Psychotherapy is an essential phenomenon in the modern world because numerous people are suffering from mental health issues. That is why medical professionals should provide such individuals with appropriate care to help them achieve positive outcomes. However, current practice shows that there appear significant challenges when it comes to delivering care. It relates to the fact that numerous factors prevent patients from utilizing health services, and these factors include race, gender, and other personal peculiarities. Among these phenomena, socioeconomic status (SES) of patients is of crucial concern because it contributes to the fact that numerous individuals are left without access to psychotherapy.
The situation above is a central topic of the article by Epping, Muschik, and Geyer (2017) and the work by Villatoro, Mays, Ponce, and Aneshensel (2018). Thus, the purpose of the present study is to review the two pieces of research and analyze how they address the topic under consideration. That is why it is necessary to read these peer-reviewed articles and comment on their content. The method above means that it is essential to use an appropriate design. Thus, the given study will focus on how the articles discuss the problem, review the literature used, evaluate the methods of these works, present overall expression, and generate conclusions. As for the findings, they state that the articles present useful theoretical information that can positively influence psychotherapy practice.
Evaluating the Problem Discussed
The two articles under critique address the problem and describe it clearly. On the one hand, Villatoro et al. (2018) stipulate that there are differences in mental health services utilization according to social status, race, and gender of patients. The researchers state that the variations above result in the fact that some individuals do not have access to psychotherapy even if they have severe mental disorders. Consequently, the authors introduce the topic understandably, and they support each idea above with credible sources, which eliminates any possible doubts concerning the relevance of the information presented.
On the other hand, the work by Epping et al. (2017) begins by describing the fact that a significant part of research analyzes how and why disease occurs. At the same time, little attention is drawn to whether there are any inequalities in the utilization of mental health services. Thus, the authors explain the direction of their research clearly and are going to investigate the problem within the German context. Here, one should also emphasize that these scientists use numerous studies on the given subject to support their ideas and create the feeling that the article is based on reliable data.
Evaluating the Literature Reviewed
As has been mentioned above, the two articles focus on reliable and credible sources. However, it is necessary to comment on them in detail to determine whether the studies have a clear theoretical framework. Thus, it is possible to say that Villatoro et al. (2018) have cited a sufficient number of sources, including more than 80 books and scholarly articles. This list does not have any pieces of literature that are irrelevant to the study. Furthermore, the authors draw appropriate attention to various sources, which means that there is no bias in presenting the references. At the same time, it is a weakness of the work by Villatoro et al. (2018) that it cites a few outdated sources that were published in the late 20th century.
As for the article by Epping et al. (2017), its reference list includes 30 entries that also include a few outdated sources. All these books and journal entries introduce relevant information because they address numerous topics reviewed by Epping et al. (2017). In addition to that, it is impossible to mention that the authors draw inappropriate attention to some ideas. It so because they use one or two sources to support every notion that they describe. Consequently, the information above demonstrates that the two articles are based on robust theoretical frameworks, which strengthens the credibility of the data presented.
Evaluating the Methods
The study by Villatoro et al. (2018) implies a relatively easy research process that is described in detail. It is so because the researchers focused on individuals who had participated in three epidemiological studies and interviewed them with the help of previously developed questionnaires. As a result, any reader can duplicate the given research process in case of necessity. This method seems to be valid for the given study because interviews of respondents are useful to obtain the required data.
However, it is necessary to consider the fact that this method can imply bias because some individuals can improperly evaluate the causes of their poor access to psychotherapy. Here, this risk is overcome by the extensive sample that includes 14,906 people Villatoro et al. (2018, p. 8). The respondents are of different races, ages, and social statuses, which contributes to achieving impartial results that reflect the current situation in the health care industry.
At the same time, the article by Epping et al. (2017) follows a similar method, and the researchers analyze information from an anonymized dataset. They determine whether there is any correlation between an SES of a person and their mental health. Consequently, every reader can duplicate this research process if necessary. The given article deals with 746,963 respondents, but the most significant attention is drawn to 10,711 psychotherapy patients, including 3,066 men and 7,645 women (Epping et al., 2017, p. 4). Age, income, occupational, and educational varieties are preserved to eliminate the risk of bias and reach impartial results.
Presenting Overall Impression
The two articles under consideration are said to give useful theoretical information that can be further applied in practice. On the one hand, Villatoro et al. (2018) present guidance for individuals on how to identify mental disorders and what to do with them.
Furthermore, the authors stipulate that their conclusions demonstrate the need to improve mental health care utilization in the United States. Thus, the article describes the necessity to develop and implement interventions to increase psychotherapy access among representatives of low SES groups. Consequently, the work by Villatoro et al. (2018) is a basis for responsible individuals to address the issue practically. On the other hand, Epping et al. (2017) also demonstrate that there are some problems with psychotherapy access. The authors insist on the fact that their work should be the guidance for psychotherapists who need to draw specific attention to patients with a low SES and provide them with decent care.
