Readiness factor to treating Alcoholism

This author writes today coming with a plethora of experience and techniques in the intial identification and treatment of acohol abuse and dependency. By virtue of having worked at two universities where the young adult population either is forming their realtionship and choices around alcohol or is already showing early warning signs of alcoholism, there are a host of entities utilized in understanding, informing, and socially “norming” young adult's decisions with alcohol. This writer resides philosophically somewhere between pusher (i.e. bartender) and prohibitionist with this topic. It's a grey place to reside and unfortunately with student's cognition development, they often have a hard time understanding the grey area instead of being clearly black and white with orientation around alcohol. Perhaps the law serves as the clear and cut parameter around alcohol and how one chooses to either abide by the law or not is where the most cognitive growth can occur around good decision making in regards to consumption.

As I project out a number of years as a psychologist and consider adult patients, I am of the understanding that acoholism is a family disease of which all parties need treatment. As stated in earlier weeks, this writer impresses upon anyone entering within a counseling treatment with a professional like myself at the healm that if “you are not part of the solution in reagards to alcohol than you are part of the problem.” Al-Anon is recommended for family members so that they learn not to support the alcoholism behavior. Not doing this step, as related to the societal and cultural constructs in psychological dynamics and within a family, creates negative feedback loops at many levels. (Nicholson, 2010).

In introductory counseling sessions the client with alcohol problems will need to define family in the terms of people in his or her daily sphere of influence. This idea of family may extend to friends, peers, and co-workers. In matters of professional confidentiality, the client may be asked about comfort level in reporting to superiors or Human Resources about garnering additional resources and assistance towards reforming alcohol dependency issues. These conversations and inquiries about support can come either directly from the client or can be facilitated by the professional.

Beyond getting the client to talk about family and supportive types, we can also begin to explore what constituted their history with alcohol. This writer gets to utilize empathy as alcoholism has run rampant in my family and I am the first generation to break the habits of the disease though my genes are wired to addiction. My consciousness is half of the battle. I work not to put any triggers in range of myself. Peers know that I have alcoholism in my family and that I will not be having any adult beverages or spirits. While I might role model strength and proactivity around the disease of addiction, what works for me may not necessarily work for my clients. Indeed these clients may not be able to ward off the alcohol so successfully. Serenity might work better for them instead of warrioring through. Group processes like AA may be a better fit. Creating a supportive, spiritual group and structure may work better for some clients (Hersen, Turner, & Beidel, 2007) .

Beyond family members and support groups being identified, issues around genetics, environment, and emotion needs to be explored. Is the client feeling guilty or ashamed of their issue? These deep emotions can work sometimes in the client and professional's favor if it acts like a catalyst for change. To uncover a family history of alcholism is not unheard of, and perhaps the client had learned poor coping skills with emotions and soothed with alcohol to a precarious brink. CBT may make its debut at this time. Within the learned behavior is also consideration of the genetic inheritance of alcoholism from biological family members. Also, questions around the client's social environment are key. If they are a clubber, they place themselves in trigger, high risk environments not only for alchol but for drugs.

Assessment of alcohol dependency issues may come to a professional by virtue of the judicial system. To be clear, if a court has referred an individual to counseling because of alcohol, it's safe to say a behavior choice involving alcohol lead to this point. While the motivation to work within the parameters of counseling may not be of the intrinsic sort, none the less, a sphere of the client indicates that some behavior is enough to indicate that the client's relationship with alcohol is not on normal, functional parameters. The client may do the motions of therapy but only when they are ready on their terms will impact on their disease really be accomplished. It is not any fault of the therapist to take things personally when a client resists treatment. The professional must believe in their capabilties should their timing and skill meet up with the right client with a “readiness” factor. This may not happen as frequently as one would like, but when one can get the client to sobriety every hassle patient or every mismatched patient within a broken system tends to fade in comparison to those that wish to be helped.

References:

Hersen, M., Turner, S.M., and Beidel, D.C. (2007). Adult Psychopathology and Diagnosis, Fifth Edition. Hoboken, NJ: John Wiley & Sons, Inc.

Nichols, M. P., (2010). Family therapy: Concepts and methods (9th ed.). Boston: Allyn & Bacon.

