QUESTION

Mary is 27 years old; she has a history of alcohol dependence over several years. Mary has a daughter Kylie aged 3 years who displays signs of fetal alcohol syndrome. Social work services have been involved with Mary and Kylie since her birth. Kylie was taken into the temporary custody of foster care as a result of Mary arriving to pick Kylie up from day care while significantly under the influence of alcohol. Mary has demonstrated ambivalence regarding her ability to control her alcohol use. Mary describes her-self as unworthy of help. Mary notes that alcoholism runs in her family (father, and grandmother) and feels that her drinking/alcoholism was inevitable and she accepts her fate. She also feels being a bad parent runs in her family.

Mary has referred herself to a local counselling agency as suggested by the social worker and her General practitioner. While there, Mary noted that she is only there because people tell her she needs to do something about her drinking. Mary notes, that for her, drinking is part of who she is and all she knows. Drinking helps her relax and she feels she is a better parent/friend when she drinks. In addition, Mary notes that she has attempted to stop before and felt less motivated, unproductive, and really did not feel like herself. She as lazy and often would not want to engage with her daughter or friends when sober. Mary notes that her daughter is currently in the system and in order for her to regain custody she must do something about her alcohol use.

Mary appears angry, and also notes that she is sad and guilty about her daughter, which is why she drinks, it helps her to forget her problems Mary noted she first started drinking to help her hide her feelings. Mary noted that she grew up with both her parents in a middle class family, but her father was both physically and emotionally abusive to her mother. Mary noted her father was often drunk during these fits of rages and in spite of her best efforts to stop she is going to end up like him. Mary admits that she drinks in front her daughter and often forgets to do basic tasks like cook dinner or do laundry. Mary notes she has been drinking for so long she is not sure what it would look like if she stopped or how she would be able to manage her feelings and just life in general. Right now her drinking allows her to be an absent parent rather than an abusive parent.

Mary notes she drinks daily mostly vodka but when money is low she will do a hard cider. She admits it is becoming harder for her to feel the effects of the alcohol and does not feel she is intoxicated. Mary admits that most of her money is spent on alcohol which leaves very little for her daughters needs. Mary ends the meeting noting that the thought of her not drinking scares her.  She feels her daughter, as well as her friends, will not love who she is when sober.

Consider how you might use the principles of cognitive and behavioral theories with Mary

1. Identify the primary problem of the client
2. What irrational beliefs does Mary display
3. How might you help Mary challenge her irrational believes
4. What would an intervention look like for Mary (cognitive/behavioral)
5. What barriers might exist that could prevent Mary from the change process and how might you address them?

ANSWER

Cognitive and Behavioral Interventions for Mary’s Alcohol Dependence and Fetal Alcohol Syndrome

Introduction

Mary, a 27-year-old woman, struggles with alcohol dependence, resulting in significant consequences for both her and her 3-year-old daughter Kylie, who displays signs of fetal alcohol syndrome. This essay aims to explore the application of cognitive and behavioral theories in addressing Mary’s issues, including identifying the primary problem, challenging irrational beliefs, designing interventions, and addressing potential barriers to change.

Identifying the Primary Problem

The primary problem for Mary is her alcohol dependence, which has resulted in neglectful parenting, financial difficulties, and adverse effects on her well-being and her daughter’s development.

Mary’s Irrational Beliefs

Mary displays several irrational beliefs, such as accepting her alcoholism as inevitable due to family history and feeling unworthy of help. She also believes that alcohol is necessary for relaxation and better parenting, and without it, she would be unproductive and unengaged with her daughter and friends.

Challenging Mary’s Irrational Beliefs

Cognitive interventions can help Mary challenge her irrational beliefs and cognitions. Encouraging self-reflection and examining the evidence for and against her beliefs can provide a more realistic perspective. Identifying cognitive distortions, such as “all-or-nothing thinking,” can be addressed through cognitive restructuring, replacing negative thoughts with more balanced ones.

Cognitive/Behavioral Interventions

Cognitive Interventions

Cognitive Restructuring: Help Mary identify and challenge negative thought patterns related to her drinking, parenting, and self-worth.
Coping Skills Training: Teach Mary healthy coping mechanisms to manage her feelings and stress without turning to alcohol.

Behavioral Interventions

 Contingency Management: Create a reward system for Mary to reinforce sobriety and positive parenting behaviors.
Behavioral Activation: Encourage Mary to engage in enjoyable and fulfilling activities with her daughter and friends to reduce reliance on alcohol for relaxation.

Addressing Potential Barriers

Fear of Change: Mary’s fear of losing her identity and not being loved by her daughter or friends when sober could be a significant barrier. Address this by emphasizing the positive aspects of sobriety, such as improved health and better parenting, which can lead to stronger relationships.

Lack of Social Support: Mary’s social environment may be enabling her alcohol use. Involving her friends and family in the intervention process can provide a supportive network for her recovery.

 Coping with Emotions: Mary’s struggles with managing emotions without alcohol may require targeted therapeutic interventions, such as emotional regulation techniques and counseling.

Conclusion

Applying cognitive and behavioral theories to Mary’s case can offer valuable insights and tools to address her alcohol dependence and its impact on her and her daughter. By challenging her irrational beliefs, implementing cognitive and behavioral interventions, and addressing potential barriers, Mary can embark on a journey towards recovery and improved parenting. Establishing a supportive and compassionate therapeutic relationship is crucial in guiding Mary through this transformative process, as she learns healthier coping mechanisms and establishes a positive and nurturing environment for herself and her daughter.