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Empowering Minority Clients
Empowering Minority Clients
In counseling, it is important for each and every client to get the help he or she needs. A counselor must be responsive to the individual culture of the clients he or she helps, and in order to do this, exposure to the culture and constant education must be intact. A counselor must be dedicated to the care of his or her clients, so proactively learning about and exposing oneself to the cultural backgrounds of the clients is extremely important.
Counseling can be a difficult process for a client to go through. When someone consults a counselor, most of the time, they may be hurt and not know who to trust. Therefore, it is important for counselors to understand that each client has individual morals and beliefs that help them make the decisions and organize their priorities. “Although there are some important cross-cultural similarities in the qualities that help children gain peer acceptance, there are also culturally based differences, especially in matters such as conflict resolution” (Blewitt, P. and Broderick, P., 2010). It is recommended “that practitioners encourage them to apply their own internal resources and self-corrective mechanisms, because this is a natural aspect of problem solving in non-Western cultures” (Murphy, J.J., 2008).
In order to help clients, counselors must be able to familiarize themselves with the client’s cultural background and the source of their morals and beliefs. “In a looking-glass society that sorts on the basis of race, ethnicity, and appearance and then reflects back to them the measure of their worth, many [people] who are members of minority or marginalized groups, confront the negative stereotypes and discriminatory practices of others head on” (Blewitt, P. and Broderick, P., 2010). Therefore, it is important that counselors are understanding in regards to each client’s culture and understand the repercussions of making an culturally insensitive decision. This doesn’t mean that they have to change their own beliefs, but it does mean that counselors need to be able to be open-minded enough to consider the differences in each client in order to help them help themselves. “The current standards and recommendations for culturally competent practice [are comprised of] treating every client as an individual with a unique frame of reference, collaborating on the goals and content of counseling, tailoring services to clients instead of expecting them to conform to our preferences, obtaining ongoing feedback from clients on the usefulness of our services, and adjusting our approach accordingly” (Murphy, J.J., 2008).
There are many ways that a counselor can familiarize him or herself with his or her client’s culture. First of all, a counselor must figure out what kind of a cultural background his or her client is from. Many people are from more or one cultures, so finding a client’s individual morals and beliefs may be somewhat difficult. Nevertheless, with careful listening and understanding, most of the time, a counselor can decipher the roots of a client’s actions and decisions. Learning why a person works the way he or she does can show a counselor the options available in helping the client. A counselor would have to determine which options would be culturally acceptable to the client and help him or her achieve his or her goals most effectively. “When I go a counselor, I expect somebody who is going to relate to the situation I am in [and] my cultural background, and not try to press their own beliefs on me,” said Isaac Carnes. “From a client’s point-of-view, the more detached that a counselor is, the less [the clients] are likely to respond.”
After figuring out the cultural orientation of a client, it may be necessary to do some research on their culture. This can be done by researching the common practices of the culture online or by reading. However, a more stable approach to this, such as exposure to the culture, would be required as well to evaluate which beliefs were due to a traditional upbringing and which beliefs are based on the client’s personal experiences. A counselor is trained to help a client, and in doing this, it is important not to make decisions that may isolate a client from his or her culture. “Research shows clients from ethnic minority groups are the least likely to make use of counseling services [because] it is an ethnocentric activity, based on the values of the white, middle-classes, an approach which can alienate those from other cultures” (NGRF, 2004). Counselors must make the process of counseling comfortable for all of their clients. This makes it easier for the clients to focus on helping themselves, and using a culturally sensitive frame-of-mind, it is more likely that the counselor’s assistance doesn’t create more issues for a client such as conflicting with his or her cultural values.
When a counselor finds the client’s frame of reference, the counselor can begin to build a relationship of trust with the client, making it more likely for the client to accept the counselor. At this point, a counselor will be able to learn about the issues going on in the client’s life, and he or she will be able to go through solutions to the problem with the client. It is very important that the client works with a counselor to find solutions to his or her issues. This is a way to make sure that the solution to the client’s issue coincides with the morals and beliefs derived from their cultural background. “Understanding the cultural and sociopolitical context of a client’s behavior is essential to accurate assessment, interpretation, and treatment” (NGRF, 2004). This also makes it more likely that the client will continue with his or her counseling, which can help him or her with his or her issues and help him or her lead a better life.
