Scenario:

Daria Acevedo, a 38-year-old interior decorator, is married and the mother of a 16-year-old daughter. She lives in Salem, MA. Mrs. Acevedo is a petite woman who arrives to therapy appropriately dressed and is interested in enrolling in counseling to bolster her case to get her license reinstated after it was suspended following her refusing to take a breathalyzer test after being stopped by police for suspected O.U.I. Her husband originally convinced Mrs. Acevedo to attend counseling after this traffic stop occurred.

Ms. Acevedo is trying to get into running with her husband & reports that she enjoys her Sundays at the church and that they usually have dinner at her mother's home on Sundays after church. Ms. Acevedo continues to work at the design firm in Boston but drives in because the commuter rail is too expensive; she reports that she doesn't mind the drive because she can listen to Christian podcasts that her husband has recommended. She reports that for the past three months, her firm has been pursuing larger contracts and everyone has been putting in longer hours, so she's been working for a few hours on Saturdays for the time being. She reports no current medical concerns, but past insomnia and anxiety. She reports after the death of her boyfriend being in treatment for anxiety that consisted of 8 weeks of "regular" therapy with a therapist and a psychiatrist who prescribed her Lexapro and Zoloft for two years; she reports that if she asks, this prescriber will still fill a prescription for Xanax that she can take PRN. Ms. Acevedo denies all current use of substances except alcohol. When asked how many drinks per week on average she consumes she says, "a normal, amount, usually just one at happy hour waiting for traffic to die down before the drive home."

Ms. Acevedo talks about feeling anxious about getting her license back so she can keep driving to work. She asks a lot of questions during the intake: how long she'll need to be in counseling as a condition of getting her license back, what would happen if she got pulled over again and whether the state ever actually cancels a person's driver's license. When asked what she wants to get out of counseling she replies to get her license back. Ms. Acevedo reports that her strengths of hers include being a good friend that people can count on & that she can get along with anyone. When asked to describe her support system she lists her mother, her sister, her daughter, her boss at the design firm, her old roommate, who is the sister of her daughter's father, and her husband.

HISTORY

Ms. Acevedo is the oldest of four children, with two younger brothers and one younger sister, and grew up in Lynn, MA. One of her brothers died at age 21 in a car accident, and her other brother has developmental and cognitive delays. Her youngest sister is in recovery from alcoholism and works as a Recovery Coach in San Francisco. Mrs. Acevedo's father died 10 years ago from a heart attack and her mother is currently teaching an art class at Northern Essex Community College and giving music lessons. Ms. Acevedo reports that both of her parents "enjoyed their liquor" and that they often had parties when she was a child. She describes these parties in favorable terms though she says that the police were often called by neighbors to stop the parties when they went on too late. She reports that she would try her parent's drinks at these parties starting when she was around 10. When her parents weren't throwing parties, they would often "sleep in"; Ms. Acevedo recalls on weekends when she was a teenager, she felt responsible for getting her younger siblings up and making them breakfast and keeping them entertained until the afternoon when her parents would get up.

Ms. Acevedo reports using tobacco, alcohol, marijuana, and ecstasy when she was in high school. She got pregnant at 19 but miscarried which she considered being a "wake-up call". She stopped using everything but alcohol, finished high school, & the summer she turned 20 got accepted to an apprentice position at a large Boston design firm. When she was 21 Ms. Acevedo started dating her college roommate's brother, who was a bartender at a restaurant in East Boston; she reports that for a little while the relationship was "perfect". She would go to her boyfriend's restaurant after the main dinner rush and sit at the bar, hanging out with neighborhood regulars and other staff, the party continuing long after the restaurant closed.

That spring she discovered she was pregnant and moved in with him in East Boston. Ms. Acevedo reports that her daughter was born prematurely and has some developmental delays and was a "handful" as a baby. She and her boyfriend both continued working which she reported was "exhausting". When her daughter was 4 Ms. Acevedo's boyfriend was killed in a car accident, 6 weeks after her father died. Ms. Acevedo was 26 & she & her daughter moved back in with her mother in Lynn. Ms. Acevedo reports that she was deeply depressed during that time and found it difficult to give her daughter the attention she deserved, but that her mother loved spending time with her. She reports that she mostly coped during that time by staying in Boston after work to go to a bar, usually alone.

When Ms. Acevedo was 30, she met a man who is now her husband, a leader at an evangelical Christian church in Salem that her mother had started going to. Ms. Acevedo says that he doesn't smoke or drink, and is "boring, which is good; it's what I need" and that her husband has been "really good" with her daughter. After a year of dating, Ms. Acevedo married her husband and moved to Salem & reports that she likes it. Her daughter continued to struggle with some developmental and cognitive delays but received academic and social-emotional support through an IEP in the Salem public schools and is on track to graduate in two years along with two good friends, with whom she'd like to live after graduation.

What assessment instruments and/or methods you woulduse with this client and why?

The likely DSM-5 diagnoses and specific diagnoses to rule out. (list at least 3 diagnoses that may fit your case but forwhich there are not quite enough symptoms present tomake the actual diagnosis). Please briefly explain eachrule-out (why you thought of it and why it does not apply. What are the specific symptoms evidenced that support yourprimary diagnoses?

What ethical issues need to be considered in thisparticular case? Why?

Recommendations for treatment considering cultural issues, acuity of presentation, previous treatment history, and evidence-based treatments for the client's condition(s)