Running head: Treatment plan 1 Treatment plan 2 Eliza’s Modified Treatment Plan PCN 610 Date: August 25, 2019 Eliza’s Modified Treatment Plan Eliza Doolittle is a Caucasian girl aged eighteen years, and a first-year student in college. Both of her parents live in a nearby town. In her initial visit, Eliza had been sent to see a counselor by the school because she was found in possession of alcoholic drinks in her the school dormitory. In the initial assessment, Eliza demonstrated depressive symptoms such as anxiety and low self-esteem. Although she denied she was intoxicated at the time, she said she had previously abused alcohol in high school. After joining college, she stated that she struggled to make new friends after parting ways with her high school friends who went to different schools. She denied having any traumatic experiences, although she stated both her high school and college friends took advantage of her on several occasions. Changes in Eliza’s Behavior In the second visit, Eliza has been brought to the health facility because she was found passed out and smelling alcohol. When questioned by the physician what had happened, she admitted that she had lied in her initial assessment of her drinking behavior. She admits that she has a problem with drinking. Eliza states that she often drinks to raise her level of self-esteem, gain confidence, and overcome from the strained relation of her parents. Eliza stated that she drinks about five times a week and also when she gets an opportunity to. She added that she lied in her previous visit because she feared being suspended from school due to abuse of alcohol in the school premises. Effectiveness and Validity of the Treatment Plan In the initial treatment, Eliza was diagnosed with mild depression because the major depressive symptoms presented were anxiety and loss of interest in normal activities. However, she had demonstrated other symptoms such as slight sleeping problems, little enjoyment of social activities, and lack of identity. The physician recommended that the symptoms could go away on their own without any treatment. However, the physician stated that Eliza should undergo cognitive behavioral therapy. The treatment plan is still valid after the new developments in his behavior, but it would be necessary for Eliza to be referred to a psychiatrist to confirm whether she held come more information about her behavior. According to Regier et al. (2013), the DSM-5 diagnostic criteria for depression states that alcohol abuse should not be a reason for diagnosing depression. Therefore, the physician can rule out alcohol abuse as a cause of depression, but alcohol abuse can be a sign of depression. According to Regier et al. (2013), most depression patients often engage in alcohol abuse. Treatment Changes  The initial treatment that was prescribed to Eliza needs to be adjusted to address the new situation. According to Eliza’s previous diagnosis, the physician recommended that.

1. Running head: Treatment plan
1
Treatment plan
2
Eliza’s Modified Treatment Plan
PCN 610
Date: August 25, 2019
Eliza’s Modified Treatment Plan
Eliza Doolittle is a Caucasian girl aged eighteen years, and a
first-year student in college. Both of her parents live in a nearby
town. In her initial visit, Eliza had been sent to see a counselor
by the school because she was found in possession of alcoholic
drinks in her the school dormitory. In the initial assessment,
Eliza demonstrated depressive symptoms such as anxiety and
low self-esteem. Although she denied she was intoxicated at the
time, she said she had previously abused alcohol in high school.
After joining college, she stated that she struggled to make new
friends after parting ways with her high school friends who
went to different schools. She denied having any traumatic
experiences, although she stated both her high school and
college friends took advantage of her on several occasions.
Changes in Eliza’s Behavior
In the second visit, Eliza has been brought to the health facility
because she was found passed out and smelling alcohol. When
questioned by the physician what had happened, she admitted
that she had lied in her initial assessment of her drinking
behavior. She admits that she has a problem with drinking.
Eliza states that she often drinks to raise her level of self-
esteem, gain confidence, and overcome from the strained
relation of her parents. Eliza stated that she drinks about five

2. times a week and also when she gets an opportunity to. She
added that she lied in her previous visit because she feared
being suspended from school due to abuse of alcohol in the
school premises.
Effectiveness and Validity of the Treatment Plan
In the initial treatment, Eliza was diagnosed with mild
depression because the major depressive symptoms presented
were anxiety and loss of interest in normal activities. However,
she had demonstrated other symptoms such as slight sleeping
problems, little enjoyment of social activities, and lack of
identity. The physician recommended that the symptoms could
go away on their own without any treatment. However, the
physician stated that Eliza should undergo cognitive behavioral
therapy.
The treatment plan is still valid after the new developments in
his behavior, but it would be necessary for Eliza to be referred
to a psychiatrist to confirm whether she held come more
information about her behavior. According to Regier et al.
(2013), the DSM-5 diagnostic criteria for depression states that
alcohol abuse should not be a reason for diagnosing depression.
Therefore, the physician can rule out alcohol abuse as a cause
of depression, but alcohol abuse can be a sign of depression.
According to Regier et al. (2013), most depression patients
often engage in alcohol abuse.
Treatment Changes
The initial treatment that was prescribed to Eliza needs to be
adjusted to address the new situation. According to Eliza’s
previous diagnosis, the physician recommended that she should
undertake cognitive behavioral therapy to help improve her
symptoms. The treatment goals remain the same as in the initial
treatment plan. They include (a) anxiety reduction. (b)
Maintaining abstinence from alcohol and marijuana. (c)
Reducing her sensitivity to traumatic experiences. (d)
Increasing coping skills. (e) Stabilizing and adjusting to new

