Sample Psychology Case Study on Little Fish


Substance abuse counseling involves giving support to individuals recovering from drug or alcohol addictions and other related behavioral issues. A counselor can provide resources, judgement-free guidance and support by building a trustful relationship with the patient for their recovery. In addition to the family support, a counselor plays a vital role in the prevention and treatment of an individual with related problems of substance abuse (Hand, 1998). The consumption of drug and alcohol might cause problems such as crime, homelessness, domestic violence and others. The families and close relatives are also at risk of undergoing stressful circumstances during such cases. In this essay, we develop skills in applying models and theories of substance abuse to a client identified as Tracy’s heart, a former addict of heroin, and develop an intervention plan involving treatment model of the client’s problems caused by substance abuse.

Case Study: Tracy Heart

Tracy Heart is a former addict of heroin and lives with her brother and the mother in the area called Little Saigon in Sydney (Clanton, 2016). The location of the family, that is Sydney, is a place known for availability of heroin. Tracy works in a video store and is determined to achieve her dreams and goals and by expanding this business. However, she is unable to secure money to start this business since her history records of drug use, poor repayments of debts, lack of collateral and criminal records have made financial providers to deny her the loan. Because of her history, she lies to her boss and the mother that she has secured the loan. The stepfather of Tracy is also a drug addict and she is helping him to overcome heroin addiction. In the past, Tracy was engaged in a relationship with Jonny, who was also a former addict of heroin. Later on, Tracy is deceived by her former boyfriend who claims to be working as a stockbroker and promises to help her get the money through share trading. Tracy discovers that Jonny is not a stockbroker employee but a drug dealer, and she gives in to the deal as the only alternative to raise money for the business. Tracy Heart is lured by Jonny and spends money from the video shop into a drug scheme and rekindles her addiction to heroin. The addiction of heroin has affected the capability of Tracy to make decisions, response to stress and her ability to control behaviors. Even after achieving sobriety, she is easily lured back into taking heroin.  Tracy had a history of miscarriages and premature births. The assessment, therefore, involves Tracy Heart as the client.

Assessment and Case Formulation

Presenting Problem

The client was led to the care centre by her brother and received by the facility coordinator. The coordinator introduced me as the counselor to assess the case of Tracy and carry out the appropriate intervention in collaboration with the family. She was reported with signs of getting easily agitated and very secretive when questioned, and also isolation from around the people. Her brother reported to have noticed the symptoms and signs of mumbled speech, fatigue, scratching/itchy skin, worsened memory, constricted pupils, negligence at work and accidents with violence influenced by drugs (Hand, 1998). The family also noticed that the client is struggling with heroin addiction after seeing the injection marks on her skin, increased nose breeding and frequent problems of respiration. The client also attempted to commit suicide after losing her business. Her brother requested for the commencement of the client’s assessment, the intervention and treatment to enable her recover from the addiction. When interviewed, the client stated that she had used heroin for two years before controlling the practice but was later lured by a friend and returned to using the substance again.

Mental health and substance use

Heroin is a psychoactive drug and affects the mood of individuals. They tend to dampen or arouse certain emotions in a person and many people use it for that reason. When the brain is affected by drugs, it causes changes in the rest parts of the body controlling the mental health. The chemicals in the brain interfere with drugs. The family of the client reported that she began acting strangely, and these are short-term effects of drugs. Heroin had impacted the mental health of the client, and the reason for using drugs was to make the bad feelings leave and she failed to control the usage. On the other hand, using the drug with a clear mind also affects the mental health and can expose bad feelings which never existed (Jarvis, 2005).

Psychosocial needs

Tracy reported social, health and psychological problems. She needed increased attention to her health which is focused on evidence-based to counter the disorders caused by substance use. She needed standardized psychosocial treatments since her health was deteriorating. Psychosocial interventions for drug abuse addiction treatment are aimed at the patient’s behavior on the use of drugs as well as alleviating related problems of emotion and cognition. They can be combined with pharmacological interventions or as stand-alone treatments. These treatments can also be implemented in groups involving several health workers or individually. Psychosocial treatments are regarded as the foundation of drug treatments, especially where the evaluation of pharmacological treatments is not sufficiently done (Hand, 1998).

Previous treatment

The client admitted to having undergone methadone treatment previously, although she did not inform her family or her boss. The treatment enabled her to return to normal functioning at the workplace, community and family. She also managed to reduce the criminal activities and improved her social, psychological and occupational functioning. She decreased the drug use and increased the behavioral therapy, but her problems were rekindled when she returned to taking drugs. The client had also stopped visiting the treatment providers and her condition deteriorated.


