Karen, a 36-year-old woman with a history of childhood abuse and unstable relationships, is diagnosed with borderline personality disorder. The therapist plans to use dialectical behavior therapy (DBT) and mentalization-based treatment to address Karen's self-harming behaviors and improve her quality of life. DBT focuses on mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness skills. It has been shown to significantly reduce suicide risks and self-injury in BPD patients. The therapist will take a nonjudgmental approach, validate Karen's experiences, and encourage new interpretations and coping skills to reduce self-harming behaviors over the course of weekly individual and group therapy sessions.
Understanding the Process of Supported Recoverysdewattignar
Understanding the Process of Supported Recovery
Early Intervention Services (EIS) for Psychosis are informed by a recovery-orientated approach to well-being, as defined by clients. The present research used qualitative methodology to explore the experiences of individuals as they began the process of supported recovery within the care of an EIS. Twenty clients of an EIS were interviewed to elicit their narrative accounts of their life at the time of referral through to recovery with a focus on their perceived satisfaction with the EIS. Data were then subject to thematic analysis. Those themes arising marked the defining features of the process of recovery and delineated the positive and negative influences that services can impart to their clients during this process. The process of supported recovery appeared to be mitigated by a number of factors, which if considered can enhance clinician insight and build on the treatment partnership between service and client.
Understanding the Process of Supported Recoverysdewattignar
Understanding the Process of Supported Recovery
Early Intervention Services (EIS) for Psychosis are informed by a recovery-orientated approach to well-being, as defined by clients. The present research used qualitative methodology to explore the experiences of individuals as they began the process of supported recovery within the care of an EIS. Twenty clients of an EIS were interviewed to elicit their narrative accounts of their life at the time of referral through to recovery with a focus on their perceived satisfaction with the EIS. Data were then subject to thematic analysis. Those themes arising marked the defining features of the process of recovery and delineated the positive and negative influences that services can impart to their clients during this process. The process of supported recovery appeared to be mitigated by a number of factors, which if considered can enhance clinician insight and build on the treatment partnership between service and client.
Here, the client substitutes the psychotherapist for the original parent. She now sees the psychotherapist as fulfilling a role in her script. But she experiences him as doing so in a more benign way than the actual parent did.
The client may experience considerable relief from child fears and anxieties now that she has this more benevolent parent to relate to.
As any clinician knows, every year witnesses the introduction of new treatment models. Invariably, the developers and proponents claim superior effectivess of the approach over existing treatments. In the last decade or so, such claims, and the publication of randomized clinical trials, has enabled some to assume the designation of an "evidence-based practice" or "empirically supported treatment." Training, continuing education, funding, and policy changes follow.
Transference is often manifested as an erotic attraction towards a therapist, but can be seen in many other forms such as rage, hatred, mistrust, parentification, extreme dependence, or even placing the therapist in a god-like or guru status.
Chapter from the book, Duped by Kottler and Carlson. Clients who taught Barry the value of believing clients and even the therapeutic impact of a big fat lie.
These slides contain detailed description of family therapy including : Introduction, Definition, Aims/Goals, Indication, Contraindication, Functions, Types, Nursing diagnosis and interventions, Nursing responsibilities, Research.
General Overview
Previously had a link to Marsha Linehan's video podcast on Mindfulness. If interested, check the reference section for a direct link for viewing.
This power point presentation is on Carl Rogers theory of personality. This ppt would be helpful for both UG and PG students and is developed to fulfill the objective of curriculum.
Here is a recent chapter I did making the case for a relational perspective in therapeutic services (Duncan, B. (2014). The person of the therapist: One therapist’s journey to relationship. In K. J. Schneider, J. F. Pierson, & J. F.T. Bugental (Eds.). The Handbook of Humanistic Psychology: Leading Edges in Theory, Practice, and Research (2nd ed.) (pp. 457-472). New York: Sage Publications.
Generalist practice in social work is an approach to client servic.docxJeanmarieColbert3
Generalist practice
in social work is an approach to client service that makes use of a variety of methods, schools of thought, and perspectives. The term describes social work practice that is not limited to only one method or point of view. Generalist social work practitioners stay informed of current research in their field, and they select methods that seem most appropriate to the different situations that their clients face.
For this Assignment,
select one of the case studies provided in the Readings. Consider different ways of describing generalist practice and how you might identify it in social work.
Submit a 2- to 3-page paper in which you address the following criteria:
Create a definition of generalist practice using your own words.
Identify at least three specific examples of generalist practices you see portrayed in your selected case study.
Indicate the characteristics that make each an example of generalist practice.
Explain the effectiveness (or ineffectiveness) of each example in terms of its benefit to clients.
Reference
Plummer, S.-B., Makris, S., & Brocksen S. M. (Eds.). (2014).
Working with survivors of sexual abuse and trauma: The case of Angela
. In
Social work case studies: Foundation year.
Retrieved from http://www.vitalsource.com
Working With Survivors of Sexual Abuse and Trauma: The Case of Angela
Angela is a 27-year-old, Caucasian female, who first came to counseling to address her history of sexual abuse. She graduated from college with a BS in chemistry and has since been employed by pharmaceutical companies. After obtaining a new job, she relo¬cated to an apartment in an East Coast city where she knew no one. Both of Angela’s parents live on the West Coast, and she has one younger brother who also lives in a different state. Angela has limited contact with both her mother and brother and does not have any contact with her father. Angela is obese and disclosed a history of struggling with her weight and eating issues. She has few friends, and those she does have live far away.
Angela has a long history of trauma in her life. She was sexually abused between the ages of 9 and 21 by her father, sexually assaulted at the age of 14 by a classmate in school, and mugged as a young adult. There was domestic violence in the home, also perpetrated by her father. Angela’s father is considered an upstanding member of the community, and he is well liked and respected by others. No one in Angela’s family believes that she was sexually abused, and her father joined a “false memory syndrome” group and is outspoken about that issue. There has been little discussion in her family about what took place in the home while she was growing up.
Angela struggled with daily functioning and exhibited symp¬toms of post-traumatic stress disorder (PTSD). She had a history of cutting herself and binge eating and displayed some charac¬teristics of borderline personality disorder. Angela also mildly dissociated when under duress..
Here, the client substitutes the psychotherapist for the original parent. She now sees the psychotherapist as fulfilling a role in her script. But she experiences him as doing so in a more benign way than the actual parent did.
