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APA Psychotherapy Training Videos are intended solely for educational purposes for mental health professionals. Viewers are expected to treat confidential material found herein according to strict professional guidelines. Unauthorized viewing is prohibited.
In Prescriptive Eclectic Therapy, Dr. John C. Norcross demonstrates this adaptable, client-focused approach to psychotherapy. This approach tailors the therapy on the basis of each client's unique needs and situation by drawing on the most effective and applicable techniques from eclectic theoretical camps. In this session, Dr. Norcross works with a 33-year-old man whose substance use and marital infidelity have resulted in problems with his relationships and career. This video features a client portrayed by an actor on the basis of actual case material. Precipitating Events The client, Sam, is a sound engineer at a network radio station. Two weeks ago, he had a 7:00 a.m. appointment to do a voice-over for a spot that was to break on the 8:00 a.m. morning show the same day. The night before this appointment, Sam stopped at a neighborhood bar on his way home from work to have a few drinks. Janice, his live-in for the last 9 months, was away on business; he figured he would stop and pick up a sandwich after the bar, go home, eat, and go to bed. After a couple of drinks Sam was ready to leave, when Dave, a friend, came in. Sam ordered a round for Dave, Lucy (the woman Sam had been talking with), and himself. They talked for an hour or so, and then Dave suggested they go to his house, which was just a couple of blocks away, to do some of his coke. At this point, Sam was feeling good and figured "what the hell." Sam, Lucy, and Dave headed over to Dave's place. Once there, they drank some more, listened to music, and did about 1/2 gram of coke among them. By this time, it was about 1:30 a.m., and Sam was on a roll. Sam asked Lucy to go back to his place. She said yes, so they had another short drink and left. When the phone rang at 7:10 a.m., Sam was a wreck. He and Lucy were on the couch in his living room, their clothes all over the place, music blaring. He felt sick, and his head was throbbing. The station was calling to find out "where the hell he was." Sam told Lucy she'd better leave. He dragged himself into the shower, threw on some clothes, and took a taxi to the station. When he walked into the sound studio it was 8:45 a.m. They had missed the spot; the talent had to be paid anyway, the producer was fuming, and Sam felt like hell. In the back of his mind, he hoped Lucy had left with all of her stuff, because Janice was due home before him that day. What was he doing? He had screwed up a lucrative spot. Why had he drunk so much? He always had a couple, but this was "weekend" style, and it was only Wednesday. Why had he done coke again on a weeknight? Lucy had been right for the moment, but what if Janice had come home early and caught him? What if the place had signs of Lucy when Janice came home? For the first time he was scared about the way his life was going. Other Incidents and Background About 3 months ago Sam went out with some clients after a day in the studio. They went to the clients' hotel room, did a gram of coke, and drank lots of scotch. Sam wound up staying out all night. He went into work the next day with no sleep, getting by on just coffee and cigarettes. He didn't remember much of what he had said or done. When the clients took their next job to another station, Sam wondered whether he had committed social and professional suicide. Toward the end of his marriage, Sam was drinking a lot, and he and his wife were constantly fighting. He occasionally fooled around with other women, never going to bed with anyone more than two or three times. The women never really meant much to him. He was just bored with his wife, his life, everything. Right before the final breakup with his wife, a woman from his office with whom he'd been having an affair for over 3 months called his wife and told her that Sam fooled around with different women at work. His wife said she had had it, and she left for good. Sam was depressed, but he figured maybe it was for the best. Maybe now he'd have some peace and quiet. Maybe now that she was gone he wouldn't drink so much. Preceding Sessions Session 1: Dr. Norcross took a clinical history, established rapport, and he and the client agreed that Sam would not drink or take drugs for at least a month. Between Session 1 and Session 2: Sam completed a Life History Questionnaire and a computer-administered MMPI–II. Session 2: Intake continues. Dr. Norcross reviewed results of the Life History Questionnaire and the MMPI–II with Sam. At the conclusion of Session 2, Sam indicated that depression, boredom, infidelity, and a slow descent into self-destruction were problems he would like to confront (action stage). However, Sam was uncertain whether drugs and alcohol constituted a serious problem (no denial but some minimization, contemplation stage). He declined a referral to Alcoholics Anonymous or Rational Recovery. He did agree to remain abstinent for another month (for a total of 2 months) to determine how alcohol and cocaine abuse affected his mood. Dr. Norcross and Sam contracted for weekly individual psychotherapy sessions combining supportive–expressive and cognitive–behavioral elements, which would include mutually created, between-session tasks. Between Session 2 and Session 3: The mutually defined tasks were to obtain a thorough medical evaluation, to remain abstinent, and to reflect on the striking parallels between Sam's current problems and those of his father. Session 3: This session. |
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