The client deemed the treatment a failure when the relapse occurred. She did not follow modification and continual evaluation which was necessary for a successful treatment of heroin addiction. When relapse occurred the client did not seek further or alternative, reinstatement or adjustment of treatment (Larimer, Palmer & Marlatt, 1999).

The Substance Abuse Model

Character model

This model was preferred because it focuses on what takes place before a person starts to use substances. This model stresses that taking the line of cocaine is not caused biologically, but it is motivated psychologically. It constructs the view that every person is vulnerable to addiction (Larimer, Palmer & Marlatt, 1999). The learned behavior and a defect in character constitute the addiction. A personality or a character which is abnormal makes a person to depend on chemicals. There are levels of psychological and personal defects that predispose a person to the traits of “addictive personality.” Some of the additive personalities advocated by this model are stress to the ineffectual mechanism of coping, poor control of impulse, complete control, portraying a big ego, feeling hopeless and powerless (The Australian Hepatitis Council, 2004). These traits were noted in the presenting problem of the client. Tracy experienced the stressful situation of work problem which constitutes the influences depicted in this model. An individual who previously took substance and is influenced and finds her friends taking drugs, she can be moved by the previous cues of association with substance use. The addictions of psychological, emotional and learning deficiencies are treated by psychological and behavioral therapies. In relation to this model, Tracy could not maintain her external behavior and inner life. This model states that an individual can develop an external control as a result of provided treatment to obtain an inner strength (Harrison & Westwood, 2009). The quality, intensity and amount of triggers identified in psychological behavior may be the behavior learned from the use of the substance. When people are given reinforcement for their addictive every time it becomes an addiction and therefore the addictive behavior in an individual can be changed by the use of reinforcements to affect the central nervous systems. The client, in this case, can be educated on how to develop the strategies of coping for substance use.

The model further stipulates that addiction results from a pair of emotions such as an emotion of pleasure and emotion of withdrawal symptoms in the theory of opponent-process. The assessment of the client shows that at the beginning there was a very little withdrawal and a great amount of pleasure. Progressively, the levels of pleasure from using the substance went low and the levels of withdrawal symptoms for taking more drugs went high (Jarvis, 2005). Despite the less emotion of pleasure, the use of the substance by the client was enhanced. The principle of this approach is that one psychological event leads to another opposite psychological event. When the client found pleasure in taking heroin, the opposite event of withdrawal followed it. The opponent processes in the nervous system are touch, mobility, hearing, vision and taste. The occurrence of the opponent processing at the sensory level leads to a behavior that is addictive. This is less complex, takes less time and cost-effective for the counseling group (Copello, Velleman & Templeton, 2005).

Intervention Plan

When planning an intervention for addiction a treatment plan is needed to ensure the client begins treatment. The client then starts the process of rehabilitation in the care facility. The average time of the first use of heroin and the time of entry into the treatment is averaged as 15.6 years. As a counselor, I helped the client to pre-plan stages. All those involved in the intervention prepare fully for the meeting. Everyone is led to write how the life of the client changed as a result of addiction. The addict cannot see her own issues. Everyone sees the addiction as a personal problem and since it is hurting no one else, they may not understand the damaging impact of the addiction. In Consequences are varied of the possibilities of the client to refuse to participate in any drug and alcohol intervention programs which are in place for treatment. The client is made to know that the counselor is there to aid reduce the addiction and reinforcement of the fact that I am there to help recover from addiction. The client is not allowed to know about the intervention before it takes place because by doing that she would become angry and defensive or even fail to show up. The professionals also assist with all the tools needed during the intervention process.

The intervention looks into the following stages (Copello, Velleman & Templeton, 2005):

Pre-contemplative – The client is unwilling to look into the change of behavior. The interventions involve using strategies that diffuse resistance positively to learn why the client may resist change.

Contemplative – Behavior is recognized as a problem at this stage but one is inconclusive about change. This stage involves thinking through the identified problem behavioral risks and the benefits of change bringing hope that the client is going to change.

Preparation – The client is committed to change in the near future in this period. It involves working with the client to assess her strengths in commitment to think creatively about developing an effective plan of action and change. In this intervention, the client is motivated and we collaborate with her in the plan of action.

