Treated Client Suffering from Anxiety - Essay Example

? Case Report on Treated Client Suffering From Anxiety Biographical Information The client was born twenty years ago in the city of New York to a middle income family but during his childhood, the parents ended up separating and eventually divorced when he was seven. This separation coincided with a time when the family was experiencing financial difficulty since the family’s grocery business ended up suffering losses because of neglect after the client’s father abandoned it. The family had to move to a poorer neighbourhood but despite this, the client’s mother ensured that the client and her younger sister lacked for nothing and that they went to school, unlike other children in the same neighbourhood. This ensured that while she was growing up, she and her sister did not share the same attitude towards education that other children her age and older in the neighbourhood felt. Instead, she grew up with a great admiration for education, something that would eventually guide her towards the path of becoming among the best students at her school. All of these, however, changed when after she turned thirteen her mother passed away leaving the two girls under the guardianship of their father. The client’s father was exceedingly incompetent and tended not to take his responsibilities seriously and this was in contrast with their mother, who had not been afraid of taking up responsibility, no matter how hard they seemed to be at first. The standard of life for the client’s family continued to deteriorate as her father completely neglected his daughters, sometimes to the extent that they had to fend for themselves in order to survive. Referral Information and Presenting Problems The client was referred to my practise by the New York juvenile court because she was in dire need of help because of her issues with anxiety, a condition which has plagued her since she lost her mother in her early teenage. I evaluated her court records and found that the client’s criminal activities started soon after her fourteenth year and they have been getting worse ever since despite action being taken to make her stop her vices and these not only included having her tried as a juvenile, but also as an adult and her serving jail time. The rationale for her being taken through juvenile court system after several offenses at age fourteen was that she was below the legal age and was considered to be immature, and not responsible for her actions. This system was meant to give the client a warning not to repeat the crime for which she had been sentenced and was a chance for her to mend her ways and make things right. I realised this was not the case when she had to be tried as an adult because despite being released, the client continued to commit further crimes, to the extent of stabbing another girl because of some minor disagreement. This was seen as a serious enough crime to warrant her being tried as an adult because in an adult court the opportunities present for a second chance are rarely ever available. In adult courts, the juvenile offender can be subject to extremely severe sentences for their crimes, and these may include life sentences, which are often without any consideration for the possibility that this child might change. Over the years, I have seen cases similar to that of the client whereby if juvenile offenders are sentenced in adult courts and instead of rejuvenating they tend to harm the young criminals. Background Information Because of her extreme cases of anxiety about their future the client opted to seek refuge and consolation from drug abuse such as alcohol, and later cocaine and heroin, and since the latter drugs are expensive, she ended up getting involved in more crime that she previously had been. Among the criminal activities that she began to engage in was prostitution and theft to finance the addictive lifestyle that had come to dominate her and her way of thinking. Because of her addictions, which came to affect her mental health severely, she came to display some psychotic symptoms, such as hallucinating, which have continued into her adult life. The client stated that an incident in which she experienced the worst psychotic episode was when she imagined that an alien creature had buried an egg into the skin on her left arm and that the creature’s offspring was feeding off her. As a consequence, the psychotic symptoms coupled with her anxiety, made her attempt to relieve the constant itch in her arm that her delusions created. She took a knife and tried cutting out the said parasite and this resulted in so much loss of blood that it is a miracle that she is still alive today. However, there is still a long scar on her arm where her delusions led her to cut herself and this has led her into displaying characteristics such as extremely low self-esteem, and mood swings that I diagnosed as symptoms of anxiety. While the client seems to have stopped the use of drugs and other substances with continuing care in support groups, she still has an extremely difficult time dealing with anger and frustration, which she previously avoided through her use of the mentioned substances, and this, has led to her continued bouts of anxiety. The academic background of the client prior to her mother’s death seems to have been above average since she reports always had good grades. All this seems to have changed soon after her mother’s death because she ended up losing an interest in her education because of the negligence displayed by her father towards her welfare. Assessment Instruments/Procedures When assessing the client, I chose to use