Even though the conclusions above are significant and refer to the essential topic, the articles are written understandably. It refers to the fact that these scholars use simple language to describe even the most complicated phenomena. Furthermore, the visuals are useful in the given pieces of research because they make it easier for readers to understand the ideas expressed. In addition to the fact that the articles are appropriately structured, the tables and charts are useful for readers to comprehend the distribution of respondents and identify any tendencies.
Conclusion
The study by Villatoro et al. (2018) determines how the rates of mental health services utilization depend on individual peculiarities of patients. The authors have reviewed numerous credible sources to create a trustworthy and reliable theoretical framework for their research. To achieve the necessary results, these scientists have analyzed a few epidemiological surveys to select the sample that is necessary for their study. This sample is relatively extensive, and it includes representatives of various racial, gender, age, and socioeconomic groups. Consequently, Villatoro et al. (2018) state that it is necessary to influence the health care industry in the United States to increase access to therapy. As for the future of this research, it can focus on specific steps that can improve mental health services utilization rates in the US.
At the same time, Epping et al. (2017) draw attention to any regularities between an SES of a patient and the utilization of mental health services. The authors have reviewed a sufficient number of reliable sources and analyzed an extensive sample to conclude that representatives of low SES groups suffer from inadequate access to therapy. This article stipulates that the problem can be addressed if psychotherapists draw more attention to the given group of patients. Further research on this subject can refer to covering a different country and developing policy measures to increase psychotherapy access rates. Consequently, the information above stipulates that the two articles under consideration are essential pieces of research that have the potential to improve the theory and practice of the health care industry.
References
Epping, J., Muschik, D., & Geyer, S. (2017). Social inequalities in the utilization of outpatient psychotherapy: Analyses of registry data from German statutory health insurance. International Journal for Equity in Health, 16, 1-8.
Villatoro, A. P., Mays, V. M., Ponce, N. A., & Aneshensel, C. S. (2018). Perceived need for mental health care: The intersection of race, ethnicity, gender, and socioeconomic status. Society and Mental Health, 8(1), 1-24.
The client resorted to a counselor because he realized his drinking problems caused a chain of unpleasant situations in his life. More specifically, James identified having alcoholic inclinations caused by enormous stress associated with his work. James’ drinking problem took a toll on his family life since his wife threatened to leave with their two children. Additionally, the client specified that he is currently having a tense relationship with a leader of the firm due to his drinking episodes which make him skip working days.
Case Conceptualization
The client is a Caucasian heterosexual male living in a family of four. His family might put a strain on his emotional health since he has to provide his wife and children with material goods. In addition, James is a religious person, which may be the factor contributing to his desire to be treated. He has an upper management position at a multinational biotechnology research and development firm. It means that his job puts much pressure on him and does not allow him to relax for too long. James resorted to alcohol to unwind the conversation with his boss and other leaders in the company. Finally, his personal life began to suffer since his wife wanted to split with him.
Assessment
A clinician may use a guide titled “Helping patients who drink too much.” This assessment tool will be helpful in identifying the degree of severity of the condition. Furthermore, it is an excellent means of determining the proper treatment (Rabow et al., 2019). AUDIT Alcohol Screening Tool will be the following method of appraising James’ state. This screening will help identify a client’s drinking patterns and feelings when consuming alcohol and recognize if a patient is exposed to alcohol-related harms.
Diagnostic Impressions
The provisional diagnosis for James is alcohol use disorder which is the cause of his mishaps. Alcohol intake violates the average balance of the activity of various body systems, causing a natural chain reaction. Alcoholic beverages are consumed in systematic intake of small doses or unsystematic intake of large quantities (Smith, 2017). The continuation of drunkenness leads to a gradual decrease in patients both socially and personally. The fact that James’ family and working relations are falling apart proves the previous statement.
The rationale for Diagnostic Impressions: Note: Use the DSM-5 to explain how the client’s symptoms are reflected in the diagnostic criteria for each diagnosis that you render.
As per the DSM-5, the criteria for alcohol use disorder in James’ case are the following:
He wants to reduce alcohol consumption but cannot succeed.
He continues drinking, disregarding the family and work problems.
He has intoxication after drinking (KM, 2017).
Sometimes, James consumes more alcohol than intended.
He uses drinks as a means of mitigating communication (KM, 2017).
Therapeutic Approach
Psychotherapy is one of the most effective methods of treating alcoholism. Alcohol abuse is a systemic, multifactorial condition; therefore, psychotherapy of alcoholism should be systemic. The treatment of alcoholism with the help of psychotherapy involves the impact on patients in several directions (Smith, 2017). On the one hand, the etiological basis of addiction is being studied, and the counselor must understand why the patient’s life is reduced to alcohol consumption. On the other hand, the doctor programs the patient for a natural desire to stop drinking alcohol. It is usually suggested to an alcoholic that alcohol causes disgust or instills fear of alcohol consumption (Fitzgerald & Puttler, 2018). Psychotherapy of alcohol use disorder should be combined with drug therapy. Only a complex effect helps to cope with the disease successfully. Additional support for the patient is the understanding of family and loved ones. In general, psychotherapy in the treatment of chronic alcoholism works by changing the human psyche. This complex approach was chosen because James needs to get rid of this bad habit as well as preserve his family and maintain his working position.
