Betty Ford Center Reflection

Working at my practicum location was eye opening and something that I enjoyed doing. I was allowed me to learn different therapeutic styles and use the interventions I had learned through school. The Betty Ford Center is located in Rancho Mirage, CA. The center is a license chemical dependency treatment hospital which treats all forms of substance abuse. The Betty Ford Center offers different levels of care from inpatient, residential, day treatment with and without structured housing, intensive outpatient level of care and therapeutic after care. The patients that come into our center are over the age of 18 and have a primary substance abuse or alcohol abuse issues. The Betty Ford Centers theoretical orientation is evidence based therapy. Their s strong sense of cognitive behavioral therapy mixed in with addiction therapy. Patients have to change behavior and patterns to help overcome their addition.
At the time of+ admissions clients are informed that the Betty Ford Center staff is mandate reporters. When I met with clients in a group and one on one setting I would inform them again that I was a mandate reporter. I went over each part

that would require me to have to break confidential which each clients I meet with. I informed that child abuse has to be reported, along with elder and adult independent adult abuse. Clients were also informed that homicidal thoughts or harm against another would also have to be reported. I would also inform the client that suicidal thoughts have to be reported to the appropriate staff members which would lead me to remind the clients that this treatment center is a multidisciplinary team which shares information to best address the client’s needs. I also informed the clients of my practicum status and current enrolment in a Master program. I also informed the clients of my background with chemical dependency.

The clients had recent suicidal attempt before she entered into treatment which caused for her to be monitored a lot closer on this aspect. The clients would have to complete our suicidal tracking questionnaire once a week to while in treatment. If the client wanted to leave treatment with potential suicidal thoughts which happened I felt it was best to discuss this with my supervisor. If the patient wanted to leave treatment with suicidal thoughts then I would contact the local authorities to have them come and assess the patient. The client never wanted to leave treatment early and continued to complete the suicidal tracking questions with her score maintaining zero after a week of entering into treatment. I would also check in with the patient when I met with her and talk about her suicidal thoughts to help gage where the patient was with these thoughts.
The client reported that she doctor shopped in order to get enough medication to support her addiction. The client used two doctors in order to get enough medication to support her habit. The client also use to different pharmacy so that she would not be getting her medication at the same place. The client was informed that she we would prefer her sign a release to her medical doctors so that she can call them and report to them her statues of addiction and that she was using both of the doctors to support her habit. The client was informed that this would help her with her treatment program because recovery is an honest program. The client was informed this was a decision she would have to make but we prefer her to do. After talking with my supervisor and double checking the policy I brainstormed the best way to present her with this. I felt it would be best to be honest with her about why we prefer out clients to do this so that she can start the process of recovery. This conversation was saved until she was stable and not going her difficult detox process. The client reported that she received two DUI’s one when was 27 and one when she was 36. The client reported that she had taken care of theses legal issues and no other current legal issue. The client reported no other ethical issues.
The client was 45 year old female who was in the process of completing her Masters in psychology, Marriage and family therapy. The client had been a serious car crash at 25 and then had another one at 35. This lead to the client being prescribed pain medication. The client started needing more and more pain medication just to manage her pain. Over a period of the time the client started to focus on pills which caused her family to worry. The client came to terms with her addiction to her pills and decide it was time to enter into treatment. The client discussed out isolated her life became due to her addiction and how it was impacting her marriage. Each client has complete initial screening over the phone prior to entering into treatment. The client completed her initial screening over the phone with me and informed me of her recent suicidal attempt. After completing the suicidal attempt the client went to a psychiatrist facility and stayed there for a seven days. Once the client was approved to admit into treatment I was able to complete her chemical dependency assessment diagnostic assessment which is based off the ASAM critical to help me determine the client’s diagnosis and individual treatment goals. The chemical dependency assessment gathers background information, the participating event that lead up to seeking treatment, then it goes through 6 dimension which gathers medical information like detox, medical conditions with current medication, mental health issues along with traumas and current significant issues, ? , relapse history with triggers, and recovery environment. This assessment helps the center provide the insurance company with the information that they need. This assessment also allows to gain insight about the client and how the client sees their disease. The diagnostic assessment is the DSM-V criteria for dependency. This allows us to determine the client’s level between mild, moderate and severe.
