Florida Gulf Coast University Therapy Responses Discussion

Contribute to the conversation by asking questions, respectfully debating positions, or presenting supporting information

FIRST DISCUSSION

1. Interpersonal psychotherapy is completed in a three-phase process. Phase one is the initial process, during which a patient or client is assessed and their presenting condition is analyzed. This is followed by phase two, the middle phase, during which a therapist will facilitate interpersonal work and help build relational skills, process grief, or assist in cohesive role transition depending upon the circumstances of the client. Lastly, in phase three, also called the termination phase, the therapist and client work to create a plan for transition out of therapy. Interpersonal therapy uses pieces of Adlerian, Rogerian, existential, and cognitive therapies to assist daily with depressive states but has been tested for other mental health conditions, such as bipolar disorder.

In the textbook, “Current Psychotherapies,” we read about a case study and interpersonal therapy example. In the example, Paul’s therapist began his therapy with the initial phase, during which they conducted an assessment of his current depressive symptoms (Wedding, 2019). This, in combination with educating Paul about the reality of how depression works, was an effective and accurate use of the therapy model.

Next, the therapist’s role in the middle phase of interpersonal therapy treatment is to establish and build skills to relieve and decrease depressive symptoms. In Paul’s case, his therapist acted as a support system to check and balance Paul’s depressive mindset in order to facilitate growth toward lessened depression. Paul’s therapist engaged him in skill-building to reduce tension with his father, to show Paul that he could make progress towards building a purposeful life and to connect with friends as a support system (Wedding, 2019). This phase of treatment saw ups and downs in Paul’s progress but the therapist continued to remind Paul of his accomplishments and kept him on track with therapy.

Lastly, Paul entered the termination phase and was able to create a plan for after therapy. Paul’s therapist reminded him once again of his progress and their plan to keep him on a progressive path towards the goals of a career and a better relationship with his father. During the termination phase, the therapist followed the interpersonal therapy model and gave Paul another assessment to verify a reduction in depression symptoms over the course of the therapy process. It was with the support of the therapist as a partner in his healing and his own continued efforts that helped Paul reduce his depression.

SECOND DISCUSSION POST

2. “No element within the system can ever be understood in isolation because elements never function separately,” (Wedding & Corsini, 2019, p.392) is a succinct but important statement in regards to understanding the nature of family therapy. There is no island in any dynamic grouping of people functioning as a system. This is compounded by multiple generations, beliefs, boundaries, personality traits, etc. A family crisis may indicate an identified patient, but dysfunction causality is not always so simple. At times, maladaptive solutions mean more problems (Wedding & Corsini, 2019). When therapy is a preventive measure, it can avoid the dysregulatory solutions being implemented in the first place. Unfortunately, it is often a resource only considered at a crisis point.

Michelle and Frank sought family therapy because their soon-to-be stepchildren were not aligning with their “instant family”, and do not get along. Michelle and Frank are also not without their own personal issues; Michelle fears abandonment, is insecure, and her daughter has joined a gang. Frank’s 12-year-old son has regressed to bed wetting, and Frank himself is faced with being compared to other men who have abandoned Michelle. It is much more than a simple issue of step-children not cooperating for family photos. These concerns have become a constellation of interconnecting issues within the family structure, potentially causing all of them harm. The therapist was able to subdivide the family for treatment, giving Frank and Michelle counseling as a parental unit, Ann individual counseling as a chance to relieve her from her assumed role of raising her little brother, and the family counseling as a whole. This allowed for isolation of issues as well as a feeling of “we are in this together”. It was not target practice; there was no blaming of some singular cause or person within the family. Everyone’s acknowledgement of their role in the family became acknowledged as well as the ways they could actively improve the experience of it. Discussed as a locus of pathology, Wedding and Corsini (2019) describe the patterns of the family as the real cause of the system break down. This therapist was likely using Structural Family Therapy techniques with Michelle and Frank’s case because the unmet/unresolved needs of the family structure were manifesting in different ways that created a sense of general chaos (i.e. joining a tagging gang, bed wetting). By creating subgroups of family members and then bringing them all together, Structural Family Therapy helps each individual understand one another (McAdams, et al., 2016).

The therapist in the Adolescent Family Therapy video was likely using the Structural Family Therapy, because Becky pointed out the paradoxical interventions of Yvette whose attempts to help were contributing to the problem. “I have seen on occasions that I have done too much for them,”(Sasson Edgette, 2002, 34:03) is a comment Yvette made in acknowledgement of her well-intended actions really being a hindrance. The therapist provided a lot of insight to help the family see how their individual behaviors were being received by the other members of the family, and how they could each make changes that would be to the advantage of the whole family system. This shines a light on the problematic patterns that become the routine and helps to facilitate change.

