Theoretical Formation and Treatment Intervention

Published: 2018-02-21 03:48:32
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Luigi is a 26 year aged man who is currently unmarried and living with his parents. The patient was referred to the clinic by a health officer where he had gone for a health check up. The officer directed that he undergoes a further outpatient evaluation and upon doing this, the doctor admitted him to the first admission ward. The patient is presented to the hospital because of a violent and unmanageable behavior which had gone on for almost two months before the parents decided to seek medical help. 

According to Luigi’s family, his behavior and personality began to change suddenly, particularly six months before they opted to seek medical intervention. This problem began to be experienced when the butcher in which he was working closed down due to financial impediments. 

The onset of these problems coincided with the closure of his butcher shop because of financial difficulties. At this time he began to show unpredictable mood swings. These mood swings escaladed up to a point where he began to show physical violence, threats and abuse towards his family members and colleagues. Some of the threats and even verbal exchanges towards his parents were incorrigible, particularly when he became agitated. Before the occurrence of these incidences, Luigi was considered to be a habitual marijuana smoker. He had been adhering to this habit together with his friends for almost three years. When his butcher business collapsed, he subsequently increased the use of marijuana and other illicit substances including LSD and amphetamines. His condition, agitations, abuses, and violent behavior   worsened by the day. Furthermore, he began to develop feelings of suspicion to almost everyone including family members, siblings, and friends whom he believed that they were all against him and that they were spying him everywhere. 

Theoretical Interventions

For the case of Luigi, the practitioner centering on positive psychotherapy can decide to encourage Luigi by informing him that the closure of his butcher cannot be the end of the world. Rather, there are so many opportunities he can choose from. Additionally, the psychologist should as well look for means of developing the client’s positive emotions and character traits so as to live positively. The other strategy that can be deployed is asking the client to express her authentic selves. This way, she will be able to identify herself, the strengths and capabilities she has and how she can exploit them for her advantage. 

Existential-humanistic model on the other hand, will emphasize on understanding the experience which Luigi goes through so as to design sound strategies of mitigating his problem. As per this approach, the first step will be to assist Luigi to identify himself, develop his capacity and reinforce his self actualization.  When he has developed self-awareness, then the client will be able to understand himself and hence; know why the behaviors are all wrong. The second approach will be requiring Mr. Luigi to manage his actions, thoughts, and behavior. This will be done by informing him the downside of such behavior and the need to improve them. 

Cognitive behavioral therapy pre-supposes behavior to be a learned aspect and as such can be unlearned. In light of this, the therapists will in the case of Luigi have to look at the feelings and thoughts of this client and their connection to the current behavior (Hollon, and Beck 2013). This first step will help them understand him from a deeper perspective. The second strategy will entail fostering positive behavior and thoughts change for Luigi. For instance, he can be encouraged to be calm and be peaceful, the disadvantages of drug abuse and all forms of violence which he is exhibiting. In modifying behavior, the therapist can opt to employ the following strategies: aversion therapy and operant conditioning. Aversion therapy is a situation where a certain drug is prescribed for the patient and taken alongside an alcoholic drink or substance to induce a negative feeling. This way, the person will be put off from taking the substance and hence be able to overcome the addiction. Operand conditioning, on the other hand, involves positive reinforcement for the client to behave desirably. It can also entail punishment for the undesirable behavior (Wolpe, 1968). This will help in modeling the patient accordingly. 

In a situation where a psychologist would want to focus on psychodynamic approach in dealing with Luigi’s issue, then he or she will need to first uncover the unconscious motivation behind his actions and behaviors and establish the strategies to break down the defenses. For instance, if the main reason why Luigi is behaving the way he does is the breakdown of his source of income, the therapist will inform him on what they are doing to ensure his business is reinstated, and or other options available. The second strategy is basically looking for means of recovering the business or finding Luigi another job. 

Case 2# Jennifer

Jennifer is a married woman aged 27 years old. She works in a white collar job which is quite demanding and stressful as a permanent employee. Jeniffer is known by her bosses and colleagues as a high achiever. She always sets herself high standards, and when she fails to meet them, she may become quite critical of herself. Of late, she has been developing feelings of being unworthy and shameful majorly owing to the deterioration of her performance over the past months. Lately, she has been finding herself extremely tired and not able to concentrate at work. This aspect has even been noticed by her colleagues who besides noting the deterioration of her production have also observed that she is increasingly becoming withdrawn and irritable. These new behaviors adamantly deviate from her former whereby: she was always been jovial, friendly and upbeat. Also unlike the past where she rarely took sick leaves, she now takes them to the point of depletion and this has made even her seniors astonished. When she is given off duty, you will in most times find her sleeping or watching TV with nothing serious to be done. 

The changes in Jennifer have been as well noticed by her family members including the mother, father, siblings, children and husband. Her husband has started complaining that the wife is no longer interested in sex matters and that she does not want to go bed early. In fact, she can decide just to sit and watch TV up-to 3 am. When she attempts to sleep early, she is regularly turning and tossing, making him unable to sleep as well. At one time, he overheard her conversing with her close friend in a very emotional manner, making him worried about her status. Interestingly, however much he has tried to persuade her to disclose the matter; she has adamantly refused to do while pointing out that there is nothing wrong with her. Overall, she is increasingly getting dissatisfied with her life. 

