Running Head: BIO-PSYCHO-SOCIAL AND PLAN OF CHANGE

Bio-psycho-social and Plan of Change

Samantha Pedri
Social Work Practice Methods 3020
April 2014

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Michelle Thomas is a 21 year old single Caucasian female that lives at home with her
parents and her younger brother and is also a college student who works three jobs. is currently
in a long distance relationship struggling with depression. She is a full time student at a
University and is also taking extra courses at a community college. She is employed with three
jobs to keep her busy and provide her money to pay for her school. She is in a long distance
relationship that adds a lot of stress to her school and work. She is coming to see a social worker
because she is very overwhelmed and fears for her health due to the amount of work she has.
Family of Origin History:
Michelles parents were in their mid-twenties when she was born, her father at age of 29
and her mother age of 27. Her parents were married at the time of birth and have been married
for 25 years. Father, Michael Thomas (pseudonym) age 50, and mother Jennifer Thomas
(pseudonym) age 48, work for a family owned business in the auto industry. They planned on
having both Michelle and younger brother Jimmy (pseudonym) who is currently a high school
student at 17 years of age. Growing up, Michelle had a very family oriented life, being very
involved with each other. The Family bonded over sports, movies, and family vacations to visit
family out of town. In the home, everyone seemed to get along. The parents had and still have a
great marriage, and Michelle and younger brother Jimmy were very close siblings.
Holidays such as Christmas, thanksgiving, Easter, birthdays, etc., were celebrated. They
consisted of close family with big dinners, gifts, cake, and games. Holidays were always an
important family get-together for them. Family holidays mostly consisted of the whole family
getting together including the aunts, uncles, cousins, and grandparents. Easter was usually with
her mothers side. In the morning they go to church for mass then go to a family members home

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to spend time together. The location of whose house it was celebrated at always differed. They
would have a big dinner and have an Easter egg hunt if there were younger children. Now that
they are all older, they mostly just sit around visiting. Thanksgiving is spent with her fathers
side. They go to her Aunts house each year eating a big thanksgiving dinner and look through
the papers for good deals for the following days black Friday shopping event they all go to. After
dinner and looking through the ads, the come up with a map of all the stores they will visit. At
ten p.m. all of the women leave for shopping and all of them men watch sports and then go home
and sleep.
Christmas Michelle celebrates with both families. On Christmas Eve, her mothers side
comes to her house. They start out with spending time together, having a big ham dinner, and
then exchanging gifts. Everyone gets a gift from everyone, with a spending limit of $20. We start
and let the two youngest kids open which are her cousins children. Once they are finished, the
next oldest open, then the next oldest, so on. At the end of the night the family leaves and
Michelle, her parents, and her brother go to bed. In the morning, they all wake up and eat
breakfast together watching holiday movies. They then exchange gifts between the four of them.
Christmas was always a good holiday for Michelle and her brother because they were really
spoiled. After they open gifts they get ready then go to her Grandmas house, her fathers mother.
There they eat a big Christmas dinner, spend time together, and then open gifts. Here you only
get a gift if you are a godchild, under the age of 18, or Grandma. Gifts here work the same way,
starting with the youngest two at a time and go up. After gifts, there is a lot of dessert and games.
The games consist of holiday games that are created by her Aunt and they are different every
year. Now that Michelle and her brother are older, they no longer have big family parties. Now
birthdays consist of the four of them going out to dinner and receiving a gift from just their

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parents. The 4th of July, New Years Eve, and St. Patricks day are all holidays that Michelle and
her brother spend with their friends.
Michelles mother took very few college courses after graduating from high school, and
her father went straight into the family business after graduating high school. Jimmy is currently
a junior in high school, and he participates in high school sports. Michelles mother has suffered
from Menieres disease for the past five years, otherwise she is healthy. Her father has a heart
condition and just recently had heart surgery to resolve the problem, otherwise he is very active
and healthy. The only major death to the family was father Michael Thomas father. Coping with
the loss was very difficult, but the family handled it very well. The talk of Michelles grandfather
is of positive memories; they are able to talk about him and his death in a positive manner.
Michelles family is catholic so they believe that when someone of practiced religion that passes
away, such as her grandfather, they go to heaven. They dont talk much about how they feel
about death as a family, but Michelle believes that after death there is a heaven and hell, and
based on your life prior to death, that will decide where you will be after death.
Developmental History:
Michelles mother was pregnant with her for the full 9 months and she had her on her
given due date. She was born at 8 pounds and 5 ounces. Her mother Jennifer Thomas was in
labor for four hours, giving vaginal birth. Michelle was a healthy baby besides catching strep.
She was kept at the hospital for five days after birth then was taken home with her parents. She
was bottle fed, and there were no issues with feeding. Michelle began walking at 1, she had basic
vocabulary at 1 as well but really began talking at 2, and was potty trained at 2 and years old.
There was no developmental delay of any sort.
Health History:

