Critical Thinking Assignment | Online Assignment

Description

write 400-600 words that respond to the following questions with your thoughts, ideas, and comments. This will be the foundation for future discussions with your classmates. Be substantive and clear, and use examples to reinforce your ideas. At the community mental health center you are assigned to counsel an adult client who has Major Depressive Disorder, recurrent with psychotic features as well as Borderline Personality Disorder. She is a 55-year-old who also has addiction issues. She is beginning to lash out at her family because she feels abandoned by them. She stopped taking her prescribed psychotropic medications a year ago. This has triggered her utilization of drugs and alcohol. She is becoming increasingly depressed, isolated, sleeps 14 hours per day, and overeats the rest of the day. She tells you that she has stopped all socializing and needs to get back into life again so that she can cope with her mental illness and work through her abandonment issues. She is willing to attend whatever groups you think will help her. You will take this case to your next team meeting to discuss with your colleagues before presenting the information to the client. Be sure to include the following in your discussion: Provide 2 goals for the client. Identify 2-3 objectives per goal. Present at least 2 types of group therapy you could use to assist this client effectively, and explain how you would utilize the chosen groups. Identify one potential benefit and one potential drawback of each of the type of therapy selected. Responses to Other Students: Respond to at least 2 of your fellow classmates with at least a 100-200 word reply about their Primary Task Response regarding items you found to be compelling and enlightening. To help you with your discussion, please consider the following questions: What did you learn from your classmate’s posting? What additional questions do you have after reading the posting? What clarification do you need regarding the posting? What differences or similarities do you see between your posting and other classmates’ postings?

Identifying Program Needs

Identifying program needs for an addictions’ group is critical to the success of the group. First, the counselor decides the goal and focus of the group. For example, there are self-help, dual-diagnosis, psychotherapy, and psycho-educational groups. This will also depend on the setting. For example, is the group at an inpatient facility, a day-treatment center, or an outpatient clinic? Is the focus holistic? Or, is treatment targeted on the outward addiction behaviors? Inpatient facilities and day-treatment centers have many groups that develop over 6 months to a year. They tend to program within the context of the treatment. For example, a day treatment center may have a fixed group of individuals referred to as a class who progress through modules, which upon successful completion, the attendees graduate and receive certificates. This also can be true of inpatient treatment. Outpatient treatment more often is a follow up to programming and is more flexible. While outpatient treatment can have some of the trappings of inpatient and day treatment, usually it is not as formal. Here clients are usually in an aftercare setting structured for ongoing treatment. These groups have individuals who come and go due to life circumstances and commitment to ongoing care. The groups are not necessarily structured but are more in tune to the lives of patients outside formal treatment. Aftercare means after intensive treatment in an inpatient or day-treatment program setting. These programs can be a fixed group or multiple types of groups that a particular program needs for its specific population. For example, if dual-diagnosed clients need a focused group for them, this may be provided in aftercare depending on the program. Or, if there is a need for a narcotics group then the program would reflect this. Identifying the program needs is the first step to providing services the client needs and will assist the program in retaining and motivating its patients.

Legal and Ethical Issues to Consider in Planning

Confidentiality is a primary issue in group and individual therapy. In group therapy it is easier to cross these boundaries accidentally. If clients are sharing in the group and the therapist knows they are being deceptive, they need to take this issue to individual therapy and not air it in the group setting. Otherwise, the therapist could bring up confidential issues that should not be shared. Other issues of confidentiality include peers in the group. During the interview process, the issue of confidentiality is addressed to each member to provide a safe space where clients can share and grow.

Personal relationships within the group can inhibit group growth. Therapists must not engage in a relationship with any client. This includes business relationships as well as personal or romantic entanglements. Depending on the state and the particular discipline boards, personal relationships may be banned with all clients current and past anywhere from 6 months to forever. They are updated and changed frequently. It is important to understand these limits as they apply locally and nationally.

Paperwork is essential in running a treatment center whether it is inpatient or outpatient.

Government funding requires the most paperwork. As a side note, if you are in private practice, this would be up to the individual practice and the insurance providers. Whenever there is funding, there are rules to be abided by according to the funding source. Most community mental health centers are government funded and have specific guideline that they follow. In some cases, if the paperwork is not completed correctly, then the auditor who checks the files will request that funding be returned to the funding source. This can have a devastating effect on the agency.

