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Which Therapy? Case Study

Lukenotes, Fall 2016

“I’m only here for evaluation. I haven’t decided yet on treatment,” Sister Patty told her evaluation chairperson, who had just explained the Saint Luke Institute evaluation process and how it is utilized to help guide treatment recommendations.

Sr. Patty went on to explain that she already had completed two residential treatment programs for alcoholism at other centers and was not convinced a third residential treatment would provide her long-term benefits. Since her last residential treatment two years prior, she had been involved in full-time ministry providing administrative support for one of her community’s schools.

Sisters in her community became suspicious about her drinking after she neglected ministry responsibilities for a number of consecutive days. Her superiors asked her either to seek evaluation and possible treatment at Saint Luke Institute (most evaluations do not result in a recommendation for residential treatment) or take a leave of absence.

“I was told your program is more integrative than the previous treatments I attended, so I guess I am open to the evaluation and to considering the team’s recommendations.”

With her mixed feelings of curiosity and skepticism, Sr. Patty embarked on the five-day evaluation process, which included clinical interviews with different members of the evaluation team, a spiritual assessment, psychological testing, neuropsychological testing, and medical labs and consultation. She was cooperative throughout the week, though she had little motivation for tasks where she feared her performance would not lead to favorable results. Similarly, during the clinical interviews, Sr. Patty shared a long history of self-doubt and self-critical thinking, particularly regarding her abilities as a religious sister.

Despite this openness, Sr. Patty was still uncertain about her motivation to enter treatment for alcohol. She did not feel alcohol use was the primary reason she neglected her ministry, though she did report that she had been unable to maintain sobriety for more than a three-month period since her last treatment. She reported feeling burned out, tired, ineffective and disconnected leading up to her work absences, and believed that increased involvement in Alcoholics Anonymous meetings would be enough to help her regain sobriety.

Impact of Emotions on Behavior

The day prior to her feedback session, Sr. Patty’s evaluation chair met with her to provide preliminary results of the psychological testing, clinical impressions and possible recommendations.

Sr. Patty was surprised to hear that the feelings she expressed and the testing revealed significant levels of psychological distress and depression. She did not think of herself as depressed and had never received that diagnosis in the past.

Her results also revealed a long-standing difficulty with identifying, expressing and managing emotions and a desire to avoid uncomfortable and painful feelings. She seemed to have difficulty forming close intimate relationships. The evaluation chair suggested that Sr. Patty’s difficulty managing emotions and forming intimate relationships likely contributed to her reliance on alcohol and avoidant behaviors to manage difficult and complex feelings, further cementing her loneliness.

Dual Diagnosis

Sr. Patty’s evaluation chair informed her that the evaluation team likely would recommend a six-month residential stay to address both her alcohol use and depression.

Sr. Patty felt somewhat overwhelmed and confused, as she was not expecting to hear that depression and the quality of her relationships seemed to be significantly impacting her functioning and alcohol use. Furthermore, she knew Saint Luke has a three-month recovery program, and was hoping at most she would enter that program.

Her evaluation chair emphasized that when both a substance addiction and a mood disorder are present, it is known as a dual diagnosis. Treatment should focus on addressing the addiction and mood struggles simultaneously. The three-month program is for individuals with previous treatment histories who have relapsed, or are at risk of relapse, and can benefit from shorter-term treatment to regain sobriety, strengthen already-developed recovery skills and stabilize psychological issues. Given that Sr. Patty’s depression had not been treated and she seemed to be minimizing the impact of her alcohol use, it was unlikely that the foundational work for treating depression and strengthening alcohol recovery skills could be completed in three months.

After her evaluation feedback session where she and her superior heard from all the members of her evaluation team, Sr. Patty had a better understanding of areas where she needed to grow. Initially not pleased about a six-month program, she knew it was the best decision. She understood that an intense focus on her emotions, integrated with spirituality and addiction recovery, was a new approach and not a replication of past treatment. She entered residential treatment with the hope of better understanding her depression and gaining new skills for managing her alcoholism, emotions and intimacy needs. Happily for Sr. Patty and her community, six months later she returned home with new insights, skills and strategies – and excitement for her ministry.

Confidentiality is important to us. This case study is not based on a particular client. Details of treatment and other information have been altered.

Crystal Taylor-Dietz, Psy.D., is director of Caritas Counseling Center, Saint Luke Institute’s outpatient program.