Treatment Goals
The primary treatment goal would be investigating the causes of James’ alcohol abuse. The first step towards disposing of a problem is admitting it and identifying the roots because both the counselor and client must know where it stems from (Singer et al., 2019). The results will be measured during sessions – if James manages to recollect the events leading him to drink, the objective will be achieved.
The second treatment aim is to make James stop drinking alcohol. Throughout the course of psychotherapeutic sessions, James will fill out the screening paper, marking the days when he does not consume a bit of alcohol.
The third initial goal refers to defining the client’s future plans. This step is vital because the alcoholic should realize that they are in charge of their lives. In case James describes his further perspectives, the goal is attained.
Relapse Prevention and Continuum of Care: Describe relapse prevention needs and challenges for the client. Discuss the continuum of care plan and recommendations for the client.
If a relapse occurs, a patient needs to undergo medical treatment and detoxing procedures (Sliedrecht et al., 2019). Ideally, psychotherapy for alcoholism should last several years, with several sessions a month. A doctor should prescribe the intake of medical remedies.
Ethical Considerations
The major challenge associated with treating alcohol use disorder is that the patient’s symptoms may worsen and lead to fatal outcomes. Additionally, the client may refuse to undergo some psychological interventions due to their disbelief.
References
Fitzgerald, H., & Puttler, L. (Eds.). (2018). Alcohol use disorders: A developmental science approach to etiology. Oxford University Press.
Smith, D. (Ed.). (2017). Emerging adults and substance use disorder treatment: Developmental considerations and innovative approaches. Oxford University Press.
The outbreak of the COVID-19 pandemic has, by all means, affected the patterns of providing quality care and the well-being of nurses in general. Hence, the PICOT question of the research concerns the extent to which the implementation of psychotherapy or counseling might affect the call-off and shortage rates among nurses. The present paper is comprised of the relevant research articles that would serve as a foundation for the research. Such platforms as PubMed, Springer, Wiley, and Elsevier were used to search for the material using such keywords as “nursing shortage,” “therapy,” “intervention,” “COVID-19,” mental health,” and others. The articles found were then grouped according to the topic: nursing shortage during COVID-19, the level of mid-pandemic emotional distress among nurses, and the therapeutic interventions and coping mechanisms to reduce the stress.
Nursing Shortage During COVID-19
The workload and systemic distress of the global pandemic have significantly affected the nurses’ motivation and resources to work. In a primarily quantitative study presented by McGarry et al. (2020), the researchers attempted to analyze the extent to which the pandemic period was associated with the pandemic outbreak. Data collected from the Centers for Medicare and Medicaid Services (CMS) COVID-19 Nursing Home Database demonstrated that more than 95% of the nursing homes in question reported both the shortage of staff and personal protection equipment (PPE) at the time (McGarry et al., 2020). Hence, lack of protection and safety is highly associated with distress and mass nurse call-off (Halcomb et al., 2020). Another primary cohort study on nurses in nursing homes also reported an interrelation between the lack of PPE, nurses’ distress, and abundant shortages (Xu et al., 2020).
The turnover intention, however, was detected not only among practicing nurses. According to the primary quantitative online survey conducted among nearly 1,000 undergraduate nursing students, the fear of the pandemic and low life satisfaction are the prevailing factors that make the respondents reluctant to pursue a career (Lin et al., 2021). Finally, in a qualitative study that conducted semi-structured interviews with 40 nursing professionals, the shortage reasons included lack of preparedness, PPE shortage, and anxiety and fear (Nyashanu et al., 2020). Hence, it becomes evident that anxiety and fear become the priority mental concerns associated with the shortage.
Mental Health Among Nurses
Undeniably, the mental health status of the workers faced with a pandemic crisis has been affected significantly. In a quantitative survey conducted among more than 4,000 Chinese healthcare employees, the prevalence of anxiety, depression, and psychological distress has been associated with working with COVID-19 patients and being a nursing professional (Liu et al., 2020). Another primary study focused on both long-term effects and interventions for psychological distress reduction among nurses, concluding in the higher issue probability for the insecure frontline workers (Cai et al., 2020). The prevalence of anxiety among nurses was also recorded in the study by Xiong et al. (2020), as this cross-sectional survey of 223 nurses demonstrated that nearly half of them manifested anxiety symptoms.
One quantitative study even demonstrated evidence that the COVID-19 pandemic could be perceived as a traumatic experience potentially leading to post-traumatic growth (PTG). Thus, according to Cui et al. (2021), guided deliberate rumination of the COVID-related events may become a beneficial healing technique for the employees. Hence, given the justification of prevalent depression and anxiety issues, it is necessary to dwell on the other potential intervention techniques.
