Running Head: BIOPSYCHOSOCIAL

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Biopsychosocial
Ec7982
Wayne State University

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Presenting Problem

Lilly Pad (pseudonym) is a 52 year old Caucasian female who is newly divorced and
lives with her two children (female 20 years old, male 22 years old) and ex-husband (51 years
old). She is living in the family home that is now hers from the divorce settlement. Lilly has been
employed as a paraprofessional at the Macomb Intermediate School District for 33 years. She
recently moved into a new classroom and then the teacher was switched. She is here today because she is not getting along with the new teacher in her classroom. She also thinks that she is
struggling from depression.
Family of Origin History
Lilly states that her mother was 28 years old and her father was 30 years old when she
was born. Her parents were married. Her father was a high school principal. Her mother was a
stay-at-home mom and later became a secretary. Her father was college educated and her mother
left college to get married and start a family. The client states that she knew her parents wanted a
large family. The babies were not necessarily planned but they were not accidental either, her
parents chose to let nature run its course. The client states that she thinks her parents had/have a
happy relationship and divorce was never considered. Her mother is now 81 years old and her
father is now 83 years old. They are still married and live together in their home nearby. Both are
in relatively good health and remain quite active. Her father did have issues with skin cancer in
the past but it does not seem to be an issue currently.
The client has 7 siblings. The first is her sister Sally (pseudonym). She is 60 years old
and married with three children. Sally was college educated and worked as a teacher until her
retirement. Lilly states that Sally had a somewhat abusive marriage. Her husband was very con-

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trolling and manipulative. Currently Sally is very ill. She has what is thought to be creutzfeldtjakob disease, the human form of mad cow-disease. The doctors are unsure of the illness and will
not know what is really going on until they can autopsy the brain. She has been dealing with this
disease for almost two years now. Essentially she is losing her mind. The brain is continuing to
lose function and her body is starting to fail. She is not expected to survive long.
Her first brother Dale (pseudonym) is 58 years old. He is college educated. He lives with
his wife and has four adult children who live across the country. Dale worked as the president of
a chemical company for most of his life and helped to develop the test for HIV. He and his family are healthy.
Her second brother Tim (pseudonym) is 57 years old. He is divorced but has one child.
He is college educated and works for a technology firm. He is in good health.
Her third brother Jake (pseudonym) is 56 years old. He was briefly married and divorced.
He seriously dated a woman for 20 years until her death. He has no biological children but considers the woman he dated son to be like his own. He is a carpenter by trade but mostly works
odd jobs. He has poor health due to being a heavy smoker for many years. There have been no
diagnoses.
Her fourth brother Rex (pseudonym) is 55 years old. He is married with three children.
He was not college educated and works as distributor for Frito Lay. He is in good health.
Her fifth brother Bill (pseudonym) is 54 years old. He is divorced with three children. He
is college educated and works as a packaging engineer. He is considered to be in good health.
Her youngest sister Jill (pseudonym) is 51 years old. She is college educated and works
as a chemist. She has no children and has never been married. She is in good health.

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The client reports a warm environment while growing up. Though there is a ten year gap
in the siblings ages, she says they were very close. To this day they all maintain good relationships. With Sallys illness the family has come closer together in order to try and deal with the
problem the best they can.
The family is Catholic so they view death in a religious sense. They were taught that
when someone died they were going to go to heaven and that eventually they would meet again.
The client says that she did not have to deal with death first hand until she was an adult and her
grandma died
The family celebrated Catholic religious holidays like Christmas and Easter by going to
mass. They were all required to go and behave. They then would have family dinners and celebrations at home. They did believe in Santa and celebrated Christmas as such. Gifts were exchanged but since the family is so large the siblings drew names so see who they had to buy a
gift for. The family also celebrated Thanksgiving. They would have a lager family dinner and the
clients maternal grandparents would attend. Easter was also a religious holiday for the family.
This included mass in the morning, followed by a family dinner. The client reports having egg
hunts with her siblings. Birthdays were celebrated by the birthday persons choice of dinner and
desert cooked by their mother. Halloween was celebrated by trick-or-treating in the neighborhood with homemade costumes.
The client says that she knew her grandparents on her mothers side and had one uncle
from that side as well. On her fathers side there was only one uncle and a grandfather that they
did not know. There was not a great deal of extended family.
The client denies any sexual or physical abuse.