The client may experience considerable relief from child fears and anxieties now that she has this more benevolent parent to relate to.
As any clinician knows, every year witnesses the introduction of new treatment models. Invariably, the developers and proponents claim superior effectivess of the approach over existing treatments. In the last decade or so, such claims, and the publication of randomized clinical trials, has enabled some to assume the designation of an "evidence-based practice" or "empirically supported treatment." Training, continuing education, funding, and policy changes follow.
Transference is often manifested as an erotic attraction towards a therapist, but can be seen in many other forms such as rage, hatred, mistrust, parentification, extreme dependence, or even placing the therapist in a god-like or guru status.
Chapter from the book, Duped by Kottler and Carlson. Clients who taught Barry the value of believing clients and even the therapeutic impact of a big fat lie.
These slides contain detailed description of family therapy including : Introduction, Definition, Aims/Goals, Indication, Contraindication, Functions, Types, Nursing diagnosis and interventions, Nursing responsibilities, Research.
General Overview
Previously had a link to Marsha Linehan's video podcast on Mindfulness. If interested, check the reference section for a direct link for viewing.
This power point presentation is on Carl Rogers theory of personality. This ppt would be helpful for both UG and PG students and is developed to fulfill the objective of curriculum.
Here is a recent chapter I did making the case for a relational perspective in therapeutic services (Duncan, B. (2014). The person of the therapist: One therapist’s journey to relationship. In K. J. Schneider, J. F. Pierson, & J. F.T. Bugental (Eds.). The Handbook of Humanistic Psychology: Leading Edges in Theory, Practice, and Research (2nd ed.) (pp. 457-472). New York: Sage Publications.
Generalist practice in social work is an approach to client servic.docxJeanmarieColbert3
Generalist practice
in social work is an approach to client service that makes use of a variety of methods, schools of thought, and perspectives. The term describes social work practice that is not limited to only one method or point of view. Generalist social work practitioners stay informed of current research in their field, and they select methods that seem most appropriate to the different situations that their clients face.
For this Assignment,
select one of the case studies provided in the Readings. Consider different ways of describing generalist practice and how you might identify it in social work.
Submit a 2- to 3-page paper in which you address the following criteria:
Create a definition of generalist practice using your own words.
Identify at least three specific examples of generalist practices you see portrayed in your selected case study.
Indicate the characteristics that make each an example of generalist practice.
Explain the effectiveness (or ineffectiveness) of each example in terms of its benefit to clients.
Reference
Plummer, S.-B., Makris, S., & Brocksen S. M. (Eds.). (2014).
Working with survivors of sexual abuse and trauma: The case of Angela
. In
Social work case studies: Foundation year.
Retrieved from http://www.vitalsource.com
Working With Survivors of Sexual Abuse and Trauma: The Case of Angela
Angela is a 27-year-old, Caucasian female, who first came to counseling to address her history of sexual abuse. She graduated from college with a BS in chemistry and has since been employed by pharmaceutical companies. After obtaining a new job, she relo¬cated to an apartment in an East Coast city where she knew no one. Both of Angela’s parents live on the West Coast, and she has one younger brother who also lives in a different state. Angela has limited contact with both her mother and brother and does not have any contact with her father. Angela is obese and disclosed a history of struggling with her weight and eating issues. She has few friends, and those she does have live far away.
Angela has a long history of trauma in her life. She was sexually abused between the ages of 9 and 21 by her father, sexually assaulted at the age of 14 by a classmate in school, and mugged as a young adult. There was domestic violence in the home, also perpetrated by her father. Angela’s father is considered an upstanding member of the community, and he is well liked and respected by others. No one in Angela’s family believes that she was sexually abused, and her father joined a “false memory syndrome” group and is outspoken about that issue. There has been little discussion in her family about what took place in the home while she was growing up.
Angela struggled with daily functioning and exhibited symp¬toms of post-traumatic stress disorder (PTSD). She had a history of cutting herself and binge eating and displayed some charac¬teristics of borderline personality disorder. Angela also mildly dissociated when under duress..
PRACTICE29Working With Survivors of Sexual Abuse and.docxChantellPantoja184
PRACTICE
29
Working With Survivors of
Sexual Abuse and Trauma:
The Case of Angela
Angela is a 27-year-old, Caucasian female, who first came to
counseling to address her history of sexual abuse. She graduated
from college with a BS in chemistry and has since been employed
by pharmaceutical companies. After obtaining a new job, she relo-
cated to an apartment in an East Coast city where she knew no
one. Both of Angela’s parents live on the West Coast, and she has
one younger brother who also lives in a different state. Angela has
limited contact with both her mother and brother and does not
have any contact with her father. Angela is obese and disclosed
a history of struggling with her weight and eating issues. She has
few friends, and those she does have live far away.
Angela has a long history of trauma in her life. She was sexually
abused between the ages of 9 and 21 by her father, sexually assaulted
at the age of 14 by a classmate in school, and mugged as a young
adult. There was domestic violence in the home, also perpetrated by
her father. Angela’s father is considered an upstanding member of
the community, and he is well liked and respected by others. No one
in Angela’s family believes that she was sexually abused, and her
father joined a “false memory syndrome” group and is outspoken
about that issue. There has been little discussion in her family about
what took place in the home while she was growing up.
Angela struggled with daily functioning and exhibited symp-
toms of post-traumatic stress disorder (PTSD). She had a history
of cutting herself and binge eating and displayed some charac-
teristics of borderline personality disorder. Angela also mildly
dissociated when under duress. Angela suffered from depression
and anxiety and had trouble establishing new relationships, both
socially and at work. Although Angela has a stable job and was
able to complete her work each day, at times she became over-
whelmed by her emotions and retreated to the bathroom where
she cried and sometimes cut herself before returning to her work-
station. Angela relied on writing, artwork, and her cat for solace
SOCIAL WORK CASE STUDIES: FOUNDATION YEAR
30
and comfort. She was also very active outdoors, often hiking,
biking, and going on camping trips by herself. Her goals in life
were to own her own home, lose weight, enjoy relationships with
others, and find peace with her traumas.
As a result of the abuse she experienced, it was necessary to
begin treatment focusing heavily on establishing trust and a rela-
tionship with the client. After 1 year of therapy, deeper process
work was being done around her traumas, and she was able to
open up much more. She disclosed more painful experiences to
the therapist and began expressing her feelings, including intense
anger at her family members.
