Reference no: EM133304120

Question: Barbara is a 29-year-old, single Hispanic mental health counselor, who shares a home with her parents. In her first session with you, she reported experiencing an increase in the frequency of "nervous episodes." During these episodes she reports pounding in her chest, sweaty palms, feeling short of breath, feeling as if the "walls are closing in" on her, and nausea. She reported that when her parents leave the house for an evening out, she becomes increasingly anxious. When left alone, she ruminates about the thought of having an "episode" and passing out with no one around to help her. She reported that she no longer drives due to her fear of having an "episode." Barbara's mother drives her to work. Barbara reports that these symptoms have occurred for several years with waning frequency, duration, and intensity. She reports that these symptoms have worsened within the last 6 months and have peaked within the last 8 weeks. 

Eight weeks ago, Barbara's father suffered a heart attack. He was in critical condition for two days, but continued to recover and is currently doing well. However, two days after her father's heart attack, Barbara drove herself to the emergency room certain that her symptoms of shortness of breath and chest pain signaled that she too was having a heart attack. The doctor diagnosed her with anxiety and prescribed a limited prescription of diazepam, which Barbara took appropriately. Barbara's symptoms decreased. However, one week later, with no precipitating event, Barbara again suffered shortness of breath and chest pain. After finishing a session with her client, she called her mother for a ride home. 

When they got home, Barbara's mother suggested that she lie down and brought her a glass of wine to "relax her." Barbara and her mother discussed the stressful nature of Barbara's job and suggested that a glass of wine at the end of the day would be "just what the doctor ordered." The glass of wine seemed to help. However, over the next six weeks, her alcohol consumption increased significantly. Barbara reported drinking at least 5-6 glasses of wine each evening. When she was feeling especially "stressed," Barbara would drink 6-8 glasses of wine. Barbara also admitted to cancelling her therapy clients on two occasions due to waking up feeling "shaky." Barbara found that having a mimosa in the morning helped manage the shakiness. 

Barbara went back to her primary care physician to discuss her symptoms. Her physician ran a battery of tests and was unable to identify any medical reasons for her symptoms.

provide an accurate assessment, diagnosis, and treatment plan for Barbara

• an assessment of the client
• determine the client's diagnoses by accessing the DSM-5-TR in the Purdue Global library
• the level of risk for the client
• a treatment plan for the client that includes a minimum of one long-term and three short-term SMART goals
• address the epidemiological implications associated with treating this client
• Address the legal, socio-cultural and ethical considerations associated with treating Barbara
• discuss how you would apply what you learned to your own work in the profession