The PRAISES (Evidence-Based) Model Applied to a Client’s Case

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Case Background

W. T., a 29 years old Caucasian man, works as a waiter in one of the five-star hotels in the country. He self-referred himself to an Indianapolis Counselling Center and reported having anxiety as well as interpersonal issues with colleagues in the workplace. This includes insulting other employees out of frustration and fear of talking to his managers and opening up about issues faced in the workplace. After he was confirmed eligible for care, the case was assigned to a social work intern. Due to the center’s rules for care, the client was scheduled for a five-day appointment to obtain the necessary information. The client filled out all the necessary clinic documentation, such as a consent for treatment form, a privacy act statement, screeners, and a sheet with information about their demographics.

The client has a family, one wife who works as a marketer in a non-profit organization and a four-year-old child who recently started school. His parents recently divorced due to family feuds, and he has two siblings living with his mother. He reported having a bachelor’s degree in business administration and hoped to work as a manager in one of the companies. However, after an unsuccessful job search in his major and the need to fend for the family, the client decided to look for a job and landed on being a waiter. In addition, the client reported being an introvert and felt comfortable being alone. However, he denied being abused during childhood because his parents cared for them.

W. reported he wants to deal with stress better, feel less anxious, and be productive in the workplace. He believes the symptoms are caused by problems with his coworkers and life disappointments, which make him feel more stressed. Additionally, he expressed concerns, noting, his feelings get the best of him. He claims that since late 2021, his anxiety symptoms have gotten worse. He said it was hard for him to deal with stress caused by work conflict. The client said he had trouble sleeping, had mood swings, felt nervous, lost interest in fun things, increased appetite for food, and had trouble stopping himself from worrying. He said he has no current thoughts of killing himself or others or a history of suicide attempts, self-harm, or violence.

Agency setting, Services, and Referral Sources

Indianapolis Counseling Center is an outpatient treatment agency in Indianapolis that provides counseling services. The facility’s main goal is to help people whose lives are being hurt by things like sexually inappropriate behavior, drug abuse, and mental health issues such as anger control, depression, and marital counseling. The setting uses psycho-education and therapy techniques that fit the needs of each person. Clients’ needs include occupational stressors, substance abuse, and other mental health issues. In addition, the organization exists to make sure that people’s health and well-being are protected. As a result, the primary goal of treatment of the facility is to ensure that clients get quality healthcare services.

Services

The counseling center provides several services to its many clients. Firstly, the facility offers individual and group therapy that can adhere to different treatment modalities, such as cognitive-behavioral therapy, psycho-education, and art therapy. Individual therapy is where a client engages with one therapist or psychologist, while group therapy involves treating more than one person in a therapeutic environment. Secondly, they provide forensic screening evaluation, a quick snapshot of an individual’s overall behavior. Thirdly, the setting offers educational training, which includes creating awareness of adopting appropriate health behaviors. Finally, the center provides services like specialty groups and referrals.

Referral Source

The referral source is important because it helps provide services that promote clients’ interests. To better serve their patients, the staff at this clinic collaborates with other mental health treatment facilities as well as local, state, and federal agencies. In addition, the facility maintains several partnerships with medical facilities located off-base to provide clients with access to higher levels of care. For mental health issues and substance abuse, referrals are available for different treatment options, such as inpatient, partial hospitalization, and intensive outpatient care. In the case of specialized care that cannot be provided within the facility, a client can be referred to a different setting with the required capabilities.

The Assessment Strategies

The patient came to Indianapolis Counseling Center to reduce her stress and anxiety levels to enhance his life quality. However, when the client is in social settings, their anxiety symptoms become more severe, leading to impairment in his social and professional life. Even though they suffer from symptoms of social anxiety, the client has expressed a willingness to participate in group therapy to improve their social support. Therefore, the social work intern determined that assessing the client for anxiety was appropriate based on their previous diagnosis, their involvement in mental health care, and the severity of their symptoms.