Angela also joined a group for survivors of sexual violence in
the same program where she was receiving individual therapy. .
Please be sure to ask questions and comment on your Anna and Monique.docxcherry686017
Please be sure to ask questions and comment on your Anna and Monique responses, and respond to their questions and comments regarding your own response
Anna Cox
What are your basic assumptions about human nature?
My basic assumption about human nature is that even though none of us are perfect, we all strive for our own idea of perfection. By working too much towards how we think we should be it can cause stress, anxiety, depression and other mental health issues and often these are the root cause of them. Humans are beautifully imperfect and while, yes, oftentimes we all have behaviors to be altered, we need to embrace ourselves with love and kindness. It is easy to give someone else our love, patience and kindness, but if we turn that inward we can be the best version of ourselves, perfect or not.
Which approach to therapy is closest to your beliefs about human nature?
The therapy that is closest to my beliefs about human nature is existential therapy. "Existential therapy focuses on exploring themes such as mortality, meaning, freedom, responsibility, anxiety, and aloneness as these relate to a person’s current struggle." (Corey, 2013). Existential therapy looks at the bigger picture of humanity and encourages celebration and appreciation of our successes rather than focusing on downfalls.
In what ways do you believe that your basic assumptions might determine the procedures that you would use when working with clients?
My basic assumptions will help me to focus on the good in my clients and not the negative that they themselves may focus on. It will give me a better understanding of why people feel their own shortcomings and how to show them that there is good and valuable qualities in everyone.
Monique post
When you look into the mirror, you are checking how you appear, and how you feel and whether it matches. Human nature is the sum of our whole species looking in the mirror. Human nature includes 3 core characteristics shared by all individuals; feelings, behaviors, and psychology. Our experiences with humans are different. Some view humans as good or bad or capable of great kindness. These views can be clouded by what our culture tells us and by people's influences in our lives. In western cultures, our discussions usually begin with classical Greece; Aristotle and Plato (Claudia, 2021).
My basic assumptions about human nature is that we can survive from our past and that humans are generally kind creatures and extremely resilient. I believe that humans construct their reality. They do not have to be destined to a certain life based solely on their past circumstances. We have the ability to overcome mountains of challenges with proper thinking and behaviors. We are responsible creatures for our choices and can therefore change and become something. I am proof of these assumptions. My teenage years were so bad that I lost my identity and lacked the proper social developments that most teens have. According to Corey, (2013.
RESPONSE 1Respond to at least two colleagues and suggest a.docxcarlstromcurtis
RESPONSE 1
Respond
to at least two colleagues and suggest alternate ways the intern might overcome barriers.
Colleague 1: Tiffany
Geller, and Greenberg, write about how therapist and clients should have a working relationship to successfully help social workers connect with their clients, in their article Challenges to Therapeutic Presence Geller and Greenbery claim "therapists must be aware of and work through the potential barriers to relational therapeutic presence. A level of intimacy with the moment is needed for therapists to go deeper through the levels of therapeutic presence, which can be scary and make one feel vulnerable"(Geller, Greenberg, 2012).
It is important to identify the internal and external barriers of social worker and client so a more trusting and strong relationship can form between social worker and client. A client needs to feel comfortable with his/her social worker so they can open up to the client more and will more in likely tell more about their troubles and life. A barrier could be dual relationships. Social worker could be sending off bad vibes by her body language, expressions she is making on her face as client is talking or telling their story. Social worker may have a different belief on a topic her client is having trouble with, social worker could be prejudice to certain aspects of the clients problems.
Some barriers between the social worker and client in the Petrakis family case was culture, ethics, religion, and values. The age differences between social worker and client. The intern needs to learn as much about her clients culture as she can. Social worker needs to find out what barriers not to cross with her client. Client needs to only suggest and make it clear she is not informing client what she needs to do but only giving a suggestion. Social worker should never use a tone other than a soft tone with her clients. Social worker needs the support of a supervisor when issues like age come up so she can address this concern of the clients better. Social workers can only suggest a plan of action for their clients they can't tell the client what to do that is an ethical issue. Social workers have to be cautious how they approach clients in these areas because you can shut down the trust of your clients.
References
Geller, S. M., & Greenberg, L. S. (2012). Challenges to therapeutic presence. In S. M. Geller & L. S. Greenberg, Therapeutic presence: A mindful approach to effective therapy (pp. 143-159).
http://dx.doi.org.ezp.waldenulibrary.org/10.1037/13485-008
Plummer, S.-B., Makris, S., & Brocksen, S. M. (Eds.). (2014a). Sessions: case histories. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].
The Petrakis Family (pp. 20–22)
Colleague 2: Tina
elf-Reflection and Awareness
As social workers, we learn from the beginning that rapport is the most important thing in the first stages of engagement. Social workers must be in tune w ...
Response GuidelinesRead the posts of your peers and respond to.docxronak56
Response Guidelines
Read the posts of your peers and respond to at least two. Try to choose those that have had the fewest responses thus far. For each response, identify other community resources that might be available in a case like the one your peer described. What crisis and confrontation skills might be necessary in assisting with the case presented?
Peer one’s posting
Discuss, while protecting confidentiality, a case example of codependency, dual diagnosis, addiction, or substance abuse you have encountered during your clinical field experience.
Client is a 55-year-old African-American male. He is widowed and currently resides alone. Last year he lost his wife to cancer. The client was diagnosed with HIV approximately 25 years ago but indicated that his wife was not “positive.” The client indicated having multiple concerns with his ability to eat, sleep, function from day to day, and that he is oftentimes afraid of what he might do to himself. Client was asked and also assessed for suicidal ideations, and was administered a PHQ-9 to assess if client should be further evaluated for depression or to determine if current symptoms are a result of “normal” grief. The client also expressed that he has a known opioid addiction to prescription pain pills. While in therapy, the client repeatedly expressed how much he was currently in pain.
Utilizing information from the course readings, describe the approach you used when working with these presenting issues, and how do you determine which approach would be most effective?