3. life experiences. (f) Improving self-worth as well as
relationships. (g) Mood stabilization. However, the physician
will focus more on her alcohol drinking problem, which may
affect her recovery process.
Ethical and Legal Justification of the Changes in Eliza’s
Treatment
Ethical treatment requires physicians to promote the
autonomy of patients through psychotherapy, especially
cognitive behavioral therapy. According to Biegler (2011),
depression occurs when the autonomy of patients is undermined
regularly and extensively. It is the moral obligation of the
physician to promote Eliza’s autonomy. Although it is legal to
use antidepressants in the treatment of depression, a therapeutic
process would be recommended to promote Eliza’s autonomy.
Eliza seems to be drinking to overcome stress. However, studies
show that alcohol consumption may worsen the effects of
depression (Biegler, 2011).
Impact of the Changes to the Treatment Plan
The initial treatment would be affected because Eliza
had not shown or stated whether she had a problem with
depression. Therefore, in the modified treatment plan, her
problem with alcohol abuse would be the main focus for the
therapist. Anxiety was the biggest problem that Eliza had
demonstrated in her assessment, and little emphasis had been
laid on alcohol and substance abuse. However, with the new
developments on her behavior, it would be necessary for Eliza
to undergo a therapeutic process to help her change her
mentality towards alcohol consumption to learn that it makes
her condition worse although it gives temporary relief.
Evaluation of Available Resources for making a Referral
According to Boden & Fergusson (2011), psychotherapy is an
effective tool for dealing with alcoholism. Eliza was reported to
have a problem. A combination of psychotherapy and

4. antidepressants have been recommended for depressed patients.
However, since Eliza’s depressive symptoms show that she is
slightly depressed, a psychotherapeutic process should be
sufficient to help her regain her autonomy. Cognitive-
behavioral therapy is the most recommended method of treating
mental illnesses, although antidepressants may be added to the
process in severe cases.
The Need for Referral
The quality of physician-patient communication is key
to the treatment of depression. Effective communication would
be critical in determining the treatment outcome. The physician
must make Eliza accept that she needs help before the
conversation about referrals is made. The physician should use
a language that is easily understood by Eliza, which should
possibly be her native language. Since the counselor cannot
provide therapeutic care, there would be a need for the Eliza to
be referred to a psychotherapist. Binge drinking can be a
hindrance to her recovery. The counselor can use a behavioral
activation or a collaborative motivation technique to assure
Eliza that the psychotherapist would help her overcome the
problems she is experiencing.
Referrals
Eliza’s drinking problem would require the counselor to seek
the services of a specialist who deals with people with drinking
problems. The counselor would, therefore, refer Eliza to an
intensive outpatient program where her drinking problem would
be assessed. The intensive outpatient program would be
recommended for Eliza because her problem with alcohol abuse
do not meet the diagnostic criteria for inpatient substance abuse
treatment. Eliza would be required to attend a minimum of 9
hours of therapeutic care in a week. This service would be a
minimum of three 3-hour sessions, depending on the severity of
her condition. Eliza would not be attending the intensive
outpatient program from school, which would help her improve

5. adjustment to new life experiences.
Instruments used in the assessment
Eliza’s assessment was done using a biopsychosocial
assessment tool. Biopsychosocial assessment is conducted by a
counselor to assess the condition of a patient. The technique
helps the counselor to assess the social, psychological, and
biological factors that might have contributed to the problems
facing Eliza. It is a holistic evaluation that looks at Eliza’s
condition from different levels. The counselor engaged Eliza in
a biopsychosocial interview to identify the various issues that
have affected her behavior. It is not enough for the counselor to
just look at Eliza, but it is important to look at her environment.
A biopsychosocial assessment is critical in assessing possible
root causes of the problems facing Eliza. The biological factors
to consider are her family history, traumatic family experiences,
use of drugs, medical conditions, and personal life history.
Psychological factors include self-worthiness, self-esteem, and
previous diagnostic assessments, whereas social factors include
her relationship with friends.
Conclusion
The intensive outpatient program would the major change in
Eliza’s initial treatment program to assess her problem with
alcohol consumption. However, her condition doesn’t warrant a
residential therapeutic process. The therapist would help Eliza
overcome the depressive symptoms that she has been
experiencing. Studies show that alcohol can worsen the
symptoms of depression or make it recur. Therefore, it would be
essential for Eliza’s use of alcohol to handle. The therapists
would help improve her coping skills, which are critical for her
recovery.
References
Biegler, P. (2011). The ethical treatment of depression:

6. autonomy through psychotherapy. Cambridge, UK: MIT Press.
Boden, J. M., & Fergusson, D. M. (2011). Alcohol and
depression. Addiction, 106(5), 906-914. doi:
org/10.1111/j.1360-0443.2010.03351.x
Regier, D. A., Kuhl, E. A., & Kupfer, D. J. (2013). The DSM‐5:
Classification and criteria changes. World Psychiatry, 12(2),
92-98. doi: org/10.1002/wps.20050
Ritschel, L. A., Cheavens, J. S., & Nelson, J. (2012).
Dialectical behavior therapy in an intensive outpatient program
with a mixed‐diagnostic sample. Journal of clinical
psychology, 68(3), 221-235. doi: org/10.1002/jclp.20863
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