The Beck Anxiety Inventory (BAI)

The BAI is a self-report inventory with 21 questions that measure how severe anxiety is in psychiatric populations. Taheri et al. (2019) have proved that BAI is a reliable and valid tool for measuring anxiety symptoms. The screener lists common anxiety symptoms and asks clients to mark how many times each symptom has bothered them in the past month. The scoring index of symptoms is not at all-0, mildly, it did not bother me much-1, moderately, it was not always pleasant-2, or severely, it bothered me a lot-3. The BAI is found by adding the scores of the 21 items (Taheri Daghiyan et al., 2019). A score of 0 to 21 means low anxiety, 22 to 35 means moderate anxiety, and 36 and above means levels of anxiety that could be concerning. The client scored 32, which means they have moderate anxiety. Thus, BAI has revealed that the patient has some element of anxiety.

DSM-5

DSM-5 is an important tool in assessing people with a mental disorder. It is the standard for the diagnosis of mental health conditions. The tool has provided criteria that therapists are supposed to use in the evaluation (Widiger & Hines, 2022). Anxiety is associated with three or more symptoms: restlessness, being easily fatigued, irritability, muscle tension, sleep disturbance, and difficulty concentrating. Drawing from the symptoms presented by the client, there was a report of difficulty in sleeping, easily irritated, and agitation. This patient’s social anxiety disorder includes self-isolation, which causes significant problems in his social and work settings. Since the symptoms are three and have occurred for the past six months, the patient has been diagnosed with anxiety disorder.

The Generalized Anxiety Disorder

Generalized Anxiety Disorder (GAD-7) was a screening tool for anxiety disorder. The tool has a 7-item scale for measuring anxiety that is accurate in clinical settings (Johnson et al., 2019). This self-report screener measures the extent of anxiety in an individual. Each of the 7 items is given a score between 0 and 3, and thus GAD-7 scale scores range from 0 to 21. For example, the client got a score of 14, which means they have moderate anxiety. Although he has more persistent symptoms, he has better daily functioning than an individual with severe anxiety. Therefore, GAD-7 is among the most important tools to diagnose an anxiety disorder.

Description of Engagement Strategies

Different engagement strategies were used to assist with the therapy. Firstly, individual and group therapy were chosen to help clients with anxiety and give them more social support. In individual therapy, a client works with one therapist or psychologist, whereas in group therapy, more than one client and therapist are involved in the process. Secondly, motivational interviewing (MI) was used to engage the patient. MI is a communication method that focuses on working together to reach a goal. In addition to active listening and summarizing, the intern asked the client open-ended questions to learn more about them. Therefore, the strategies enhanced engagement and built rapport, improving the intern and client relationship.

The other engagement strategies are maintaining confidentiality and incorporating the client’s preferences in the treatment. For clients, a trust includes feeling like they can talk to therapists and being informed at the start of therapy about what confidentiality means and how privacy is preserved. For example, the intern briefed the client that anything shared during the discussion would remain with them and no third party would hear. For effective engagement, the therapist must ensure that the penchants of a client are incorporated into the process. When the therapist listens carefully and considers the client’s preferences when making treatment decisions, the client is more likely to work with the therapist.

The Factors That Will Promote and Inhibit Change

After extensive assessment, the social work intern determined potential sources of support and obstacle to change. The factors that will enhance change are the client’s willingness to change, supportive wife, and the current workplace. The patient indicated dissatisfaction with interpersonal issues with colleagues and other anxiety-related problems and demonstrated a willingness to embrace the solution. Having a supportive wife will ensure that the client overcomes the challenges. The current work environment will provide social support, which is essential when dealing with anxiety. However, factors that will inhibit change are introversion personality, parents’ separations, and inability to get a job of choice from his major. These aspects will provide an unconducive environment for change in the process.

Baseline Measures

The baseline measures will play an integral role in determining the effectiveness of the engaged treatment plan. The first baseline measure is DSM-5 because it helps to assess anxiety. According to Widiger and Hines (2022), DSM-5 provides criteria that a therapist will use to determine whether the patient has anxiety or not. Next, the GAD-7 and BAI were used to keep track of a client’s symptoms and improvement. This was done based on how bad the client’s mental health history and symptoms were. The techniques are valid and reliable screening tools for assessing anxiety disorder (Johnson et al., 2019). Therefore, GAD-7, DSM-5, and BAI have been tested in different settings and with different groups of people, which means they can be used to measure a client’s anxiety.