The intern and supervisor let the client express himself and his reasons for coming into the facility, as he presented himself to be in a crisis. One particular approach that the intern attempted to use with the client was motivational interviewing by expressing empathy, offering reflective listening, attempting to help the client develop self-efficacy, and attempting to understand where the client is and where he would like to be. The intern wanted to determine and help to strengthen the client’s motivation overcome his addiction in order to link him to other services, such as that could help provide pharmacological treatment, address physical health needs, and locate other social support systems that can be beneficial to helping his current presenting issues.
However, the client came to therapy and dropped out of therapy after the first session and did not keep his follow-up appointment for his HIV care, per the client’s primary physician. Thus, it is hard to decipher if the patient came to therapy because he wanted help dealing with his mental incapacities and his physical health or whether this was an outcry for an attempt to retrieve pain medications. Although Koehn and Cutcliffe (2012) suggest that instilling hope in individuals with addictions is a necessary component for clients to stay in therapy, Wachholtz, Ziedonis, and Gonzalez (2011) suggest that it is oftentimes more difficult to treat patients with ...
SOCW 60 and 61 response to students and professorSOCW 60week.docxwhitneyleman54422
SOCW 60 and 61 response to students and professor
SOCW 60week 5 response to students
Respond to colleagues by in one of the following ways:
Offer and support an opinion about the likely outcome based on the theories your colleague described.
Make a suggestion for another way in which each theory your colleague described might inform social work practice when working with Tiffani.
Expand on your colleague’s posting with more evidence in support of your colleague’s position.
Support your posts and responses with specific references to this week's resources. Be sure to provide full APA citations for your references.
1. Justine Lutzen
RE: Discussion - Week 5
Collapse
Top of Form
Total views: 6 (Your views: 1)
Women are often perceived a certain way within our society. These images differ between various cultures. Women in positions of power are also stigmatized and constantly struggle in the fight for gender equality. According to Hatton (2013), " Both women and men, they maintain, are highly sexualized in popular media. At the same time, scholars have examined the sexualization of women as part of a broader cultural ‘backlash’ against the gains of second-wave feminism and women’s increasing power in society" (p. 65). This study looks at the progression of media representations of power females over time. There is a lot of pressure for women of power to behave and look a certain way.
I chose to focus on the Relational-Cultural theory for this discussion. This theory centers on the development of women while being influenced by the cultural conformities. "Included within this theory is the understanding of how relationships occur within particular cultural contexts such as the devaluation of people due to their gender, race, class, and sexual orientation. Thus, the theory accounts for how discrimination, stereotyping, unearned advantage and privilege impact people’s sense of connection and disconnection. Therefore, another central tenet is that people grow (or fail to grow) in relationships that exist within a cultural context" (Robbins, Chatterjee, & Canda, 2012, p. 125). This thepry can help influence our understanding of how culture, gender, race, class, and sexual orientation play a role in the different ways a woman experiences feminism.
In Tiffani's case, she is feeling the backlash of societal views on women. She was put in a position of prostitution at her young age. The men in the court room look at her in a negative light because of this. They don't see as a victim in her circumstances but rather a prostitute who broke the law. This is noticed by Tiffani and as a result, she finds herself feeling negative about her current situation. The next step to take with her would be to conduct a strengths-based approach to shed light on her positive attributes and actions. This will help her to feel more confident and take her upcoming challenges head on.
References
Hatton, E. (2013). Images of powerful women in the ag.
1Disabilities and Older Adults Case ConcepEttaBenton28
1
Disabilities and Older Adults Case Conceptualization
xxx
Graduate School of Professional Psychology, University of St. Thomas
CPSY 680-01: Diversity Issues in Counseling
Dr. Gigi Giordano
May 10, 2022
Case Vignette: Counseling Older Adults - Sarah
Assessment/Conceptualization
Sarah’s presenting concerns are clear signs of depression and anxiety seemingly stemming from the demands of her caregiving responsibilities for her husband with Alzheimer’s. She describes her feelings as being overwhelmed, anxious, and very sad about the changes her husband has gone through. Sarah talks about getting angry in response to her husband expressing anger as well as getting upset when he is difficult to care for. Other notable aspects of Sarah’s presentation include that she becomes tearful when speaking about her husband, and she explains that she helps him with daily activities, dressing, bathing, on top of her taking care of all their home management and maintenance upkeep. She also describes not sleeping well at night due to her husband wandering around during the night and having her own health problems including being morbidly obese, with high blood pressure, high cholesterol, and peripheral vascular disease. The main sociohistorical contexts of Sarah’s identity that I am privy to now are the fact that she is an older adult, and caregiver to her spouse. I am unaware of her racial, ethnic, religious, or socioeconomic identities, and therefore cannot take these into account before meeting with her.
Current existing research suggests that given Sarah’s particular presenting concern, and the other aspects of Sarah that I know about, the evidence-based practices to implement when working with Sarah will be cognitive behavioral therapy (CBT), as well as relaxation training such as breathing exercises, progressive relaxation of the muscles, and visualization (U.S. Department of Health and Human Services, 2021). Ayers et al. (2007) conducted a review on evidence-based treatments for late-life anxiety and concluded that CBT and relaxation training had the most support for lessening symptoms of anxiety, whereas cognitive therapy and supportive therapy did not show lessened symptoms in older adults. Trevino et al. (2021) carried out a research study to test effectiveness of different anxiety interventions for older adults with cancer and their caregivers and concluded that a seven-session CBT-based psychotherapy intervention was associated with the greatest reduction in anxiety among the pairs of participants. Although Sarah’s husband has Alzheimer’s and not cancer, this study’s focus on an ill older adult and their caregiver further shows support for using CBT as the primary evidence-based practice in treating Sarah.
Sarah has many strengths and protective factors. A major strength and protective factor is that Sarah has two adult children who live locally and are both involved and supportive of their father’s care, which alludes to Sarah having a ...
This is an example of what you are being asked to do in Weeks 2, 3.docxjuliennehar
This is an example of what you are being asked to do in Weeks 2, 3, 4, 6, 7, 8 and 9.
DO NOT apply psychoanalytic to any of the case studies.
Case of Deidre: Conceptualization of Problem through Psychoanalytic Theory
A case conceptualization is a report that is written to explain a client’s presenting problems, establish goals as they relate to a theory, plan interventions, and explain the rationale for the interventions and expected outcomes for the client. The interventions chosen will reflect the theory being focused on this week and will include citations from a minimum of two of the week’s resources.
