Essay on Client's Personality Disorder: CBT Is the Preferred Treatment Modality

Introduction

The client in the assessment presented symptoms that are linked to personality disorder, which include insecurity, fear, and disturbance were common. The most preferred treatment modality is cognitive behavioral therapy (CBT). This approach helps to understand the situations that are challenging and problematic reactions to patients. Its emphasis is on the components of the psychological problem among the behaviors, emotions, and thoughts. However, for the case of the subject patient, the specific CBT used as dialectical behavioral therapy (DBT), which applies in patients with emotion dysregulation, which may be assumed to be temperamental, leading them to the emotional reactions to stressors (American Psychiatric Association, 2013). It is suitable considering that the patient has experienced an invalidating environment having been divorced, lost her job, highly tempered mother, and unprotective family with most of the members involved in drug abuse. She was also abused physically and sexually while still young, and after divorce, the patient is forced to bring up the child alone having lost job with the little savings.

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DBT is effective for patients with emotional reactions because of the self-invalidation caused by the experiences of life. Such patients would try in futile to achieve self-regulation, which then would limit the behavioral stability, affective, interpersonal, and self-identity aspects. This approach, when used, it considers the behaviors, emotions, and the thoughts of the patient to facilitate the clarity on the intervention in case an issue arises (Gabbard, 2000). Through DBT sessions, the patient gets an assurance that their actions and behaviors are valid and understandable. The approach applies skills to teach patient ways she could manage her emotions, improve relationships, and tolerate distress.

Progress or Lack of Progress toward the Mutually Agreed-Upon Client Goals

The goal of the treatment plan was to reduce anxiety and gain control over anger. It aimed to prevent interpersonal problems by reducing explosive outbursts and controlling emotions (Hollon & Beck, 2013). This involved stabilizing the mood of the patient. There is positive progress towards the client achieving these goals as agreed upon in the treatment plan. Though the patient still consumes alcohol, the rate of consumption has reduced drastically, and she only prefers drinking over the weekend from home. Often, she spends time with her child, and she can frequently talk to people while paying some attention. This shows that she no longer perceives her son as a burden only left to her by the divorced husband, who is reducing her anxiety to grant the child what she cannot afford. The fact that she goes shopping by herself and sometimes on foot while interacting with people means she is gaining control over her anger.

Modification(s) of the Treatment Plan Made Based on Progress/Lack of Progress

Progress was observed based on the goals of the treatment plan. However, even with the observed progress, there was a need for adjustments to modify the treatment plan (Wheeler, 2014). This involved advising the patient on the psychological and social interventions, which included the most important one of getting access to the peers for support. The peers for the patient were the workmates who will make things more normal to fasten the recovery process. The same accessibility was extended to the family members. Another important notification to treatment was introducing some specialist teams to help in training. Doing exercise is one of the perfect ways to end anxiety because it improves mental health.

Clinical Impressions Regarding Diagnosis and Symptoms

From the diagnosis of the patient’s progress, the subject patient still exhibits some occupational and social functioning challenges, which have to make her continue being anxious about things she cannot do (Rafaeli, 2009). The difficulty associated with social functioning is what had denied her gain full control over her anger. These conditions have been compounded by significant problems associated with medical and financial aspects. Overall, her moods are stabilizing.

Relevant Psychosocial Information or Changes from Original Assessment

Before the treatment process, the situations of the patient caused her emotions that could not allow her to interact and share with others. After divorce, all her previous relationships had been ruined by her anger. Progressively, the patient to doing well psychosocially and has now started to create new relationships with her own son after she came in terms with the fact that she still could raise him along. New relationships are growing with the colleagues at the workplace and the family members. The patient is also contemplating moving to a new, better house after getting another job with a well-paying company to give the best to her son.

Safety Issues

People who suffer personal disorders portray multiple crises because of their behaviors, among them impulsive aggression and disturbance, and self-harm (Ellis et al. 2015). In the case of the subject patient, she has some intense anxiety, anger, and feels depressed. This means she requires precautions taken into account to protect her and others. The safety measures considered included ensuring that non-threatening attitude and calm was maintained while exploring the reasons for distress. Advise patients to minimize the use of alcohol and illicit drugs that would likely cause risks. Primary subscribers were identified, and consensus reached among prescribers and the therapist about the drugs before used. Only a single drug was used, and poly-pharmacy avoided.

