Running head: Bio-Psychosocial Plan of Change

Bio-Psychosocial Plan of Change

SW 3020
EF8852

Running head: BIO-PSYCHO-SOCIAL PLAN OF CHANGE

Presenting Problem
Madam X is a 50-year-old Caucasian female who is currently single.
Madam X stated that she currently lives with her son and daughter and was
divorced six years ago. Madam X explained that she is currently not working
because she is on disability. Madam X mentioned that she had a lot of issues
that led to her receiving disability so I decided to hold of on this subject until
we could list them in the Health History portion of this report. It was noted
by me that she looked pale and fatigued. Madam X replied that at this time,
she is attending school full time and hoping that she can earn another
degree in a profession that allows her some flextime. Madam X also noted
that she is hoping that she may be able to find a job that works with her
disability so that she can earn an income. Madam X also mentioned that
right now she is below the poverty level and she has a very tough time
making ends meet. Madam X also stated that her current situation is
causing her a great amount of stress, which is further affecting her health.
Madam X explained that she is coming to see a social worker because she is
in a tough place and she has to make a decision whether or not to continue
with school and struggle financially or quit school and find a job where her
disability will be tolerated. Madam X also mentioned that she is fearful that
if/when she decides to work that she may get fired because of her disability.
Madam X also stated that she is very frustrated because she has gone to the
county that she resides in and she does not receive any financial help from
them. Madam X admits that she is making an effort by going back to school

Running head: BIO-PSYCHO-SOCIAL PLAN OF CHANGE

so that she can get off of disability and earn an income but in order to do so,
she lives a life of poverty, which is affecting her children as well.
Family of Origin History
Madam X stated that she was born on August 26th, 1963 at St. Johns
Hospital in Detroit, MI. Madam X also noted that she is the daughter of
Madam XX, who was 23 when she gave birth to Madam X and her husband,
Mr. XX who was 25 at the time of birth. Madam X also added that Mr. and
Mrs. XX were married to each other at the time of Madam Xs birth. Madam
X also noted that they both have an academic history where they both
graduated high school. Madam X also mentioned that she had one sibling,
Mr. XX Junior who was born in December 1960. Both pregnancies where
planned by their parents. Madam X explained that Mr. XX Junior, died
suddenly at the age of 52 years old. Madam X also noted that he was
married and was the owner of a Heating and Cooling Company. Madam X
also said that his academic history included a high school education with
some college. Madam X explained that her parents divorced when she was
18 years of age. Madam X also mentioned that the reason for the divorce
was due to Mr. XX and his cheating ways. Madam X also noted that Mr. XX is
presently married to the woman with whom he had the affair that terminated
his marriage. Madam X also said that both Mr. and Mrs. XX are still alive and
Mr. XX is at the age of 77 while Mrs. XX is at the age of 75. Madam X said
that the atmosphere in the home while the client was growing up was that of
a modular family with her Mother, Father, Brother and Sister all living

Running head: BIO-PSYCHO-SOCIAL PLAN OF CHANGE

together. Madam X also said that her mother stayed home with the children
while her father worked outside the home and her mother took care of the
home. Madam X also mentioned that her home life was typical in
comparison to other WASP households during that era with the exception of
her fathers drinking and occasional temper tantrums, which consisted of a
lot of yelling, throwing things and physical punishments which caused a lot of
fear in both children. Madam X also recalled that all of her holidays were
celebrated with extended family members, Aunts, Uncles, Cousins and
Grandparents. Madam X also stated that holidays were celebrated in the
traditional WASP manner where church was attended before every family
gathering. Madam X stated that she enjoyed each holiday gathering
because it included food, alcohol and poker. Madam X also made mention of
this family tradition during Easter, Christmas and Thanksgiving. Madam X
also noted that the childrens birthday parties also included extended family
members from both sides of the family. Madam X also stated that at this
time, there were no health concerns for any immediate family member,
which is remarkable, seeing that Mr. and Mrs. XX are in their mid to late 70s.
Madam X also mentioned that her family handled the concept of death in a
manner where the family holds a service for their loved one and a
celebration of their life following the burial. Madam X also stated that the
family follows a life after death type of spirituality. Madam X denies any
sexual abuse within the family.
Developmental History

