Monday, November 17, 2014

DSM and ICD Health Problems

Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Statistical Classification of Diseases & Related Health Problems (ICD)



Diagnostic and Statistical Manual of Mental Disorders (DSM)
o Handbook for mental health professionals.
o Includes all categories of mental disorders and their corresponding diagnosable criteria.
o Intended to be used by those with clinical training.
o In accordance with the American Psychiatric Association.
o Uniform criteria for diagnosing.
o Includes sociological, psychological, biological, criteria.
o Each revision has discarded some previously diagnosable disorders such as pre-menstrual dysphoric disorder and masochistic personality disorder to show the manual is contemporary with social times.
o It now no longer includes homosexuality as a mental disorder, replacing it with sexual orientation disturbance, though still controversial.


Diagnosing Categories
o Axis I: Clinical disorders, including major mental disorders, as well as developmental and learning disorders
o Axis II: Underlying pervasive or personality conditions, as well as mental retardation
o Axis III: Acute medical conditions and Physical disorders.
o Axis IV: Psychosocial and environmental factors contributing to the disorder
o Axis V: Global Assessment of Functioning GAF score
o A scale from 100 (good functioning) to 0 (several dysfunction)


International Statistical Classification of Diseases and Related Health Problems
o Abbreviation ICD.
o Classification system for diseases including a directory of symptoms complaints, and external causes of injury or illness.
o Published by the World Health Organization.
o Used by hospitals and healthcare facilities to best describe clinical assessment of a client.




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Monday, November 10, 2014

Gestalt Therapy

Gestalt Therapy



Techniques

■ The experiment in Gestalt therapy

  • o To assist clients self awareness of what they are doing and how they are doing it
  • o Expanding awareness of client
  • o Opportunity to “Try on” new behavior
  • o Experiments bring struggles to life, inviting client to enact them in the present
  • o Major emphasis on preparing clients for experiments though trusting relationship


Confrontation

  • o Imposing stance

● Therapist meets own agenda for the client
● Acts as expert, power and control in therapist

  • o Competing stance

● Therapist promotes rugged individualism with lots of negotiation compromise and confidence

  • o Confirming stance

● Acknowledging the whole being of client
● Client’s needs and experience center of relationship
● Ideal type of confrontation
● Invites client to look at incongruities in verbal and nonverbal language, in words
versus action.

■ Internal Dialogue o Identifies the struggle for control in a person, fragmented between controller and controlled, through Introjection of aspects of others

  • o Between top dog and underdog
  • o Between critical parent should and oughts and passive recipient without responsibility and with excuses
  • o Empty chair

● Shift client into two chairs for dialogue role lay.
● Experiences conflict

■ Reversal technique

  • o Role play the opposite of symptoms and behaviors client suffers
  • o Client tries the very thing fraught with anxiety, therefore submerged and denied
  • o Help clients to accept personal attributes that they have tried to deny


■ Rehearsal exercise

  •  o Behavioral rehearsal: role play a planned for new behavior with a person or people in client’s environment.
  • o Reduce stage fright, anxiety or fear
  • o Encourages spontaneity and willingness to experiment with new behaviors


■ Exaggeration Technique

  •  o Exaggerate movement or gesture repeatedly to intensify feelings attached by behavior to make inner meaning clear
  • o Trembling hands or feet, slouched posture, bent shoulders, clenched fists, tight frowning etc.


■ Staying with Feelings

  • o Keep client from escaping fearful stimuli and avoiding unpleasant feelings
  • o Encourage to go deeper into feeling or behavior they wish to avoid
  • o Facing, confronting, and experiencing feeling makes them able to unblock and make way for new levels of growth

● Takes courage and pain.





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Tuesday, November 4, 2014

Social History Collateral Data

Social History and Collateral Data

A social history is an individual or family assessment that includes information, both past and present, needed for developing an understanding of and working with clients. The appropriate use for collateral information is to augment the patient’s history. Collateral reports (e.g. family reports, hospital discharge summary, school reports, and arrest record) can be useful in verifying client data or augmenting the information given in the verbal report(s). Collateral reports are particularly useful when substances or mental illness impairs a client or no collateral sources of information are available because in such cases, the availability of information is a primary challenge. A social history will vary from setting to setting, depending on the needs of the provider or providers and the specific client population. However, there are some stable categories all should share. A social history will include information about the presenting problem, social role functioning, family history, employment/educational history, physical health issues, alcohol or drug issues and mental health issues. If the identified client is a child, collateral data may be sought, with signed consent by the parent or legal guardian, from teachers or other caregivers. If the identified client is an adult, additional information may be desired and sought, with permission and signed consent by the client, from a physician, probation officer, other provider, family member, discharge summary, medical record or other applicable collateral source.