Clinical Emergencies/Actions

A range of emergency services was undertaken, including approaching the families of the patients to help manage any situation considered a crisis in the treatment process. People with the personal disorder often causes self-harm or attempt suicide which required the availability of the ambulance services. Special teams could be called in to offer the patient any immediate support needed and ensuring that regular contacts were offered.

Medications Used By the Patient

For patients with personality disorders, the initial step is to stabilize the moods. This is was the case with the subject patients where the medications prescribed were based on stabilizing her moods (Buriola et al. 2016). The medication process began with prescribing carbamazepine as an anticonvulsant medication that treats behaviors that are considered impulsive and changes in emotion that are considered rapid. At some point, the patient was given anti-anxiety drugs, particularly Klonopin, to lower the anxiety. The fundamental issue was to ensure that the medication levels were within the required range

Treatment Compliance/Lack of Compliance

The patient was given multiple recommendations to comply with, and to a great extent, the level of compliance was high. She was to appear for follow-up appointments, which she attended all of them, and if she ever missed one, she could come the next day on appointment. She often engaged in preventive measures, which included avoiding harmful tools like a knife whenever she got angry. The medications, including carbamazepine and Klonopin were applied as prescribed.

Clinical Consultations

Her clinical consultations were scheduled twice a month during Saturday, and she has been attending all of them. Sometimes when she could make it to the clinic, she could contact through phone calls or using the facility website to link with the clinical officer. Most consultations have been about her adjustment to the new norm, including making friendships again.

Collaboration with Other Professionals

Besides the psychotherapist, the patient has been getting in touch with family therapists. One of the issues she has been experiencing is divorce and the inability to bring up her child on her own. She, however, wants to cope up with the loss of the marriage and challenges of being a single parent by consulting a family therapist who has been counseling her. Impressively, she seems to be coping up well, considering her acceptance of the situation around her.

Referrals Made/Reasons for Making Referrals

The patient was also referred to consult the neurologist. Neurologist deals with issues to do with brain health and problem associated with it. This was important considering that the patient’s problem has been consistent since she was young when she was exposed to sexual abuse. The invalidating environment around her could not only affect her cognition but may physically affect the functionality of the brain. Then neurologists would be in a position to confirm that the functionality of the brain is intact.

Termination/Issues that are Relevant to the Termination Process

A national insurance company insured the patient and all along, she was confident that the company would come in to bill her expenses. However, to her surprise, the company could not make the payment citing the nature of treatment that it is not recognized as one of the services offered by the company. The company informed the patient that mental issues are relative, and it was difficult to value the expenses through therapy. This means that the patient had to look for money from another source to clear the bill terminating the treatment contract with the facility.

Issues Related to Consent and Informed Consent For Treatment

Under the HIPAA regulations, for any patient to undergo treatment, they must consent to it themselves or their kin (Nicholson, 2002). This was the initial aspect upon diagnosing the patient with a personality disorder. Since the issue had affected the patient over a long period, she first acquired about the nature of the treatment, duration, and the type of medication she would be subjected to before consenting to the treatment. There was also agreement on the goals of the treatment plan, considering that the main issues of the problem had been identified.

Information Concerning Child Abuse and Elder or Dependent Adult Abuse

In her disease history, the client had indicated having been abused while in her tender age. When asked about the documentation on abuse allegations, she could not produce. However, she appears to be getting better and did not want to talk more about the abuse issued. The therapist’s focus was on helping the client get better and continue with normal activities while cooperating with others. The psychotherapist did not insist on the information about the abuse since the client was already mentally disturbed.

Information Reflecting the Therapist’s Exercise of Clinical Judgment

Since the beginning of the treatment process, the patient has been doing well. The positive, progressive report informs about the qualification and the experience of the therapist in diagnosing the problem with the client. By talking to the client, the therapist could tell the problem bothering the client and prescribe the right medications. This reflects on the requirements of the medical practitioners to abide by the medical rules when attending to the patient. This also tells about the ability of the therapist to create rapport with the client.