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COUN6543 Counselling

Case Study

Treatment planning in special cases: Imagine a situation in which the conclusions of the assessor called for a person to be admitted to an inpatient rehabilitation program.  However, the individual is unable to accept this recommendation because he or she is the primary care provider for children or a disabled spouse, is the primary source of income for the family and does not have health insurance benefits that will pay for residential treatment, etc.  Now you are faced with a dilemma very similar to that of the physician who has a patient who responds to the recommendation for surgery by saying, “I can’t afford to take time off from work to recover!  I have to find a job!  Can’t you do something less drastic?”


  1. What do you do if the patient’s position in life will not allow him or her to participate in the recommended form of treatment? 
  2. Should you allow the client or patient (depending on who is working with the individual at the moment) to refuse the recommended treatment, would you be acting in the individual’s best interests?  How do you balance the patient’s needs against the patient’s desires?  This is an ongoing dilemma for treatment professionals.
  3. To complicate matters, substance abuse rehabilitation professionals know that some clients will ask for the less intrusive outpatient treatment modality because it has been possible for them to continue abusing alcohol or illicit drugs when in an outpatient rehabilitation program in the past.  For example, a client might drink alcohol in the morning, safe in the knowledge that the alcohol will be biotransformed and that he or she will test “negative” for alcohol by the time of an evening therapy group.  How do you identify which cases should be referred to a lower level of care, and those that you must insist enter the recommended treatment program?  Can you defend your answer?

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