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Developmental History

The length of pregnancy is believed to be full term, nine months. The client does not
know her exact birth weight but she knew that she was a big baby, over 8 pounds. The client was
delivered vaginally. There were no reported issues at birth. The client states that she was bottle
fed, but she does not know when she was weaned. There were no other reported feeding issues.
The client joking stated that she was a genius baby and she reached all the regular milestones
very early, especially toilet training. The client does not know the exact age of the toilet training,
but remembers her mother telling her it happened earlier than all her other siblings.
Health History
The client reports living a healthy life. She was healthy at birth and throughout childhood. She had chicken pox at age 6. She suffered from no surgeries, chronic illnesses, serious
accidents, or broken bones. Her first menses was at age 13. She had a regular period since then.
She stared menopause around age 51 and no longer has periods. She suffered from a minor skin
cancer about two years ago. It was removed and she is believed to be cured of the illness, though
she still keeps lookout. She has high blood pressure, high cholesterol, and hypothyroidism. She
takes medications to help with these issues. She reports no serious issues with her weight, it has
fluctuated over time. Skin cancer is common in some of her family members, as is the other three
reported issues. She exercises semi-regularly and takes many vitamins and supplements.
Relationship/Sexual History
Lilly states that she had many friends while growing up. None of these friendships are
currently going on. She says that she has a large amount of friends, but only a handful of very
close friends. Some of them have been for over 20 years, while some are new. The client says

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that she was officially allowed to start dating at age 16, but she actually started around age 14.
She has had many serious boyfriends throughout her life. She was engaged to a man besides her
ex-husband but it did not work out. She is heterosexual. She says that she first had sex at the age
of 16, but wished that she would have waited longer. Her main form of contraception was condoms. After her children were born, her husband had a vasectomy and that was their birth control. She states that she was and is a sexual person. She enjoys sex and has the ability to orgasm.
She reports she cheated on her husband throughout the marriage and used condoms in these encounters. She says that most of these were longterm, loving relationships. Her relationship with
her husband suffered when he found out, though they did not divorce for many years. There are
no reported sexually transmitted diseases.
The client states that she still has sexual relationships with some men and sometimes still
has sex with her ex-husband.
Family of Creation History
Lilly states that she had about five serious relationships before her marriage. She married
Luke (pseudonym) when she was 28 and he was 27. The couple married by choice and because
they were in love. They were married for 23 years until they divorced. The couple met while living in the same apartment complex. Luke had been previously married and had two young children when they met. They dated for 4 years before getting married. Shortly after getting married
Luke cheated but the couple chose to work through it. The client states that she was very happy
with the marriage for about ten years. Tension grew in the marriage due to parenting differences
and she states that Luke was always angry. She says that this is the reason she looked for love
elsewhere.

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Luke was not college educated and worked as a carpenter. He was married at 19 to his
former wife. They got married because she was pregnant. The marriage resulted in two children,
Darcy ( female, now 30 years old) and Cate ( female, now 29 years old). My client states that the
divorce was messy and that Luke and his ex-wife did not have a good relationship.
The children were 2 and 3 when Lilly and Luke began dating. She says that she loved
them and treated them as if they were her own children. They lived with their mother on the
weekdays and stayed with Luke on the weekends. The client states the Lukes ex-wife did not
like her and did not want the kids to be around her. This did not change anything and she continued be a part of their lives.
Darcy is now 30 years old. She got pregnant at 18 with her high school boyfriend. They
were married before the baby came. He became abusive and the marriage was ended. She was
offered a full-ride scholarship to Michigan State University but turned it down to get married
again. She then had three more children. They are now ages ten, seven, five, and four. Their seven year old is dealing with a serious illness called langerhans cell histiocytosis. This is a disease
in which immature white blood cells attack certain parts of the body. In this case it is the organs
and the bones. It is very similar to leukemia and is treated with chemo therapy. This has put a
strain on their family relationship but they are working through it. Her current marriage appears
to be happy. Darcy and Lilly have a good relationship.
Cate is 29 years old. She is married and has two children ages 4 and 1. She is married and
it is thought to be happy. She went to community college but did not complete her degree. The
family struggles financially. My client says that she has offered to help her with finishing school