Learning about a client’s culture and familiarizing oneself with the values and beliefs that go along with that particular culture can help a counselor create a better relationship with the client. This enhances trust and communication, making it easier for the counselor to know the full extent of the situation that the client is having issues with. Education on the client’s culture can assist a counselor in determining which psychological methods would be most effective in helping the client solve his or her problems, while still remaining culturally sensitive. Acting as a team when coming up with solutions to the client’s issue can help the counselor and client figure out which solution would work better with the client without impacting another part of his or her life. This increases the likelihood that the client will fulfill his or her responsibilities in helping him or herself, while still remaining comfortable with the counselor process. As it is stated that many people see counseling as a ethnocentric practice, it is important that counselors go the extra mile and make their clients feel accepted (NGRF, 2004). A counselor’s position is to help every client regardless of their identity. Therefore, constant education on various cultural practices is important. Society is a changing force, and knowing and understanding the different practices that one’s clients may have can help a counselor determine the correct responses to the various issues that his or her clients are having. Feedback from a client can also be helpful to a counselor. This can help him or her decide with psychological approaches are working with people from certain cultures and which ones aren’t, allowing him or her options to consider when a person from the same or a similar culture begins counseling. This can also show a counselor if he or she was being culturally offensive in anyway and make it more likely for counseling to become a more culturally acceptable practice. Understanding and education can help a counselor communicate with his or her clients more effectively, regardless of his or her culture. Experience with clients of different cultural backgrounds can enhance a counselor’s knowledge, hopefully creating a more welcoming counseling environment for clients of all cultures.
Blewitt, P. and Broderick, P. The Life Span: Human Development for Helping Professionals. (3rd edition.) Upper Saddle River, NJ: Pearson Education, Inc.
Isaac Carnes., Personal Interview
Murphy, J.J. (2008) Solution-focused counseling in schools. (2nd edition). Alexandria, VA: American Counseling Association
NGRF. (2004) Multicultural Counseling. Retrieved December 18, 2011, from http://www.guidance-research.org
Porter, Natalie. Empowering Supervisees to Empower Others: A Culturally Responsive Supervision Model. University of New Mexico
Bipolar Disorder vs. Major Depressive Disorder
Though there are different disorders with depressive symptoms, the treatments for all of these disorders are not the same.
Bipolar Disorder vs. Major Depressive Disorder
Rapid thoughts, mood swings, and problems concentrating are all symptoms of bipolar disorder. Individuals with this order have to learn to adjust to life in a completely different way. Depending on the intensity of their disorder, many individuals may have trouble communicating with others and holding professional conversations. It may be an even more demanding task for these individuals to maintain a successful lifestyle and become financially independent. It is not an impossible task, but it takes strong will and sometimes the proper medical care in order to accomplish this sense of independence.
There have been many different studies done focusing on bipolar disorder, but a study performed on bipolar patients that utilize the drug lithium seemed most interesting and proactive. Researchers Carrie Bearden and Paul Thompson decided to test the effects of the drug lithium on bipolar patients and compare their brain matter with that of those individuals that were bipolar and not taking lithium. Lithium has been used to reduce bipolar characteristics that may hold individuals back from maintaining a successful life. This drug is said to stabilize mood swings and make it easier for patients to focus.
Bearden and Thompson decided to take two groups of individuals, all bipolar, and have half of the group take lithium and keep the other half of the group unmedicated. After having the medicated group take lithium for a liable amount of time, Bearden and Thompson took the two groups and gave all of the individuals an MRI. After the MRI results were returned, the two researchers compared the unmedicated group to the medicated group and found that the group that was taking lithium had more gray matter in the areas of their brains that focused on mood swings, motivation, and attentiveness. They theorized that this gray matter was necessary to maintain these parts of a human brain and also predicted that the gray matter in the medicated individuals brains must have been damaged and malfunctioning before taking the lithium.
This is an amazing discovery due to the fact that it may be able to tell us the deficiencies that hold people back from living content lives. These researchers tested the validity by comparing two groups of people with the same disorder and medicating only half of their subjects. However, the trade-off was that the researchers did not test the effects on the gray matter after the medication was stopped. This is a problem, because the subjects with an increased amount of gray matter could have gotten that matter in their brains another way, and by testing the subjects off of the medication as well, researchers would have been able to see if the gray matter went away with the lithium intake. This could also be bad, because it could mean that if a patient misses a dose more than once, the gray matter in their brains may deplete.
Major Depressive Disorder is a disorder in which a person experiences changes in their sleeping patterns and appetite, decreased energy or fatigue, thoughts of guilt or worthlessness, poor concentration and indecisiveness, and thoughts of death or suicide. The symptoms of this disorder impair the person so much that he or she begins to have issues in his or her social and/or occupational life. After a person is diagnosed with this type of disorder, he or she may have to go to counseling and will probably be prescribed antidepressants.
One type of antidepressant that he or she may be prescribed is a selective serotonin reuptake inhibitor (SSRI). “When the brain does not make enough serotonin, or it cannot use existing serotonin correctly, the balance of chemicals in the brain may become uneven” (Holland, 2012). The SSRIs help adjust the serotonin levels in the brain by blocking the reabsorption of serotonin in the brain, and by doing this, neurotransmitters will send and receive chemical messages more effectively. The goal is to boost a person’s mood, which in turn will relieve depressive symptoms. The side effects that a person should be warned about when taking this type of medication are: digestive issues, nausea, restlessness, headaches, insomnia or drowsiness, decreased sexual desire, erectile dysfunctions, and agitation.