Presenting Problem
From a psychoanalytic perspective, Deidre appears to be experiencing anxiety because of unconscious conflicts originating from her early childhood experiences (e.g., parents’ divorce and mom’s moods), her complicated family relationships, the untimely death of her father, and her abortion. Additionally, Deidre is experiencing a high level of guilt indicating that her ego is struggling to balance between the instinctual drives of her id and the drives of her superego (i.e., the aspect of self that looks at the morality of choices) (Johnson, 2016). It could be that Deidre is experiencing unconscious psychological conflicts surrounding the secret of her abortion, her desire to feel safe with her boyfriend, Tom, and her need to remain loyal to the values she learned from her childhood (i.e., to kill is wrong).
Deidre is using some defense mechanisms—including repression, which blocks these conflicts from her awareness, avoidance, and rationalization—that help her cope with her fears of abandonment. According to Johnson (2016), these defense mechanisms, unconsciously employed to bolster Deidre’s fragile ego, could be linked to Freud’s concept of death instincts that might be related to her father’s early death and her fear of losing Tom.
Goals
According to Johnson (2016), the primary goal of a psychoanalytic approach is to bring Deidre’s unconscious processes into her conscious awareness to illustrate how she is blocking past experiences to help herself cope with her present experiences. The overarching goal of psychoanalysis is to help the client gain self-awareness, so she will be able to understand how past experiences and relationships are causing emotional and cognitive distortions (Johnson, 2016).
In addition to the overarching theory goals, one clinical goal the counselor will work on with Deidre is reducing the overall frequency, intensity and duration of her anxiety so that her daily functioning is maximized; this will be accomplished with the use of psychoanalytic interventions.
Interventions
Free Association
During the counseling session, clients are encouraged to state any thoughts or feelings that come to mind without censoring them. Then, in a nonjudgmental way, the counselor assists clients to analyze the underlying unconscious feelings associated with these disclosures (Johnson, 2016). The goal is not to u ...
Discussion 2 Cultural CompetenceThe term cultural competence.docxmickietanger
Discussion 2:
Cultural Competence
The term
cultural competence
denotes an integrative perspective on the cultures of other people. Individuals displaying higher levels of cultural competency tend not to promote their culture over others or vice versa—they instead demonstrate an interest in learning more about the customs, habits, and behaviors of those whose backgrounds are different from their own.
Post a description of your level of familiarity with the culture of the client.
Describe at least two additional pieces of information you would need to gather from the client in order to best assist him or her.
For this Discussion, review the case studies below and consider your knowledge of the client’s culture.
References
James, J., Green, D., Rodriguez, C., & Fong, R. (2008). Addressing disproportionality through undoing racism, leadership development, and community engagement.
Child Welfare, 87
(2), 279–296.
Retrieved from the Walden Library databases.
[removed]O’Brien, M. (2011). Equality and fairness: Linking social justice and social work practice.
Journal of Social Work, 11
(2), 143–158.
Retrieved from the Walden Library databases.
Plummer, S.-B., Makris, S., & Brocksen S. M. (Eds.). (2014).
Working with survivors of domestic violence: The case of Charo
. In
Social work case studies: Foundation year.
Retrieved from http://www.vitalsource.com
Working With Survivors of Domestic Violence: The Case of Charo
Charo is a 34-year-old, heterosexual, Hispanic female. She is unemployed and currently lives in an apartment with her ve chil- dren, ages 2, 3, 6, 7, and 8. She came to this country 8 years ago from Mexico with her husband, Paulo. During intake, Charo reported that she suffered severe abuse and neglect in the home as a child and rape as a young adult. Charo does not speak English and currently does not have a visa to work.
Charo initially came for services at our domestic violence agency because Child Protective Services (CPS) and the court ordered her to attend a domestic violence support group after allegations of domestic violence were made by one of her chil- dren to a teacher at their school. Her husband was ordered to attend a batterer’s intervention program (BIP). Charo attended the domestic violence support group but seldom said a word. Although she rarely shared during group, she also rarely missed a session. While she attended the group, she also met with me weekly for individual sessions. During these sessions I informed her of the dynamics of domestic violence and helped her create a safety plan. She often said that she was only attending the group because it was mandated and that she just wanted CPS to close her case. One week, Charo suddenly stopped attending group. When I called her, she said that she had been busy and unable to attend. That same day her husband called me to verify that I was who his wife said I was, as he often accused Charo of having affairs.
Charo showed up to group again one day.
Example amanda is a 23 year old recovering alcoholic and
Psychotherapy Design
1. Celebi 1
Nurcin Celebi
Principles of Psychotherapy
Tracey Rogers
December 5, 2014
Psychotherapy Design
Karen, a 36-year old single Caucasian woman, has a history of childhood physical and
sexual abuse, along with self-harming behavior in adulthood. Her constant fear of abandonment,
history of unstable interpersonal relationships, frequent self-harming behavior, emotional
instability and lack of a stable self-image indicate that she has borderline personality disorder
(BPD).For our therapy with Karen, one of the approaches I would use is dialectical behavior
therapy (DBT). Another approach I would use is the mentalization-based treatment (MBT).
Study done by Harned et al.(2010) shows that dialectical behavior therapy is effective in
treating the life-threatening conditions of BPD. In this study, after a year of DBT, the BPD
patients’ suicide risk and recent self-injury rates decrease from 96.2% to 29.2%, which shows
that DBT is effective in reducing self-harming behavior. Considering Karen had recently been
hospitalized for two weeks for a suicide attempt, I think that DBT would be effective in her case.
Another study by Carter et al. (2010) shows that after 6 months of DBT compared to therapy as
usual and wait list for DBT, a significant improvement of the quality of life is seen in BPD
patients who received DBT. Due to these results, DBT would also be a helpful approach for
Karen in terms of improving her sense of worth and her interpersonal relationships. I think that
overall, DBT is a suitable approach for Karen’s case as she needs to work on reducing her self-
injurious behavior and improving the quality of her life.
