The client is a 32-year-old male who arrived at treatment following an episode of catatonia. Upon his admission into Destination Hope, the client presented as paranoid, guarded, anxious, and delusional with an obsessive thought process. The client has a history of excessive substance use history, reporting that he has been using alcohol and Adderall since the age of 17 to self-medicate. The client’s substance use disorder inevitably led to a loss of functioning and exacerbation of mental health symptoms however the primary precipitating factor that led to the client requiring residential treatment was noncompliance with his psychiatric medication regimen.
Throughout the first few weeks of his treatment, the client continued to present with psychotic features preventing him from gaining insight into his mental health symptoms experienced. Given that client’s recent mental health decompensation was related to his medication, the client was referred out for genetic testing to determine what medication would work best for his presenting issues. The client was also provided with empathy and support from clinical staff using various modalities to treat his presenting symptoms. The client’s obsessive thought process related to hyper-focusing on external factors continued to impede the client’s treatment progress. The client’s therapist used Motivational Interviewing to focus on the client gaining insight and awareness of his mental health issues which was achieved using a collaborative approach. This collaborative non-confrontational approach was most appropriate for this client as his guarded behavior prevented him from trusting his previous therapist. The client’s therapist also provided psycho education on his symptoms and diagnosis to assist the client in gaining an understanding of his own issues and the most effective methods of navigating these issues upon his discharge from treatment.
In conjunction with Motivational Interviewing and education, the therapist employed aspects of Dialectical Behavior Therapy (DBT), an evidence-based treatment that is useful for emotional regulation, distress tolerance, and interpersonal effectiveness. The client’s therapist frequently communicated with the client’s fiancée to gain insight into the client’s progress, discuss discharge planning, and provide his fiancée with suggestions on how to support the client on his path to recovery. In addition to individual therapy and structured programming, the client and his fiancée attended evening family programming sessions on a weekly basis. Both client and his fiancée reported that they found these sessions to be especially beneficial in improving the communication in the relationship. The therapist and clinical staff noticed a gradual change in the client’s mood and affect during his course of treatment at the PHP level of care. The therapist observed the client with an increase in his range of facial expressions and his obsessive thought process became manageable. The client was also observed with increased communication and socialization skills that allow for a healthier relationship with his fiancée, as well as the skills to establish and maintain a support network.
After the client was adjudged to be clinically appropriate to return to work, the client transitioned to sober living to gain support and work towards autonomy. The client has been successful in the management and compliance of his psychiatric medication and has successfully returned to work in the construction industry. The client has been attending meetings, working with a sponsor, and establishing healthy relationships within the 12-step fellowship. Upon his discharge from treatment, the client was provided with community resources and information on Destination Hope’s alumni program as an adjunct source of support.