Another type of drug that may be given to a person with major depressive disorder is a serotonin and norepinephrine reuptake inhibitor (SNRI). These types of drugs block the reabsorption on serotonin and nor epinephrine. “With additional serotonin and nor epinephrine circulating in the brain, the brain’s chemical balance is reset, and the neurotransmitters are thought to communicate more effectively” (Holland, 2012). This type of drug is also meant to improve a person’s mood and relieve depression. A couple well-known SNRIs are Cymbalta and venlafaxine. The side effects of this type of medication include: increased sweating, increased blood pressure, heart palpitations, dry mouth, a fast heart rate, digestive problems, changes in one’s appetite, nausea and dizziness, restlessness, headaches, insomnia or drowsiness, decreased sexual desire, and agitation.
Tricyclic Antidepressants (TCAs) are another type of drug used to help with major depressive disorder. These drugs have been around for a long time. “TCAs work by blocking the reabsorption of noradrenaline and serotonin, and this helps the body prolong the mood-boosting benefits of the noradrenalin and serotonin it releases naturally, which improves mood and reduces the effects of depression” (Holland, 2012). Side effects of this type of drug include: weight gain, dry mouth, blurred vision, drowsiness, fast heart beat, confusion, bladder problems, constipation, and loss of sexual desire.
Norephinephrine and dopamine reuptake inhibitors (NDRIs) are also drugs used to treat major depressive disorder and bipolar disorder. Wellbutrin is one of the most common types of this drugs. “These medicines block the reabsorption of norepinephrine and dopamine, which helps reset the balance of these chemicals in the brain. These types of drugs are also used for seasonal depression issues and to help people stop smoking. The side effects of this type of drug include: seizures, anxiety, hyperventilation, nervousness, agitation, irritability, shaking, trouble sleeping, and restlessness.
Monoamine Oxidase Inhibitors (MAOs) are also medications given to people with major depressive disorder. “MAOs prevent the brain from breaking down the chemicals norepinephrine, serotonin, and dopamine, which allows the brain to maintain higher circulating levels of these chemicals, which boosts mood and improves neurotransmitter communication” (Holland, 2012). Side effects of this type of drug are: daytime sleepiness, insomnia, dizziness, low blood pressure, dry mouth, nervousness, weight gain, reduced sex drive, erectile dysfunction, and bladder problems.
It is important that a client is monitored during the first few months of taking these drugs. It is also important that each client’s medical history is reviewed before giving them medication to prevent adverse side effects before they happen. There is a possibility that bipolar clients may have issues with both depression and manic episodes if the drugs have a negative effect. There is also a possibility that clients with major depressive disorder may have issues with suicide. It is important to have information about a client’s past before he or she is put on prescriptions and for him or her to be advised about possible side effects.
Anonymous. Lithium Builds Gray Matter in Bipolar Brains, Study Shows. Researched July 11, 2011 from PhysOrg.com and UCLA: http://www.physorg.com/news95351363.html.
Anonymous. Lithium. Researched July 11, 2011 from PubMed Health, National Center for Biotechnology Information, and the U.S. National Library of Medicine: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000531.
Bipolar Disorder. (2008). In National Institute of Mental Health. Retrieved October 17, 2011, from http://www.nimh.nih.gov/health/publications/bipolar- disorder/complete-index.shtml
Holland, K. (2012). Depression Medications and Side Effects. Healthline. Retrieved July 20, 2014, from http://www.healthline.com/health-slideshow/depression– medications-and-side-effects#11
Winans, E. A., & Bettinger, T. L. (2005). Major Depressive Disorders. Pharmacotherapy Self-Assessment Program, 1-44.
Depending on the intensity of a person’s disorder, many individuals may have trouble communicating with others and holding conversations. It may be an even more demanding task for these individuals to maintain a successful lifestyle and become independent. It is not an impossible task, but it takes strong will and sometimes the proper medical care in order to accomplish this sense of independence. Schizophrenic clients also struggle with communication and independence. These symptoms of these two disorders are very similar. Diagnosing a client that shows a struggle with social issues and independence can be difficult, but it can be done.
Introduction of Symptoms
Schizophrenia is a mental disorder in which people affected by this disorder hear voices or hallucinate. People with this disorder may also show signs of having multiple personalities. According to the National Institute of Mental Health (NIMH), there are both positive and negative symptoms associated with schizophrenia. The positive symptoms include: hallucinations, delusions, dysfunctional thoughts, and movement disorders. Negative symptoms include lack of pleasure in everyday activities, lack of hygiene, no facial movement, or lack of conversation. Also, schizophrenic clients exhibit more delusions and hallucinations in their thought processes.