2. Celebi 2
In DBT, the relationship between the therapist and the client is very important. A
collaboration between the two is crucial to the effectiveness of this approach. While working
with Karen, I will need to be highly engaged during the sessions, as that will be a way to show
her that I am not rejecting her and that her opinions are not dismissed like they have been in her
previous interactions (Bedics et al., 2013). I will also need to approach Karen’s feelings,
thoughts and actions with an open mind and a nonjudgmental attitude. As Karen has a tendency
to engage in self-injurious behavior when she feels that she is being rejected, I will need to
reassure her that I accept her as she is and that I am not judging her for her emotions or actions. I
will also need to balance validation and efforts for change as I interact with her. Considering that
her mother denied Karen’s experiences of molestation when she was younger, as an adult Karen
looks for validation from others when she experiences different situations and expresses
emotions. I think that I will need to reassure her that I believe her experiences and that her
reactions to the situations are normal. In doing so, I will be encouraging her to form a more
positive self-image of herself, which will be learned by modeling. Another factor in the client-
therapist relationship is the feeling of equality between the two, which empowers the patient
(O’Connell &Dowling, 2013). I think that will help Karen because she has mostly been in
significant relationships where she did not have much power or control, as with George, her
parents and the new partners that find her “needy”. Having more say in the therapy while
creating the agenda and setting goals would make her realize the capacity she has for thinking
and making decisions for herself.
Establishing therapy goals will be a collaborative process. However, due to Karen’s
suicidal attempts and self-injurious behavior, I will suggest that first step should be to reduce her
likelihood to harm herself. After the life-threatening behaviors are under control, we will focus
3. Celebi 3
on our behavior that interfere with the therapy. Karen will probably not be ready to open up
because in the past, she has been dismissed and abused by her mother and her ex-husband for
doing so. I will need to help her identify these moments when she holds back due to her past
experiences and remind her that this is a new experience and that she should not reflect her past
relationship problems onto a new relationship that is forming. I will also have to reassure her that
I will listen to her thoughts and emotions and I will not judge. After we successfully work out the
problems in our therapeutic relationship, we will start discussing what she finds most troubling
in her life. In her case, this might be the instability of her past romantic relationships and her lack
of friends. We will work on her modeling of the nature of our therapeutic relationship outside of
the therapy. We will make it a goal, if agreed, to start establishing healthier interpersonal
relationships and reducing emotional dependency on others. (Bedics et al., 2013)
The therapy will consist of weekly individual therapy and skills group training and phone
consultation in times of crisis as needed. Individual therapy sessions will start out with the
discussion of the diary card. The diary card is a way for the patient rate the level and frequency
of their urges(drug use, self harm, suicide), emotions(pain, sadness, shame, anger, fear),
substance use and positive(coping skills used) and negative actions(self-harm, lying) for the time
between the last therapy session and the current session. This will be a way to start every therapy
session in order to know what state Karen is in and how the therapy is going. It will also be
helpful for setting an agenda for the session and prioritize goals, such as reducing excessive self-
injurious behavior if the ratings are high as the first goal. Also, after every session, Karen will fill
out the same diary card and this way we will know whether the therapy is helpful or not. (Bedics
et al., 2013)
4. Celebi 4
Throughout therapy, I will be using problem solving and validation strategies, and
balancing the two with dialectics. Through problem solving, I will try to show Karen that her
problematic behavior, such as hurting herself, is an attempted solution to her problems. After
discussing the diary card at the beginning of the session, we will move on to a chain analysis of a
recent specific event, such as a recent suicide attempt. We will talk about events prior to the
incident, how she felt, what she thought and how she acted, as well as her feelings, thoughts and
actions after the suicide attempt. Following the chain analysis of the specific incident, we will
start thinking about the solutions to this event. In case of the attempted suicide, I will reinforce
using the coping skills she is learning in skills group training. I will also suggest that she consults
me over the phone during time of crisis rather than not talking to anyone. I will also encourage
openness to new experiences, reminding her that she is bringing in her feelings and thoughts
from her previous relationships into the current ones and not living the present. After the
solutions are discussed, I will remind her to commit to the solutions that we have agreed on and
to apply them whenever she encounters a problem similar to the one we have discussed. (Bedics
et al., 2013)
Validation will help form the relationship and will make Karen comfortable. I will need
to show her through validation that her emotions and thoughts make sense. My nonjudgmental
approach will give her confidence in her own thoughts and feelings. It will change her negative
self-view of herself due to the abusive relationships that she has been in. While offering
validation is great, I will need to use a dialectical technique that will incorporate change into the
validation. I will need to show her empathy about her experiences, but at the same time
encourage her to interpret incidents differently, making her realize what she is feeling is normal
but questioning her way of expressing her emotions. I may say things like “I understand that you
5. Celebi 5
felt lonely and you are right, anybody would feel the same way; but…” or “What could you have
done instead to express this emotion?” which would express both acceptance and encouragement
of change. (Bedics at el., 2013)
Karen will also be attending weekly skills group training. This training will have 4
modules: mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness.
Mindfulness will help her focus on the here and now rather than thinking about her past abusive
relationships. Distress tolerance will help her handle difficult times without causing harm to
herself. Emotion regulation will help her identify her emotions and reduce the intensity of them.
Interpersonal effectiveness will increase her self-respect and help her identify abusive
relationships and make the decision of leaving those kinds of relationships.
The study of DBT is mainly done with female BPD patients. In the study done by Harned
et al.(2010), the population is self-injuring or suicidal women with BPD, half of whom also have
PTSD, that are between the ages of 18 and 45. The population of the study done by Carter et
al.(2010) is also women with BPD, who are between the ages of 18 and 65. The research and
application of DBT show that this approach is generally used with women with BPD who are
between 18 and 65. I think that if Karen was an adolescent younger than 18, I would not choose
to use DBT with her. It is not found to be any less effective with older patients, so if Karen was
older, I would still be able to use DBT with her. (O’Connell &Dowling, 2013)
Another approach I would use with Karen is mentalization-based treatment. As defined
by Eizirik and Fonagy(2009), metalization is “the capacity to make sense implicitly and
explicitly of oneself and others in terms of subjective states and mental processes, such as
desires, feelings and beliefs” (p. 2). It is known that childhood trauma can lead to the impairment
of the capacity to mentalize. (Eizirik& Fonagy, 2009, p. 2) The disruption of mentalization can
6. Celebi 6
then lead to adult psychopathology, such as BPD. (Choi-Kain& Gunderson, 2008, p. 1) A study
done by Banes et al. (2012) shows that patients with severe BPD show more improvements in
symptom distress(quality of life, general symptom distress, depression), social and interpersonal
functioning(interpersonal problems, interpersonal relations, social role functioning), and
personality pathology and functioning(borderline symptoms) after MBT for 18 months in
comparison to treatment as usual. (p.9) Another study, done by Bateman and Fonagy (2008),
shows that after treatment, patients in the MBT group compared to the treatment as usual group
have shown more improvements in the attempts of suicide, as only 23% attempted suicide at
least once compared to 74%. (p.3) Also, only 13% of the MBT group continued meeting the
diagnostic criteria for BPD compared to 87% of the treatment as usual group. (p.5) There were
improvements seen in unstable relationships and efforts to avoid abandonment as well. (p.6) In
this study, what really distinguished MBT from treatment as usual was that the positive effects of
treatment lasted longer and did not diminish over time, which is usually the case after therapy.