Coping Mechanisms and Therapy Interventions
Some of the most commonly mentioned coping strategies with the stress associated with the pandemic are self-care and self-efficacy. The latter stands for one’s ability to believe in oneself to such an extent they one cope with the challenges faced along the way (Xiong et al., 2020). Hence, as far as self-care is concerned, the quantitative survey by Labrague and de Los Santos (2021) demonstrated that it could be achieved through building personal resilience toward a stressful environment. Other interventions that contributed to the reduced levels of anxiety included social and organizational support (Labrague & de Los Santos, 2021). Self-efficacy, for its part, has demonstrated a negative correlation with depression and anxiety in a large cross-sectional survey by Hu et al. (2020), which means that higher self-efficacy interventions could potentially lead to the better mental health of the staff.
Psychological resilience has also demonstrated positive outcomes in terms of reducing distress and anxiety in a cross-sectional descriptive study by Yayla and Ìlgin (2021), as an intervention on building resilience contributed to the lack of compassion fatigue and, as a result, improved nurses’ well-being and meaningful communication outside the hospital. Another cross-sectional study conducted by Engelbrecht et al. (2021) revealed the need for psychological intervention for South African nurses working during the second pandemic wave. This study had also demonstrated that apart from the psychological help and counseling, tangible solutions such as rotation and PPE access increase should be encouraged in the first place (Engelbrecht et al., 2021).
The variety of intervention tools based on the examples of previous health crises was found in a systematic review by Zaçe et al. (2021). The interventions include resilience training, peer support groups, increasing access to PPE equipment, personal resilience planning, counseling, and education on anxiety and stress precursors (Zaçe et al., 2021; Fiol-DeRoque et al., 2021). Finally, a primary quantitative study by Shen et al. (2020) surveyed 85 practicing COVID-19 nurses and planned organizational psychological interventions based on their concerns. Hence, since some of the major concerns included anxiety, lack of preparedness, worry, fatigue, and distress, the interventions included:
Presenting a professional psychologist to every team;
Preparedness interventions;
Emotional support in peer groups;
Enhancing teamwork and unity through online and offline communication;
Regular check-up meetings;
Counseling;
Social support systems (Shen et al., 2020).
Although unable to track long-term results so far, the aforementioned interventions proved positive for the overall stress levels among nurses and their perception of job complexity during the pandemic. Hence, it may be concluded that currently, psychological interventions are vital for the nurses to cope with the existing scopes of the COVID-19 pandemic in order to increase the rates of job satisfaction and decrease the levels of nursing shortage.
Concluding Remarks
The implementation of psychotherapy and counseling for nurses as a preventive tool for shortage and burnout has been proven to be a positive tendency in terms of battling the complications of the global pandemic. Out of the studies discussed in the paper, the five major primary studies that relate to the PICOT question include the researchers by Shen et al. (2020), Liu et al. (2020), Fiol-DeRoque et al. (2021), Hu et al. (2020), and Cai et al. (2020). These studies tend to provide major insights into the patterns of psychological distress, anxiety and their impact on the nursing shortage in the US and other countries affected by the pandemic.
NTU is a pluralistic therapy approach that allows the therapist to conduct a process-oriented intervention that empowers the client’s systems. This is especially relevant to people of color since it is based on an African worldview that considers African people’s views, processes, and learning styles (Williams, 2021). It emphasizes that therapists have a responsibility to help strengthen clients in their cultural context (Soto et al., 2018). Its emphasis on process let the client system to determine what constitutes a family and community itself. NTU practice is a strategy for trying to improve life by comprehending life problems, experiences, and solutions (Gregory & Phillips, 2018). These stages are necessary for a person to create healthy connections with themselves and others in their lives. The ultimate purpose of NTU psychotherapy is to restore harmony, authenticity, and connectivity through raising awareness of emotions and feelings (Williams, 2021). The chosen client has a phobia, has experienced trauma, and has low self-esteem, and the NTU method will be used to identify the components of each of these aspects and to design a successful program.
Conceptualization of Presenting Problems
John is the offspring of a Somalian first-generation family. After his father’s financial difficulties during the 2008 financial crisis, he began drinking regularly and verbally and physically attacked his wife and kid. John began to struggle with marijuana and juvenile court difficulties because of these circumstances, and he dropped out of school. In this case, it is crucial to get a psychological assessment of John, assess the trauma level, and understand his cultural tendencies. He currently resides alone in a Florida mobile home park with his dog. Part-time work and freelance activities are John’s primary sources of income. John refuses to finish high school and find a respectable career, despite his father’s best efforts. John suffers from social anxiety and lacks self-confidence since he is constantly looking for weaknesses in himself. John was raised in Islamic surroundings and regularly attends Friday prayers at local mosques. He likes listening to various sheikhs’ lectures online. Islam seemed to have aided him in dealing with his father’s actions. John, on the other hand, continues to suffer from despair since he is closed to everyone and does not attend Friday prayers.
John is unsure of where he wants to go with the counseling and begins to complain about himself and his position. It is clear that he prefers folks to come to him first and fix his problems rather than accepting responsibility for their own. This sounds appropriate for John’s age since he needs to be more conscious of his abilities and objectives. Because he is not completely cooperative, the best approach is to ask more open-ended questions that will lead to a more profound dialogue about what John wants to receive out of the meetings. The next step is to create coping techniques to assist John in dealing with his psychological distress and figure out what causes it. One of the key challenges John is struggling with is his marijuana addiction, as well as the trauma of his father’s past actions, which has harmed their connection. These are John’s primary concerns, which must be addressed in order to help him develop self-confidence and a good connection with his father and others.
