Psychotherapy Individuals Clients with Addictive Disorders.

Psychotherapy Individuals Clients with Addictive Disorders.

In our work as a Mental health specialist, we see individuals suffering from addictions even if they are not abusing any substance. An addiction is a tendency to use repetitively and, hence, without thought. This can involve a substance, a state, an experience, or a relationship. The addiction can be in the form of substance abuse, gambling, pornography, use of the internet, shopping, and perverse ways of relating. This either provides immediate relief or at least a distraction from something that feels unbearable. The individual set up a repetitive cycle that offers a retreat from the real feelings of others and, importantly, allows for the illusion of complete control. Most people come to psychotherapy because they are troubled by something and because they feel that their problems are having an adverse impact on those they love and care for. They are troubled by the fact that despite talent, they have become stuck in their lives. In contrast, a person with addiction is often brought by others. Most persons with addictive disorders are not able to think about changing anything, at least not in themselves (Verma & Vijayakrishnan, 2018).

The First Episode

At the start of the episode, Mr. Leavy is seen sitting at the kitchen table and looks ill. He states, “I’m not going to work today. I am sick.” Mrs. Leavy addresses the fact that Mr. Leavy drinks all night long by himself in a dark room watching TV. From the encounter, you can tell that Miss Leavy is worried about her husband’s drinking and states that their relationship is not the same due to his irritability and being hungover. She is also concerned about the negative influence that the drinking could be having on their children. “go to bed before the kids see you.” During this first encounter, Mr. Leavy becomes irritable and defensive when his wife tries to communicate with him about his drinking. “It’s called leave me the hell alone.” Mrs. Leavy admits to her husband that she does not know if she can continue a marriage if Mr. Leavy’s behaviors do not change. “You were not like this when we first met. I want that back.” To that, Mr. Leavy reveals that he is not the same person since going to “Iraq.” At the end of episode one, Mrs. Leavy is unable to convince her husband that he should seek assistance with his substance abuse and other mental health issues. One well-documented reason that individuals in the military do not seek treatment is to avoid the stigma associated with having a mental illness. Stigma is typically defined as a “mark” that distinguishes one from others and links them to undesirable characteristics (Brown et al., 2010).

Episode 2

The second episode starts with a therapist discussing the Leavy case with her supervisor. The therapist taking the case is excited about the opportunity, admitting that she does not work with younger veterans with substance and PTSD issues. She mentions a few different types of treatments that she thinks might be beneficial to the client, including art, therapy, yoga, and meditation. At this point, the supervisor rightfully interjects the therapist. At this time, he wants to make sure that the client will be at the center of the treatment planning. The supervisor wants to make sure that in treating the client best, evidence-based practice is being used, according to Gallegos et al. Findings suggest that complementary approaches to the treatment of PTSD that utilize meditation or yoga are warranted among veterans, with interventions yielding small to moderate effects on PTSD symptom reduction. Complementary health interventions increase patient choice and may be offered as a second-line treatment option for PTSD, but more research needs to be done to warrant these types of therapies as first-line treatment of PTSD. The gold standard initial treatment for veterans with posttraumatic stress disorder (PTSD) is cognitive behavior therapy (CBT). This first line of treatment for PTSD is CBT, which can be considered before antidepressants are administered, CBT has been proven effective in decreasing the symptoms of veterans with PTSD with prolonged exposure (Wheeler, 2014). The goal of therapy is for the client’s symptoms to improve; therefore, taking a risk on non-evidenced practices can lead to possible failure and disconnect with the client.

Episode 3

In the first session, the therapists’ approach proved to be successful. The therapist opted for Exposure therapy, which is a form of Cognitive Behavior Therapy (CBT), to have Mr. Levy learn to cope with his traumatic experiences in Iraq. Research suggests that CBT therapy focuses on the importance of past emotions, identification of patterns of behavior, contemplations, moods, and occurrences, and emphasis on personal relationships (Wheeler, 2014). During the interview, the client became anxious when describing traumatic details from his employment in Iraq. He is unable to continue communication at that time due to high levels of anxiety. Currently, the therapist chooses to incorporate Diaphragmatic breathing. Diaphragmatic breathing is the process of contracting on inhalation and relaxing on the exhalation of the diaphragm, which slows respiration down to prevent shallow breathing and increases the amount of oxygen in the blood (Ma et al., 2017). The breathing exercises help distract the client’s thoughts and reduce muscular tension, leading to an ease in anxiety. Through attentive listening and an empathetic approach, the therapist appeared to have a sincere concern for the client. Mr. Levy seems to appreciate her interest and empathy and can continue discussing his traumatic past situation after the breathing intervention. According to Bakic-Miric & Bakic, 2008, success in communication largely depends not only on the doctors’ clinical knowledge and technical skills but also on the nature of the rapport that is established between doctor and patient.

Episode 4

The therapy session appears to be going well after the breathing intervention. The client was able to elaborate on a traumatic event that occurred during his employment, including witnessing the death of his platoon officer. After the client disclosed the traumatic story to the therapist, he seems to have gained some insight. He admits that he has anxiety and is unable to sleep because of vivid nightmares. He then states that is why he drinks so that he can black out and get sleep. In response, the therapist continues to have an empathetic, calm, and caring approach; this will allow for further rapport between the client and therapist. CBT therapy would still be an appropriate therapy for this client as his sessions continue; he could gain more insight into his negative behaviors and ultimately replace the negative behaviors by recognizing them and dealing with them in a non-destructive way. If the client continues to have sleep disturbance due to nightmares, a pharmacological intervention might be needed.