(p.6) Due to these improvements in self-injurious behavior, interpersonal relationships and
pathological symptoms, and given Karen’s history of suicide attempts, problematic relationships
and childhood abuse, I think that this would be a good approach for her.
The focus of our mentalization-based treatment will be the therapist-client relationship.
(Jorgensen sen et al., 2013, p. 4) During our sessions, I will be working collaboratively with
Karen to explore my feelings and thoughts as well as hers. (Bateman&Fonagy, 2008, p.2) This
will guide Karen to be more reflective on her own mental states.(Eizirik&Fonagy, 2009, p.3)
However, as BPD patients have a discontinuity of beliefs, feelings and desires, I will need to
keep in mind this while interacting with her. I will need to be accepting of the simultaneous
opposite views she may have within her belief system and work with both perspectives.
7. Celebi 7
(Bateman&Fonagy, 2004, p. 8) Through this, I will be modeling acceptance and understanding
of feelings and thoughts of oneself and others. Due to her attachment problems and fear of
abandonment, Karen might question my loyalty or get overly attached to me as we will form a
secure relationship. In that case, I will need to address her fear and explore why she thinks I will
stop the therapy or how this makes her feel. As she has been accused of being needy in the past, I
will focus on how that makes her feel and why she thinks her previous partners found her to be
needy.
The initial phase of our therapy will consist of the assessment process. The focus of the
assessment will be in the context of important relationships, as Karen’s mentalization capacity is
most likely impaired in relationships involving attachments. To work on improving
mentalization, I will need to map out Karen’s important interpersonal relationships and how
these relationships are related to the problematic behaviors, such as self-injury and “needy”
behaviors mentioned by previous partners. This assessment process will lead us to our diagnosis,
possible causes of BPD and therapy goals. Throughout therapy, I will take some time at the
beginning of our sessions to give Karen an assessment that will allow her to self-report her levels
of anxiety, social function and depressive symptoms (Jorgensen et al., 2013, p.9), which are
areas of improvement expected with MBT.
Our goal throughout the therapy will be to increase Karen’s capacity to mentalize. This
will mean that she will become more aware of her current mental states and that these states are
the drive behind her actions. She will be able to recognize that others’ behaviors are also driven
by their feelings and thoughts. (Ezirik&Fonagy, 2009, p. 2) The focus on our relationship will
give Karen an example of how to mentalize during interactions with others. Her awareness of her
own mental state and her analysis of my behavior in terms of my feelings and thoughts will help
8. Celebi 8
her practice her mentalization skills, which will help her become aware of her irrational beliefs
and improve her interpersonal relationships.
We will practice the mentalization process and address Karen’s self-injurious behavior
and her interpersonal problems in three dimensions: modes of functioning, objects and aspects.
The modes of functioning are divided as implicit and explicit. The implicit modes of functioning
are unconscious and automatic whereas the explicit ones are conscious and deliberately
exercised. I will use implicit mentalization by encouraging Karen to consciously focus on her
moment-to-moment feelings and thoughts in our weekly psychotherapy sessions. In order to
accomplish that, I will ask Karen to stop and pause to think about how she is feeling and why she
is feeling that way when she seems to not pay attention to her state of mind. Her homework will
be to continue this exercise outside of therapy when she has the urge to harm herself and when
she feels abandoned in a relationship. For explicit mentalization, she will attend weekly art
therapy and writing therapy. (Bales et al., 2012, p. 4) The second dimension, objects, is divided
as self and other. These two work together; imagining one’s own state of mind in a certain way
determines how one perceives the other’s state of mind and vice versa. In order to consider both
aspects, I will ask Karen to identify her own feelings and then encourage her to identify the
feelings and the thoughts that may be behind the actions of the other person. We will exercise
this in our therapeutic relationship, which then will help Karen carry it onto her interpersonal
relationships outside of therapy. The third dimension, aspects, involved in mentalization is
divided as cognitive and affective. The process of mentalization requires the exploration of both
thoughts and emotions. I will encourage Karen to think about her and others’ actions in terms
thoughts and emotions in order to understand the complex reason behind others’ behavior as well
as her own. (Choi-Kain& Gunderson, 2008, p. 2)
9. Celebi 9
In terms of diversity of this approach, it seems to me that there are limitations to the
populations that it can be used with. In the study done by Jorgensen et al.(2013), most patients
are women in their twenties and thirties and there is not enough evidence for its effectiveness for
younger or older women or males. (p.11) According to Bales et al.(2012), most studies on MBT
exclude most severe BPD patients with co-morbid substance use disorder, and paranoid or
antisocial personality disorders. (p.11) In their study, the only exclusions are patients with
schizophrenia and intellectual impairment and it is said that those with ASD and PPD seem to
have benefited from this approach just as much as the patients without co-morbid disorders. (p.
11) Due to these findings, if Karen had any co-morbid disorders or intellectual impairments, I
would not find this approach suitable. Although it is said in one study that co-morbid disorders
do not make a difference on the results of MBT for BPD patients, given the other studies that
argued the contrary, I would choose a different approach in case of co-morbidity.
For our therapy with Karen, I will start with DBT due to this approach’s strength of
reducing self-injurious behavior. I think that DBT is more appropriate to start with, as Karen was
hospitalized just 2 weeks ago due to a suicide attempt. Once Karen’s safety is established, I will
then continue with MBT, as it is found to have long-lasting effects. I also think that MBT will be
more effective in teaching Karen cognitive abilities that will be useful in her future interpersonal
relations. DBT seems to fall short on teaching the cognitive processes involved in improving the
quality of life. This can be because it is more focused on the modeling of how a healthy
relationship can be formed, but not teaching how the feelings and thoughts of oneself and others
affect behavior and form a healthy relationship. Although they are fairly similar in some aspects,
there are certain elements in MBT, such as the relationship between the therapist and the client
and the techniques, that I think will be more appropriate for Karen.