Running head: BIO-PSYCHO-SOCIAL PLAN OF CHANGE

Mrs. XX experienced a normal pregnancy and delivery when pregnant

with Madam X. She delivered vaginally and the babys APGAR score was
normal and at a score of 9. Madam X was breast fed only briefly due to her
Madam Xs allergy to breast milk. Subsequently, it was discovered that the
baby (Madam X), was also allergic to cows milk and was put on a special
formula. Madam X does not remember what that formula consisted of. The
client had no issues with feeding or any other food allergies after her
episodes with milk allergies and was weaned off of her bottle at an
appropriate time. Madam X stated that her milestones were reached on
schedule and her development was normal. She also state that there were
no signs of developmental issues, delayed or advanced.
Health History
Madam X stated that as an infant, there were no noted health issues
aside from her milk allergy. She states that she was in general good health
throughout most of her childhood with the exception of chicken pox and her
being legally blind. She also added that at the age of 3 years, Mrs. XX began
to notice Madam X running into walls. Madam X also noted that Mrs. XX
thought that her daughter had some developmental issues so she took her to
a doctor. Madam X recalls that the doctor referred her to an eye specialist
and there it was discovered that she was legally blind. Madam X mentioned
that she has since worn glasses or contact lenses. Madam X notes that at
one point she also had Lasik eye surgery done to regain some of her vision.
Madam X mentions that she had one childhood surgery that involved a hiatal

Running head: BIO-PSYCHO-SOCIAL PLAN OF CHANGE

hernia, which she had repaired. Madam X states that as a child, she did not
have any major illnesses or accidents although she did suffer some broken
arms and sprained wrists. Madam X said that as an adult, Madam X has had
a lot of health issues. Madam X mentions that in recent years, she has been
diagnosed with diffuse disease of connective tissue, a disease of the
connective tissue, interstitial cystitis, a bladder disorder,
hypogammaglobulinemia, a blood disorder, anemia, a blood disorder, clinical
depression, a mental disorder, fibromyalgia, a nerve disorder, anxiety, a
mental disorder and ADHD, a mental disorder. Madam X notes that she is
currently under the care of several specialists as they are now attempting to
rule out MS and Lupus. Madam X told me that she has also had some
surgeries as an adult, which include 2-Cesarian Sections, tubal repair, hernia
repair and a bladder repair. Madam X also stated that she had her detached
and torn retina repaired, too. Madam X also mentioned that she has not had
many weight issues although her menses did stop for several months back
2009 because of stress from her divorce and she lost an alarming amount of
weight. Madam X also said that she was down to 96 lbs., which is not a lot
on her 55 frame. Madam X also noted that she had her first period at the
age of 14. Madam X also explained that she is currently on Wellbutrin, for
depression, Adderall, for ADHD, and Fentanyl for pain. Madam X also told me
that she has a sulfa allergy. Madam X also mentioned that aside from
alcoholism on her paternal side of her extended family and obesity on her

Running head: BIO-PSYCHO-SOCIAL PLAN OF CHANGE

maternal side of her extended family, her immediate family has no known
illnesses.
Relationship/Sexual History
Madam Xs friendships as a child growing up in the suburbs included a
best friend and several other friends that she hung around with after school.
Madam X also stated that she maintained those friendships throughout her
childhood until she moved to a new neighborhood. Madam X also noted that
she moved to a new suburb as a teen and got wrapped up in the wrong
crowd and she stayed with a clique known as the burnouts. Madam X also
told me that she began dating at the age of sixteen and soon after became
involved in sexual relationships. Madam X also mentioned that she explains
that she is in a monotonous ( yes, boring), healthy relationship at this time
and enjoys a healthy sex life and does not have an issue with orgasms.
Madam X said that due to her age, she no longer needs birth control,
although I explained the importance of using protection to avoid getting any
sexual transmitted disease. (JK-I was repeating what you had written down
on my previous relationship/sexual history) Madam X also noted that at this
time, she does not have any STDs.
Family of Creation History
Madam X notes that is currently not married, although she was married
and is now divorced. Madam X also said that she was 32 when she got
married and she did so because she became pregnant. Madam X states that
she is a firm believer in pro-choice, but on a personal level, she could not

Running head: BIO-PSYCHO-SOCIAL PLAN OF CHANGE

abort her own child. Madam X also mentioned that her husband at marriage
was 27 years old and together they had two children, Tyler who is now 17
years of age and Peyton who is now 12 years of age. Madam X also notes
that the relationship between the two was more of a brother/sister type of
relationship, love and hate with a lot of arguing manipulation and verbal
abuse. Madam X noted that after 13 years of marriage, she filed for divorce.
Madam X also said that her current relationship with her ex-husband is
tolerable and they are not considered friends. Madam X also noted that at
this time, she has been divorced for 5 years, mostly due to the abuse that
she endured at the hand of her ex-husband that included verbal abuse,
manipulation and some physical abuse. Madam X notes that she is now in in
a happy and healthy relationship with another man for the last 2 years.
Madam X mentioned that she has no intention of getting married anytime in
the near future but may change her mind when the children are grown.
Madam X said that she has a wonderful relationship with her children and
that they are living with her. Madam X also stated that aside from the
normal teenage angst, her children are decent kids and she is proud of them.
Madam X also mentioned that her children, Tyler and Peyton are in high
school and middle school and are doing well with their studies. Neither child
is employed at this time. Madam X had four pregnancies in her lifetime with
only two of them resulting in live births. Madam X also added that the other
two pregnancies resulted in miscarriages and she lost a total of three babies.
Madam X also said that two of them were in the first trimester and the

