Describe how you would assess the problem orientation of the client in your selected case study (i.e., how the client perceives the problem). Remember to keep the problem solving model and cognitive behavior theory in mind in the assessment stage.

Discuss the problem definition and formulation based on the cognitive behavioral theory.

Identify and describe two solutions from all the solutions possible. Remember, some of these solutions should stem from the cognitive behavior theory and the problem-solving model

Describe how you would implement the solution. Remember to keep the cognitive behavior theory in mind.

Describe the extent to which the client is able to mobilize the solutions for change

Discuss how you would evaluate whether the outcome is achieved or not. Remember to keep the cognitive behavior theory in mind.

Explain how well the problem-solving model can be used for short term treatment of this client

Describe one merit and one limitation of using the problem solving model for this case.

Sam Franklin

Sam Franklin is a 41-year-old, married, African American male. Sam's wife, Sheri, is 41 years old. They have two sons, Miles (10) and Raymond (8). The family resides in a three-bedroom home in a middle-class neighborhood in Rockville, Maryland. They have been married for 11 years.

Presenting Problem

Sam, a war veteran, came to the Veterans Affairs Health Care Center (VA) for services because his wife threatened to leave him if he does not get help. She is particularly concerned about his drinking and lack of involvement in their sons' lives. She told him his drinking is out of control and is making him mean and distant. Sam reports he and his wife have been fighting a lot and that he drinks to take the edge off and help him sleep. Sam expresses fear of losing his job and his family if he does not get help. Sam identifies as the primary provider for his family and believes this is his responsibility as a husband and father. Sam realizes he may be putting that in jeopardy because of his drinking. He says he has never seen Sheri so angry before, and he sees she is at her limit with him and his behaviors.

Family Dynamics

Sam was born in Alabama to an African American family system. He reports his time growing up to have been within a "normal" family system with a large extended family in his town and nearby towns. He states he was emotionally close to his mother and worshipped his father. His father was strict but loving, pushing Sam to become fairly independent from a young age. His dad had previously been in the military and was raised with the understanding that his duty is to support his country. His family displayed traditional roles, with his dad supporting the family after he was discharged from military service. Sam was raised to believe that real men do not show weakness and must be the head of the household.

Sam's parents are deceased, and he has three older sisters who live in Atlanta. He is close to the sister who is close to him in age, and they talk frequently on the phone. Sam has not, however, shared his current struggles with any of his siblings. He is afraid to let them down.

Sheri is an only child, and although her mother lives in the area, she offers little support. Her mother never approved of Sheri marrying Sam, so she thinks Sheri needs to deal with their problems on her own. Sam reports he has not been engaged with his sons at all since his return from Iraq, and he keeps to himself when he is at home.

Sam and Sheri met during one of his stateside deployments prior to being deployed to Iraq. At the time, Sheri was still in college. Sam and Sheri both say they "fell for each other fast" and kept in touch during Sam's deployment to Iraq. When Sam's deployment was over, Sheri encouraged him to complete a bachelor's degree while stationed back in the U.S. After Sam's graduation, they married and had Miles within a year.

Employment History

Sam is employed as a human resources director for the military. Sam works in an office with civilians and military personnel and mostly gets along with people in the office. Sam is having difficulty getting up in the morning to go to work, which increases the stress level with Sheri. Shari is a special education teacher in a local elementary school. Sam thinks it is his responsibility to provide for his family and is having stress over what is happening to him at home and work. He thinks he is failing as a provider.

Social History

Sam and Sheri identify as Baptist and attend a local church on major holidays. They do not otherwise practice, though both were raised with stronger religious community. Sam used to be quite social in the neighborhood, but he is withdrawn and tends to keep to himself. He says he sometimes feels pressured to be more communicative and social. Sam believes he is socially inept and not able to develop friendships. He says he is able to "fake it" at work but is not sure how long that can last. The couple has some mutual couple friends, since Sheri gets involved with the parents in their sons' school. However, because of Sam's recent behaviors, their socializing with other couples has tapered off. He is very worried that Sheri will leave him due to the isolation.

Mental Health History

Sam reports that since retiring from the military 10 months ago, he has difficulty sleeping, frequent heart palpitations, and moodiness. After his deployment, during his stateside assignments, he reports he did not experience intense feelings from his experiences on the battlefield. He would occasionally have intense memories, but he reports that he was able to "lock them back up pretty quickly." It is only since his retirement that these feelings arose.

Sam has seen Dr. Zoe, a psychiatrist at the VA, who diagnosed him with post-traumatic stress disorder (PTSD). Dr. Zoe prescribed Paxil to help reduce his symptoms of anxiety and depression, and suggested Sam also begin counseling. Sam says he does not really understand what PTSD is, but thinks it refers to a person who is "going crazy." He admits he thought was happening to him at times.

Sam expresses concern that he will never feel "normal" again and says that when he drinks alcohol, his symptoms and the intensity of his emotions ease. Sam describes that he sometimes thinks he is back on the battlefield, which makes him feel uneasy and watchful. He hates the experience and tries to numb it. He has difficulty sleeping and is irritable, so he isolates himself and soothes this with drinking. He talks about always feeling "ready to go." He says he is exhausted from being always alert and looking for potential problems around him. Every sound seems to startle him. He shares that he often thinks about what happened "over there" but tries to push it out of his mind.

Nighttime is the worst, as Sam has terrible recurring nightmares of one particular event. He says he wakes up shaking and sweating most nights. He adds that drinking is the one thing that seems to give him a little relief.

Despite his close and normally supportive relationship with his sisters, Sam is unwilling to share his struggles with them. He fears that he will let them down and prove that he is not able to carry on the strong provider and family patriarch role of their father. He sees this role as crucial to his self-identity. Sam reports that he never saw his father drunk and is ashamed that his own children may have a memories of him being drunk.

Educational History

Sheri has a bachelor's degree in special education from a local college. Sam received a bachelor's degree in human resources management upon his return from the military.

Military History

Sam is an Iraqi War veteran. He enlisted in the Marines at 18 years old. Sam was stationed in several states prior to Sam being deployed to Iraq. Sam left the service 10 months ago but still works in human resources as a civilian.

Medical History

Sam is physically fit but an injury he sustained in combat sometimes limits his ability to use his left hand. Sam reports sometimes feeling inadequate because of the reduction in the use of his hand, but he tries to push through because he worries how the injury will impact his responsibilities as a provider, husband, and father. Sam considers himself resilient enough to overcome this disadvantage and "be able to do the things I need to do." Sheri is in good physical condition and has recently found out that she is pregnant with their third child.

Legal History

Sam and Sheri deny having criminal histories.

Alcohol and Drug Use History

As teenagers, Sam and Sheri used marijuana and drank. Both deny current use of marijuana but report they still drink. Sheri drinks socially and has one or two drinks over the weekend. Sam reports that he has four to five drinks in the evenings during the week and eight to 10 drinks on Saturdays and Sundays. Sam spends his evenings on the couch drinking beer and watching TV or playing video games. Shari reports that Sam drinks more than he realizes, doubling what Sam has reported.

Strengths

Sam is cognizant of his limitations and has worked on overcoming his physical challenges. Sam is resilient. Sam did not have any disciplinary actions taken against him in the military. He is dedicated to his wife and family.

Father: Sam Franklin (31 years old) Mother: Sheri Franklin (28 years old) Son 1: Miles Franklin (10 years old) Son 2: Raymond Franklin (8 years old)