Schizophrenia is usually diagnosed in a person’s early 20’s. No specific cause has been identified. However, it is common for the illness to run in families that have the illness. Prenatal complications also have been thought to be factors in schizophrenia. It is also thought that schizophrenia comes from an imbalance of neurotransmitters like dopamine and glutamate.
Schizophrenia isn’t always noticeable upon onset. There are three different phases: prodromal, active, and residual. These phases repeat throughout a person’s life in cycles. During the prodromal phase, the person starts to lose interest in things that he or she is normally interested in. The person also begins to withdraw from those close to him or her. People going through this phase may want to spend their days alone and may also take a greater interest in philosophy or religion. Once a person hit’s the plateau of this phase, he or she ends up in an active phase. During this phase, a person experiences delusions, hallucinations, and distorted thinking. The next phase that a person goes through is the residual phase. During this stage a person is even more reserved and begins to lose the ability to do the things that he or she normally did well. The only way to lessen the likelihood of these cycles is if a client takes his or her medication and pays attention to his or her symptoms, communicating them to his or her therapist before they progress.
Though medical care has improved and will improve as the years go by, the population of people in the United States affected by schizophrenia need more than one treatment to maintain their incurable condition. “In the United States, schizophrenics account for about 25 per cent of all admissions to mental hospitals and occupy almost half the beds“ (Bellak, L., Lemkau, P. V., & Crocetti, G. M. , 1958). According to the Center for Disease Control and Prevention (CDC), schizophrenia affects 1 percent of the population of the United States and Europe. There is more than one treatment for schizophrenia as it is a lifelong disorder. Treatments are directed towards easing the symptoms that people with this disorder have, so that their condition doesn‘t progressively worsen. NIMH recommends that people with this disorder are treated with antipsychotic medication along with some sort of therapy program. Psychosocial treatments, illness management, rehabilitation, family education, cognitive-behavioral therapy, and self-help groups are all options for people with schizophrenia. “People with schizophrenia can [also] get help from professional case managers and caregivers at residential or day programs” (NIMH, 2011).
Antipsychotic medication is usually used in helping patients with schizophrenia. These medications ease irritation that the patient may be feeling and help the hallucinations that this patient may be having disappear. The NIMH states that these medications can help patients adapt better as long as they are used correctly and prescribed by a doctor. These medications do not make the disorder go away, but they are shown to ease the symptoms of schizophrenia within six weeks of taking the medication. “Antipsychotic medications have been repeatedly shown to be effective for the treatment of acute psychosis and the prevention of relapse for persons suffering from schizophrenia“ (Bustillo, J. R., Lauriello, J., Horan, W. P., & Keith, S. J., 2011).
Psychosocial treatments may also be used to help people with schizophrenia. Psychosocial treatment is given in correlation with the patient taking their medication. This type of treatment helps regulate the patient’s day-to-day life, by focusing the counseling on the patient’s social interaction and their difficulties coping with the everyday changes in life. “Patients who receive regular psychosocial treatment also are more likely to keep taking their medication, and they are less likely to have relapses or be hospitalized” (NIMH, 2011). Psychosocial treatment also improves a patient’s illness management skills by teaching them how to overcome the day-to-day barriers in their occupational, educational, financial, and social lives presented by their condition. Rehabilitation programs like job counseling or tutoring may also coincide with psychosocial treatments, allowing the patient the resources necessary to maintain his or her lifestyle.
Family education and self-help groups are also important when dealing with schizophrenia. Family education helps the patient’s family better understand his or her condition and better empathize with what he or she is going through. Self-help groups can help the patient understand that he or she isn’t the only person faced with this condition and that others go through similar obstacles in their day-to-day lives. These groups can also help family members learn how to deal with certain situations that may arise due to this condition. “On average, relapse rates among schizophrenic patients whose treatment involves family therapy are approximately 24 percent as compared to about 64 percent among those who receive routine treatment” ( Bustillo, J. R., Lauriello, J., Horan, W. P., & Keith, S. J., 2011).
Cognitive-behavioral therapy has also been shown as an effective way to help with the symptoms of schizophrenia. This type of treatment helps patients ignore hallucinations and manage the symptoms of schizophrenia better so that they can maintain better social relationships with other. NIMH states that this type of therapy helps prevent relapse and even works to maintain symptoms that are not maintained by antipsychotic medication.