Running head: BIO-PSYCHO-SOCIAL PLAN OF CHANGE

second one in the second trimester, because one of the pregnancies involved
twins. Madam X also mentioned that aside from her first pregnancy, all of
her pregnancies were planned because she and her husband at the time
wanted to start a family. Madam X also added that she has had no abortions
and she never inquired about foster care or adoption.
Substance Abuse History
Madam Xs involvement with cigarette smoking, drinking alcohol and
experiencing with drugs started at the age of 14. Madam X stated that as a
teen, she mostly dabbled with alcohol and experimented with drugs.
Madam X also said that her drug of choice was marijuana, although she
experimented with mescaline, acid, downers and uppers. Madam X also
explained that she did not involve herself in heroin, crack cocaine or ecstasy.
Madam X also mentioned that as time progressed, she found that her only
addiction was to cigarettes. Madam X noted that she eventually grew out of
that phase and continues to enjoy a drug free lifestyle although she admits
to drinking socially and she recently quit cigarette smoking, which was very
difficult. Madam X also said that she claims to not have any other addictions
(gambling, eating, etc.) so she has not been involved in any treatment or
treatment facilities. Madam X also said that she did express that she used
medication to quit smoking.
Mental Health History
Madam X made mention of following the deliveries of Madam Xs two
children, she experienced post-partum depression. Madam X also stated

Running head: BIO-PSYCHO-SOCIAL PLAN OF CHANGE

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that ever since then, she has been on depression medication under the
advisement of her doctor. Madam X also said that she was diagnosed with
clinical depression and she has also been diagnosed with ADHD. Madam X
also said that she is currently being treated for both and is currently on
Wellbutrin for depression and Adderall for ADHD. Madam X mentioned that
these medications are helping her so she is still currently on them. Madam X
also reports that she has not had any other treatment or hospitalizations due
to these issues and is not currently in therapy.
Military History
Madam X denies any involvement with being in the military; therefore
she has no experience to report.
Financial History
Madam X lived in a well-to-do family as a child. Madam X also states
that her father was successful business owner while her mother was a stay
at home mom. Madam X also said that currently, because of her disabilities
and divorce, Madam X is having a very difficult time financially and this has
brought her a large amount of stress.
Legal History
Madam X denies any legal history or involvement with the law, past or
present. She has had no arrests in her lifetime and has not been on
probation or parole.
Immigration History
Madam X denies any immigration history..

Running head: BIO-PSYCHO-SOCIAL PLAN OF CHANGE

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Religious History
Madam X stated that Madam X was brought up as Lutheran. Madam X
also said that her family was very involved in the church when she was a
child. Madam X said that she went to church every Sunday and was involved
in Sunday school, was baptized and confirmed. Madam X stated that
currently, she claims to be non-denominational and attends Kensington
Community Church on Sundays. Madam X also said that she believes in a
higher power and an after life. Madam X also mentioned that these two
factors keep her going to church although she does not have any
involvement outside of that.
Educational History
Madam X shared that the client has attended school since kindergarten
and has completed public school through to the 12th grade. Madam X also
said that after that, she worked but still too k time to attend community
college and non-college credit classes. Madam X also mentioned that she
obtained a cosmetology license and was a trained travel agent. Madam X
stated that she decided to go back to school full time after her divorce and
has since earned an Associates degree and is now working toward a
Bachelors degree at a local university. Madam X mentioned that since she
returned to school, she has been on the deans list each and every semester
since starting college. Madam X also said she would have loved to
participate in the honors program, but the expenses were too much for her.

Running head: BIO-PSYCHO-SOCIAL PLAN OF CHANGE

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Madam X said she is proud that she is doing well although she puts too much
time into her classwork and that is taking time away from her children.
Madam X noted that she is currently looking to find an equal balance
between the two.
Employment History
Madam X shared the point that Madam Xs father taught her very good
work ethics as she grew up. Madam X said by the age of 14 she was already
working at a local A&W restaurant as a waitress. Madam X noted that she
also did a lot of chores around the house, as it was a part of her training to
become a good wife, per her mother. Madam X also shared that from the
age of 14, Madam X worked until she became disabled in 2008. Madam X
stated that it was a difficult transaction for her because she became divorced
and unemployed, both in the same year. Madam X reports that she has
done so many different jobs that she cannot remember them all. Madam X
recalls that she had cleaned offices, worked in a dry cleaners, waitressed,
bartended, worked in offices, worked as an outside saleswoman, managed
offices and was a medical assistant for a plastic surgeon. Madam X noted
that she misses being around people and developing friendships on the job.
Madam X stated that as a full time student she feels very isolated and
disconnected from the outside world.

