Implementation of the problem management framework

Addictions Counseling

Bobby is a 41-year-old man who has been seeing you for counseling to address issues with alcohol and marijuana abuse. Bobby’s mother is Native American and he spent his childhood living on a reservation in Arizona. Both he and his mother were physically abused by his father; at the age of 12 they left the reservation and relocated to live with relatives in a large city in another state. His mother passed away last year.

Bobby is HIV-positive due to use of intravenous (IV) drugs in his early 20s. He has not used IV drugs for over 15 years and has been working closely with a physician to maintain his health and monitor any symptoms that emerge. He has not disclosed his HIV status to anyone except you.

Bobby works as an overnight residential counselor for adolescent boys five evenings a week; he is also in school to complete his degree in counseling and hopes to become a licensed therapist some day. He tells you that he attends Alcoholics Anonymous and Narcotics Anonymous meetings several times a week.

Two weeks ago Bobby comes to one of his counseling sessions with alcohol on his breath. He admits to having a relapse and reveals he’s been drinking and smoking marijuana for the past month. He was afraid to tell you because he didn’t want you to be disappointed in him. Bobby further discloses that he’s been drinking “just a little” in the evenings at work after the boys are asleep. He says that some of his own abuse issues from childhood have been emerging and he’s having a hard time dealing with the horrible memories.

Bobby also admits that some of his anxiety is being triggered by meeting a woman in his NA group to whom he’s very attracted. He finally got up the nerve to ask her out and they have been on three dates. He believes they will be sexually intimate soon but he’s not ready to tell her about his HIV-positive status. He assures you that he’s extremely careful to practice safe sex, and that he’ll tell her “when the time is right.”

You have read about the three stages of the problem management framework:

• Stage 1: Help clients explore their concerns.
• Stage 2: Help clients determine problem managing outcomes and set goals.
• Stage 3: Help clients draw up plans to accomplish goals.

Revisit the Responding to Ethical and Legal Issues – Case Study media presentation and select the same scenario you chose to examine in discussion for Unit 8. Describe how you would apply the problem management framework in this scenario.

• Discuss each stage of the problem management framework.
• Indicate the client’s starting point, how you would proceed, and what possible small steps the client could take.
• Incorporate citations from The Skilled Helper readings, reviewed throughout the course.