Case Study Matt, a 30-year-old, contacted Dr. Reid for individual counseling. During the intake session, he reported that issues from his family of origin were affecting his marriage. Matt additionally complained that he had been feeling angry, anxious, bored, confused, depressed, fearful, and tense. He identified other problems as important also: family, sexual orientation, marriage, religion, procrastination, lack of motivation, and physical health. Matt presented with a history of drug/alcohol use, impulsivity around sex, a pattern of unstable relationships, affective instability, feelings of boredom, and intense fear of abandonment. He complained that his in-laws are opposed to his being married to their daughter, especially in light of their discovery of his gay lifestyle. Matt also indicated his brother is currently in prison for rape. He stated he was abused both emotionally and physically as a child by his brother. Of importance is that Matt initially experienced a conflict between the religion that he grew up with (Lutheran) and that to which he converted to please his wife (Jehovah Witness). His wife's religious support system was highly opposed to his sexual orientation.

Matt began dating at 18 years of age. He indicated he has had difficulty trusting women. He is currently married to Nancy, 32, for 2 years and has been separated for approximately 1 year. He reported that he told her of his sexual orientation prior to marriage. Matt initially expressed ambivalence about wanting to separate from his spouse until he resolved his family-of-origin issues. He stated that he and his wife had previously been in therapy with Dr. Buford in a private practice off and on with apparent limited investment.

Matt initially reported past use of marijuana for 14 years, cocaine use for 3 years, and alcohol use for 15 years. He also initially reported that he rarely uses alcohol and does not use any other mind-altering chemicals except for Zantac prescribed by his family doctor, Dr. Espino. Over the course of several sessions with Dr. Reid, it became evident that Matt had lost control over his drinking on numerous occasions. It was also observed that when he is in a relationship, he tends to put on weight, discontinues having anonymous sex with partners he meets in bars, and limits his drinking and drugging (cocaine and marijuana). When he is not in a committed relationship, he loses weight and resumes drinking, drugging, and sexual acting out.

1. Sociocultural model?

2. How does this model explain the client's problems?

3. What issues does the model not explain?

4. What could they do as a support worker or paraprofessional counsellor to help this client?

5. What treatment suggestions would you consider?