Action – The modification or change of behavior takes place at this stage.  It involves listening carefully and affirming for the client that she is doing what is right and checking with her to see the needed revisions.

Maintenance – It involves modification of lifestyle to stabilize the change of behavior and avoid relapse. It is focused on practising an intelligent and active maintenance of the attained change by the client (Funderburk et al., 2008).

When ambivalence is overcome by the client, we use clinical skills to assist the movement along the continuum stages of change and the progression of the client.


Previously, the stand-alone psychosocial treatments were given to the client. Its implementation was done individually since the case of our client was unique (Patterson, Cloud & McKiernan, 2004). Therefore she received specialized and intensive psychosocial treatments. In this treatment plan, Opioids (methadone) medication was withdrawn and other models of treatments administered. According to Harrison & Westwood (2009), methadone acts as heroin in the brain relieving cravings and suppressing symptoms of withdrawal. This medication was meant to reduce the related criminal behaviors, drug seeking and open her up to behavioral treatments. However, the client’s behavior and criminal activities did not change. Thus, a different approach was embraced.

Behavioral therapies

The client was recommended for behavioral therapies to modify behaviors and attitudes and improve a healthy living. These are delivered through regular schedules of health counseling, and the client was admitted to individual drug counseling through the following approaches (Jason & Ferrari, 2010):

  • Cognitive-behavioral therapy – It helps the patients to avoid, cope and recognize situations that may arouse the need for the drug.
  • Motivational interviewing – It is meant to change the behavior of the client.
  • Motivational incentives – It reinforces thinking positivity encouraging drugs abstinence (Miller, 1998).

The client attends multiple sessions of outpatient each week and also outpatient treatments to facilitate her quick recovery.

Inpatient treatment

The client was also recommended for residential treatments if the outpatient treatments fail to improve her condition. The following treatments were recommended:

  • Therapeutic communities – Patients are treated within the residential area.
  • Shorter-term inpatient treatment – It involves detoxification and provision of community-based counselling.
  • Recovery housing – Provides short-term residential treatment and housing (Funderburk et al., 2008).

Ethical Issues

Substance abuse rehabilitation

Inadequate training on ethics creates problems in the practice of counseling, especially when recognizing ethical dilemmas. Mainly, being a counselor in substance abuse is only based on the experience as a person who has fully recovered from drugs addiction. There is no framework within which ethics are applied in substance abuse counseling. The codes of practice were being used in the past to resolve ethical problems regarding substance. Different backgrounds of training counselors affect the ethical background of a person. However, professional conduct can be guided or improved using the articulate values and ethics. A set of ethical framework and standards can help the counselors to clarify the management of case decisions and advance the competence in providing service to the clients. Without these standards counseling experiences the pressure to adhere to given set of causes and beliefs. The achievement of good conduct is normally undermined by when counselors refuse to participate in the comprehensive evaluation of the program (NCETA Consortium, 2004). Code of ethics protects the client’s health by laying down quality standards, promoting and protecting professional identity, providing guidance to behaviors and integrity of the profession. The principles of ethics in rehabilitation counseling are independence or autonomy, capacity and freedom for self-governance. Autonomous refers to a client having an autonomous voice in treatment to make decisions. On the other hand, beneficence is an ethical principle that promotes the welfare of the client. Also, non-munificence is avoiding any actions that may harm the client. The fidelity principle emphasizes honesty and loyalty in relationships of the profession between the client and the counselor.


Confidentiality in substance abuse counseling refers to not disclosing the client’s information without their consent. It includes the client’s identity, the client’s professional opinions or any content from the records. Ethical issues arise where the professional counselors are being compelled by the law to disclose the client’s information for specific reasons, for example, the commission of crimes and threats of violence. Similarly, our client has been denied a loan to expand a business on the basis of the records showing criminal activities. The counselors are required to assure clients of the confidentiality of the material before taking any intervention plan (Swan & Tyssen, 2009).


Using the case study from “Little Fish” film, the assessment and formulation were done to the identified client (Tracy Heart) which majored on her psychological disorders caused by the addiction to heroin.  The character model was selected depending on the psychosocial needs of the clients and used as a counseling model. An individual intervention plan was developed and used in the process of treatment to alleviate the client’s heroin addictions. The previous treatment plan was adjusted to withdraw the symptoms and behavioral therapies; and these recommendations showed successful outcomes of reduced criminal behaviors and drug addictions. Furthermore, the possible challenges in the recovery process of the individual and the substance use ethical issues were discussed.




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