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and finances but she does not take the help. Cate and Lilly have an okay relationship. There is no
animosity, but they are just not close.
The couple had their first biological child when Lilly was 29 and Luke was 28. It was a
boy, Jake (pseudonym, age 22). Lilly has a good relationship with Jake. He moved out but recently moved back into the family home. He is currently working in a factory. He is starting to
express interest in going to college but he does not know what for. He is not married and has no
children. He does have a serious girlfriend who he has been dating for over four years.
The couple had their second child when Lilly was 30 and Luke was 29. It was a girl
named Charlotte (pseudonym, age 20). She lives at home and is currently enrolled in college.
She is not married and does not have any children. Lilly and Charlotte have a good relationship.
Both of the pregnancies were planned and delivered by c-section. The client said she just
wanted to start a family. Lilly reports that there were no abortions, adoptions, or foster children.
Life in the household got stressful after about 10 years of marriage. The couple seemed to
be growing apart but nothing was done to fix the relationship. The client reports parenting differences to be the root of the problem. From that stemmed anger, rage, disappointment, and hostility. There was never any physical abuse but Lilly considered the way Luke acted to be somewhat
abusive. She states that he was always yelling and disrespectful.
The marriage ended because the client was unhappy. She did not feel as though she could
take being married anymore. She states that the divorce was a long time coming and that it was a
relief. She says that since the divorce her and Lukes relationship has improved. She does not
want him out of her life, but she did not want to be married to him anymore. Though she now
owns the house from the divorce settlement, they still live together. They sleep in separate bed-

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rooms. She said she does not mind that he lives there but he is starting up with his old ways
again.
Substance Use/Abuse History
The client reluctantly reported that there was an alcohol abuse issue. She said she first
started drinking around the age of 18, but she did not start drinking heavily until her marriage
was going bad ( mid to late 30s). She said that she does not think she has a problem but many
people in her life think that she does. She says that she mostly drinks wine but will also drink
beer or liquor. She says that she usually drinks every day, usually about five glasses. She does
not smoke cigarettes but she does smoke marijuana quite regularly, she reported using around 45 times per week. She has taken prescription pills but does not do it frequently. She went to rehab
for alcohol two years ago. She felt as though she did not belong there and that she did not need
any help. She checked herself out after three days. She stopped drinking for about a month after
that but started back up. She states that her children and ex-husband are worried about the
amount that she drinks and what it may do to her health. She is worried that it is effecting her
relationships with them. She still does not think she as a problem but is considering stopping so
her family will not worry.
Mental Health History
Lilly stated that she has had issues with depression. She does not know why she was depressed but she seemed like she could just not get out of a rut. She said that almost every Christmas she gets depressed and she thinks that it is due to stress. She said that it used to come and
go, but now it seems more long term. She did not ever want to do anything or get excited about
anything. When she gets depressed she reports feeling very isolated. She was prescribed two

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anti-depressants. She said they made her feel better but one of them made her very forgetful. She
now takes only one of them and has cut back on the dosage. She does not think she is cured but
she now manages it better.
Military History
The client denies any military history.
Financial History
The client reports that her family was very poor when she was growing up. With 8 kids
and only one income the family had to pinch pennies. She states that even though money was
tight, she never felt like there was not enough of anything. She states that she really did not know
they were poor until she looked back as a adult.
While married her family was considered middle class. They both had jobs and money to
support themselves/the family. The family was able to afford things like vacations and a camper.
Currently finances seem to be an issue for Lilly. She now owns the house and is responsible for the payment and the bills. Though Luke still lives there and helps to pay the bills, she is
worried about how to survive when he leaves. The couple has money invested for retirement but
she does not want to touch that money until she retires. She thinks Luke will be moving out soon
and thinks she does not make enough money to make things work. She wants to ask her children
to pay rent, but she knows that they are trying to save for college.
Legal History
Besides her divorce, the client has had no legal issues.
Immigration Issues