Use of NTU Stages of Psychotherapy
In John’s session, the first part of the NTU phase is to build harmony in his life and relationships. It was established early on that John feels that if he is dissatisfied with himself, he cannot be happy without strong connections with his father. He is not forceful in discussion or seeks to be honest with his family. He was initially indecisive, but over time he became more attentive and receptive, which led to the awareness stage. John originally did not comprehend the causes of his conduct and did not feel comfortable discussing it with a social worker, which changed over the course of time. John was able to think about these topics and his position after additional conversations utilizing open-ended inquiries. As a result, it became evident what fundamental requirements and restrictions he would require in order to progress. During the alignment phase, John was able to provide the first specifics of his anxiousness and the reasons that produced it. He began to approach his difficulties in a more balanced and complimentary manner. In other words, John was able to establish an internal congruence of ideas, feelings, and conduct.
The actualization phase was an area where he needed to develop, including motivation and accountability to keep working toward his objectives. To prepare John for his meeting with his father, the social worker and John resorted to practicing and trying new attitudes and actions in real-life settings. In this stage, John showed his willingness not to hurry up things and move gradually since the traumatic experiences of the past are still fresh in his mind. In terms of the synthesis phase, religion appeared to be significant to John and may be included in his self-esteem growth through his faith. In the context of what he is going through and will continue to go through, John evaluated the efficacy of what he has gone through. In this context, his affiliation with Islam proved to be a binding mechanism that only benefited John.
Use of NTU Principles of Psychotherapy
W: John, would you like to talk about how things have been going since we met this morning? (Balance)
J: I was thinking about what we discussed and our objectives. During a break, I emailed my father about having supper with him over the weekend.
W: How did you start a dialogue about meeting him? When you asked him directly, how did you feel?
J: I was concerned about the response and paused before asking. In the end, I am pleased I went through with it. I’m tempted to tell him that I am single and lonely and that I would like to visit and talk to the family on occasion. (Harmony)
S: What was his reaction when you told him about your feelings?
Jay: He told me that I wasn’t bothering him and that I’d always have time to speak with him. (Connectivity/Interconnectedness)
W: Do you not want him to accompany you to Friday prayers? (Cultural Awareness)
J: Yes, but not straight now. I believe I am still struggling with feelings.
W: How does preaching affect your daily life, and how do you put their teachings into practice? (Authenticity)
J: I have only recently been aware of their positive sentiments, which fit with my current situation. They did, in fact, alter my perspective and cause me to calm down.
W: During the next meeting, you can reflect on your experiences and we can discuss them.
Summary of Progress and Next Steps
According to what has been observed, John is making progress, as evidenced by his willingness to approach his father openly and be candid about his thoughts during the session. Despite the earlier tragedies in their connection, John realized that his father didn’t recognize how alone he felt since he could not seek counsel from him. Despite his unwillingness to address anything, John appears to acquire confidence during the session, as evidenced by the scheduled appointment with his father. At the same time, John wants to take things slowly, which is arguably the ideal strategy for him because he believes it is the only way he can succeed.
The next step was for John to recognize the value of faith, which he seemed to be ashamed of at first. He refused to discuss his faith in the early hours, yet he subsequently revealed how important Islam was to him. John’s religious views appear to guide him in the right way and provide him the assurance he requires to make adjustments. Going to church and engaging with other Muslims can help him identify other community members who can help him cope with his social anxiety. In offering direction and support to John, the church community’s assistance will be crucial.
The trauma John had while coping with an abusive relationship is still a problem that has to be handled and considered as he moves forward. John appears to prioritize reuniting with his family, but only after gaining trust that the previous wounds inflicted by his father have healed and that the circumstance would never occur again. In general, John’s desire to be more open will aid him in coping with the trauma, while religion can aid in the resolution of social concerns and the cessation of marijuana addiction.
References
Gregory, S. D., & Phillips, F. B. (2018). “Of Mind, Body, and Spirit”: Therapeutic Foster Care—An Innovative Approach to Healing from an NTU Perspective. In Serving African American Children (pp. 125-140). Routledge.
Soto, A., Smith, T. B., Griner, D., Domenech Rodríguez, M., & Bernal, G. (2018). Cultural adaptations and therapist multicultural competence: Two meta‐analytic reviews. Journal of clinical psychology, 74(11), 1907-1923.
Williams, K. M. (2021). Centering Mindfulness in an Afrocentric Worldview: African American Women, Social Support and Health When Creating Culturally Relevant Mindfulness Techniques Connected to African American Families. Western Journal of Communication, 1-9.
