Assessing Clients with Addictive Disorders
NURS 6640: Psychotherapy with Individuals
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5, 2013), reports on criterium for diagnosing addiction is a complicated process. The disorders are not limited to substance-related habits but are also associated with other alike conditions that trigger the same reward systems in the central nervous system (DSM-5, 2013).
Herman& Roberto (2015) define addictive disorder as the use of “chemical substances” that generates temporary alteration in a state of mind and which eventually leads to dependence on those substances
The situation regarding Mr. and Mrs. Levy looks like any couple having a misunderstanding about their lives. As the video progresses one can sense that Mr. Levy is going through a mental health situation because of the list of symptoms that he mentioned and his Iraq deployment. Mr. Levy stated, “I am sick. I am not going to work.” He is aware that he is not doing well and sound helpless that he was unable to do things.
Mrs. Levy sounds equally frustrated because she was aware that her husband is not functioning at his usual level. Mrs. Level may not be mindful of ailments associated with war veterans.
The symptoms heard on the video were alteration in the usual ways that Mr. Levy uses to function, such as missing work, excessive alcohol use, increased anger, depression, and signs related to an Iraq war veteran.
It is good to see the therapist’s enthusiasm for her new client, but she forgets that the first phase of therapy is to meet and form a trusting relationship with the client. Her ideas of yoga, meditation, and art therapy are good ideas bust she needs to meet the client and see where the assessment will direct the treatment instead of forming one up. The supervisor was right to address the social worker to re-process her approach to the first meeting. He advised the therapist to wait and assess the client before coming up with a new plan of treatment. Assessment is always the best initial approach to a new therapist-client relationship.
The therapist stayed calm and actively listened to Mr. Levy to tell his story. The therapist intervened with appropriate technique, guidance, and responses that show evidence of empathy. The therapist assisted the client in identifying his trauma-related symptoms such as fear, restlessness, anxiety, and rapid breathing. She offered an intervention for readjusting his breath to a proper level. Finally, when the trust has been established, she offered Mr. Levy exposure therapy (ET), and the client accepted. Evidence has shown the efficacy of ET in the treatment of PTSD
Post-traumatic stress disorder (PTSD) is a growing and common mental health condition that clinicians are encountering in their medical practice. According to the diagnostic and statistical manual of mental disorders (2013), describes PTSD as a condition that is “trauma- and stress-related.” The contact with these disturbances may be straightforward or obscured. Some examples of these adverse situations include death threats, life-threatening injuries, and sexual aggression (DSM-V, 2013). Lancaster, Teeters, Gros, & Back (2016) reported on specific distresses such as “earthquakes, mudslides, fires, floods, tsunamis, tornadoes), war, domestic violence, rape, violent crime, accidents, and medical procedures may trigger the development of PTSD.” Additionally, PTSD is complicated with comorbidities that are unrelenting and can burden patient’s “social interactions, the capacity to work, or other areas of functioning” (Lancaster, Teeters, Gros, & Back, (2016).
As suggested by Mr. Levy’s therapist, there is supportive evidence that trauma-focused exposure therapy is effective in managing some symptoms of PTSD. Watkins, Sprang, & Rothbaum, (2018) covers prolong exposure (PE) therapy that has been endorsed by the American Psychological Association (APA) and the Department of Veterans Affairs (VA) as one of the treatment options for the treatment of military service-related trauma. The findings indicate that PE helps the client change the fear exposure that was stored in the memory and adapt to the changes without causing illness. What’s more, the PE approach helps the patient trigger the unpleasant memory, and stimulate new information that replaces the negative symptoms like fear, anxiety, and restlessness (Watkins, Sprang, & Rothbaum, 2018
The therapist shows empathy and assisted Mr. Levy in performing deep breathing exercises. Which led to the reduction of the negative symptoms he was experiencing. The focused moved carefully to the presenting mental health symptoms of been easily distracted, constant thoughts about Iraq and fellow soldiers, mood swings, insomnia, and alcohol use. Mr. Levy responded positively to the EP and the breathing exercises. It empowered him to recall his war experience without having to feel the actual trauma emotions. The therapist learns more information from the client about his experience, and the therapeutic communication allowed her to formulate a client-centered plan of treatment for a PTSD person. This video highlights some pitfalls to avoid, and for a future therapist, I learn the importance of allowing the client to tell their story. Other reflections are related to watching the breathing exercises and learning the proper techniques. Also, knowing that there are other options for treatment, such as cognitive approaches. The EP works for this patient, and I will try this approach in the future.
Therapists are human beings with feelings. I am not surprised that the therapist empathizes to the point that there may be a likelihood of counter-transference. The supervisor was non-judgmental and offered support to the therapist. Gait & Halewood (2019) have explained the countertransference in the practice of a practitioner as a dichotomy that can have both positive and negative consequences. It may give helpful awareness into the therapist-client alliance. If there is no insight into where the emotion and feelings stand, it may make the therapy ineffective.
Many people in the community have PTSD, and if not understood or managed well, the negative symptoms may increase while putting the person’s mental health in jeopardy. The therapeutic relationship with a client starts with proper evaluation, and the therapist needs to be aware off this phase before moving diligently to generating the treatment plan. These clients need empathy, trust, and sensitivity approach to their care, and the therapist should avoid any intervention that may re-traumatize them.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Gait, S. & Halewood, A. (2019) Developing countertransference awareness as a therapist in training: The role of containing contexts, Psychodynamic Practice, 25:3, 256- 272, DOI: 10.1080/14753634.2019.1643961
Herman, M. A., & Roberto, M. (2015). The addicted brain: understanding the neurophysiological mechanisms of addictive disorders. Frontiers in integrative neuroscience, 9, 18. doi:10.3389/fnint.2015.00018
Lancaster, C. L., Teeters, J. B., Gros, D. F., & Back, S. E. (2016). Posttraumatic Stress Disorder: Overview of Evidence-Based Assessment and Treatment. Journal of clinical medicine, 5(11), 105. doi:10.3390/jcm5110105
Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A Review of Evidence-Based Psychotherapy Interventions. Frontiers in behavioral neuroscience, 12, 258. doi:10.3389/fnbeh.2018.00258