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Her health at birth was great other than the strep. After then, she was a healthy child.
Michelle never suffered from any major illnesses. At age 11 she broke her left wrist roller
skating, broke four fingers, and, over time, as a competitive dancer she has broken all of her toes.
There hasnt been any adult illness besides depression, an anxiety disorder, and insomnia.
Michelle has always had a healthy weight, sometimes close to underweight due to stress. Major
family illnesses include heart disease, breast cancer, and leukemia. Michelle started her
menstruating cycle at the age of 13. Current medications being taken only include birth control
and she is allergic to penicillin.
Relationship/Sexual History:
Michelle bonded very well with children growing up. Her childhood best friend still
keeps in contact with her. She also has very strong friendships with people she developed
friendships with at the age of 7. Now, Michelle has very few friends she sees regularly which are
the friends she has had for years. They all currently go to different universities that are all pretty
far in distance from each other. Because of the long distance, she does not see them very often.
They only come home on the weekends if they need to and she has a full time job on the
weekends and cannot visit them. If she takes work off she loses the hours and money. Her
boyfriend currently lives in Florida. They have been dating for a year and a half. He is
considered to be her best friend. Although the distance with him is very stressful and hard, he has
been a great support for her depression and anxiety. Her friendships normally are long lasting,
such as the close ones she has now. Michelle was 18 years old when she had her first sexual
experience with her first love. Her currently sexual relationship is not very existent due to the
long distance relationship. She used birth control for protection. Michelle expressed that she does

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not feel comfortable talking about the ability of having orgasms. She did talk about how she has
had two sexual partners, her ex-boyfriend and her current boyfriend.
Michelle had experienced negative sexual experience when she was about 19 years old.
She was pressured into doing sexual things with her first boyfriend. He threatened to leave her if
she did not have sex with him, threatened to spread rumors about her if she didnt have sex with
him, and then eventually he did not give her an option and he made her have sex with him.
Michelle did not do anything about her rape. Her boyfriend at the time told her it was rape if she
loved him and there was nothing she could do about it. This was a traumatic experience for her
and she kept quiet. She did not tell anyone out of fear that this had happened to her until over a
year later when it was too late. She now has problems trusting people especially men. Her
current boyfriend is the only man that she has been able to trust completely, not only as a friend
but sexually as well. She no longer likes being alone in a room with guys that she doesnt know
or if she only knows a little bit about them, does not feel comfortable sexually expressing herself
with her boyfriend, and fears that she will be abused in the future.
Family of Creation History:
Michelle is not married and does not have any children. She is in a committed long distance
relationship until work allows him to come back home. She has experienced bad break ups with
past relationships that have affected her mentally due to physical and emotional abuse. She was
sexually abused and physically harmed at one point in her first relationship. This has caused trust
issues with not only men but people in general. She has poor self-esteem about her body and
appearance as well as her self-worth because of this abuse.
Substance Use/Abuse History:

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Michelle has never had an addiction issue. She does not drink alcohol nor do any drugs. She has
never once tried cigarettes, any form of smoking, or any illegal drugs. She has never formed any
addiction.
Mental Health History:
Michelle as stated has suffered from depression, anxiety, and insomnia. She was diagnosed with
depression at the age of 17 years old. She was diagnosed with an anxiety disorder at the age of
21, and just recently is experiencing insomnia. She didnt get any further treatment for these
issues. There are no medications currently prescribed to her. She has denied any form of
prescription drug due to beliefs to not put drugs into your body for something that she thinks she
can fix. She is not okay with the thought of putting something unnatural into her body if she
does not have to. She has declined any prescription for her depression, anxiety, and for her
insomnia.
Financial History:
Family finances growing up were set. Michelles parents made a good amount of money
where they never struggled. Michelle currently pays for school with the help of her parents, her
car insurance, and her phone bill. She has three jobs to help pay. She is in no financial trouble
currently. Since she lives at home finances are pretty steady for her. She pays for her gas, food,
and extra activities.
Legal History:
Michelle reports that she does not have anything on her record nor does she have
anything pending. No probation, no arrest, no parole, she has not been in trouble with the law.
Immigration Issues:
Michelle was born in the United States, therefore there are no immigration issues.