questionnaires in order to determine whether she did indeed display the symptoms of anxiety. The questionnaires involved open-ended questions both written and oral so that the client could give as much information as possible. Moreover, employed close conversational like interview procedures in order to unearth relevant information about their backgrounds that could assist in making conclusive assessments. When I was examining the client, who as has been stated suffered from anxiety, I made sure to rule out other psychological conditions by conducting an interview. In addition, wit was important that when diagnosing the clients’ anxiety also induced by the use or abuse of drugs substances that I use DSM-IV, since as a psychologist I had to determine whether there was a relationship between the use and abuse of the substance and the psychological symptoms presented by the client. In addition, I had to consider whether the likelihood that the particular pattern of the substance use or abuse can result into psychological symptoms that could be observed and whether or not there was a better alternative explanation to it.  Assessment Outcomes As a result of the client spending time in an adult prison they experienced stigma because instead of being taught how to re-establish herself in society once she left prison, she ended up being exposed to worse crime and this may have played a role in the development of her anxiety about future. Due to her father’s negligence as well as her constant anxiety about their future, this may have led to her involvement in crime and drug abuse due to their feeling of desperateness and helplessness. Her constant anxiety concerning her living conditions may have also led to her dropping out of school in the ninth grade and showed no further interest in school afterwards, concentrating instead in satisfying her addictions. While this may have been the case then, after several sessions with me, I convinced her that the best way to improve her life was to complete her education so that she could regain her self esteem. Because of this, the client is determined to compensate for her lost time in school through getting a GED and soon after attend a community college in a bid to gain a degree; however, she has yet to decide on what she would like to do in college. Counsellors’ Conceptualization of the Presenting Problem As has been stated above, the client suffers from anxiety which makes her experience extreme transformations in mood and has some of the psychotic symptoms which are related to this disorder such as hallucinations. The psychotic symptoms displayed by the client are often reflected when she is unable to differentiate between what is real from what is imagined, and the occurrences of these symptoms seem to vary (Andreasen et al, 2005). While the symptoms may be mild for in certain circumstances, they can manifest themselves very severely in some occasions. The cases of anxiety that the client experiences are always accompanied by various characteristics such as loss of appetite and this tends to result in her loss of weight. Furthermore, the client’s anxiety have come to affect her sleeping patterns so that she may either end up sleeping too much or too little, depending on her situation. The anxiety, that the client experience is always accompanied by excessive restlessness as well as a lack of energy in the body. The client ends up experiencing a lack of interest in those activities, which she was very active in and there are times when she may have feelings of being worthless or hopeless and this ends up bringing about a sense of guilt or self-blame. Anxiety may also bring about the client’s inability to think coherently or to concentrate, and the client states that she has at times been tempted to commit suicide to end it all, in the belief that all of her problems are too much for her to bear (Gwynn, McQuistion, McVeigh, Garg, Frieden & Thorpe, 2008). In my assessment of the client, I found out that the anxiety the client experienced was often accompanied by obsession which results in the increase in a diverse number of activities in the client, and these include social and sexual activities. This situation also results in the increased talking of the client and this is because of the rapid and racing thoughts, which are symptoms of anxiety. I found that because of this, the client often ended up having little need for sleep and may in fact prefer staying up late trying to do other activities and there are also times when she might also be very agitated about nothing important in particular. Furthermore, there is a chance that her anxiety might be the reason why the client has low self-esteem which brings about very destructive behaviour such as having unsafe sex, having spending sprees, as well as driving recklessly. As has been previously stated, the client has experienced delusions; this is where she has come to have very strange beliefs, which have no real basis in reality, and there are occasions where she has held onto these beliefs even when presented with evidence on the contrary, as was the case when she was using drugs. Hallucinations also came to affect the client and this happened when she perceived sensations, which were not real, such as hearing voices in addition to having experiences of disorganized thinking, as well as displaying behaviour which many would find to be odd or unusual. I noticed that there were instances where the client would be slow in movement or be immobile and this was sometimes accompanied by a lack of emotional display in either her face or speech. There were also instances when the client had poor motivation