The Case of Melvin Udall - Assignment Example

? The Case of Melvin Udall Here s Here The Case of Melvin Udall Initial Impressions In my experience as a psychotherapist I have encountered many individuals that society would most likely label as being unpleasant, but few could compare to the contemptuous Melvin Udall. This client is misanthropic, racist, homophobic, and generally unkind in every conceivable manner. Melvin is a best-selling author, allowing him to be self-sufficient. Unfortunately, he often uses his success as a justification for isolating himself from society and maintaining behaviors that impair his ability to function within society. However, Melvin Udall has sought out treatment for his behavioral difficulties in becoming my client. This action is indicative of his will to change, and bodes well for his long-term prognosis. Symptoms and Diagnosis It is my opinion that Mr. Udall suffers from obsessive-compulsive disorder (OCD). He exhibits several characteristics that are consistent with the diagnostic standards set forth in the current version of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000) also known as the DSM-IV-TR. Within this manual, OCD is diagnosed based on the presence of five criteria. Criterion A requires the presence of obsessions (recurring and intrusive thoughts or impulses that a person knows they did not initiate and attempts to ignore or suppress) and/or compulsions (repetitive behaviors that are unrealistic responses to obsessive stimuli). Melvin displays signs of both obsessive thought (diseases and cleanliness) and compulsive behavior (overly strict regimens, cleaning). He also recognizes, rather abrasively, that his obsessions and compulsions are unreasonable and cause severe distress in his life and social activities, satisfying Criteria B and C. This client shows no signs of another Axis I disorder, and the effects do not appear to be due to a substance. Therefore, Criteria D and E are also met. Cognitive-Behavior Therapy (CBT) for OCD Theory Cognitive-behavioral theory arose from a union of cognitive and behavioral approaches to the treatment of mental illness, even though they were quite different in theory. Behaviorism focuses on the stimulus-response nature of behavioral learning and negates the usage of unobservable constructs of the mind, while cognitive psychologists are interested in the various mental processes underlying behaviors and often employ the constructs that are opposed by strict behaviorists. Despite these contrasts, cognitive-behavioral theory includes aspects from both approaches in developing treatments for various psychological afflictions. Through the observations of this theory, Melvin’s situation could be interpreted as an intense learned response to stimuli that is inappropriately interpreted by Mr. Udall’s own mental processing patterns. Goals CBT is largely based upon the establishment and accomplishment of personalized goals. In general, the goals associated with this type of therapy are related to favorably changing the client’s behaviors through the alteration of learned associations and internal processing/interpretations of various affective stimuli. In the case of Melvin Udall, specific goals could include spending more time with his neighbor’s dog and changing his eating routine. These modifications would require a significant functional improvement in Mr. Udall’s behavior. Therapeutic Techniques Melvin would most likely benefit from a combination of therapies that is commonly used to treat OCD (Foa, Rothbaum, & Furr, 2003). One part of the process, cognitive restructuring, would address the client’s interpretation of his obsessions and compulsions by attempting to reconstruct his the exaggerated beliefs that may underlie his condition. Additionally, a behavioral therapy known as exposure and response prevention (ERP) would involve the gradual exposure of negative-behavior inducing stimuli (a dog, for example) while suppressing the client’s ability to make a compulsive response (such as cleaning). Over time, this treatment should result in a reduced response to stimuli that would have previously caused overwhelming anxiety. A unique but possibly more enveloping approach to treating Melvin Udall’s OCD using CBT would be to employ a technique such as acceptance and commitment therapy. ACT, as it is otherwise known, is a form of psychotherapy that is based in cognitive-behavioral theory. The treatment emphasizes self-reflection, acceptance, and action. This approach may not only reduce the symptoms experienced by Melvin, but it may also aid in helping him to discover more meaning in his life through value assessment. This would go a long way in changing his acrid demeanor and increasing the likelihood of deeply needed social development. Supporting Research A 2003 study by Abramowitz, Foa, and Franklin provides an empirical analysis of CBT, as well as the comparison of short intensive sessions with less intense sessions over time. The experiment involved 40 subjects with diagnosed OCD. Half of the subjects received intensive exposure and response prevention therapy every day for three weeks, while the other half were treated more gradually over a period of 8 weeks (2 sessions per week). The subjects’ OCD related symptoms were assessed prior to and following the interventions using itemized questionnaires. Using an analysis of variance (ANOVA) statistical analysis, it was observed that both forms of exposure and response prevention therapy led to significant improvements in symptoms experienced by and clinical observations of the subjects. Intensive therapy led to significantly better results than the longer treatment plan in the short term, but both approaches were equally effective in the long term. This study faces several limitations, most significantly lacking are a random assignment process and control group. Additionally, time was not accounted for as a possible confounding variable. These limitations are severe and take a great deal of power from these findings. However, the aspect we are interested in is the efficacy of exposure and response prevention, and the observed significance of the positive result is large enough to be taken seriously. If we accept the validity of the results under these limitations, then this study suggests that either intensive therapy or long-term treatment should be an efficient approach to managing Mr. Udall’s disorder. Conclusion Melvin Udall has experienced severe OCD for many years, and his personality may be a result of the hardship he has faced as a result of his condition. This client is a candidate for a CBT based therapeutic approach based on previous research that supports the efficacy of such treatments in treating OCD. I intend to combine exposure, response prevention, cognitive restructuring, and ACT in order to aggressively treat these symptoms that are obviously causing a great deal of distress in Melvin’s life. An appropriate and likely necessary addition to this treatment regimen will be pharmaceutical medication such as serotonin-affecting antidepressants or atypical antipsychotics. References Abramowitz, J. S., Foa, E. B., & Franklin, M. E. (2003). Exposure and ritual prevention for obsessive-compulsive disorder: Effects of intensive versus twice-weekly sessions. Journal of Consulting & Clinical Psychology, 71I(2), 394. American Psychiatric Association. (2000). Diagnostic and statistic manual of mental disorders (4th ed., text rev.), Washington, DC: Author. Foa, E., Rothbaum, B., & Furr, J. (2003). Augmenting exposure therapy with other CBT procedures. Psychiatric Annals, 33(1), 47-56. Read More