Counseling Psychology Essays

Counseling Psychology Essays Counseling Psychology Paper Counseling Psychology Paper Richard is a 44 year old man who has been refereed to our agency for counseling by his doctor. Richard’s doctor believes he has a major drinking problem. Counseling sessions with Richard will be conducted in separate categories of psychodynamic and cognitive behavioural paradigms. The case study will help Richard and his counselors develop specific prevention, intervention, and treatment resources. Psychodynamic Paradigm Psychodynamics is defined as, â€Å"the mental and emotional process underlying human behavior and its motivation, esp. as developed unconsciously in response to environmental influences† (Webster’s 1982, p. 1147). In other words, psychodynamics is predominately concerned with unconscious conflict, until Erik Erikson came along. Erikson, a Neo-Freudian, came up with his own theory of development in psychodynamics called â€Å"psychosocial† (Funder 1997, p. 270). Erikson’s theory of psychosocial stages expands on Freud’s psychosexual stages as the basis of unconscious conflicts. Moreover, Erikson believes that â€Å"the ego does not just mediate between id impulses and superego demands. It is also a positive force in development. At each stage, it acquires attitudes and skills that make the individual an active, contributing member of society† (Berk 2001, 17). Thus, Ericson postulates the not all differences occur in the unconscious area of the mind- many conflicts are conscious. Richard has many identifiable unconscious and conscious conflicts going on in his mind. When a doctor announces that you have a drinking problem, the accused usually does not agree with the diagnosis. But when a professional mental health worker illustrates a number of specific factors that identify alcohol as a disease, the drinker begins to believe their problem is real. If you want to convince an alcoholic that they have a problem, you must get passed their denial. In addition, if the worker wants to treat the alcoholic, a problem has to be acknowledged by the drinker. My first step is to conduct an open-ended interview with Richard’s father. The premise for this interview is to gather as much information on Richard as possible to gauge the truthfulness of his story and to see if there is any family history of drinking problems. Richard’s father agrees that he may be to blame for the abandonment of Richard at the age of ten, but accepts no responsibility for Richard’s drinking problem or interpersonal relationship failures. Next, I got Richard’s previous medical records sent to me so I could go over his past case history. I ordered medical tests and an MRI to see if Richards liver, kidneys, or brain function has been damaged by the drinking. Finally, I sat down with Richard for his interview. During the interview I notice Richard is trying to project his problems on others instead of taking responsibility for his actions. Richard denies he has a drinking problem and blames his inconsistent behavior on depression. I allowed Richard to â€Å"free associate† the rest of his story to me. The prodromal stages leading up to the numerous disruptions in Richard’s personal and business life lead to the conclusion that Richard is in a mild for form of delusion as well. According to statistics in the United States on alcoholism and drinking: â€Å"14% of men are heavy drinkers† and â€Å"about one-third of these are alcoholics† (Berk 2001, p. 433). Berk goes on to point out that, â€Å"Alcohol acts as a depressant, impairing the ability of the brain to control thought and action. In heavy drinkers, it relieves guilt and anxiety. † John Higgins supports Berk’s analogy in his journal publication Psychodynamics in the excessive drinking of alcohol. Higgin’s concurs that â€Å"excessive drinking functions as a defense mechanism against anxiety† (p. 713). In other words, denial, Richard’s defense mechanism in his case, is leading to his delusion that depression is the cause of his problems with anxiety when in reality it is his alcoholism. Erikson uses his psychosocial stages of psychodynamics to explain Richard’s inconsistent behavior throughout his life. At the age of 9-11 years old Richard will go through Erikson’s theory of industry versus inferiority (Berk 2001, p. 320). The origins of Richard’s problems started in late childhood when his mother died and his father sent him away to boarding school. According to Sandra Hutchison she, â€Å"applies Erikson’s psychosocial stages of ego development to the understanding of children’s reactions to traumatic incidents† (2005, p. 174). The risk at this age is to gravitate