Once the client signed a release and was informed that I was going to contact her husband to gain additional information I did. I asked the husband basic question about the patient use. I asked him how he felt the patient use impacted her ability to function in day to day life. I also asked how the husband felt about the patients using. This allowed me to introduce myself to the husband and provide him with my contact information and my role has as a practicum student and that I would be helping his wife during this time. This conversation with the husband was entered in the clients chart along with the information that he provide about his wife using. The patients husband felt like his wife’s using impacted their relationship and lead to their separation.
The client had been to two detox centers in the past to help her get off her pain medication but was unsuccessful after detox period. The client was working with an addiction therapist and a psychiatrist prior to entering into treatment. The client stated she was having no luck maintaining her sobriety on her own which lead to her wanting to seek treatment. The client was open to therapy because even though should could not maintain her sincerity she enjoyed therapy because she did see the benefit of it. The client stated that she was also diagnosed with depression but felt it was linked to her current situation and her use of medication. The client felt like she was heard in her treatment and also was provide referrals to help her seek a higher level of care which she met with resistance at first but ultimately new that she needed to come seek treatment with the help of her therapist.
Prior to client entering into the treatment center they asked basic red flag question. Recently suicidal thoughts and suicidal history, homicidal thoughts, self –harm behavior, eating disorder history, substance abuse and alcohol abuse. This allows the staff to determine if a client is appropriate for our treatment center. Once a client has entered into our treatment center then we will do another screening with them. When I met with the client I completed her suicide tracking scale to get a new reading and baseline which like stated before was continued during her treatment stay. The client was asked if she had any current homicidal thoughts. The client was asked about her eating habits and if she felt like she ate healthy. The client stated she was not eating healthy due to her drug use but wanted to start eating healthy. The client was referred to see our dietitian to address her health concerns. The client was older and had adult children with no access to children.
The client was diagnosed with severe opioid use disorder and severe sedative, hypnotic and anxiolytic use disorder. The client was given this diagnosis based off her answered to the DSM- V criteria. The client provide examples of when she would use more opioids then she intended. The client attempted to cut down and control her use of opioids. The client provided a great deal of time under the influence and seeking out her opioids. The client expressed great desire to use opioids. The client was unable to go to work due to her use of opioids which resulted in begin fired. The client expressed that she was starting to feel depressed due to her using but continued to use. The client started to isolate and would not attend social events due to her using. The client shared that she started to feel more and more depressed because of the medication and her isolated life but continued to use opioids. The client started by only taking 4 of her opioids and ended up needing to take 10 to 15 a day to manage her pain. The client experienced a difficult withdrawal period. The patient experienced nausea, muscle aches, sweats and was unable to sleep during her medically monitored withdrawal. The client had similar responses for her use of Ambien. This led to her severe sedative, hypnotic and anxiolytic use disorder.
The client experience her depression feeling during the course of her treatment and while she was taking the opioids. The client was assessed for substance/ medication- induced depressive disorder. The client expressed a prominent and persistent disturbance in her mood with a decreases in her interest or pleasure in majority of her life. The client had lab work which showed her levels of opioids which were high. I asked the client if she had feeling of depression prior to her taking her opioids and for how long. The client stated that she been feeling depressed prior to taking the medication on and off for years. The client stated that she felt like she has been struggling with this hopeless feeling for a while before her car accident. The clients depressed was looked at outside of the substance/ medication-induced depressive disorder and after talking to my supervisor about her symptoms, the client was diagnosed with persistent depressive disorder.
Due to the client’s opioid use, her marriage was suffering. The client shared that she loved her husband but had cheated on him early on their marriage and never told him. The client shared that she carried that shame and guilt with her since their afire. The client shared that this guilt and shame was something that she wasn’t sure she could get over. The client also shared that her pain was severe during many of first one on one sessions we had. The client shared her pain in the group and would always have her ice pack ready when going into group to help her focus on group rather than focus on the pain. The client shared that her childhood was traumatic because her father was an alcoholic who was mean and would hurt her. The client shared that she struggled with men who reminded her of her father because it brought up the memories of the abuse she suffered from. The client had also developed poor eating habits due to her using.