Strengths

Running head: BIO-PSYCHO-SOCIAL PLAN OF CHANGE

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Madam X said that she relies on just a few people for support. Madam
X stated that her father had helped her find a house and helped her
financially to buy it. Madam X said she does not rely on many people to help
but she does have a good friend who will help whenever possible. Madam X
mentioned that her boyfriend is very busy with work but he picks up the tab
when she wants to go out and do something fun. Madam X said she and her
mother have been estranged and her mother has and is not a support
system at all, through all of Madam Xs difficulties, which is the reason that
they are estranged. Madam X added that she turns to her Aunt for advice
since she is very good at giving good advice. Madam X said that her
greatest strength is that she has a lot of skills, due to her vast work history.
Madam X also mentioned that now that her children are getting a little older
they are a little more self-sufficient which is a big plus for her.

Running head: BIO-PSYCHO-SOCIAL PLAN OF CHANGE

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Plan of Change
I. Goal #1
Set up an appointment with Madam X to discuss the intervention process.
We will go over the assessment phase and begin to work on setting goals. I
will clarify Madam Xs needs and wishes in the process. I will focus on the
problems that she recognizes as being most important and develop a plan
that relates to these issues. I will restate these problems to her so it will help
clarify that we both understand them and confirm that we are on the same
page. I will also be sure that the problems are prioritized based upon the
degree of need. I will also interpret whether the issue is based on survival,
well-being or to achieve a sense of fulfillment.
A.

Objective #1
Increase Madam Xs understanding of depression and its symptoms.
1. Task #1
To identify symptoms of depression and identify indications in
Madam X.
2. Task #2
To identify triggers and work toward alleviating those triggers in

B.

Madam X.
Objective #2
To acquire resources for Madam X to help alleviate her depression and
anxiety.

Running head: BIO-PSYCHO-SOCIAL PLAN OF CHANGE

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1. Task #1
To provide Madam X with a list of therapists in her area/city and follow
up with her to be
sure that she is scheduling and attending her sessions.
2. Task #2
To provide Madam X with a list of doctors that can perform a med
review to see if she needs
to change some medications to help alleviate her anxiety and
depression.
II. Goal #2
To establish additional goals based upon the recognition of Madam Xs
perspective of her
depression and decrease the symptoms by incorporating coping skills.
A. Objective #1
To recognize depressive thoughts and feelings and develop coping skills for Madam
X.
1. Task #1
When a depressive thought is recognized, help Madam X to immediately switch
thought process
to positive thoughts.
2. Task #2
For Madam X to keep a journal of thoughts so that they are written down on
paper instead of lingering in her thought processes.
B. Objective #2

Running head: BIO-PSYCHO-SOCIAL PLAN OF CHANGE

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To assist in helping Madam X to develop techniques to alleviate anxiety.

1. Task 1
To help Madam X to learn specific relaxations techniques
(breathing/stretching/exercise) that will help to alleviate some anxiety and
depression.
2. Task 2
To teach Madam X skills such as talk to a friend or family member
when exhibiting signs of
anxiety. If they are not available, listen to calming music.

III. Goal #3
Develop Treatment Plan
A.

Objective #1
To develop treatment plan next visit for Madam X.
1. Task 1
To be certain that Madam X continues with weekly therapy.
2. Task 2
For Madam X to follow her treatment plan.
3. Task 3
I will make appointment with psychiatrist to see Madam X for
assessment.

Running head: BIO-PSYCHO-SOCIAL PLAN OF CHANGE

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Contract for Intervention Plan

Client Name: Madam X
1. Description of Problem:
2. We, the undersigned, agree to the objectives in the following plan:
A: Increase Madams understanding of depression and its symptoms.
B: Acquire resources for Madam X to help alleviate her depression
and anxiety.
C: Help Madam X to recognize depressive thoughts and feelings and
develop coping skills.
D: Assist Madam X in developing techniques to alleviate anxiety.
E: Weekly visits for therapy for Madam X.
F: For Madam X to attend an assessment with a psychiatrist.
---------------------------------------------------------------------------------------------Client Signature

--------------------------------------------------------------------------------------------Date

Worker Signature

Date

Running head: BIO-PSYCHO-SOCIAL PLAN OF CHANGE

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