There are several different methods that need to be utilized when helping individuals with schizophrenia. In order to maintain their mental health, antipsychotic are needed to ease the stress and hallucinations that come with this disorder. Psychosocial therapy is needed so that the patient stays focused on his or her occupational, financial, and educational lives. Also, this type of therapy teaches a person to work with the barriers that his or her condition triggers. Family education therapy is needed to help the patient’s loved ones understand his or her condition and adapt. Self-help groups help the patient with schizophrenia “fit-in” by allowing him or her to talk to individuals that are going through the similar, if not the same, problems that they are, and cognitive-behavioral therapy helps an individual work with his or her mental outlook regarding schizophrenia.
Bellak, L., Lemkau, P. V., & Crocetti, G. M. (1958). Vital Statistics of Schizophrenia (pp. 64-81). Oxford, England: Logos. Retrieved October 28, 2011, from http://psycnet.apa.org/index.cfm?fa=main.doiLanding&uid=1959-06638-002
Bustillo, J. R., Lauriello, J., Horan, W. P., & Keith, S. J. (2011). The Psychosocial Treatment of Schizophrenia: An Update (pp. 163-175). N.p.: American Psychiatric Association. Retrieved October 28, 2011, from http://ajp.psychiatryonline.org/cgi/content/full/158/2/163
Childhood Trauma and PTSD. (n.d.). In Talk Therapy Television. Retrieved October 17, 2011, from http://www.talktherapytv.org/4/post/2011/05/national-childrens– mental-health-awareness-day.html
Coon, D., & Mitterer, J. O. (2010). Introduction to Psychology: Gateways to Mind and Behavior (12th ed., pp. 482-483). Belmont, CA: Wadsworth.
National Institute of Mental Health. (2011). What is Schizophrenia?. In Schizophrenia. Retrieved October 28, 2011, from http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml
Rabiner, David. Behavioral Disorders that Often Co-occur with ADHD. Archive retrieved from: http://www.helpforadd.com/co-occurring-disorders/
Schizophrenia.com. (2010). What Causes Schizophrenia?. In Schizophrenia Information. Retrieved October 28, 2011, from http://www.schizophrenia.com/hypo.php
Torrey, E. F., & Yoken, R. H. (2003). Toxoplasma gondii and Schizophrenia (11th ed., Vol. 9). N.p.: Center for Disease Control and Prevention. Retrieved October 28, 2011, from http://wwwnc.cdc.gov/eid/article/9/11/pdfs/03-0143.pdf
Working with Teenagers on School Performance
Working with Teenagers on School Performance
Younger clients can be difficult to work with, especially when they are court-ordered to go to therapy. There are issues with resistance, and sometimes, these clients have problems understanding their emotions and opening up to a stranger about their daily struggles. Teenagers that struggle with their educational goals can be stereotyped into specific groups and given attention for common struggles instead of the specific treatment that they may need for their own individual performance. During my internship, I was given the chance to work with a few teenagers that were having issues with their school performance and help them understand their struggles and find solutions to help them better help themselves. I will attempt to analyze the clinical reasoning used.
A 16-year-old, Caucasian male presented with multiple stressors, signs, and symptoms. He was recently brought into the court system on truancy charges that his guardian claimed were due to the lack of transportation that she had at the time. His affect was sad, and he seemed to have a guarded attitude. The client was cooperative as he relayed that his mother had been having issues getting a job and had, had to get her license back in order to get a car to take him and his brother to school. He reported that the conditions in the household were stable, except for a few altercations that he had with his stepfather in the past.
The client continued to tell me about his history of being bullied and an abusive relationship that he had with his ex-girlfriend. He stated that he had been bullied all through elementary school and middle school and had finally found solace in high school. However, the client also stated that he had been engaged with a female that emotionally abused him and held him back from his efforts to progress. The client stated that he began feeling depressed to the point where he was having complications getting motivated to do household chores and school work. He stated that at that point, he often thought of death and different ways that he could die and couldn’t get the images out of his head. The client stated that he began to watch his grades go downhill at this point, and the fact that his mother couldn’t always provide transportation for him to get to school didn’t help him.
He states a need for help with his depression and reports that he has difficult controlling his anger at times. He states that he wants to be able to learn to cope with the things that bother him and craves a sense of balance. His diagnosis includes 300.40 Dysthymic Disorder on Axis I. There was no diagnosis found for Axis II or Axis III, and he had physical abuse of a child and academic problems on Axis IV. His GAF was 75 with no past GAF to compare it to.
Related Professional Knowledge
The article that I found was about how depression affected the functional abilities of juveniles. The article is called, “Cognitive and Social Cognitive Development of Depressed Children and Adolescents”, and it discusses how a student’s school performance can be endangered by depressive disorders. “Actual school performance seems to be more consistently affected by depression than cognitive and intellectual abilities; in addition, depressed youth appear to be less socially adept than nondepressed peers, although depression does not consistently impair social cognitive abilities” (Kovacs & Goldston, 1990). I found this interesting, because I feel that my client is one of these juveniles suffering academically due to depression.