Long-term psychotherapy is generally a type of psychotherapy that goes beyond the traditional time parameters allocated for the nursing of numerous psychological illnesses. In this case, Thelma is the client and was recommended for long-term psychotherapy by her caseworker. For long-term psychotherapy, there is no definite time frame allocated for the treatment. Studies show that, in most cases, individuals suffering from psychological distress often recover when nursed through short-term psychotherapy (Teyber & McClure, 2017). Nevertheless, Thelma suffers from a more debilitating or complex psychological disorder, which requires long-term psychotherapy. According to research, this form of therapy takes at least one year to treat (Wright et al., 2017). Generally, the long-term psychotherapy process usually involves both inpatient and outpatient treatment. In this instance, the psychotherapy process mostly employed outpatient treatment. The paper will study Thelma’s case, identify her diagnosis, describe how her relationship with her relatives affected her behavior, and provide recommendations for the future.
Assessment
Description of the Professional Setting
In Thelma’s case, the counseling process involved two professional settings. The first setting is referred to as the private practice, which was based on counseling sessions with the client. The second session was community-based and entailed including the family members to establish the cause of Thelma’s condition. To examine the client’s disorder, the first step is to define Thelma’s background. The client, in this case, is a woman aged 48, and she originates from a mixed race. Thelma’s mother was African American, and her father was Hispanic, thereby making her both Hispanic and African American. Thelma never knew her father; however, she had a stepfather who was an alcoholic. Additionally, Thelma had an identical twin sister, two brothers, and an older sister. According to Thelma, she was certain that her stepfather sexually abused her when she was young. Despite these claims, she was unable to recall her encounters with her stepfather because she was too young.
Children experience memory loss when they reach a particular age, and that might explain why Thelma was not able to remember being sexually molested by her father. According to Goodman et al. (2003), children usually experience what is known as childhood amnesia, and this generally occurs when they reach the age of 7 years. However, she remembers that her stepfather frequently abused her emotionally. The reason for this may be because she was already old enough to remember what was happening in her surroundings. Furthermore, Thelma could remember being sexually abused by her brothers. She further believed that her brothers abused her twin sister and could not tell anyone. Thelma believed this occurred to her sister because she described having experienced sexually abusive behavior from both her brothers. Furthermore, when she reported this sexual abuse to her mother, she could not protect her. Thelma reported that her brothers were generally treated better than everyone else.
To ensure that Thelma did everything the mother and the twin sister wanted, they took advantage of her need for closure. As a result, they usually manipulated her into giving them financial support. For instance, the twin sister was a drug addict who could not support her habits. As a result, she manipulated Thelma into providing her with money to buy drugs in exchange for her lover and care. Similarly, the mother utilized this tactic to ensure that Thelma provided her with money. Consequently, Thelma had difficulties developing relationships outside her family, particularly between her mother and her twin sister. Mostly, she stayed indoors, which made it challenging to establish new relationships.
Thelma found it difficult to identify her sexual orientation because she was sexually abused by both her brothers and stepfather. According to epidemiological research, there is a close link between sexual and physical abuse at a young age and sexual orientation (Gaesser & Karan, 2017). It is because of this reason that Thelma found it challenging to identify sexual orientation. Consequently, she dressed androgynously, kept her hair short, and had no sexual desires. Additionally, the fact that she did not have her mother’s support contributed to her confusion regarding her sexual orientation. She lacked self-confidence and, therefore, was unable to talk about her gender identity. Furthermore, besides her choice of dressing, she was unable to apply makeup because of how she felt about her gender identity.
In terms of family composition, Thelma’s family had different types of people. To begin with, Thelma’s father was not available, and it is recorded that she never met him. However, Thelma had a stepfather, and according to her narration, she was not a father figure. She believes that the stepfather molested her while she was young. Nevertheless, she could not remember anything about her molestation, but she could remember that the stepfather was emotionally abusive. In addition to this, Thelma had two brothers who she recalls sexually abusing her. Furthermore, after her twin sister described her relationship with the two brothers, she deduces that her twin was sexually molested by her two brothers. Thelma’s mother adores the brothers compared to Thelma and her sisters. As a result, when Thelma reports incidents of sexual abuse from the brothers, the mother blames Thelma for their actions. In the end, due to their guilt, Thelma’s eldest brother and sister separate from the family.
As a person originating from mixed ethnicity, specifically from an African American and Hispanic ethnicity, Thelma’s condition may be exacerbated. Thelma originates from communities that are classified as minorities, and these often experience depression or mental illnesses differently. Studies state that mental health illnesses among Hispanic and African American communities are frequently stigmatized, and as a result, these individuals suffer for a long time (Holden et al., 2017). In Thelma’s case, this could explain why she has been treating her condition for 18 years. Despite being a patient and having her own caseworker, Thelma was unable to associate with different people. In most cases, this means that Thelma was silent about her condition, and only a few people knew about it. Studies state that this type of silence contains a type of experience that may result in mental health disorders, including trauma, depression, and antisocial behavior. Furthermore, individuals from mixed racial ethnicities face unique systemic and institutional barriers that may negatively affect their access to mental health services.