Treatment Goals

The client and the social work intern devised an 11-week schedule for the therapy. The patient was expected to attend a closed group meeting for five weeks and meet one-on-one with the intern twice a week for six weeks. The client was given assignments between the group and individual sessions to help him gain more understanding and lessen anxiety symptoms. The treatment plan, developed with the client’s assistance, focused on three major difficulties. The primary issue is anxiety, and the goal is to alleviate its effects. A group and individual therapeutic intervention that employs motivational interviews and Problem-Solving Therapy (PST) were engaged to inspire the client to continue with the process to the end.

Moreover, treatment goals were designed to address problems the client was experiencing. The other goal of the intervention is to develop a positive relationship between the client and colleagues by ending the stress in the workplace. It equipped the client with relevant skills to solve problems and talk to his coworkers better, which improved his social functioning. Another goal is to ensure the client can deal with hard times instead of avoiding them, shutting down, or burning out. Using weekly GAD-7 tests, BAI screens, and the clients’ self-reports, the effectiveness of group and individual treatment was measured, and in the end, progress toward meeting the treatment goals was tracked.

The Selected Interventions

The interventions used in the process were group therapy and Cognitive behavioral therapy (CBT). Group therapy was integrated as a program into the treatment of the client. Arlo (2019) has shown that group therapy can help reduce anxiety symptoms because it gives people more opportunities to interact with others and be exposed to social stimuli. In addition, CBT emphasizes the negative ideas that individuals with social anxiety disorder hold regarding themselves, their social relationships, their poor self-images, and negative thoughts and behavior in social circumstances (Rababa et al., 2021). As a result, these interventions were integral in helping the client eliminate episodes of anxiety disorder.

Intervention Evaluation and Goal Achievement

The therapy initiated motivated the client to talk about his understanding of behaviors, make a list of how he sees conflicts with other people, and try to find connections between negative thoughts, feelings, and outcomes. Even though the client’s symptoms were very bad, he did not want to take medicine and instead chose to talk to a counselor. Psychological interventions like exposure in vivo, training in social skills, applied relaxation, and cognitive restructuring was used. After the client went to the 5-week group therapy and 6-week individual sessions, he said that her anxiety symptoms improved, which was supported by lower scores on the weekly GAD-7 and BAI anxiety screeners. Thus, the interventions were effective in assisting the client in the management of anxiety.

Termination Process

The termination process starts when the person is referred and should continue throughout treatment. At first, this client said he worried his anxiety or work conflicts would worsen. He was concerned about how his treatment was going and had difficulty giving himself credit for his work in and out of the session. However, after the five-week group, this client said that his symptoms had improved, which helped him progress in the next six weeks of individual sessions. The client became more aware of his anxiety and used some of the things he learned in therapy to deal with its symptoms.

References

Arlo, C. (2019). Integrated Group Psychotherapy Program [IGPP] for Multi-Diagnosed Clients. International Journal of Group Psychotherapy, 69(2), 149-171. Web.

Johnson, S. U., Ulvenes, P. G., Øktedalen, T., & Hoffart, A. (2019). Psychometric properties of the general anxiety disorder 7-item (GAD-7) scale in a heterogeneous psychiatric sample. Frontiers in Psychology, 10, 1713. Web.

Rababa, M., Alhawatmeh, H., Al Ali, N., & Kassab, M. (2021). Testing the effectiveness of cognitive behavioral therapy in relieving nurses’ ageism toward older adults: A randomized controlled trial. Cognitive Therapy and Research, 45(2), 355-366. Web.

Taheri Daghiyan, A., Qasemi Motlagh, M., & Mehdian, H. (2019). The effectiveness of dialectical behavior therapy on anxiety and rumination in depressed patients. Medical Journal of Mashhad University of Medical Sciences, 62, 264-274. Web.

Widiger, T. A., & Hines, A. (2022). The Diagnostic and Statistical Manual of Mental Disorders, alternative model of personality disorder. Personality Disorders: Theory, Research, and Treatment, 13(4), 347. Web.

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