Final Episode

In the final episode, the therapist reveals to her supervisor that she is having a hard time forgetting the traumatic story Mr. Leavy told her in her session. One of her biggest worries is that Mr. Leavy will soon be having a new child, and this might cause more stress, creating a worse situation. In this scenario, the supervisor should acknowledge the therapist’s concerns, letting her know that her worries are not unwarranted. In a study by Haveman et al. assessing the rate of PTSD treatment dropout of veterans overall found that risk factors for patient nonadherence to treatment included non-Hispanic ethnicity, ages 20 to 30 years, and being a veteran of the US wars with Iraq or Afghanistan. The study also found that veterans’ reasons for dropping out of treatment included not being comfortable with their provider, believing they could fix the problem themselves, feeling that 4 or 5 sessions are sufficient, and/or not finding the treatment effective in a timely manner. As a supervisor, I would stress the importance of continuing to build a trusting report will increase the hood of adherence to the program and treatment outcomes. The importance of assessing the client for suicidal ideas or behaviors. Suicide rates among veterans have increased markedly since the onset of Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF; LeardMann et al., 2013). It is also important to remind the therapist that the client did come in for counseling with prompts from her wife but, at this time, is at least looking for treatment. At this time, I would encourage the therapist about the positive outcomes of therapy for PTSD victims. I would also suggest looking for opportunities to implement additional therapies ( family, Substance) or adding medication to help relieve symptoms.

References

Bakic-Miric, N. M., & Bakic, N. M. (2008). Successful, Doctor-Patient Communication and Rapport Building as The Key Skills of Medical Practice, FACTA Universitatis, 15, 74-79. Retrieved from https://simidchiev.net/fid/Dissert/BakichMirich2008.pdf

Brown, C., Conner, K. O., Copeland, V. C., Grote, N., Beach, S., Battista, D., & Reynolds III, C. (2010). Depression stigma, race, and treatment-seeking behavior and attitudes. Journal of Community Psychology, 38(3), 350-368.Retrieved Walden Library.

Gallegos, A. M., Crean, H. F., Pigeon, W. R., & Heffner, K. L. (2017). Meditation and yoga for posttraumatic stress disorder: A meta-analytic review of randomized controlled trials.

Clinical psychology review, 58, 115–124. https://doi.org/10.1016/j.cpr.2017.10.004.Retrived Walden Library.

Haveman-Gould, Bradley MHS, PA-C; Newman, Chelsea Posttraumatic stress disorder in veterans, Journal of the American Academy of Physician Assistants: November 2018 – Volume 31 – Issue 11 – p 21-24 doi: 10.1097/01.JAA.0000546474.26324.05

LeardMann, C. A., Powell, T. M., Smith, T. C., Bell, M. R., Smith, B., Boyko, E. J., … & Hoge, W. (2013). Risk factors associated with suicide in current and former US military personnel. Jama, 310(5), 496-506.

Ma, X., Yue, Z.-Q., Gong, Z.-Q., Zhang, H., Duan, N.-Y., Shi, Y.-T., … Li, Y.-F. (2017). The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults. Frontiers in Psychology, 8, 874. http://doi.org/10.3389/fpsyg.2017.00874

Verma, M., & Vijayakrishnan, A. (2018). Psychoanalytic psychotherapy in addictive disorders.M Indian Journal of Psychiatry, 60(Suppl 4), S485–S489. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_16_18 retrieved from Walden Library.

Wheeler, K. (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.

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PSYCHOTHERAPY FOR CLIENTS WITH ADDICTIVE DISORDERS

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Addictive disorders can be particularly challenging for clients. Not only do these disorders typically interfere with a client’s ability to function in daily life, but they also often manifest as negative and sometimes criminal behaviors. Sometimes, clients with addictive disorders also suffer from other mental health issues, creating even greater struggles for them to overcome. In your role, you have the opportunity to help clients address their addictions and improve outcomes for both the clients and their families.

Psychotherapy Individuals Clients with Addictive Disorders.

RESOURCES

To prepare:

Review this week’s Learning Resources and consider the insights they provide about diagnosing and treating addictive disorders. As you watch the 187 Models of Treatment for Addiction video, consider what treatment model you may use the most with clients presenting with addiction

THE ASSIGNMENT

In a 5- to 10-slide PowerPoint presentation, address the following. Your title and references slides do not count toward the 5- to 10-slide limit.

Provide an overview of the article you selected.

What population (individual, group, or family) is under consideration?

What was the specific intervention that was used? Is this a new intervention or one that has already been studied?

What were the author’s claims?

Explain the findings/outcomes of the study in the article. Include whether this will translate into practice with your own clients. If so, how? If not, why?

Explain whether the limitations of the study might impact your ability to use the findings/outcomes presented in the article.

Use the Notes function of PowerPoint to craft presenter notes to expand upon the content of your slides.

Support your response with at least three other peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly. Provide references to your sources on your last slide. Be sure to include the article you used as the basis for this Assignment.