Insights about the Case
Most of the clinical assessments performed at this internship site are completed by the psychologists. However, the interns are responsible for the Pre-treatment Assessments (PTA) and the Mental Status Exams (MSE) for their clients. The PTA helps us gather a lot of background information that can play into a client’s way of thinking and show us the cultural environment in which he or she grew up in. This assessment begins by asking questions about a client’s family history and support system. There are also questions in the first part about a client’s social and multicultural background. The second part of this assessment focuses on a client’s past therapy treatment and medical history. There is also a section on personal substance abuse and whether or not there is a history of substance abuse in the client’s family. The last section focuses on the activities that the client enjoys, whether he or she is having suicidal or homicidal ideations, and the diagnosis that the therapist thinks is appropriate. The MSE follows the PTA, giving the therapist’s interpretation of the client’s mood and behaviors during the session. This helps the therapist pay attention to the non-verbal language that may be going on during the session.
In the case of my client, a PTA and MSE were administered. There were no further psychological evaluations, partially because the client’s guardian didn’t have insurance and would have had to pay out of pocket. The PTA and MSE did tell me a lot about the client’s upbringing and current living conditions. I also learned a lot about the family structure and beliefs.
Overcoming Initial Impressions about Diagnosis
Based on the client’s history, signs, and symptoms, I diagnosed him with dysthymic disorder. The client had stated that he had felt this way for at least a year, and according to the DSM-IV, this is one of the main necessities for adolescents. Also, he had stated that during that time, he had ongoing feelings of hopelessness, poor concentration, and difficulty making decisions. The client claimed that one of the things that he needed to work on was his low energy and lack of motivation to get things done. He stated that he experienced insomnia frequently, and most of the time, it would take him a couple of hours to fall asleep.
Initially, I was going to diagnose him with an adjustment disorder due to the fact that his mother had experienced a drastic economic change, which affected both him and his brother. However, the client stated that he had been experiencing these symptoms since before this change. Explaining this diagnosis to the client was easy, but his mother didn’t take it as well. She seemed to have the attitude that labeling her child with a mental disorder would make him more of an outcast. She wasn’t as accepting of the therapy as the client was, but she insisted on sitting in on the therapy.
I believe that the client’s history played a large part in the development of the presenting problems. For example, the client’s physical abuse issues with his stepfather made him feel less connected to the male role model in his house and protective of his mother and brother. This provoked him to establish a leadership role for his family. His mother’s divorce from his biological father also may have incorporated into these issues. The economic issues that presented themselves made it more difficult for him to make it to school, which caused another issue. On top of these issues, the client has been dating since he was very young and has a tendency to get emotionally intimate with his female partners, creating a great distress when he is rejected in this capacity. The client also has a history of emotional abuse from his previous relationship, which left him with grave self-esteem issues.
It seems that these situational stressors have caused a great deal of harm. The client is highly stressed about his family’s well-being to the point that he is the one that listens to his mother’s problems and gives her advice. He doesn’t yet have the capability to drive or work, so he has felt trapped for the last year or so, trying to push forward, even in difficult circumstances. This has left him little time to reflect on himself and his own needs, which also seems to create him stress. He looks for the approval of others when he has to make a difficult decision, and he still hasn’t learned how to formulate his own personality.
Treatment Plan Preparation
In order to formulate a treatment plan, one must gather all of the facts about the client, looking at the information closely in order to bring out the main problem the client is having. The client has input in this process as well as the therapist will ask him and her about his or her therapy goals and what he or she wants to accomplish. Treatment plan objectives, always measurable and specific, must also be written on the treatment plan. This process will be much easier if the client is cooperative with the goals chosen. Also, insurance agencies may have to look at the treatment plan to determine if the client is getting a positive level of treatment.
Culture and Personality Factors
The client that I am working with is from a strong African American background. He lives in a wealthy area of the city, and he speaks very articulately. His mother seems very traditional, and the family is very close. I feel that it is very important to gage the client’s cultural background and beliefs in order for him or her to cooperate with therapy. I also think that this is a way for the therapist to bond with the client without offending his or her principals and learn how the client processes things. Though his personality is very different from his mother and brother, the cultural ties are the same.
Transference and Counter-transference
During the first couple of sessions, I didn’t feel like there were any transference issues. The sessions were very professional, even when the client opened up about his history and his issues. As the sessions went on, the client stated that he was the oldest in his family, which brought on some counter-transference issues due to the fact that I am also the oldest in my family. The respect for this position hindered my ability to be objective, so I had to deal with that situation in order to move further into the counseling process.
Supervision meetings occur once a week though we are able to walk in our supervisor’s office and consult about cases if necessary. At this point in my internship, I am not very close with my supervisor, as most of my training has been done by other therapists or interns that she supervises. I have consulted briefly with my supervisor on cases, but it seems that since the other interns are two internships ahead of me, there is a lot that she assumes I already know. I am trying to work with her in order to establish a positive professional relationship. However, I feel that will take more time.