towards an inferior and pessimistic outlook towards responsibility and moral obligations. It does appear that Richard did get affected by the traumatic events of his mother dying and his father abandoning him to acquire separation anxiety that led him to become an adult alcoholic. Richard’s problems carried through to middle adulthood. Alcoholism tends to run in families, is biological and psychological, and influenced by social factors and relationships (Oltmanns, Emerey, Taylor 2002, p. 382-383). Erikson labeled this stage of his theory generativity versus stagnation. In this stage of Erikson’s theory the middle aged adult decides to mix inner desires with cultural demands to prepare for the next generation. In Richard’s situation, there seems to be little self interest in external community welfare. For the time being Richard is completely focused on his self interests and over indulgence in alcoholism. According to Charles Slater there are seven psychosocial conflicts that give breadth to the central crisis in This stage of Erikson’s theory that include: 1. Inclusivity vs exclusivity. 2. Pride vs embarrassment. 3. Responsibility vs ambivalence. 4. Career productivity vs inadequacy. 5. Parenthood vs self-absorption. 6. Being needed vs alienation. 7. Honesty vs denial (2003, p. 53). As you can see from the description of Richard’s case story, he is in the negative field of all these identified categories of Slater. In other words, Richard is in Erikson’s stagnant part of the stage. Connecting Erikson’s late childhood theory to his middle adulthood theory sheds some light on the situation Richard faces. Richard will need an extensive and intense treatment plan to overcome his deep rooted alcoholic problems. How will Richard’s treatment structure proceed? First, Richard will be required to attend a 30 day alcohol treatment center. Second, Richard will require continued counseling sessions upon completion of his 30 treatment stay. A pilot study done by Daniel Coleman, that integrates psychodynamic theory with cognitive behavioural theory, will be used in conjunction with contemporary psychodynamic therapy to monitor Richard on a weekly basis (2005, p. 206). Third, with the recent empirical hypothesis confirmation of â€Å"unconscious mental processes and phenomenon such as repression and transference† (Funder 1997, p. 280), Richard would benefit from psychoanalytic therapy based on theories of childhood attachment to adult patterns of inter-relations of dysfunctional romances. My prognosis for Richard is deferred for the moment; however, his situation does look good if he is open to the treatment suggestions and lifestyle changes recommended in this case study. It will be a long road of recovery for Richard. Cognitive Behavioral Perspective Cognitive Behavioral Paradigm is defined as, â€Å"behavioral processes that underlie learning† (Oltmanns, Emery and Taylor 2002, p. 39). Oltmanns et el goes on to list the influences of Cognitive Behavioral Therapy (CBT) as originating on the introspection of William Wundt and influenced by Ivan Pavlov (classical conditioning), B. F. Skinner (operant conditioning), and John B. Watson ( behaviorism). However, social learning theories such as J. B. Rotter and Albert Bandura’s, brought CBT into the current research era. Today’s psychologists and counselors may define the complex paradigm cognitive psychology as, â€Å"patterns of individual differences in behavior and the psychological processes behind them,† (Funder 1997, p. 409), as an accurate description of current CBT. Since its early influence the importance of cognitive processes in learning has been identified and â€Å"behavioral† has been modified to â€Å"cognitive. † Today CBT is â€Å"the scientific study of mental process† that â€Å"account for human behavior† (Hunt, Ellis 1999, p. 32). Richard has many obvious problems that can be categorized as â€Å"learned† and â€Å"cognitive. † When Richard was abandoned by his father after his mother’s death, he learned how to cognitively detach his feelings from loved ones. CBT would suggest that people like Richard who suffer mood swings are affecting their encoding, retrieval, and schema network of memory and facilitating a cognitive break from their emotional state. In other words, Richard is his own worst enemy. The mental processing of Richard’s mind also affects his perception. Thus, his cognitive melt down of three failed marriages, abusive nature, and excessive job firings and demotions, are all comorbid with Richard’s main disorder of alcoholism. Three areas of the memory and one area of information processing have been identified in cognitive psychology: Short term, working, and long term memory along with the sensory/perception (where veridical information is processed) buffer. Some of the possible etiological causes are rather complex in Richard’s past memories. The tragic incident of his mother’s death encountered as a developing young child is obviously the start of Richard’s deep rooted processing problems. First, I believe that the core cognitive problem for Richard is PTSD from the mother’s death. Second, the complex nature behind PTSD makes the disorder cyclical. Is it the traumatic event which caused Richard to become a cognitive processing mess and an alcoholic; or, is it Richard’s premorbid personality characteristics that caused the alcoholism? Third, in my opinion because Richard shows no previous history of psychological problems before his mother’s death, and due to the fact that all his problems seem to generate from that one incident, I see his alcoholic disorder, and the cognitive processing failures of his memory influence on current decisions, being a direct relation to his tragic memory of his mother’s death, and future abandonment by his father, to be the motive and underlying reasons to the pathology behind his alcoholism. Richard’s mental processing of events seems to be mixed with faulty memory dispensation, PTSD, and poor judgment. Treatment will need to function from a new set of developed strategies for Richard in CBT. The recommended treatment plan for Richard will begin with short term motivational therapy (STMT). Because Richard was ten years old when the tragic event occurred, and no Critical Incident Stress Debriefing took place at the time, Richard will need STMT to recognize the severity of his problem(s). Next, Richard will undergo a new PTSD screening test developed by Rachael Kimerling et el called the Validation of a brief screen for Post-traumatic Stress Disorder with substance use disorder patients (2006, p. 2074). Following the STMT Richard will require intense coping skills training and relapse prevention techniques therapy. Richard should also be put in Aversion Therapy (Oltmanns, Emery, Taylor 2002, p. 85), so his alcoholism can be associated with the unpleasant consequences of his behavior where his sight, smell, and taste of alcohol are paired with the nausea. Furthermore, I would like to see Richard join an alcoholic’s anonymous group. I believe that once the PTSD is dealt with, as Sudie Back et el confirmed in their study Symptom Improvement in Co-Occurring PTSD and Alcohol Dependence, that the alcoholism will be reduced to an after affect of the larger problem. Moreover, Back et el backs up my diagnosis by stating, â€Å"PTSD had a greater impact on improvement in alcohol dependence symptoms than the reciprocal relationship† (2006, p. 690). If the alcoholism remains as the excuse for Richard’s destructive behavior after the PTSD has been immobilized, I will recommend future treatments. Richard went a long time without help; however, the good news is that the treatment for PTSD clients has a high outcome of success (Oltmanns, Emery, Taylor 2002, p. 245) once a resolution and strategic treatment plan for the symptoms is put into motion. I expect Richard to make a noticeable recovery in his cognitive processing activities a year from now. At that point I will reassess Richard’s treatment. Analytical Comparison On the one hand, psychodynamics does not originate from empirical evidence; cognitive theories do. Psychodynamics postulates that sexuality is the basis for unconscious conflicts; cognitive psychology disagrees. Psychodynamics relies on human interpretation of dream analysis and other psychoanalytic treatments; cognitive psychology is backed with experimental qualitative and quantitative data. On the other hand, psychodynamics raises some questions that border on genius; while cognitive therapy (the most popular in psychology today) is deluged with redundant questions and experiments bordering over-kill. Psychodynamics is beginning to empirically test and answer some of the questions it raises; cognitive theory seems to be raising more questions than it can answer. In the end, each theory has its positive and negative points; the disorder, and the person, will have to decide which therapy to choose. References Back, S et el 2006, ‘Symptom Improvement in Co-Occurring PTSD and Alcohol Dependence’, Journal of Nervous and Mental Disease’, Vol 194 (9), pp. 690-696. Berk, L 2001, Development Through the Lifespan, 2nd edn, Allyn Bacon, Boston. Coleman, D 2005, ‘Psychodynamic and cognitive mechanisms of change in adult therapy: A pilot study’, Bulletin of the Menninger Clinic, Vol 69 (3), pp. 209-219.