Depending on the situation, collateral data may be more or less required. If a client is seeking voluntary services, is highly motivated for treatment and his story is consistent with his presentation, collateral information may not be necessary. For example, Ben presents for help with his drinking. Ben wants to stop because he believes he is relying on it to cope with his problems rather than to deal with them. He attends all sessions as scheduled, completes all homework as assigned and the writings and step work he presents are consistent with dedicated recovery work.

However, if a client is seeking services to stop drinking following a third arrest for driving under the influence and is facing jail time if he is not compliant, collateral information may be indicated. Involuntary clients who may only be motivated by the avoidance of negative consequences have some motivation to be less than forthcoming. Additionally, when the legal system is involved, the social worker is at risk of having to produce records or possibly testify about a client. If this is the situation, the social worker is best advised to seek collateral data to verify the client’s story, both past and present. While the client may have “hit bottom” and be completely truthful and motivated following a bad event, too much is at stake to not verify information. When alcohol and other substances are involved, honesty is the first casualty. Encouraging clients to be honest may be the therapeutic thing to do, but when a significant probability of testimony is involved, the social worker must be self-protective and best protect the client and society at large by having all of the facts to make the best and most informed decision.





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Monday, November 3, 2014

Gestalt Therapy

Gestalt Therapy



Major Principles
Holism

  • o Interested in the whole person
  • o Emphasis on integration of thoughts feelings, behaviors, body and dreams


■ Field Theory

  •  o Organism must be seen in its environment or its context as part of a constantly changing field

● Relational
● In flux
● Interrelated
● In progress

■ Figure Formation Process

  •  o How client organizes environment from moment to moment
  • o Background

● The undifferentiated field or ground

  • o Figure

● The emerging focus of attention

■ Organismic Self Regulation o Restore equilibrium or contribute to growth and change


Therapy Process
■ The Now

  •  o Power in the present
  • o Nothing exists except the now
  • o The past is gone and the future has not yet arrived
  • o For many people the power of the present is lost

● They may focus on their past mistakes or engage in endless resolutions and plans for the future.

■ Unfinished Business

  •  o Feelings about the past are unexpressed
  • o These feelings are associated with distinct memories and fantasies
  • o Feelings not fully experienced in the background and interfere with effective contact
  • o Preoccupation, compulsive behavior, wariness oppressive energy and self defeating behavior.


■ Layers of Neurosis

  •  o Perls likens the unfolding of adult personality to the peeling of an onion.
  • o Phony layer- stereotypical and inauthentic
  • o Phobic layer- fears keep clients from seeing themselves
  • o Impasse layer- giving up power
  • o Implosive layer- fully experiencing deadness
  • o Explosive layer- letting go of phony roles





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Monday, October 27, 2014

Foundations of Gestalt Therapy

Gestalt Therapy



Foundations

■ Existential and Phenomenological

  • o Grounded in the client’s “here and now”


■ Initial goal is for clients to gain awareness of what they are experiencing and doing now

■ Promotes direct experiencing rather than the abstractness of talking about situations

■ Rather than talk about childhood trauma, the client is encouraged to become the hurt child

■ Holistic approach to personality vs. mechanistic approach of Freud.

■ Value of examining present situations vs. repressed intra-psychic conflicts from early
childhood

■ Focus on process versus content

■ On presently experienced vs what is revealed by client from memory

■ Self understanding comes from individual’s behavior in the present versus why they behave as they do

■ Therapist goal: create experiments for client to assist their self awareness of what they are doing and how they are doing it.


Therapy Process
■ Promote awareness in client through

  • o Insight
  • o Self acceptance
  • o Knowledge of the environment
  • o Responsibility for choices
  • o Paradoxical theory of change
  • o Ability to make contact with others
  • o Clients expected to do their own seeing, feeling, sensing and interpreting vs passively allowing therapist to give insight and answers


■ Concepts of human nature

  • o Clients are manipulative
  • o Avoid self reliance
  • o Avoid taking on personal responsibility
  • o Clients have to stand on own two feet to deal with life problems themselves
  • o Move clients from environmental supports to self-support
  • o Help clients reintegrate disowned parts of personality





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