and this result in her having problems with speech or with communication (Davis, Saeed & Antonacci, 2008). Intervention Plan and Recommendations The specific type of treatment that was to be administered on the client depended on various factors and these included; how severe the symptoms are as well as the symptoms of anxiety that were displayed by her. In addition, it is often advisable for the individuals who have been affected by anxiety to undergo a rigorous psychological treatment, and counselling to enable them to cope with their lives as well as to realize that they have a problem (Moritz et al, 2011). There were several treatment choices for the client’s anxiety, but the most effective to tackle in the case of the client was through psychological and counselling intervention in order to rectify the mental state of the client. The best intervention procedure was for the client to arrange CBT-cognitive behavioural therapy sessions because this is the best way through which she could be assisted to deal with her anxiety. Moreover, she could significantly benefit especially when the symptoms of anxiety have been going on for longer than usual. Thus, I recommend 3-7 sessions of counselling to the client because such intervention would greatly help them in ensuring that they were able to have a life of relative normalcy. The first step that the client had to take was to organise and plan counselling and therapy sessions that are appropriate for her so that an accurate diagnosis of her condition could be made. This required that she be given a complete psychological examination to determine whether she indeed suffers from extreme anxiety, and if this is the case, what type of anxiety from which she is suffering. However, I had to be careful concerning the client’s therapy sessions, as I came to realise that certain approaches may have undesired effects on the client. Intervention Procedures First Session; From my interview and assessment, it was my observation that general mood of the client was overly optimistic and forgiving of the contribution of others to her difficulties, especially those who abused herm such as her father. She credited her ability to forgive her abusers to her belief that all evil will be punished and that eventually, they will end up receiving divine punishment, as she can do nothing about it. The client was quite open concerning her past experiences of drug abuse as well as the traumatic experiences she encountered as a result, and this openness was quite worrying because it was delivered in a most casual manner, as if she did not care that these events had taken place in her life. Second Session; On the second session, we had a discussion concerning her expectations and goals for therapy and her talking about her concerns led to a realization that she has extremely low self-esteem. While framing of her therapy according to her needs, I aimed at achieving the goal of improving her current functioning and increasing her positive self-assessment and the intended result of this move was to ensure that she regained her self-esteem which would be most helpful during the subsequent sessions. During the selection of those strategies that would be used in her therapy and would help in the achievement of the intended goals, I decided that although her historical addictions and relapse prevention would be important in the treatment plan, there would be a focus on the client’s interpersonal difficulties with historical assessment. The short-term objectives of the treatment strategies that I selected are aimed at increasing the client’s self-esteem, deal with her cases of anxiety more effectively, and to help improve her relationship with her son. Third Session; It was my intention the CBT and counselling plan for the client be finalized in the third session and this would serve as a basis upon which further sessions in the future, if needed, would be conducted. However, during this session, the client unexpectedly came in with her father, and this led to a session of enabled mirroring and framing their interactive prospects for the client. Therefore, if her father simply asked for her forgiveness, then this would not lead to her gaining her self-esteem nor would it lead to a reduction in anxiety or initiate a satisfying father-daughter relationship. Fourth Session; From the interview and questionnaire session during this session, I came to discover that along with childhood neglect through the use of alcohol that was made available by her irresponsible father, she was verbally and physically abused him. The father started doing this soon after he took responsibility for the client and her sister soon when their mother passed away. As the older of the children, she believes that it made a difference in how her father treated her and this led her to have a feeling of not being completely accepted by her father, and even questioning whether her father had wanted her as a child. In addition to this, her father was an alcoholic and aside from her very early exposure to alcohol, the client’s father created a situation or environment where it seemed fine for the children to take alcohol alongside him and this is perhaps the reason for her own teenage and adult alcohol use. Through her description of this state of her upbringing, I was able to make a connection between the genetic and environmental influences on her dependence on alcohol as well as her need to do anything to have a drink, including getting involved in theft (Lichtenstein et al, 2009). u Fifth Session; In this session, I found out that the client seemed to had an inaccurate opinion that, outside of her abuse