The client’s diagnosis affected her ability to have a social life. The client would use her pain and her pain medication as an excuse to not join her friends. The client also did the same thing when it came to family functions. The client shared that she would isolate in room all and diet. The client shared that she stopped working because her pain was too much to bear and she needed too much medication to deal with her pain. The client shared that she lost the majority of her friends because she would never show up. The client shared that somehow she was able to do well during the pursuit of her degree. Client felt like she was able to do this because it was only focus and her only connection to the real life once she shut everyone out. The client shared that she stopped cooking and cleaning. The client shared that she forgot she was making food and went to sleep and also burned the house down. The client shared after she did this twice she stopped all together and would only eat things she could warm up in the microwave.
The client has been using different opioids on and off for 20 years but became and everyday user at 7 years before entering into treatment. The client shared that after her car addicted she was in so much pain from her pain from her neck, shoulders and lower back that she could not live without the pain medication. The client shared that for a few years after the car accident she could function without needing to take them every day but it got bad that she needed them daily which is when she has to stop working because she could not work while taking the medication. The client would forget how to do things but she was not supposed to drive while taking the medication. The client shared that it took her along time to realize she needed to get off the medication. Patient shared even after the detox experiences she was not ready to get off the medication because she would taking them shortly after because the pain was unbearable. The client felt like since she started taking the pain medication she was taking herself down the path of addition but felt that after the age of 37 she really started to slip and take more medication then what she was supposed to. The patient shared that she started to doctor shop so that she could get enough medication to keep up with her use of medication. The client shared that she need to maintain her use and would run out if she did not have more then on doctor. The client reported she knew this was wrong but felt it was the only way she could get enough medication to support her habit. The client shared that she knew she struggled with her addiction but it took her a while to come to terms with it.
The client reported that she has had her suicidal attempt prior to entering into treatment but when meeting with her she shared not thoughts of suicide or ideation. The client also shared that she had no current plan of suicide and really felt like her attempt was a cry for help because she was so hopeless in her life. The client reported that she did have any homicidal thoughts toward anyone. The client shared that she did report any child abuse, adult dependent abuse or elder abuse. The client also did report her substance abuse and denied any alcohol use. The client reported that she did not eat healthy but showed no signs of eating disorder. The client reported that she wanted to start eating healthy and get back on track with having a healthy diet. The client did express a great feeling of sadness and hopelessness but felt some hope once entering into treatment.
The client was educated and had an understanding of therapy and believed that therapy could help her. This was a huge strength that the client had because often time’s clients can be resistance toward therapy. Once the client was stable she has had a strong desire to change her behaviors and get better so that she could live healthy life. The client also had understanding that this was disease but did struggle with maintaining that belief. The client was also strong willed which was strengthen for her even thought at points it was a weakness for her. The client was highly compassionate and once she was stable she was ready to change.
The client was living with her husband until he told her that it was time for her to move out due to her addiction. The client reported that her husband could no longer take handle her addiction and asked her leave. The client reported that she found a roommate to move in with so that she was not living alone. The client reported that she since she no longer worked she struggled financial and had to rely on her husband to support her financially. The client reported that when he asked her to move out she only agreed if he would provide her with an allowance to allow her live on her on. The client shared that she did not pick the best roommate because her roommate drank and also took pills. The client reported this help normalizer. The client shared that she was fully dependent on her husband financial which really she felt contribute to her depression and hopelessness.
The client struggled through her detox so our first few meeting went slow so that she could adjust and allow her body time to adjust through the withdrawal period. The client’s prior suicide needed to be addressed so that a plan could be formed if the client was to show signed of becoming suicidal. The client struggled with pending divorce because she was not sure what the outcome would be and it was consent crisis for her during her treatment state. The client struggled with her feeling of being hopeless around her pending divorce, her family and her disease early on in treatment. The client also struggled with depression issues during her treatment and once past the detox period felt very anxious over what the future would bring. The client struggled with pain early on in treatment which needed to be addressed.