Countertransference issues in therapy: Schizophrenia & APD study critique

While there are a lot of interesting topics and sub-studies abundant in the field of psychology, nothing
intrigues this writer more than the wide path of Freudian theories so relevant still today. The concern
to account for, recognize and steer clear of countertransference issues is still a work in progress for any
professional. CT is understood to be reactions to clients on both the surface and underlying
motivational levels (Freud, 1910).
Just recently this writer was thinking about how often in professions new professionals are groomed in
kind to old professionals. Yes mentoring and teaching is a wonderfully inspiring thing, but to an extent,
is it possible that all one does is create machines in one's own likeness? This may happen on many
levels. For instance, psychology professionals are held to standards of the APA. Daily one goes about
their practice within these constructs and never really may push the envelope. Parallel to this thought
is the review and discussion of professional composure both on the conscious level and even that of
the subconscious level.
As we mix, mingle, and intertwine, are all we doing is convoluting ourselves and acting out the
Freudian schema of CT? How much of it happens via our shared collective unconsciousness (Jung,
1970)from being human having a shared history versus a methodical personality having the upperhand
in manipulation when one's personality is highly dominant? And if not personality strength, could
being placed in a position of authority tip the CT scale in one's favor?
While Scwartz, Smith, and Chopko in 2007 wove a study to outline CT in instances of schizophrenia and
anti-social personality disorder, daily professionals have to account for and reflect on how much of
their own issues help or hinder their work. Professionals need to ask themselves at the end of the day
how much they were fully present, in their game, and know where their course of treatment or scope
of duties may serve humanity. Ideally, professionals in the field of psychology and
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social work are some of the fiercest people in being even-keeled to any client that may walk through
their door, the reality is that their own issues can at times distract them from their best work.
As the study of Schwartz, Smith, and Chopko unravels, it presents the data that persons with
schizophrenia become endeared while those of anti-social personality disorder are managed more
harshly in experienced professionals (2007). More interestingly is the realization that often the
persons with schizophrenia tend to look toward the professional for additional guidance and steering
while quite predictably, the persons with APD continue in their path of being resistant to another's
influence of the situation, often challenging it. As these disorders and personalities collide with
therapist, much can be garnered in the effort to maintain professional best practices when one is of
the consciousness that we do not operate in a vacuum and that others will impact services rendered.
What this may boil down to is managing preferences and preferential treatment with patients and
what they bring to bare to the counseling dynamic. For instance, if it's psychometrically valid that
persons with schizophrenia may be holding their helper in high regard, this actually may work well for
the therapist to show them their flaws so as to level the playing field and to introduce more
unconditional positive regard about the human condition in general. This may alleviate feelings of guilt
or embarassment around their disorder.
Knowing that the person with schizophrenia is easy to ingratiate to the trust needed in clinical
relationships, how might the well-functioning client with schizophrenia in turn become empowered
from the counseling sessions to recognize a reversal in CT in that they may be an authority? Could they
do work in group sessions at their center for groups around the theme of coping with schizophrenia?
Let's take a recognized CT situation and realize it may not be so bad if used positively.
In instances of CT going out to APD types, what we need to do is be conscious of things that irritate us
and provide roadblocks. The APD personality in and of itself may constitute one of the most
challenging personalities to help. Perhaps reflection about that which we don't like about ourselves is
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what we see in APD and become most critical of. Can a professional know of expert strategies to
minimize dislike of a patient of APD when they might be sharing aspects of the human condition?
Could sharing these flaws help ingratiate a relationship? While this remains a theory, the CT we come
to therapy with in these clients may unlock a lot of reflection potential in us all. This would be taking CT
and using it in a positive manner again.
While the research of Schwartz, Smith, and Chopko,( 2007) is very illuminating on the topic and
identification of a personality and disorder that lends well to extremes of CT, there was a major flaw to
the study that was not covered in the researcher's considerations of experimental drawbacks. This
writer is of the educational background understanding how media can control a message and behavior
in the masses. The fact that that clients were portrayed on video may need addressing. In reaction to
the experiment, the production, editing, message delivery, implied perceptions, actual perceptions are
all the artwork of a person or team and even within that may be an issue of CT. To be sure, there is a
reason and message that any media has in communicating. That needs to be accounted for in this
study. The clients in each scenario must be addressed for dependent variables of the production of the
video. Controls need to be offered.
In spite of the delivery of the media message, this writer approaches all potential clients with intrigue.
My emotion will be conveyed as curiosity and intrigue around how they function despite something
being outlying to "normal". This goes back to my concentrated interest in positive psychology and how
people persist towards being their authentic self and how this writer may help them capitalize on this.
For instance, in persons with schizophrenia, documenting the stories of their multiple selves may make
the work for a truly layered artistic expression. They have multiple stories to tell and it could be told in
so many fashions. They could paint, write, direct, or musically create their schism experiences if they
have an inclination to take a bad situation, embrace it and spin it positively. How many of us are not
ideas people? These patients may be full of potential if they see it that way. In
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viewing this so positively, I may be counter-transfering my inclination to the arts on my clients. Is this
really that bad though?
In anti-social personality types, I would believe that there resistance towards the therapuetic alliance
may present me with some of the most challenging work possible. Within that dynamic this writer
imagines having to do an immense amount of preparation and research to break down barriers. It
should serve me well. Even if I don't succeed in creating an allegiance, I know that I will have at least
tried. It's never wrong to feel bad about a referral if the relationship is too difficult to be formed. I may
have to wonder of my own CT in abandonment issues as this writer approaches life quite individualistic
at times. However, that may lend itself to a strength area with APD clients as I am aware of functions,
professions, and networks of an individualistic nature.
One last thing to impress upon is the need for any professional to be networked for consultation and
referrals. One must be able to keep CT to a minimum especially when it's one's own issues that have
not been dealt with adequately. This is a field that must build consultation and support among
practitioners to consult on difficulties and shortcomings. Practitioners must do whatever is necessary
to be the rock in a seemingly volatile patient's world.
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References:
Freud, S. (1910). The Future Prospects of Psycho-Analytic Therapy. London, U.K.
Jung, C. (1970). Collected Works, Volume 10. Routledge & Kegan Paul, London.
Schwartz, R. C., Smith, S. D., & Chopko, B. (2007). Psychotherapists' countertransference reactions
toward clients with antisocial personality disorder and schizophrenia: An empirical test of
theory.American Journal of Psychotherapy, 61(4), 375-393. Retrieved from EBSCOhost.