Insights on Learning and Growth
This case has taught me a lot and showed me better ways to handle situations with clients. I feel that I learned how to incorporate different learning theories when explaining different concepts to clients. I have also learned how to work with a variety of age groups, genders, and cultural backgrounds. I learned about dealing with resistance and how not to work harder than the client. I learned how to be a better listener and accept the choices that the client makes, even if they wouldn’t be the ones that I would make in my own personal life. I feel that all of these things will help me become a better therapist and help my clients in the future.
Kovacs, M., & Goldston, D. (1991). Cognitive and Social Cognitive Development of Depressed Children and Adolescents.Journal of the American Academy of Child & Adolescent Psychiatry, 30(3), 388-392. Retrieved July 28, 2013, from http://www.jaacap.com/article/S0890-8567(09)64555-X/abstract
Post-Traumatic Stress Disorder vs. Other Anxiety Disorders
Anxiety disorders are treated with cognitive behavioral therapy and sometimes pharmaceuticals. Post-traumatic stress disorder has a similar treatment, but there are also a few differences in how the treatment is handled. “Behavior therapy has much in common with other psychological therapies, particularly those that tend to be brief and directive, [and] in some cases, behavior therapy has borrowed concepts and methods from other systems” (Wedding, D., & Corsini, R., 2011). This kind of therapy is used to treat many different disorders, especially anxiety disorders, obsessive-compulsive disorders, and depression.
Post-Traumatic Stress Disorder vs. Other Anxiety Disorders
Behavioral therapy is used to help people learn habits that will promote positive behavior and enhance their lifestyles. The three main approaches to behavioral therapy are applied behavior analysis, a neobehavioristic medicational stimulus or response model, and social-cognitive theory (Wedding, D., & Corsini, R., 2011). Behavioral therapists that use these approaches can help people with anxiety disorders, obsessive-compulsive disorders, and depression (Wedding, D., & Corsini, R., 2011).
“Several well-controlled studies have established that behavior therapy is an effective form of treatment for anxiety disorders” (Wedding, D., & Corsini, R., 2011). People with anxiety disorders may feel an overwhelming stress that feels uncontrollable, and they may experience a feeling of dread before they go to work or school or in the process of trying to accomplish a goal that is somewhat important to them (Anxiety Disorders Association of America, 2012). These people also constantly worry to the point to where it impacts their daily life; avoid social situations for fear of being judged, embarrassed, or humiliated; have panic attacks; have an irrational fear or avoidance of an object, place, or situation that presents no danger to them; perform uncontrollable repetitive actions such as excessive cleaning or checking; and have reoccurring nightmares or flashbacks (Anxiety Disorders Association of America, 2012).
“Anxiety disorders are the most common psychiatric illnesses affecting children and adults, [and] only about one-third of those suffering from an anxiety disorder receive treatment, even though the disorders are highly treatable” (Anxiety Disorders Association of America, 2012). One of the exercises performed in behavioral therapy to assist with phobias consists of exposing patients to their fears in order to get them to the point where they won’t panic when in that situation (Wedding, D., & Corsini, R., 2011). “In [behavioral therapy], the patient is actively involved in his or her own recovery, has a sense of control, and learns skills that are useful throughout life” (Anxiety Disorders Association of America, 2012). Clients utilizing behavioral therapy must be actively engaged in the recovery process in order to change their behavioral patterns. “[This process] typically involves reading about the problem, keeping records between appointments, and completing assignments in which the treatment procedures are practiced” (Anxiety Disorders Association of America, 2012).
Behavioral therapy also can be used with people with obsessive-compulsive disorder. “OCD is less a manifestation of people who have irrational thoughts than it is an anxiety disorder in which people respond instinctually to feelings of being in grave jeopardy, [and] devoting a significant amount of time in an attempt to explain the irrational nature of the thought content misses the underlying characteristics of the disorder” (Phillipson, S.). The most effective behavioral technique that has been utilized is exposure and response prevention, which entails exposing an OCD person to an object that they see as ‘contaminated’ and allowing them to see their irrational response (Wedding, D., & Corsini, R., 2011). A rational response must be learned by a person with OCD in order for them to understand that their irrational behavior must change (Phillipson, S.). “The majority of people with OCD are aware of the excessiveness and absurdity of their thoughts and perceptions, [and] therefore, helping OCD suffers to see the irrational nature of the thought content is counterproductive” (Phillipson, S.). By provoking an event to happen that may cause the OCD person to think that he or she was exposed to germs, one will think about the belief that they have that the germs are bad, go through the emotional guilt or worry about exposing his or herself to germs, and be forced to make a rational response to the situation (Phillipson, S.). “Research has shown that roughly 65 to 75 percent of patients with OCD show marked improvement following behavioral treatment” (Wedding, D., & Corsini, R., 2011).