of alcohol, she did not have any behavioural health problems. I believe that her anxiety came to the fore when she became pregnant at the age of fifteen by a man who was much older and had a family of his own, and as a result, she had the responsibility of raising a son on her own since the man disappeared soon after learning that she was pregnant. Because of her failure to connect with her father, who is the only parent she has left, it seems that the same is also her current situation with her son, as her anxiety seems to be influencing their relationship. Sixth Session; During our session, the client revealed to me that because of her extensive abuse of substances, she was a victim of numerous episodes of rape when she was in drug induced hazes and she states that it was a miracle that she never contracted any sexually transmitted infections nor did she become pregnant. Furthermore, I found out that while she could not recall most the details of her numerous encounters with law enforcement, she does remember that on certain occasions, it was some police officers who were the perpetrators whenever she was raped and this has worked towards her developing mistrust for all male police law enforcement officers. In addition to her drug addiction, she also reports that she indulged in gambling especially when she was high on one of the substances that she abused. She gambled with the assumption that she would be able to have more money for drugs whenever she won, a situation which never happened. I find that while this may have been the case then, it seems that since she stopped abusing drugs and alcohol, she has not indulged in any gambling, a situation which is highly complementary with her recovery. Evaluation of Intervention Outcomes This therapy was very important and helpful because it worked effectively iin helping the client to begin living a normal life once again. The client was able to relate freely and constructively with the other members of the society and especially his family members of whom there before the therapy and counselling had a cold relationship with her. Moreover, the court upon evaluating her conduct for about 3 months withdrew their criminal charges on the account that she had reformed tremendously and could live harmoniously with the other members of the society. The entire procedure required an immense amount of endurance, by both the client and me because without this endurance, the treatment would have been a failure. In addition, the endurance was necessary because there were times when I needed to try out different approaches in order to find one that perfectly suited the needs of the client (Jobe and Harrow, 2005). However, when choosing the client’s therapy approach, there was a need to consider her age, medical conditions, as well as the way through which she was likely to respond to the different approaches I tried out. As a consequence, the therapy sessions that we conducted was a success and the client has not only made peace with her father and is dealing with the resentment she had for her little sister, but she has also started a new relationship with her son with the hope that he will not have to undergo what she did. Overview and Further Recommendations In conclusion, it can be said that anxiety is an extremely serious condition, which should be dealt with as soon as its symptoms are noticed. This condition should be handled with a complete understanding by all the people who are affected by it, or are in any way involved in it, so that it can be batter managed. Psychologists, who handle patients suffering from anxiety, should be given the necessary training on how to handle these patients so that their therapy sessions can proceed more effectively. Many individuals have this condition but since there is remarkably little public knowledge about it, very few people even know that they have it. To prevent this ignorance in the public from going on, initiatives should be put in place, to ensure that the public is made aware of the existence of this condition as well as the various ways that are available for its treatment. This will not only create a greater understanding of the condition, but it will also make people more aware of it, and if individuals happen to notice the symptoms in themselves, they may seek immediate treatment. References Andreasen, N. C., Carpenter,William T.,,Jr, Kane, J. M., Lasser, R. A., & al, e. (2005). Remission in schizophrenia: Proposed criteria and rationale for consensus. The American Journal of Psychiatry, 162(3), 441-9. Davis, E., Saeed, S. A., & Antonacci, D. J. (2008). Anxiety disorders in persons with developmental disabilities: Empirically informed diagnosis and treatment. Psychiatric Quarterly, 79(3), 249-63. Gwynn, R. C., McQuistion, H. L., McVeigh, K. H., Garg, R. K., Frieden, T. R., & Thorpe, L. E. (2008). Prevalence, diagnosis, and treatment of depression and generalized anxiety disorder in a diverse urban community. Psychiatric Services, 59(6), 641-7.  Jobe, T. H., & Harrow, M. (2005). Long-term outcome of patients with schizophrenia: A review. Canadian Journal of Psychiatry, 50(14), 892-900.  Lichtenstein, P., Yip, B. H., BjA¶rk, C., Pawitan, Y., Cannon, T. D., Sullivan, P. F., & Hultman, C. M. (2009). Common genetic determinants of schizophrenia and bipolar disorder in Swedish families: A population-based study. The Lancet,373(9659), 234-9. Moritz, S., Veckenstedt, R., Randjbar, S., Vitzthum, F., & Woodward, T. S. (2011). Antipsychotic treatment beyond antipsychotics: Metacognitive intervention for schizophrenia patients improves delusional symptoms. Psychological Medicine, 41(9), 1823-32. Read More