For the next 4 discussions, Critique the strengths and weaknesses of their comments on the cultural or ethnic diagnostic controversy. What additions or deletions would make their handout more effective, and why?

THIRD DISCUSSION POST

• If you were working in the emergency room of a hospital, how would you distinguish between three individuals, one of whom presents with schizophrenia, another with a schizoaffective disorder, and the third with a brief psychotic disorder?

To distinguish between someone with schizophrenia and schizoaffective disorder, I would want to determine if the patient was experiencing any depressive or manic symptoms and how long their active symptoms have been present. If the patient is not experiencing symptoms of a depressive or manic episode, and their active symptoms are not lasting for the majority of the duration of their disorder, they would be presenting with Schizophrenia. If the patient is experiencing a manic or depressive disorder, with their symptoms lasting the majority of active periods, they would be presenting with Schizoaffective Disorder. The third patient who is presenting with a psychotic disorder would not have been experiencing their symptoms for the same amount of time as Schizophrenia, where symptoms are present for at least one day but no longer than one month.

• What is the basic ICD-10 code (the number) for each of these diagnoses?

Diagnosis (APA, 2013)

295.90 (F20.9) Schizophrenia

295.70 (F25.0) Schizoaffective Disorder, Bipolar type

295.70 (F25.1) Schizoaffective Disorder, Depressive type

298.8 (F23) Brief Psychotic Disorder

• Create a brief PowerPoint presentation you could provide to families that explains the prognosis for two of these disorders and any treatment issues of which the family needs to be aware. Remember that, when using PowerPoint, the slide should present headlines, rather than paragraphs. The idea is that you would walk through the slides with the family, filling in the details as you speak. The Notes section should be used to store your details. Upload your PowerPoint presentation as an attachment to this discussion.
• Identify, analyze, and discuss both sides of one current controversy related to cultural and ethnic issues in the diagnosis of schizophrenia.

As stated in the DSM-5 some cultural factors regarding “visual or auditory hallucination with a religious content” can be considered “ a normal part of religious experience” (APA, 2013). With a client or patient who is experiencing signs of schizophrenia, they may not think anything of their hallucinations or delusions because they believe it is part of their religious experience in their life. This can be difficult as the client or patient does not see anything wrong with them and will most likely refuse treatment as this would make those religious experiences disappear. On another end, being a Christian, if I were to have auditory or visual hallucinations advising me to do things in the name of Christ, I would have a hard time wrestling with what to do. Being a Christian, I would want to follow the word of God that I was told, yet with knowledge of psychology and psychological disorders, I would have trouble following through. I would wrestle with following what I was told or going to see a therapist for the condition that I know is present.

FOURTH DISCUSSION

1. If you were working in the emergency room of a hospital how would you distinguish between these three individuals: one of whom presents with schizophrenia, another with a schizoaffective disorder, and the third with a brief psychotic disorder?

According to the DSM 5, the diagnostic criteria for schizophrenia includes symptoms for at lest six months and difficulty in one or more of the functional groups (APA, 2013). Schizoaffective Disorder can be diagnosed by noting if the disorder has been present for at least seven days with expansive moods, hallucinations, or delusions (APA, 2013). A brief psychotic episode can be diagnosed by will express a short period of delusions, hallucinations, and disorganized speech. They will usually have a shorter period of the episode and a quick recovery time. All three of these disorders present similar and have similar specifiers, but the difference from interpreting the different disorders is time. The time in which the person is affected by the episodes is the key to distinguishing these patients in an emergency room.

2. What is the basic ICD-10 code (the number) for each of these diagnoses?

Diagnosis (APA, 2013)

295.90 Schizophrenia

(F20.9)

259.70 Schizoaffective Disorder

(F25.0 or F25.1) Bipolar Type or Depressive Type

298.8 Brief Psychotic Episode (with marked stressor, without marked stressors, with postpartum onset)

(F23)

Each of the diagnosis has different specifiers. The diagnosis of schizophrenia, schizoaffective disorder, and a brief psychotic episode can have an additional diagnosis attached of with Catatonia.

The additional diagnosis is 289.89 (F06.1) (APA, 2013).

3. Attach / upload the PowerPoint presentation that is consistent with the directions and tips found in the Unit 7 Announcement.

4. Identify, analyze, and discuss both sides of one current controversy related to cultural and ethnic issues in the diagnosis of schizophrenia.