I discussed with my supervisor having a plan in place if the client starting to feel suicidal again. With the help of my supervisor I was able to have a solid plan in place if the client started to have these thoughts again. During the time that I worked with the client she did not have any suicidal thoughts. The client struggled with her pain and after discussing with my supervisor it was recommend that she attend the centers pain management track so that she could address her pain issues. The client also struggled with her depression during her treatment stay. The client also struggled with her negative self-talk. After talking with my supervisor about interventions that would work best with the client I decide that it would be use to cognitive behavioral therapy with the client along with the women’s way through the 12 steps. The client also struggled with the pending divorce and talking with my supervisor about having the client focus on what she wants out of the life.
With the clients negative self-talk it was important to address the self-talk with the client because she was always putting herself down. I use interventions to help the client work on her negative self-talk which would impact her and cause a fair up with her crisis issues. Helping the client plan her life around her pending divorce and come to terms with the potential divorce was a focus early on in treatment. The client was referred to the centers psychiatrist to address her depression issues and be evaluated on wheatear or not medication was needed. The clients anxiety level was also address as well during this referral appointment. Addressing the client’s long term sobriety was continually done.
With the client I used cognitive behavioral therapy and acceptance and commitment therapy. This was along with the 12 step work that was done with the client as well. I felt these two theories would give me a lot to work with, with this client because she had she was struggling with a lot. With addiction I think that client gain value from using more than one theory. Using a theory that would address her negative self-talk and along with her acceptance was an important goal I had given myself. I discussed with my supervisor that I wanted to use these two theories primary with the client because I felt it would best address her needs and the client’s crisis issues along with providing the client long term healthy coping skills. The client was lacking with healthy coping skills and needed them to be address. The cognitive behavioral therapy was used a log to help the client manage her negative self-talk and thoughts. The client had a strong belief that she was not good enough to be sober. The client was also dealing with a long history of substance abuse which is struggled with coming to terms that she would no longer need the medication. The client was highly controlling of her medication and levels of pain which I felt using an acceptance and commitment therapy could help her with.
When the client came into treatment I asked her what her goals where while in treatment. The client stated that she wanted to decrease her pain, understand her addiction, and learn to live without the opioids and sleep medication, and function in life again. After learning more about the client and completing my initial evaluation I went through to pull some more goals for the client to work on. The more time I spent with the client the more her goals would change and shift. I sat with the client and I asked her if would be willing to work on dealing with negative self-talk and thoughts that seems to be a consistent in her life. The client agreed it would be best to address this. The client would go back and forth between believing she could stay sober and not be in pain in more to believing she need the medication to control her pain. Once this pattern was established I felt it was important to use the acceptance and commitment therapy. I added the goal of accepting her addiction and that she could manage her pain without the use of opioid medication.
Working with the client on her cognitive fusion is one of the main focus early one this also tied into reminding the client about the cognitive behavioral triangle that thoughts impact beliefs and feeling. Helping the client understand that he langue impacts her mood and feeling was something that we worked on for a while. The goal was set to help the client understand that her self-criticism is damaging her feeling and behaviors and potential leading to her pain. Once the client was open to the idea that her self-criticism could contribute to her negative mood, depression, anxiety and pain she was willing to work on her thought pattern. The client was asked if she would be willing to look at her automatic thoughts. The client was informed of what automatic thoughts are and how they can contribute to her. The client stated that she remembered learning about automatic thoughts and would be willing to explore her automatic thoughts. The client was asked to discuss a current issue so that we could explore her thoughts better. The client shared that she is really worked about the potential divorce that she is having a hard time because she would never be able to find another person like her husband and how she has ruined her life which makes her feel overwhelmed and sad. The client was if she felt like her thoughts where driving her feeling. The client took time to think and shared that she has been feeling so sad and overwhelmed lately that she views ever life in a negative manner which is differently contributing to her feeling. The client was very willing to keep looking at her automatic thoughts and started to name her automatic thoughts when she having them during the course of her treatment.