10. Celebi 10
I choose to use DBT as the starting approach in order to reduce Karen’s self-injurious
behavior. As she might not be able to adapt to the cognitive processes of mentalization right
away, I think DBT techniques can be useful in making her aware of the problem and prevent her
from harming herself further. Using the diary card assessment system, we can keep track of how
often she gets the urge to engage in this sort of behavior and help her use positive coping skills
when she notices the urges. Using the problem solving technique from DBT, I will bring to
Karen’s attention that she is looking for solutions to the problems in her life by engaging in the
problematic behavior of harming herself. We will also do a chain-analysis of the incidents of
self-injury by looking at the events that took place prior to the incident and exploring the feelings
and thoughts she had after the incident. After this phase of the therapy helps keep Karen’s self-
injurious behavior under control, we will start the mentalization practices and shift our focus to
her interpersonal relations.
I think that the therapist-client relationship formed in MBT is more useful for Karen than
the one formed in DBT. Both of these approaches promote a nonjudgmental and accepting
attitude. However, in DBT acceptance is used to comfort the patient and relieve her of the fear of
abandonment, whereas in MBT it is used to teach acceptance of oneself and others as a general
concept. In DBT, I would simply reassure Karen that I would not end our therapy and that her
reactions are normal, which would help her with her fears to a certain extent. However, in MBT,
I would explore our relationship by asking her why she has those fears of me abandoning her and
how that makes her feel. This would be more beneficial for her as she can use the same cognitive
processes for her other relationships in the future. It would also give her a higher sense of
control, as she would come to the realization that her fears are irrational by herself rather than me
reassuring her that I would not leave her. As she tends to get overly attached in close
11. Celebi 11
relationships, addressing this issue would also prevent her from getting more attached to me and
having a greater fear of abandonment.
I think that the techniques used in MBT will be more effective in helping Karen with her
interpersonal relationships. When I compare the problem solving and validation techniques of
DBT and the three dimensions of mentalization in MBT, I find the DBT techniques helpful for
building Karen’s trust and self-image but MBT seems to teach a life-long cognitive skill that can
be used to maintain this sense of trust and positive self-image in the long-run. Using implicit
mentalization techniques, Karen will learn to stop and pause to think about how she is feeling
and and why. She will also identify feelings and thoughts that may be behind the actions of
others. This will help her interpret her and others actions in terms of thoughts and feelings.
Practicing this in therapy and outside the therapy will help her internalize this process of pausing
considering what lies behind the actions will help her improve her interpersonal relationships.
While DBT is good for the first phase of the therapy, which is mainly ensuring Karen’s
safety and stabilizing her emotions, MBT will further this by changing her cognitive process and
her interactions with others.
Overall, I would like to use DBT as my first approach while building the relaionship with
Karen and addressing her self-injurious behavior. However, to move further in our therapy and to
make changes in Karen’s life in terms of how she sees herself and her interpersonal relations, I
will utilize the therapist-client relationship format and mentalization techniques in MBT, as I
find these to be more beneficial for Karen.
12. Celebi 12
References
Bales, D., van Beek, N., Smits, M., Willemsen, S., Busschbach, J. V., Verheul, R., & Andrea, H.
(2012). Treatment outcome of 18-month, day hospital mentalization-based treatment
(MBT) in patients with severe borderline personality disorder in the Netherlands. Journal
Of Personality Disorders, 26(4), 568-582. doi:10.1521/pedi.2012.26.4.568
Bateman, A. W., & Fonagy, P. (2004). Mentalization-Based Treatment of BPD. Journal Of
Personality Disorders,18(1), 36-51. doi:10.1521/pedi.18.1.36.32772
Bateman, A., & Fonagy, P. (2008). 8-year follow-up of patients treated for borderline personality
disorder: Mentalization-based treatment versus treatment as usual. The American Journal
Of Psychiatry, 165(5), 631-638. doi:10.1176/appi.ajp.2007.07040636
Bedics, J. D., Korslund, K. E., Sayrs, J. R., & McFarr, L. M. (2013). The observation of essential
clinical strategies during an individual session of dialectical behavior therapy.
Psychotherapy, 50(3), 454-457. doi:10.1037/a0032418
Carter, G. L., Willcox, C. H., Lewin, T. J., Conrad, A. M., & Bendit, N. (2010). Hunter DBT
project: Randomized controlled trial of dialectical behaviour therapy in women with
borderline personality disorder. Australian And New Zealand Journal Of
Psychiatry,44(2), 162-173. doi:10.3109/00048670903393621
Choi-Kain, L. W., & Gunderson, J. G. (2008). Mentalization: Ontogeny, assessment, and
application in the treatment of borderline personality disorder. The American Journal Of
Psychiatry, 165(9), 1127-1135. doi:10.1176/appi.ajp.2008.07081360
Eizirik, M., & Fonagy, P. (2009). Mentalization-based treatment for patients with borderline
personality disorder: An overview. Revista Brasileira De Psiquiatria, 31(1), 72-75.
doi:10.1590/S1516-44462009000100016
13. Celebi 13
Harned, M. S., Jackson, S. C., Comtois, K. A., & Linehan, M. M. (2010). Dialectical behavior
therapy as a precursor to PTSD treatment for suicidal and/or self-injuring women with
borderline personality disorder. Journal Of Traumatic Stress, 23(4), 421-429.
doi:10.1002/jts.20553
Jørgensen, C. R., Freund, C., Bøye, R., Jordet, H., Andersen, D., & Kjølbye, M. (2013).
Outcome of mentalization-based and supportive psychotherapy in patients with
borderline personality disorder: A randomized trial. Acta Psychiatrica Scandinavica,
127(4), 305-317. doi:10.1111/j.1600-0447.2012.01923.x
O'Connell, B. B., & Dowling, M. M. (2013). Dialectical behaviour therapy (dbt) in the treatment
of borderline personality disorder. Journal Of Psychiatric And Mental Health Nursing,
doi:10.1111/jpm.12116