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Religious History:
Michelle was raised as a Catholic. She was baptized at the age of 6 months old, had her
first communion, and her confirmation. She went to a Catholic school from 1st grade till 8th
grade, then attended public school for high school. Religion is fairly important to family. She
does not attend church regularly like she did while going to Catholic school. There is a strong
importance of God in the household, and maintaining a relationship with God is stressed. Both
her parents are Catholic as well.
Educational History:
Michelle started preschool at 4 years old. She switched schools when starting 1st grade at
a Catholic school, then she started public high school afterwards. She graduated from
community college with an associates degree, and is now working on her bachelors degree at a
university. She is very confident in her intelligence. At first when she started college she did not
care for school or her grades, now that she is working towards something she is very determined.
Employment History:
Chores Michelle had at home growing up and currently consisted of emptying the
dishwasher, setting the table, emptying the garbage, cleaning her bedroom, and little things every
now and then. Her first job was working at a movie theatre in 2010, she worked there for a year
then quit to work elsewhere. She then worked at a retail store and a pizza place for about a year
starting in 2011. She was laid off from the retail store in January of 2012 and directly after she
received another job in retail a month later in February that she still works at. She still works at
the pizza place and also is a dance teacher. She was hired at the dance studio in 2012. She enjoys
the three jobs she currently has. She highly disliked the first retail job she had due to unfair
treatment.

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Strengths:
Michelle is a very warm hearted individual. She cares for the wellbeing of others. She
also is very determined and has a good head on her shoulders. She values family more than
anything. She wants to focus on her health and get out of this funk she has been in. She cares
deeply about the friendships she has and would do anything for the people that she cares about.
She has skills as a dancer and as a photographer. She currently uses dance as a healthy way to
express aggression indirectly.

Plan of Change:
Step 1: Working with the client
Michelle Thomas discussed with me some things that have been concerning to her, she would
like to address these issues and work on them. These issues consist of:
Issues:
1. The client is experiencing emotional distress: anxiety, depression, and is having sleeping
problems.
2. She refuses any medication for her emotional distress and needs to focus on how to get
better since it is affecting her health.
3. She is struggling with her abusive past and it is affecting her current relationship.
Step 2: Prioritize the problems
1. Emotional distress
2. Abusive past
3. Alternative form of medication

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Step 3: Translate the problem into need

Problem

Need

1. She is experiencing emotional distress

1. Reduce the emotional distress

2. She is struggling with abusive past

2. Find ways to help cope with past

3. She refuses medication for emotional distress

3. Find alternative forms of medication

Step 4: Evaluate Levels of Intervention for Each Need

Need 1: Reduce the amount of emotional distress
Micro Strategy: Get a second opinion for treatment for her emotional distress (Anxiety,
Depression, and Insomnia).
Pros:
-

The client has health insurance that covers the complete cost of mental health
assessments that she has already done before. A second re-evaluation would be of no
cost to her.

She could talk about ways to eliminate her emotional distress with a doctor, and
alternative ways to help with her depression if she declines medication again.

Cons:
-

The client may not open up to the doctor a second time since she finds it difficult to
open up to people she does not know well.

The client already has been diagnosed with depression and anxiety and may resist
being reassessed.

Mezzo Strategy: Find support group for struggling young adults.

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Pros:
-The client may find that she can relate to others and learn from others similar situations.
-The client may make friends from this support group since she does not have close
friendships since her friends are all away at school.
-It may be easy to talk about her problems with people her age who she can relate to.
-She may feel more comfortable speaking with someone other than a doctor or family and
it may be relieving to express her feelings.
Cons:
-Since the client is so busy with three jobs and school it may be out of her schedule.
-She doesnt trust people easily so it may be hard to open up to new people.
Macro Strategy: Does not apply to this client because there are already services available to her.
Need 2: Find ways to help cope with her past.
Micro strategy: Recommend a book based on healing to women, men, and children who have
been wounded by their sexual pasts.
Pros-Inexpensive way to address her problem.
-It can be relaxing for her to read.
-She can find ways to cope through these readings.
Cons-Books may be difficult to find in store or online.
-She may not find reading as helpful as speaking to someone.
Mezzo Strategy: Go to therapy.
Pros-

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-The problem with be directly addressed.