The client was asked if she had any knowledge on experiential avoidance versus acceptance. The client shared that she could not remember if she had or not. The client was educated that experiential avoidance is when the person tries to change frequency, form of the situation sensitivity of an experience which can result in harm to life. The client was then informed that acceptance is choice to experience things as they are, while being open and aware without becoming defense. The client really liked the idea of embracing life as it comes verse trying to control life as it comes. This educational intervention helped the client with linking giving things to her higher power which is important in 12 step therapy. The client was able to see that she many she did not need to control the outcome of her marriage and maybe she can just take it as it comes. The client spent a lot of time of trying to control the outcome of her marriage now that she was in treatment instead of focusing her recovery on herself.
The client was also reeducated on cognitive distortion. When I provide the client with the cognitive distortion she informed that she had already learned about them and did not need to go over them. The client was asked since she knew about them then she would be able to provide me examples of how she does each one if not most of them. The client shared an example of how she used each cognitive distortion. The client was asked how she felt the cognitive distortions would impact her recovery. The client shared that if she was not mindful of her cognitive distortions they could pull her back to her negative state of mind and contribute to a potential relapse. After reintroducing the client to cognitive distortions the client was introduced to cognitive thought log. The client once again shared she was aware of what thought are. The client was asked if she was willing to go through a thought log to see if it would help her. The client shared that she would. The client was asked what presenting issue she wanted to work on while we went through the log. When the client would state that she was already aware of the tool or the intervention I would ask her if she had been using it on current issues. The client would then allow herself to work on her cognitive distortions and thought log towards managing and working on her negative self-talk. Using the client’s negative altitude to help address wavering resistance was something I felt would be useful in therapy.
The client was consistently battling with focusing on the future and worried about the things that were going to happen which is why I felt it would be important to have the client work on staying in the present moment.

Reminding the client that she can benefit from staying in the present was an important intervention not only for her thoughts on her divorce, pain but also for her recovery. It’s important that the clients start to focus on the here and now and when the client would start to project to far into the future I would remind her that she was projecting and bring her back to the here and now. Helping the client work on her psychological flexibility was important in having her stay focused on her recovery. The client also received a huge part of education surrounding her addiction so that she could better understand

it.
The client in engage in many mindfulness techniques to help her manage her pain and help keep her in the present moment. It was important that the client learned how to control her breathing and her thoughts once she was stable and willing to do so that she could help stay in the present moment. When the client would start to get really worked up around her divorced or family I would check in and ask her to rate her pain level. The client would also rate her pain when she was dealing with one of the difficult issues.
The client started to reach out to her children while she was treatment and wanted to help repair the relationships that her using had damaged. The client would struggle with how to communicate to her adult children. The client would engage in role play of how to she would talk to her daughters. The client enjoyed the role play because it allowed her to brainstorm what she wanted to say. The client was also encouraged to write a letter to her children expressing her feeling towards her children and bring it to the group and get feedback. The client also wrote a letter to her husband expressing her feeling towards him which allowed her write down her feeling toward her husband and marriage in a way that did get her emotions worked up. Having the client write down how she felt really help her see her feeling and emotions.
They learned about her addiction in a way that help her with surrendering and allowed her to be come to terms with why she couldn’t live with her opioids and sleep medication. The client would struggle with sleeping while she was in treatment and would be reminded to use her mindfulness techniques that she learned. The client also learned to manage her thoughts which she felt contributed to her feelings and behaviors. As the client progress in treatment she felt like her thoughts affected her pain. The client started to realize that more she got worked up the more her pain would fare up. The client had the benefit to work on her pain in management which contributed to her ability to manage her pain. There were many conversation that would take place about what the best course of actions would be the client so that she could reach her goals. The client really started to work on her negative self- talk and felt that it was also contributing her mood. The client focused on having a positive outlook on her life outside of her opioid and sleep medication.
The client struggled early on in treatment during her withdrawal. I started working with her during this period of time because clients have a limited amount of time in treatment at the center. Without this time pressure I would haven’t have started working with her as soon and given her time to get past her difficult withdrawal period. The client was pushed when she started to push back especially when she would say she that already knew about the interventions but using her negative statement help because it allowed me as the therapist to use it to the client’s advantage.
When I started working wi