Case Formulation

Read the following case and answer all questions.

Laura is a Hispanic woman in her late-forties. Laura is married and has two daughters aged 15

and 17. She works in the high-stress, high-powered world of corporate finance. Laura presents

herself as a no nonsense business professional. She has come to the clinic that you are

presently working in as a social worker for an assessment because her husband and two

teenage children are very concerned about her drinking. Her husband has insisted that she seek

professional help.

Laura tells you that although she promises herself that she will only have one or two glasses of

wine per day, she routinely finds herself finishing the whole bottle and sometimes half or more

of a second bottle. Laura reports that it seems to take more wine these days to help her feel

relaxed at the end of a stressful day. She does not see this as a problem but she has missed a

few important business meetings lately. This has made her feel quite upset with herself and

guilty because she has lied to her boss about the reason for her absences.

About three years ago, Laura began to have trouble sleeping and the doctor prescribed the

medication Xanax (an anti-anxiety drug and central nervous system depressant). Her father

died about one year ago and her use of alcohol and Xanax has steadily increased since that

time. She often takes five or six times the prescribed dose of Xanax. When her physician

presented his concerns about the amount of Xanax she was taking on a regular basis she began

to search for other physicians in order to obtain more prescriptions for Xanax. She now takes

Xanax during the day as well as at night when she is feeling stressed.

11

2020/2021

Laura notices that her mind is quite fuzzy in the mornings and she cannot remember certain

things from the evening before. Of major concern to her family is that she recently totaled her

car in a crash on the way to work on a morning that she had a very bad hangover from

drinking the night before. Laura states “I guess I am really lucky to have walked away

unharmed”. Her children told her that they are beginning to feel embarrassed by her slurred

speech and staggering gait in the evenings when they bring their friends home. Laura admits

that she felt ashamed and guilty when her children told her that they felt embarrassed by her

behavior. Laura’s husband has told her the car accident terrified him and he wants her to get

help.

a) What are your initial impressions of Laura?

b) Describe your approach and engagement of Laura and include professional and

ethical considerations in working with Laura.

c) Provide an assessment and DSM-5 diagnosis with a rationale for choosing the

specific diagnosis for Laura.

d) Does Laura need to be referred to a physician to be assessed for possible medical

detoxification/stabilization and if so provide an explanation as to why?

e) Provide a treatment plan including models or treatment used and interventions.

f) Should Laura’s family be involved in her treatment? If family involvement is

indicated outline the rationale for including Laura’s family in her

treatment plan.