Theoretical Analysis and Treatment

The psychodynamic approach is premised on the idea that individual’s feelings and behavior are significantly affected by the unconscious motives. In this regard, the therapist handling Jenniffer’s case will need to dip up the unconscious mind of the client to establish the motives behind her new reactions. Since all behavior harbors a cause as per this theory, it will be easier to identify it and thus facilitate the use of defense mechanisms. One way of doing this is to appreciate what she does and also apply positive reinforcement in her achievements. Another way is to encourage the patient to engage herself in active activities such as sports, movie watching or other games to keep her mind feel focused on something else. 

For cognitive-behavioral therapy (CBT), the practitioner would need to find means of altering the negative behavior of the patient. This can be done through the use of cognitive restructuring which should be done through assessing assumptions behind Jenifer’s thought patterns alongside behavioral therapy approaches. This technique which can be identified as validity testing is whereby; the therapist will request the client to defend her thoughts and beliefs. If the patient will be unable to deduce evidence to support her thoughts, this will expose the invalidity of the assumptions. The second step will as well entail positive systematic reinforcement so as to motivate and reward positive behavior. 

As earlier observed, Existential psychotherapy employs a positive approach in applauding the aspirations and capability of a given individual, while at the same time acknowledging his or her limitations. This implies that for Jennifer’s case her aspirations and goals should be applauded so as to motivate her interests. In addition, she should be made to identify her strengths and capabilities and learn how to exploit them accordingly. On the other hand, she should be made aware that no one can maintain perfection forever and as human beings, we are bound to fail at one time or another. This way, she will be able to understand herself and the nature of humanity in general. 

In line with the positive psychology approach, the patient will be supported to change their thoughts and behavior through motivations. The motivation can be done by presenting those who were in a similar situation and how they succeeded in achieving sobriety. This is a way of assisting the client build self-efficacy. The first strategy that can be employed in this case is to refer Jennifer to a group who will mold, and motivate him accordingly. According to a study by Ashford et al (2010), groups have the power to support behavioral change on a long term basis. The second strategy in this perspective will be to instill new habits on Jenniffer. For instance, she will need to be encouraged to partake proactive roles while on a rest rather than just sleeping or watching movies. She also needs to be trained on being satisfied with her abilities instead of having high expectations every time. 

Case 3# the Fritz Case

The Fritzl case involves a woman by the name Elisabeth Fritzl born in 1966 who was held captive by her father for 24 years. Behind this captivity was also physical assault, consistent rape, abuse and physical molestation by the father. The constant abuse went on to result in the victim siring seven children, four of which were as well enjoined with her mother in captivity while one of them died in the cell. The rest remained the custody of Fritzl and his family Rosemary who had reported them as foundlings. Joseph Fritzl, his father tricked her into a secluded and sealed room within the apartment of his rental apartment when she was eighteen years old and locked here up together with three of her children. Elizabeth and her children did not get the opportunity to see light or talk to anybody else except her abusive father.

During this confinement, the father also subjected Elizabeth into watching pornographic videos and forced to act the scenes in front of her children.  The captives were also given food irregularly as the perpetrator was keen to seal all loopholes of getting known. Therefore, this subjected the victims to psychological, emotional and physical torture. However, the incident was later to be found when Elizabeth’s elder child, Kerstin became seriously ill and required her mother to be at the hospital. Upon the discovery of the happenings, Joseph Fritzl was questioned and eventually imprisoned for life. After the psychiatric assessment, it was later established that Elizabeth and her children were greatly traumatized, owing to the difficult life they went through. 

Theoretical Approaches

The psychoanalysis theory postulates that all behavior has a cause. Consequently, the trauma experienced by Elizabeth and her children were as a result of the long enclosure in a small room and open sexual abuse by Fritz. This also includes the personalities of the victims which were adversely affected because of what they went through (Adler, 1927). According to Adler (1927), females were more prone to anxiety since they had a weaker superego compared to their male counterparts. This may help in explaining why Elizabeth had a significant level of trauma. 

Cognitive-behavioral therapy, on the other hand, presumes that the way each person thinks, behaves or feels interact with one another. In particular, each individual’s thoughts determine their behavior and feelings (Hollon, & Beck, 1994).  In light of this, it can be rightly said that the negative thoughts on Elizabeth and his children about his father and the experiences she went through were the cause of the distress that followed them later. This degenerated into a skewed interpretation of their situation as well as how they affect their behavior. 

On his part, Carl Rogers, a re-known psychologist argues in his humanist approach that behavior is subjective and personal. According to this premise, all individuals irrespective of their status are subjective and as such, have got the ability to decide for themselves how to behave, perceive or think.  This implies that Elizabeth had a choice whether to do away with the negative thoughts or let them remain in her minds for as long as she wanted. 

Positive psychology refers to a perspective of human behavior that emphasizes on a person’s strengths rather than the weaknesses (Seligman et al, 2010). The author reiterates that the techniques of positive psychology offer a much-needed balance in the focus on pathology and psychic pain reduction. For this case, the first strategy that can be utilized to mitigate the negative impact is fostering hope on Elizabeth that everything will not be the way they used to be. In other words, we need to inculcate in her positive thoughts and assist her to note that has come out from her predicament. By doing this, the scope of the problem could have been reduced to a significant level.

sheldon

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