe anxiety

Thus, the BAI can provide a good measure of the client's issues with anxiety.

H. Data Analysis

Since this is a qualitative study no statistical analyses will be performed. Instead most of the data will be looked at in terms of the descriptions of both the client and his parents regarding his progress, number of drinks consumed, severity of anxiety, and number of episodes of anxiety that occur over the course of treatment. Compliance with AA will be measured by attendance sheets and qualitative information obtained from counseling sessions. Client data will be gathered weekly; data from the parents will be gathered pre -- and post-treatment and at specific post -- treatment follow-up times.

I. Limitations of the Evaluation Study.

There are several limitations to this study:

1. The study only uses a single participant, thus generalizability is limited.

2. The study relies heavily on self-report data which can be unreliable and requires the single participant to be candid.

3. There may be several interventions going on at the same time including treatment for anxiety or substance abuse and AA. It is impossible to tell which treatment(s) are actually being effective here.

4. The study will utilize data from the client and the client's parents and this data may not coincide. Moreover, the parents may not have a realistic view of what is going on with their son.

5. The study cannot determine which disorder came first: GAD or substance abuse. It must rely on the self-report of the client to postulate this relationship. Moreover, the study cannot infer that one disorder caused the other to occur as it is correlational nature.

6. If in the current study it is determined that the client's anxiety disorder preceded the alcohol abuse or vice versa concentrating treatment on one particular disorder and achieving success in both behaviors does not necessarily mean that one disorder preceded or caused the other.

J. Ethical Considerations.

There are four major ethical considerations to consider here (Pope & Vasquez, 2010):

1. Getting Informed Consent. Getting informed consent from clients for therapy and a research study is of fundamental importance as it assures the client's independence in entering and following the guidelines of counseling and research as well as informing them of the procedures including roles, rights and responsibilities of all parties involved.

2. Counselor Competence. Counselors have an ethical responsibility only to practice within the scope of their professional competence as judged by education, training, and experience. Moreover, counselors should base treatments on established methods backed by sound theory. The counselor should be able to describe the theoretical basis for providing a counseling service or using a particular method. In this vein is also important for the counselor to make sure that all issues of concern are subject to treatment during the intervention (e.g., both the substance abuse and the anxiety and any other issues).

3. Confidentiality. Counselors need to carefully guard against the unauthorized disclosure of client information. This issue should be explained to the client and his parents.

4. The maintenance of appropriate boundaries during the sessions and afterwards should be discussed with all parties.

K. Directions and Recommendations for Future Practice Evaluation Studies.

In order to answer the questions regarding whether one disorder triggers another it may be prudent to use large sample research, standardized measures to investigate the onset of the disorders, corroboration from significant others, and more advanced statistical analyses such as structural equation modeling, path analysis, etc. (Tabachnick & Fidell, 2012). In addition, it may be the severity of the symptoms of one particular disorder such as an anxiety disorder that leads to later substance abuse as opposed to its mere presence. These are the types of research hypotheses that are best answered with larger sample sizes and quantitative data or mixed research designs. The question of cause and effect requires experimental designs (Tabachnick & Fidell, 2012).

Likewise, research that is intended to investigate the effectiveness of concentrating on the treatment of one comorbid disorder in order to determine if improvement in the one disorder will result in improvement in other comorbid disorders would require larger sample sizes. However, this last question might raise several ethical issues and such research may not be approved by human subjects research review boards. Certainly any competent counselor would want to address all the issues as directly as possible and not leave the door open for issues not to be addressed in counseling.

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.-text revision). Washington, DC: Author.

Beck, A.T., Epstein, N., Brown, G., & Steer, R.A. (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of consulting and clinical psychology, 56(6), 893-903.

Covin, R., Ouimet, A.J., Seeds, P.M., & Dozois, D.J. (2008). A meta-analysis of CBT for pathological worry among clients with GAD. Journal of Anxiety Disorders, 22(1), 108-116.

Dutra, L., Stathopoulou, G., Basden, S.L., Leyro, T.M., Powers, M.B., & Otto, M.W. (2008). A meta-analytic review of psychosocial interventions for substance use disorders. American Journal Psychiatry, 165 (2) 179-187.

First, M.B., Spitzer, R.L., Gibbon, M., & Williams, J.B. (1997). Structured clinical interview for DSM-IV axis I disorders, clinician version (SCID-CV). Washington, DC: American Psychiatric Association.

First, M.B., Spitzer, R.L., Gibbons, M., Williams, J.B.W., & Benjamin, L. (1996). User's guide for the Structured Clinical Interview forDSM -- IV Axis II Personality Disorders (SCID-II). New York: New York State Psychiatric Institute, Biometrics Research Department.

Pope, K. And Vasquez, M. (2010). Ethics in psychotherapy and counseling: A practical guide (4th ed.). San Francisco: Jossey-Bass.

Rollnick, S., Kinnersley, P., & Stott, N. (1993). Methods of helping patients with behaviour change. British Medical Journal, 307, 188 -- 190.

Rubak, S., Sandbaek, A., Lauritzen, T., & Christensen, B. (2005). Motivational interviewing: A

systematic review and meta-analysis. The British journal of general practice, 55(513), 305-312.

Sadock, B.J. & Sadock, V.A., (2007). Kaplan and… [END OF PREVIEW]

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