Post-traumatic stress disorder is an anxiety disorder obtained when a person undergoes a traumatic experience. Stress, physical or emotional abuse, death of a loved one, war, and the experience of being in a natural disaster are all reasons that a person might get post-traumatic disorder. Symptoms of people with this disorder include high anxiety, stress, anger, nightmares, and sleeping disturbances. The people will also avoid things that remind them of the trauma that they endured, and their disturbance over their past ordeals may hinder their ability to live a normal life. Post-traumatic stress disorder is diagnosed to individuals that have had these symptoms for one month or longer, and the symptoms must interrupt one or more of the important area in a person’s life, such as a person’s occupational life, family life, friendships, or educational endeavors.
Post-traumatic stress disorder is categorized into three different groups. The first group that this disorder is categorized is acute stress disorder. Acute stress disorder is when a person suffers from trauma for two days or longer but not more than four weeks. This person may avoid things that remind them of the trauma that they endured. Chronic post-traumatic stress disorder is the second category that this disorder can be divided into, and the individuals that have this type of post-traumatic stress disorder will have it for their entire life. A person diagnosed with chronic post-traumatic stress disorder has symptoms for more than 90 days, and the symptoms may last for a period of days and in some instances, a period of weeks. A person can also have a delay-onset version of this disorder. Delayed-onset post-traumatic stress disorder occurs when a person is reminded of a traumatic event that he or she endured, but he or she does not have symptoms of dissociation until years after this traumatic event has passed.
Treatment for post-traumatic stress disorder include cognitive-behavioral therapy. This is where a person goes to therapy to work through their feelings regarding the traumatic experience and work through their guilt regarding the situation. Medication may be given to individuals with post-traumatic stress disorder to ease their anxiety and help them sleep. Family therapy is also recommended for people that have post-traumatic stress disorder. This enables the affected person to work through the symptoms of post-traumatic stress disorder and maintain a positive relationship with their family members. It also helps, because this builds an active support system for the person that has this disorder by helping the family members understand what he or she is going through.
For the most part, medication can be given for both PTSD and other anxiety disorders, but the cognitive behavioral therapy can actually vary dramatically. Also, with PTSD, there are special therapies that can help a person work through the traumatic situations like psychotherapy. The medications can help to relieve the anxiety that a person with PTSD feels but not flashbacks or feelings towards the original trauma. With other anxiety disorders, the CBT may help manage the daily situations that create the anxiety. However, with PTSD, the medication can’t even come close to solving the original cause of trauma and the feelings that a person goes through when experiencing these situations through flashbacks or triggers.
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Phillipson, S. (n.d.). A Prelude to Cognitive-Behavioral Techniques for the Treatment of OCD. In When Seeing is Not Believing: A Cognitive Therapeutic Differentiation Between Conceptualizing and Managing OCD. Retrieved July 11, 2014, from http://www.ocdonline.com/definecbt.php
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Wedding, D., & Corsini, R. (2011). Current Psychotherapies (9th ed.). Belmont, CA: Brooks/Cole.
Kai groaned as she plopped out off bed and wiped the sleep from her eyes. The redundant sound of her alarm clock echoed throughout the room, and the faint break of silence was irritating. She switched off the noisy machine and slipped into some shorts and the first T-shirt that she could find. It was the first day of the new school year, which meant one thing…she better have her coffee.
Kai had taken the position at East High two years ago with no intent to make it permanent. It was the only other school that she had taught at besides the one that she did her practicum and student teaching observation at. It was a pretty decent job, and at the time, she was getting herself on her feet and trying to introduce herself to a more comfortable lifestyle than she had been used to growing up.
Kai had chosen teaching, because she felt that she would be able to teach students not only the knowledge needed in life but actual life skills. She had grown up on a street where too many people lost their common sense in their teens and some their lives. She wanted to help prevent that from happening to future generations and wanted the students to see their full potential.
Kai walked into the empty kitchen and started to make some coffee. Her house was silent, which sometimes made her feel more lonely, but with her busy schedule, she didn’t spend much time in there anyways. Kai flicked on the television to the morning news. It was somewhat entertaining to see what was going on in the world around her though she didn’t care much for politics and would believe in the weather man once she saw the Easter bunny.
Out of the corner of the kitchen, another ring erupted, this time the phone. “Hello,” Kai answered, wondering who would be calling this early.
“Hey, Kai,” she heard a familiar voice reply. She would recognize Sam’s voice anywhere. “Do you have the news on?”
“Yeah,” Kai said, waiting for the punch line.
“One of the kids at school got abducted last night,” Sam stated.