How Membership in an Oppressed Group Might Contribute to or Exacerbate the Problem
In Thelma’s situation, she was experiencing mental health issues common to the Hispanic community. One of the characteristics she went through involved long-term treatment. In her case, she was recommended for long-term psychotherapy, which is a common treatment among her community. Additionally, she was silent about her condition, which was a contributing factor to mental disorders among the Latino community. The primary reason she was quiet about her condition was that she desperately needed her mother’s and twin sister’s affection. Her twin sister and mother knew that she craved their love and used it against her. They never considered what effect their action could do on Thelma. Despite all this, Thelma had a stable income, which she used to support herself and her family.
Family Issues and/or Stressful/Traumatic/Developmental Experiences Have Contributed to the Client’s Current Problem
One of the traumatic experiences that contributed to Thelma’s situation was the lack of a father figure. According to research, children who grow up without a father figure are more likely to be depressed compared to those who grow up with father figures (Otte et al., 2016). Additionally, children who suffer from sexual abuse from their caregivers generally have gender identity issues and lack self-esteem (Davenport, 2016). In Thelma’s case, she did not know her father, and she suspected that her stepfather sexually abused her. The other factor that contributed to her mental state was the relationship between her twin sister and the mother. Research states that manipulative behaviors from close relatives negatively impact the development of a child, especially when it comes to forming external relationships (Dir et al., 2013). For instance, Thelma was unable to form outside relationships and was mostly indoors. The reason was that she did not trust anyone because her closest relatives, the mother and the twin sister, manipulated her when they needed financial support.
Psychiatric Diagnosis According to DSM-5
According to the fifth edition of the Diagnostic and Statistical Manual (DSM-5) of Mental Disorders, Ms. Thelma meets the criteria for major depressive disorder (Roehr, 2013). The reason for this is because the client experiences persistent feelings of hopelessness, sadness and has no interest in a lot of activities. According to the DSM-5 criterion, a person must experience at least five signs within a period of two weeks (Hasin et al., 2018). In addition to this, among the five symptoms, at least one must be loss of pleasure or interest or depressed mood. Other symptoms include weight gain or loss due to increased appetite. According to the case study, Thelma used engaged herself in binge eating. Furthermore, reduced physical movements and when an individual experiences slow thinking are other symptoms of major depressive disorder. Fatigue and inappropriate guilt or feelings of worthlessness also demonstrate that an individual may be suffering from a major depressive disorder.
Thelma’s Strengths
Despite suffering from a mental disorder, Thelma had some positive attributes (strengths). In a family that seemed dysfunctional, she was the common factor that united a part of their family. One of the strengths she had is that she cared for her sister. She stated that her sister described being molested by her two brothers. For this reason, her twin sister was engaged in drug abuse and had little money to support her habit. Despite Thelma feeling manipulated by her sister, she still provided financial support to her twin sister. Similarly, her mother manipulated her into giving her money, which she provided. The other strength that Thelma had was the courage to enroll herself in therapy. The first step to recovery is accepting that an individual has a problem. As a result, Thelma went into psychotherapy treatment, and despite the process taking a long time, it helped her address her disorder.
Thelma’s Treatment Goals
To ensure that a psychotherapy session is successful, a client must have specific and measurable goals. In this case, the client’s goal involves improving social or family relationships. Thelma’s family was one of the contributing factors to her mental disorder. Ensuring that the family members are supportive and provide everything that Thelma needs in her psychotherapy treatment would help improve her situation. A psychotherapist would know whether the client’s goal has been achieved by observing the relationship between Thelma and her family members. The other treatment goal for Thelma involves increasing positive health behaviors after her psychotherapy. One of the unhealthy behaviors that Thelma had was binge eating. Through psychotherapy, Thelma could learn ways to avoid distractive search habits. A psychotherapist could identify whether the session provided positive outcomes when Thelma stops binge eating.
Interpersonal Interaction
Successful therapy sessions depend on an individual being honest when sharing their behavior and experiences. Through such elements as the client’s body language and their interaction with the therapist, a specialist can identify how the client relates with other people. In this situation, Thelma was not reluctant when it came to seeking treatment. She pursued treatment because she wanted to and not on behalf of another person. From this type of relationship, one can perceive Thelma as confident, especially around her family members. Thelma was most anxious, which could have affected her therapy session. From this, a therapist might establish that she was antisocial. For instance, the client was mostly indoors and was unable to form new relationships outside her family. Furthermore, the client should sign of trauma, which made it hard for her to trust others.
Engagement
Role of the Holding Environment
The therapeutic holding environment concept was created during the 20th century by Donald Winnicott. From Winnicott’s perspective, the holding environment is based on the relationship between the mother and the child. A loving mother must provide emotional and physical support based on the child’s needs (Warren, 2017). Therefore, psychotherapists must create a holding environment suitable for their psychotherapy clients. Currently, numerous psychotherapists utilize the holding environment because it offers crucial tools during the therapy session. In Thelma’s case, the holding environment is especially important because it provides an empathetic and compassionate surrounding. These attributes were lacking from her mother and from other family members. The holding environment means that the client receives help from a consistent and reliable therapist. By maintaining these attributes, the therapist remains consistent, meaning that the caseworker will be able to maintain boundaries that are appropriate with Thelma. Since the client comes from an erratic and abusive family, these characteristics of a holding environment may be advantageous to her.