Being diagnosed with any type of psychotic disorder has always been a stigmatism by any culture. Most people are under the impression that if you are diagnosed with Schizophrenia that your are diseased and should be avoided at all cost. The biggest problem with the diagnosis of a disorder such as schizophrenia is that it is not being diagnosed throughout the entire world as an equally ethnic diagnosis. People of Hispanic or African decent have noticeably been diagnosed less than Euro-white people. This problem is causing an uneven number of diagnosis and making it hard for psychologists and psychiatrists to treat the disorder from a multicultural aspect. Multicultural diagnosis is what should be done across the world, but another problem is seen amongst cultures. Some cultural religious practices see diagnosis of a mental disorder as a threat to their way of life. Religious restrictions cause many people who would normally be diagnosed and treated to fall through the cracks and suffer. Religious treatment of mental health disorders in some cultures is seen to be cause by the devil and the person suffering from the disorder is seen to be possessed. Religious and cultural restraints will be a problem for proper diagnosis and treatment of mental health disorders until the end of humanity.

FOR THE NEXT 2 POSTS- In each case, begin by explaining the extent to which you agree, or disagree with your peer’s conclusions, providing your reasons. Then describe what you think might be determined by a further diagnostic evaluation.

FIFTH DISCUSSION

My original diagnostic of Ben from part 1 was the following:

780.09 (R41.0) Unspecified Delirium
294.11 (F02.81) Major Neurocognitive Disorder due to traumatic brain injury
907.0 Late effect of intracranial injury without skull fracture
or 799.59 (R41.9) Unspecified Neurocognitive disorder
Imagining that I had not seen Part 2 of the case study and moving directly from Part 1 into Part 3, there shows a need for change within the diagnostic. There was a similar incident that Ben had gone through in college with symptoms lasting about 8 months, according to the wife. During the episode in college, Ben attacked his roommate over a false belief. Ben ended up being put on medication prescribed by a psychiatrist at the time, but we are unsure as to what type of medications they were. An additional piece of information that we learn is that Ben had an uncle who had been placed in a psychiatric facility for 14 years until his death, there were no further details of this uncle. Ben also had an issue with his previous boss due to a false belief that his boss had copied his work since both of their articles started with the same letter. Recently Cindy, Ben’s wife, has discovered some articles that Ben has written, that would be described as irrational. The car accident that Ben was in proved to have not caused any traumatic brain injury.

Describe your new diagnostic hypotheses, and justify your conclusions.
?295.90 (F20.9) Schizophrenia, Multiple episodes, currently in an acute episode, with catatonia
?Other Factors: ?V61.10 (Z63.0) Relationship Distress with Spouse ?V62.29 (Z56.9) Other Problems related to Employment

Ben has experienced delusions as well as anger in regards to his roommate in college, then delusions and irritability with his boss with the articles, he has disorganized speech (including that of irrational writings within his articles), negative symptoms, a decrease in his level of functioning, and continuous signs of disturbance (American Psychiatric Association, 2013). Ben’s uncle was in a psychiatric facility “for the case of the nerves” for 14 years until he passed away. Schizophrenia does have genetic factors, although we are not sure what Ben’s uncle suffered from, if he suffered from schizophrenia then it is possible it passed down to Ben “Schizophrenia (SZ) is a highly heritable and common disorder, with a population lifetime prevalence of 0.4-0.8%” (Mitchell, K. J., & Porteous, D. J., 2011).

What further diagnostic evaluation do you believe is warranted?

Ben needs to be further evaluated by a psychiatrist to gain the correct therapy and psychiatric medications that may be needed. We would need to find out what type of medication Ben was on when he was in college, as well as find out the medical history of Ben’s uncle, and any other possible mental health history that runs in Ben’s family.

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SIXTH DISCUSSION

1. Describe how the new information alters the picture presented in the original case study.

Initially, I had thought that Ben had been suffering from PTSD and possibly a neurocognitive disorder. Now after reading this part of the case study and finding that there were no lasting effects from the accident and the fact that Ben has had episodes like this in the past has changed my entire perspective of a diagnosis of Ben.

1. Describe your new diagnostic hypotheses and justify your conclusions.

It is possible that since Ben has had this sort of episode in the past with delusions that Ben could be either suffering from a Brief Psychotic Episode, but reoccurring or maybe a better explanation could be Schizoaffective Disorder. It seems that Ben does recover from these episodes and they do not happen all the time, but they have happened more than once. As far as I read, there was no mention of auditory hallucinations, but I am finding myself leaning towards a psychotic episode disorder. at this point I would definitely rule out Schizophrenia, but not other psychotic disorders. Ben does not meet the criteria at this point for Schizophrenia or the full criteria for the Delusion Disorder.

What further diagnostic evaluation do you believe is warranted?

At this point, further evaluation of what happened during each episode would be ideal. Also, more details of what happened just before the episode happened. Multiple interviews with multiple people other than Ben’s family would be optimal. Would need to have Ben’s sign a waiver allowing us to talk with any of his family and friends. More visits to the clinic and a complete evaluation of his mental capacity would help. I would suggest finding out what medication he is taking and if at any point he stopped taking it. That may help to figure out why he had a reoccurring episode. Finally, I would try to rule out any diagnosis that would not help Ben during his recovery process.