Metoka L.

Welch, PhD Winter 2013 1

W. B.____________________________S Treatment Plan

1. Identify precipitating problems or symptoms

Client is a 27 year old, single White male. He has requested services due to relationship issues. Client shared
that he has been in a year long relationship with his partner who is living with HIV. Client revealed that the
illness was contracted during the time of their relationship which is still ongoing. Client admitted that he has
been tested for HIV and at his most recent doctors appointment he tested as negative. However, client is
nearing a second testing and is concerned with the possible results. Client is also torn with the decision to stay
with his partner through his sickness or become unemotionally attached and move on from his sick partner.
Client shares that he has told very few people about his choice in life partner and has told even fewer about his
partner having HIV.
Client states that he has been extremely tired and has not been able to get over his chest cold. No other
significant symptoms, as they relate to the clients issue, were reported.










2. Conduct a comprehensive biopsychosocial assessment/history


Client did not report any known mental health or general medical conditions nor use of medication. There was nl
known history of drug use reported. Client is the only boy and youngest member of his immediate family and
has an older sister. Clients parents were recently divorced. Client is very close with his mother, a stark contrast
to his strained relationship with his father.
Client has been in a one year relationship with his partner who has HIV. Client is provocative in his sexual
behavior and finds it difficult to be a part of a monogamist union. Client has a habit of meeting with persons he
has met online and tends to spend time over night with these persons.
Client shares that he was molested by a family friend at the age of 15 and is still in frequent contact with this
person who is also considered a mentor by client. Client explained that he witnessed his father becoming
physical with his mother and often being intimidated by his fathers presence.
Client showed no evidence of suicidal potential.
Client was neat in appearance and practiced good hygiene. Client was friendly and cooperative toward the
counselor. Client presented as stable but concerned and anxious about information he share about his partner.
Client spoke in a light manner. The session was not tense. Client did not display any concerning behaviors in
relation to hallucinations, orientation, memory or insight.








Metoka L. Welch, PhD Winter 2013 2






3. Identify individual and relationship functioning


Client demonstrated his ability to succeed professionally as an elementary school teacher despite his personal
issues in his relationship. Client has close friends yet, he is not comfortable telling his secret about his partners
HIV. Client also reveals he is close to both his mother and his sister but his relationship with his father is
strained. Client believes he shares an emotional connection with his partner that he has never had with anyone
else but still finds it difficult to commit to a monogamist relationship.
4. Integrate client assessment and observational data to form a conceptualization
Client issue of being concerned he may have contracted HIV from his partner is a reasonable concern. Client
has an inability to commit to one person while in a relationship and his admits to meeting and engaging in
sexual acts with complete strangers. Clients need to be loose may result in an incurable disease which is
harmful to the client and potentially harmful to others the client is sexually involved with. Because of the
strained relationship between client and his father perhaps client is on an unhealthy search to validate an
insecurity from childhood in risking his health and safety to connect with strangers. Client has a close
relationship with his mother and a fair amount of close friends, however, client has not shared his partners
health concern with anyone.
Though client is concerned about his health his light attitude and reflection on his partners disease was not
responded to in a way that would be expected.





















Metoka L. Welch, PhD Winter 2013 3





Metoka L. Welch, PhD Winter 2013 4

Axis DSM Code # Diagnosis
I. 301.9 Personality disorder NOS
I.
II. V71.09 No diagnosis
II.
III. 995.53 Victim of child abuse
IV. No one at work is knowledgeable of sexual orientation
Partner is HIV positive (client is not)
V. Current
GAF = 61
Past GAF (if known) =





Axis DSM Code # Justification for Diagnosis
I. 312.30 Though client is currently preparing to test for HIV, he still engages in sexual
activity with strangers met online despite the dangers. His behavior deviated
markedly from what the norm was considered in his culture. Cognition: he
could cheat but his partner cant), his concern for having HIV was not marked
with extreme emotions of fear or sadness but just focus on the lie that led to
the contraction of the disease

I.
II. .
II.
III.
IV.
V. Current GAF
= 61
Past GAF (if known) = client shows he is able to function as far as vocationally,
however, clients support group isnt large and they have no knowledge of the
problem that client has presented. A few meaningful interpersonal relationships.

Metoka L. Welch, PhD Winter 2013 5







ACTION PLAN
Long Term Goal.
Reduce thoughts that trigger impulsive behavior and increase selftalk that controls behavior.




CHARACTERISTICS/OBSERVATION/JUSTIFICATION FOR THIS GOAL: several sexual partners with strangers met on line


WHAT (Short Range Goal)


WHO IS RESPONSIBLE

Identify the impulsive behaviors that have been engaged in over the last
six months
Client and counselor
HOW (Support/Intervention)
1: review the clients behavior pattern to assist him in clearly identifying, without minimization, denial, or projection of blame,
his pattern of impulsivity.

2:


3:




CHARACTERISTICS/OBSERVATION/JUSTIFICATION FOR THIS GOAL:


WHAT (Short Range Goal)


WHO IS RESPONSIBLE

List the negative consequences that accrue to self and others as a result
of impulsive behavior

HOW (Support/Intervention)
1: Assign client to write a list of the negative consequences that have accrued because of impulsivity.

2: Assist client in making connections between his impulsivity and the negative consequences for himself and others.


3: confront the clients denial of responsibility for the impulsive behavior or the negative consequences.











Metoka L. Welch, PhD Winter 2013 6









CLINICAL PRACTICE




Determine and identify other services that could meet the clients needs

Group counseling





Identify and discuss applicable ethical and legal issues


There are ethical issues in confidentiality as well as the sensitive topic of the LGBT community as well as the possible legal
issues in the spreading of a life threatening disease




Discuss the scope of practice parameters and any foreseen limitations

Client doesnt recognize his dangerous unhealthy behaviors and is there presenting another problem.





















Metoka L. Welch, PhD Winter 2013 7