Cognitive Behavioral Therapy
Uncovering Automatic Thoughts
The first cognitive intervention that may be used to help the client achieve her goals involves looking at her negative thought pattern. The intervention is found under the cognitive reframing or restructuring theory. The intervention helps the client in managing her thought patterns. Thelma had difficulties establishing relationships with other people because she did not trust them. What can explain this behavioral condition is that the client generally assumed the worst would occur. Consequently, her thought patterns affect what she did because she mainly stayed indoors. The intervention allows a therapist to ask a client about her thought process in particular circumstances to determine negative patterns. In Thelma’s case, the caseworker can decide to question her about what she feels when around other people. These will help the therapist identify negative patterns, which the caseworker would utilize to reframe or restructure her thought patterns.
Thelma also is unable to create sexual relationships and has never been engaged in consensual sexual behavior. The reason for this is that Thelma was sexually abused by her brothers, and since then, she has developed negative thoughts when it comes to sexual relationships. Through the negative thought intervention method of cognitive-behavior intervention, a therapist is able to identify such negative thoughts. By identifying these negative patterns, the therapist may restructure her thoughts. By doing so, Thelma will be able to achieve her goal of forming relationships with others. Additionally, she would be able to think positively concerning others, thereby improving her association with others. She would be able to make more friends, thereby improving her general health and wellbeing.
Thought Recording and Journaling
The other cognitive behavior therapy involves thought and journaling records. One of the mental disorders Thelma had was binge eating. Furthermore, when Thelma could not control her thoughts, she engaged in self-mutilating behaviors. One of her goals was to stop unhealthy, destructive behaviors. To ensure that a client achieves such a goal, a therapist can encourage them to journal and record their thoughts (Gibbons et al., 2019). According to research, the intervention method helps a client get in touch with their thoughts. A therapy session utilizing this form of intervention also involves asking questions. The therapist may ask the client to identify both negative and positive thoughts that she experiences in the course of the therapy. The therapy session involves the client identifying the thoughts that led to the self-manipulative behavior. In Thelma’s case, it may have been thoughts associated with self-esteem and the manipulative behavior from the mother and the twin sister. Writing them down would help her identify new thoughts, thereby leading to positive outcomes from the psychotherapy process.
Thelma further experiences episodes of depression, which result from her relationship with her family members. According to research, abusive behaviors from family members negatively impact a child’s psychological and mental development (Roxburgh, 2009). In Thelma’s situation, she felt that, at times, she was being misunderstood. The result of this behavior is that Thelma wanted to commit suicide most of the time. Journaling as a therapeutic intervention offers a means of self-expression to the client. Some of the health advantages that this technique has been that it helps manage depression, anxiety and reduces stress. Furthermore, the client experiences mood fluctuations resulting from stress. Through journaling, she would be able to prioritize concerns, fears, and problems. Since the client is writing her thoughts every day, she would be able to recognize what triggers her situation and find better ways to control them.
Professional Use of Self
Countertransference
Several factors may influence the development and maintenance of a therapeutic relationship between a therapist and a client. One of these factors is countertransference, which occurs when a therapist transfers emotions to a client. Psychologists who experience this phenomenon may find it challenging to correct behavior in clients (Davenport, 2016). Problematic countertransference stems from situations where the doctor transfers personal issues to the client. However, countertransference may be used to the advantage of the client, especially one who finds it challenging to share information with the psychologist. In this case, the doctor may decide to direct the conversation and offer additional prompts to the individual to improve the discussion process. Countertransference further occurs when a client has specific beliefs and special preferences that differ from that of a psychologist. For instance, a client may have different views concerning the sexual orientation of others or might have different racial views. To correct this behavior, a psychologist can establish the origin of such views and discuss them with the client.
Personal Bias
The other element that influences the development and maintenance of a therapeutic relationship between a therapist and a client is personal bias. In psychology, personal bias is defined as an idea, emotion, attitude, or perception that limits a psychologist’s ability to associate with their clients (Kinavey & Cool, 2019). These emotions may further cause a psychologist to develop tendencies that marginalize elements of a client’s experiences. If personal bias is not corrected, it can negatively affect an individual by replicating the bias and stigma the client faces in society. Additionally, if personal bias is not changed, it may trigger internalized oppression, thereby resulting in the sense of self-damage. Personal bias can further be used to study both the client and the psychologist. The result could be used to transform, deepen and enlighten the relationship and connection between the therapist and the client.
How I Modified My Practice
In some way, I needed to adjust my practice because I realized that there are some methods I utilized that did not produce a result. For instance, in some situations, I experienced countertransference in my therapy sessions. I would transfer emotions to the client without knowing it could harm a client. Therefore, in the future, I will attempt to ensure that I change my methods to ensure that the sessions achieve positive results. Secondly, I believe that I have had instances of personal bias, especially when dealing with a client who had racist views. Initially, I would ignore this issue and continue with the main therapy session. To change this method, my therapy sessions would involve interviewing the client to establish the origin of such racist views.
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