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The client does not have any immigration issues. She is a legal citizen and was born in
America. Both of her parents were born here as well. There do not seem to be any cultural issues
that are affecting the client.
Religious History
My client was raised to be Catholic. Religion was important. All of the children were
baptized, had a first communion, and were confirmed. They attended church every Sunday.
When the client had her own family, she and Luke also raised them to be Catholic. They
went to church every Sunday while the children were young. Church membership started dwindling around the age of 40.
Currently, the client says that she still considers herself Catholic and is religious, but she
is more spiritual now. She says for her this means that she thinks of religion in her own way and
does not think of it the same way as the church does. She does not have issues with the church
but she chooses to do things in her own way. She does not attend church anymore, except on occasions such as weddings and/or funerals. She claims that she prays often and maintains a relationship with God.
Educational History
The client went to public school to get her primary education. She claims that she maintained straight As. She enjoyed school and reports being popular. She knew that she wanted to
go to college. She decided to pursue education. She attended Central Michigan University. She
only went for two years. She claimed that she partied too much and did not take school as seriously as she should have. Her parents understood this and choose not to send her back or pay for
her education. She said that she thinks that she should have continued to college and wanted to

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complete her degree. She never went back to school. She says that she cannot afford to go back
now, nor does she think it is a good use of her time at this point in her life.
Employment History
The client did many chores in the family home. The roles were generally gender specific.
She was responsible for cooking, cleaning, laundry, etc. She was responsible for most of the
childcare.
Lilly reports having a few unimportant jobs as a teen. She said she worked as a maid in a
hotel, a waitress, and in retail. She cannot remember specific dates or pay rates. She says she did
not consider them permanent, so she did not take them seriously. She left all the jobs voluntarily.
The client has held her current job since she was 19 years old. She is a paraprofessional at
Macomb Intermediate School District. She worked in the gym at a school who dealt with emotionally impaired children for over 30 years. She enjoyed this job but wanted a change. She then
moved to another school within the district to help mentally impaired adults. Her first class was
retail management. She enjoyed this but moved into another class to teach with a friend. She is
now in the custodial maintenance class but there is a new teacher in the classroom.
The new teacher and my client do not get along. The client says that she likes him as a
person but not as a teacher. She stated that she has more experience than him, so when he does
not value her or her opinions it is very disrespectful to her. This is causing a lot of stress in her
life.
The client says that she loves her job and does not want to leave. She cannot currently
transfer classrooms, so she is looking at how to deal with her current situation.

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She makes around $24,000 per year. She is part of the teachers union. She thinks that for
her level of experience she should be paid more.
Strengths
During the interview, the client often spoke of her support systems and people she relies
on. She has good relationships with many family members and friends. Some of her siblings and
her parents both live close by. She can visit them or vice versa if she ever needs help or support.
It seems as though these people are there for her and will be able to support her in changes that
she might make.
The client has a lot of experience at her current job. She has been there for over 30 years
and understands the ins and outs of the school system. She has a lot of passion for what she
does and wants to help her students. Though she is having difficulties with the teacher, she is trying to find a way to move past them.
Lilly seems like she is working hard to maintain her place in life and wants things to
work out. Though her financial situation will be changing soon, she is able to recognize that and
is trying to plan ahead.

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Step 1:Work with the client

There were a few key issues that Lilly stated that she intends to work on. The client identified these issues as:
1. She is struggling with depression and she is no longer on medication
2. Her work environment is becoming stressful because she feels disrespected and
undervalued by the new teacher in the classroom
3. The client reports a drinking problem and is afraid she is becoming dependent
Step 2: Prioritize problems
1. Work issues
2. Depression management
3. Alcoholism
Step 3: Translate problem into need
Problem

Need

1. Work issues with new teacher

Confront problems within the classroom

2. Management of depression

Seek help from a medical professional

3. Alcoholism

Begin sobriety
Step 4: Evaluate levels of intervention

Need 1: Work issues with new teacher

Micro strategy: Equip the client with interpersonal skills to confront the new teacher with a conflict resolution book
Pros:
The book can potentially give her new ways to look at the situation and potentially solve it

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She can learn things quickly through the text

A book like this can easily be found at a library
Cons:
The book may not provide her with enough confidence to confront the teacher
She may not have the time to read the book

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Mezzo strategy: My client and the new teacher can confront their issues face to face or with a
meditator, whichever the client feels most comfortable with
Pros:
They may be able to easily settle the disagreements and issues if they address them to each
other face to face
If they choose to use a mediator, there may be a neutral party to help them solve the issues rationally
She can learn what will or will not work when confronting the new teacher
Cons:
The new teacher may become defensive
There is the possibility that even if they talk out their issues that nothing will change

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Macro strategy: Lilly can contact her union representative and report her issues
Pros:
The union will have to address the issues
Cons:

