Psychology Question

Written Case Presentation

The client I will be doing my written and oral presentation on is my client Miley. Miley is 26

years old, and her pronouns are she/her. Mileys ethnicity is American, but her father does have hispanic

heritage. Miley did graduate high school, and she did take college classes, which she ended up failing and

dropping due to her addiction. Miley is currently attending our treatment center for both substance abuse

and mental health. She is currently on the IOP mental health track, but when she first started at the

treatment center she was on PHP level. I have currently had 14 therapy sessions with Miley. She is always

cooperative and friendly in our sessions. Miley has been to multiple treatment centers before, she has

been in residential treatment, rehab, sober living, and detox. She is currently living in a sober living house

and attending our outpatient treatment care.

Miley is seeking therapeutic help for wanting to be more in control of her thoughts and develop

more positive thinking skills, as well as wanting to be less codependent. Miley does have a history of

being in long term relationships, where she loses her self identity and claims that she just starts living for

her partner. Miley began smoking marijuana everyday in sophomore year, and then she began partying

almost everyday and drinking alcohol with her friends, which escalated into her having an alcohol

addiction in junior year. Miley started dating her ex boyfriend Chad in senior year. Chad was not a

drinker, smoker or partier, so Miley became one year sober in her senior year for Chad. She stopped

drinking, partying, and smoking everyday. Chad ended up moving out to Germany, and that is when

Miley started going back into her addiction after her high school graduation over the summer. Miley grew

up and lived in Catalina Island all her life. Mileys mother does have anxiety and depression and so does

her father. Mileys younger sister also had an alcohol and substance disorder, and bipolar 1 disorder.

Miley does feel closest to her younger sister from all her family members because they have a best friend

sister bond together. After Mileys relationship with Chad, she started dating Chris, their relationship

lasted for 6 years. Miley does claim that it was a very toxic relationship. She was emotionally and

physically abused, Chris got Miley into becoming addicted to other substances like xanax, mushrooms,

and cocaine. Miley was abusing all these substances daily. While Miley was abusing all these substances

everyday, she was also managing and working three jobs, she would be awake for multiple days in a row,

she was very overly confident in herself, she had many friends and was very popular. She always thought

that she was better than everyone else, would have intense joy and happiness, and was very impulsive

which would last about one week for her. Then, would lead to Miley isolating herself and becoming

severely depressed for multiple days on end. Miley does claim that her biggest trigger for relapse is going

through a breakup.

Miley is currently in a significant relationship with Danny, Danny is also in recovery for his

substance addiction, and they have been dating for about 6 months now. Miley does claim that this

relationship is like a relationship that she has never been in before. It is a very healthy relationship. Miley

does suffer from having intrusive negative thoughts, some of her thoughts are, that her boyfriend will

break up with her which will cause her to relapse, that she is a burden on her boyfriend, that her boyfriend

might cheat on her and that she will fail all her college classes that are starting in the middle of February.

Miley is currently 9 months sober. The interventions that I utilize in our therapy sessions

are cognitive restructuring, DBT skills like STOP and DEAR MAN. I also provide psychoeducation on

the long term effects of the different substances that Miley would abuse, emotional regulation skills, and

self love/care and self empowerment. Once our therapy session is over, Miley does take the GAD-7

patient assessment to track her anxiety levels and the PHQ-9 patient assessment to track her depression

level. DBT skills were incorporated to address emotional dysregulation, impulsivity, and interpersonal

challenges, particularly within romantic relationships. I have chosen to psychoeducate Miley on the long

term effects of substances, mainly marijuana and cocaine, because those are Mileys primary and

secondary choice of drugs. She does like to read and educate herself on that because she never knew the

actual negative effects that it has on the brain, emotional regulations, and the effects on the brains

cognitive developing functioning.

Miley has maintained nine months of sobriety and demonstrates increased insight into her

relational patterns and triggers for relapse. She actively participates in sessions, applies learned skills, and

reports improved awareness of intrusive thoughts. While anxiety remains present, Miley shows a growing

ability to challenge maladaptive thoughts and utilize coping strategies. Continued work is needed to

strengthen emotional regulation and reduce reliance on external validation.

Short-term goals:

Reduce frequency and intensity of intrusive negative thoughts

Increase use of emotion regulation and distress tolerance skills

Strengthen insight into codependent relationship patterns

Long-term goals:

Maintain sustained sobriety

Develop a stable sense of identity independent of romantic relationships

Improve emotional regulation and resilience during relational stressors

1. How can treatment best address codependent relational patterns without

reinforcing reliance on the therapeutic relationship?

2. How should mood fluctuations be conceptualized and monitored in the context of

Mileys substance use and trauma history?

3. What additional strategies may support relapse prevention given Mileys primary

trigger of romantic relationship stress?

WRITE MY PAPER