Answered: • What would you have done to support…

Ciccarelli: Psychology_5 (5th Edition)

5th Edition

ISBN:9780134477961

Author:Saundra K. Ciccarelli, J. Noland White

Publisher:Saundra K. Ciccarelli, J. Noland White

Chapter1: The Science Of Psychology

Section: Chapter Questions

Problem 1TY

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Question

Ellen, described as "challenging" by several therapists at a trauma program, was assigned a new therapist. The team of clinicians had struggled for many years with understanding and helping Ellen, a client with multiple diagnoses (bipolar disorder, major depressive disorder, post-traumatic disorder, and dissociative identity disorder) who was frequently admitted as an inpatient at various local hospitals. Both of Ellen's prior therapists were interns. The intake coordinator concluded, quite wisely, that forming a therapeutic relationship with a staff person over a longer period of time might improve Ellen's stabilization. When the therapist initially read her two-volume file, she learned a great deal of basic information about Ellen. It soon became apparent that it would be difficult, at best, to develop a clinical formulation that could be used as a road map for future therapy sessions. Since Ellen began treatment in the program three years ago, she had developed a pattern of requiring inpatient treatment at least once every six months. There did not appear to be any definable triggering event to these recurrent admissions. Each time Ellen was discharged, some well-meaning psychiatrist would give her a slightly different diagnosis and several new medications to try. Ellen attended therapy once a week for a period of six years. In the final two years of her therapeutic engagement, Ellen was not once admitted as an inpatient. Furthermore, she was employed part-time at a department store so she would not have to rely solely on her Federal Disability grant. After getting married, she considered relocating to another state so she could live closer to her daughter and granddaughter. What factors contributed to Ellen achieving such an improved level of functioning? In describing the factors, the process of her treatment is described. First, it was important for Ellen to be psychologically tested in order to exclude concerns of neurological disorders and frontal lobe malfunctioning. Other personality and trauma screens, some of which are outlined later in this chapter, helped provide objective data on her functioning. Second, the therapist attempted to understand Ellen's perspective by exploring the role her hallucinations may have served and the underlying causes of her mood fluctuations. Often, new therapists are afraid to examine the inner workings of a client's psychoses. As Ellen began to develop trust in the therapeutic relationship, she started to engage more fully. The recollection soon emerged that she had been sexually abused by her maternal uncle from the age of five until her teenage years. This trauma explained the origin of her mixed moods; her recollection also gave some clarity to her report of hearing negative internal voices. Ellen claimed that for the first time in her life, she felt heard and understood. Early in her treatment, when Ellen was hospitalized, the therapist attended Ellen's discharge meetings so she could advocate for her. At these meetings, the health care providers involved in Sischarging Ellen were intormed about treatments that had already been tried without success. By advocating for Ellen, the therapist served as the container that temporarily held Ellen's world together. Assessment Challenges Assessing trauma survivors can be a challenge for many reasons. Trauma is seldom the presenting issue that brings clients to therapy. It is often not until much later in the therapeutic relationship that a therapist discovers an underlying history of trauma in a client's life. Discovering this painful history illuminates a possible source for a client's current difficulties. In Ellen's case, treatment was sought for severe mood fluctuations; Ellen also wished "to get rid of the voices that tell me I am no good." The client was correctly diagnosed with manic depressive disorder. Later, as her visual and auditory hallucinations became more debilitating, Ellen was given the diagnosis of schizoaffective disorder. However, merely assigning these diagnoses without understanding her symptoms at a deeper level failed because it neglected to fully address the underlying cause of her difficulties. For clients who may possess multiple psychiatric diagnoses, knowing the area on which to focus during a therapy session can be a challenge for the therapist. One possible strategy is to allow the client's mood to dictate the focus of a particular session. This method of conducting therapy can also help the client maintain a sense of control and competency.