Borderline Personality Disorder

It is former Harvard professor and psychiatrist Theodore Millon's life work that personality is composed of numerous major spheres of structure and functioning. In essence personality is not simply about behavior, or about cognition or unconscious conflicts, but the interaction of all of this to comprise a person (Millon, 2006). Echoing proof in this capactity is the continued discussion of individuals with borderline personality disorder. These individuals show a very distinctive black and white cognition, rationale or irrationale. Indeed twenty to forty percent of these individuals have episodes where reality is elusive within extreme episodes. Another significance is that roughly seventy five percent of these folks are women (Hersen et al., 2007).

What are some of the possible causes that contribute to the development of BPD?

Research from a genetic etiology indicates that attributes of impulsivity and affective instability are partly inheritable. Other research traces the quantity and firing work of serotonin, like in so many other psychological quandries (Hersen et al. 2007).

In the psychosocial developmental realm, instances of traumatic childhood expreriences appear as themes in self-reportings of those within researched studies. Teasing out other variables of these client's childhood experience within the abuse or neglectful home is always complicated work. A weakened family structure so pervasive in American homes is considered causal to the higher instances of this disorder here in the states.

Describe the essential characteristics of someone struggling with a Borderline Personality Disorder.

Millon describes personality disorders through the lenses of structure and function. Functional attributes are as follows:

Expressively spasmodic- impulsivity, lack of energy, self-harming behaviors

Interpersonally paradoxical- manipulative, volatile, angry all working against their need of others

Fluctuating Cognition- vascillating love, rage, and guilt creating conflicting feedback for others

Structural attributes are:

Uncertain self-image- waivering identity, emptiness, self-punitive

Incompatible object relations- aborted lessons, incongruent memories, contradictory needs, erratic impulses and poor skills in conflict resolution

Regression regulatory mechanism- lower development skill set

split morphologic organization- inability to be consistent across the elements, schism with reality

labile mood temperament- shifts in mood, energy from mania to melancholia

What seem to be the most effective treatment techniques with clients struggling with Borderline Personality Disorder?

Personalized psychotherapy joins with thinkers of the past and argue that the following cannot extend beyond the scope of a clinician’s regard: the family and culture, neurobiological processes, unconscious memories, and so on (Millon, 2006).

More specifically, Millon offers CBT and catalytic sequences in personalized psychotherapy. The patient's thoughts and behaviors are corrected concurrent to catalytic sequences in step with tasks that can be meaningfully resolved within the new and improved thinking and behaving to reinforce the larger picture of working on the self towards an improved self.

References:

Hersen, M., Turner, S.M., and Beidel, D.C. (2007).Adult Psychopathology and Diagnosis, Fifth Edition. Hoboken, NJ: John Wiley & Sons, Inc.

Millon,T. (2006). Institute for advanced studies in Personology and Psychopathology. Retrieved 1/25/2011 at http://www.millon.net/index.htm