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The union may not side in her favor
She could gain a bad reputation in the workplace

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Need 2: Management of depression
Micro strategy: Go see a doctor for depression
Pros:
The doctor can prescribe her new medications
The potential for decreased alcohol dependency
Reduced risk of self-harm and isolation
Cons:
New medications may not work or have similar side effects as the last ones
She may not be able to take medications due to her drinking
The visit and medications could be costly

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Mezzo Strategy: Attend a support group
Pros:
Meet new people and reduce isolation
Gain new information on potential treatments and/or medications
Normalization of her mental health condition
Cons:
There may not be an appropriate group in her area
She may be too far into the depression to go

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Macro Strategy: Macro Strategy does not apply in this situation because resources are already
available in lower levels of intervention

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Need 3: Alcoholism
Micro strategy 1: Stop drinking alcohol
Pros:
Increased health
Potential to lower depression levels
Better relationships with family members and friends
Cons:
Withdrawal symptoms
May not be able to stop without intervention
The client may not think she has to completely stop drinking

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Micro strategy 2: See a doctor regarding alcohol issues
Pros:
Getting advice from a medical professional may be a motivation
Increased bodily health
Help with withdrawal symptoms
Cons:
The visit and possible interventions could be costly

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The client may not think she needs help from a doctor
She may not be honest with her doctor and therefore not receive appropriate help

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Mezzo Strategy: Attend rehab
Pros:
Help with withdrawal symptoms from medical professionals
Group counseling
Learn effective ways to manage alcoholism
The client has insurance and belongs to a union, so it is likely covered and her job will be safe
Cons:
The client may still be responsible for some of the costs
She may not be ready or far along enough in her recovery process to face this step
She will have to abandon her home life and her daughter for a certain period of time in order to
attend

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Macro Strategy: Macro Strategy does not apply in this situation because resources are already
available in lower levels of intervention

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Goals, objectives, and tasks
Goal 1: Improve relationship with new teacher
I.

The client will improve on interpersonal conflict skills

A. She will obtain a book regarding workplace conflicts from the library or bookstore

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B. She will read the book within two weeks

C. She will report how the book influenced her thought process and how she now views the
situation
II. The client will confront the teacher face to face with her issues
A. She will throughly think through the issues she wants to address with the teacher and list
them
B. The client will then decide if she wants the confrontation to be between just them or if
she needs a mediator
1. If she decides on a mediator she needs to schedule an appropriate time
C. She will talk to the teacher regarding her issues in a calm and collected manner
Goal 2: Manage depression
I.

Go see a doctor regarding her depression

A. The client will schedule an appointment within a week
B. The client will attend the appointment and be honest and open with the doctor
C. She will take the prescribed medications for the amount of time suggested by the doctor
1. She will note any side effects she is experiencing and report them back to the doctor

II. She will seek support for her depression

A. The client will look for a depression support group in her area within two weeks
B. She will attend a meeting and see if it works for her within a week
C. If she does not like that group she will try at least one more
Goal 3: Manage alcoholism
I.

The client will face her alcohol addiction

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A. She will see a doctor regarding her alcoholism within two weeks
B. She will be honest with the doctor regarding her usage and medical problems
C. If the doctor thinks the condition is severe, the client will attend a rehabilitation program
II. The client will stop drinking alcohol
A. The client will remover the alcoholic beverages from her house immediately
B. The client will try and surround herself with supportive friends and family
C. She will not put herself in situations that can be triggers for drinking
D. She will report back within a week on how this method is working

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Contract for Intervention Plan
Client Name: Lilly Pad
Description of Problem:
Mrs. Pad needs to improve on her conflict resolution skills and the ability to confront others in
the workplace. She needs to address her alcoholism and know when to seek help from others.
She needs to better manage her depression.

Primary Goals:
1. Confront work issues with the new teacher
2. Better manage her depression
3. Address alcoholism
We, the undersigned, agree to the objectives in the following plan:

A. Obtain and read a book regarding conflict management in the workplace within two weeks
B. Confront the new teacher in an appropriate fashion
C. See a doctor regarding her depression within a week

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D. Locate a depression support group in her area

E. Face her issues with alcohol by seeing a doctor
F. Stop drinking alcohol

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______________________________________________________________________________
Signature of Client

Date

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______________________________________________________________________________
Signature of Worker

Date