-There may be more effectiveness by sharing her feelings about the past.
-Therapy can be sessions, so she can heal over time.
Cons-It may be difficult talking about something so traumatic.
-It may be difficult talking about something so personal with someone who she just met
since she struggles to open up to others.
-This may not fit into her busy schedule.
-She may not know what is available to her, or where to find a counselor.
Macro Strategy: This does not apply here because she already has resources readily available to
her.
Need 3: Find alternative forms of medication.
Micro Strategy: Dance more at her dance studio.
Pros-She has access to the dance studio, so she can go and dance whenever she felt depressed
or stressed and let her emotions out there.
-Its something she already likes to do.
-It is of no cost.
Cons-Her busy work and school schedule limit this.

Mezzo Strategy: Recommend working out at a gym when stressed out, to get out of the house
and meet new people.
Pros-

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-There are a few gyms near her house open 24 hours

-This is a great way to indirectly express aggression
-When she is depressed working out is a great way to take her mind off of things
-This is healthy for her and can keep her in shape
-If it is open for 24 hours this could fit into her schedule when she would like and it does
not have to be a strict schedule, she can go at her own pace.
-She can meet new friends here.
Cons-The cost of a gym membership may be expensive for her.
-She may find it adding to her schedule in a negative way.
Macro Strategy: Does not apply to this client because there are already services available to her.
Goals, Objectives, and Tasks
Goal 1: Reduce her emotional distress
A. The client will make an appointment with a different doctor for second opinion on her
emotional distress.
1. Locate a doctor in your area within two weeks.
2. Make an appointment within two weeks of finding a doctor.
3. See the doctor and discuss her depression, anxiety, and insomnia.
4. If you deny medication, go over ways to reduce anxiety and depression, and
alternative ways to help with these issues.
5. Follow up with the doctor two months after implementing the things he
recommended.
B. Find a support group for struggling young adults with similar issues.

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1. Locate a support group in her area within a week.

2. Schedule to meet with them within a week.
3. Attend the meetings and focus on expressing your feelings and relate to
others.
Goal 2: Find ways to help cope with her past.
A. She will find the recommended book on healing from sexual pasts.
1. The client will either locate the book online or in a local book store within
five days.
2. As soon as she receives the book read a chapter each night until she is
finished.
3. Once she is finished, relate the book to her story and find a positive way of
coping she found throughout her reading that she can implement in her
everyday life.
B. Go to therapy.
1. The client will receive a referral from her doctor within five days
2. Contact the therapist within a week from receiving her referral.
3. Schedule an appointment with the therapist.
4. The client will attend her scheduled appointment and begin her treatment.
Goal 3: Find alternative forms of medication.
A. Dance more at her dance studio.
1. Contact owner of the dance studio and gain approval to dance outside of
studio hours within two days.

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2. Prioritize daily tasks and find time to dance twice a week on free time for at
least an hour.
3. Dance twice a week for at least an hour for the first month, then try to make it
three times a week.
B. Work out a local gym.
1. Find the gyms in her area within 3 days.
2. Find the prices that would best fit her budget within 3 days.
3. Pick a gym to work out at within 4 days.
4. Work out on her open time three times a week.

Contract for Intervention Plan

Client Name: Michelle Thomas (Pseudonym)

Description of Problem:

Michelle Thomas would like better stress management skills and alternative forms of medication
for her stress, anxiety, and depression. She needs to be active and focusing on the future rather
than her past.

Primary Goals:

1. Reduce the emotional distress.

2. Find ways to help cope with her past.
3. Find alternative forms of medication or ways to help with her emotional distress.

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We, the undersigned, agree to the objectives in the following plan:

A. The client will obtain treatment for her emotional distress and make an appointment to
meet with a doctor.
B. Find a support group for struggle young adults with similar issues and attend group
meetings.
C. Obtain and read a book on healing from sexual pasts.
D. Go to therapy to find better ways to cope with her abusive sexual past.
E. Take more independent time to dance more at her studio twice a week.
F. Work out at a local gym three times a week within her area.

Signature of Client

Date

Signature of Worker

Date