How to Plan Treatment

Planning must include what the clients can expect to get out of treatment if they achieve the goals. Goals are identified and objectives are planned to accomplish each goal. There can be several goals, but there are usually about three to four. First, you pick the group type and then determine the goals for the group. Objectives are planned to meet the goal. Objectives are what you do to get to the goal. For example, you are planning a thinking errors cognitive behavioral group. One goal of the group will be to learn new skills while altering old patterns of thinking to change your behaviors and emotions. Other goals might state the following: Clients will learn to decrease impulsiveness, relationship difficulties, out-of-control emotions, and illogical thinking. Or clients will learn to increase personal effectiveness skills, emotional regulation skills, distress tolerance skills, or self-assessment skills. Depending on who is financing the center, each goal may need to be measureable. For example, clients will reduce illogical thinking by successfully demonstrating the utilization of three new skills. In the objectives, you will state how you will teach the client these new skills. For example, the client will participate in the thinking errors group one time per week for 6 weeks, or the client will successfully complete illogical thinking module of thinking errors group. Depending on the certification needs of the center and where its funding comes from will determine the degree of measurability.

Once staff identifies the program needs, treatment planning begins. Successful treatment planning relies on coordination of needed services for the clients served in relation to the ability and qualifications of the staff providing the service. Following are examples of planning for three settings including inpatient, day-treatment, and outpatient providing treatment for drug and alcohol addictions.

In-patient treatment provides detox services for those clients who need to get off of drugs or alcohol. This service provides a safe place for clients to clear their bodies of the substances used in their addictions and often includes medication to ease them through the process. Physicians and nurses closely monitor this group. This is a serious stage for clients because it also can be life threatening not only physically but also emotionally. It is important to note that people who are coming off addictive substances are in a fragile state. The more ingrained and intense the substance is, the more difficult it is for the client to break free. For some, the substance is the only way they know of coping with the chronic problems and traumas in their lives. According to Freud, the addiction serves to quiet the rage clients feel and are unable to process it by self-soothing. Providing a safe, secure atmosphere is essential in planning groups for these clients, especially in this phase or shortly after.

After successful detox, clients can be placed into programming according to addiction type. If the program is substantial, then alcohol and narcotics addictions can be run in separate groups. For example, according to classical psychological theory, one of the basic tenets of alcohol addiction is an oral fixation because it is imbibed. However, the root of a needle-based narcotic addiction is not orally fixated because it is put directly into the body. The highs can be different as well as the criminal activity that surrounds narcotic addictions. This is why a 12-step self-help group might split into more specific groups. The basic tenets are similar, but the members of different groups can experience the specific addictions differently. Treatment planning takes these into consideration when planning groups to meet the needs of these clients. Some groups will overlap, and some will not.

Inpatient treatment planning may include groups such as psychoeducational groups such as medication education, drug and alcohol education, and dual-diagnosis education. Most inpatient settings provide self-help, 12–step groups, usually run by experienced clients and staff. Self-care groups, such as sleep hygiene and basic self-care, assist clients in meeting personal basic needs. Cognitive behavioral groups that touch on the thinking–behavior model are an integral part of treatment planning. If clients act out threats of self-harm or harm to others, then dialectical behavioral groups are planned. Holistic inpatient treatment centers focus on nutrition and alternative medicine for healing such as acupuncture, acupressure, massage reflexology, meditation, and behavioral groups, but their primary concern is getting to the root of the addiction not just modification of the outward behavior, which is what almost all treatment centers focus on. Also, non-12-step based therapy treatments are starting to emerge. Twelve steps rely on a higher power and teach the clients that they are powerless over their addictions, which they will have the rest of their lives versus an empowerment model that challenges the clients to take charge of their own behavior and responsibility for their health. In the newer, holistic models, addiction is not seen as a lifelong disease as in traditional models but that the clients have needs they are not attending to which form the basis for treatment. Depending on which type of inpatient treatment center the client chooses, the focus can be quite different.

Day treatment is similar to inpatient, but the clients live at home rather than residing in the facility. Patients in this type of atmosphere are normally detoxed upon entering the program. Frequent drug testing of the clients assists them in staying on track. Behavior modification can include rewards for milestones reached. For example, those clients who successfully complete the initial module may get treated to an outing for dinner or go to the fair for the day if it is summer.

Outpatient groups are mostly singular. They are not usually linked together with outcomes in sets of groups like graduating from a day-treatment program. Individuals in therapy are encouraged to join a group for a specific purpose. The same goals and objectives apply. The group is picked according to the client’s current needs. For example, you have a dually diagnosed client in individual therapy who is having difficulty understanding medication issues. Rather than referring him to the psychiatrist or nurse who have previously explained the meds, you refer the client to a psychoeducational group specific to his medication. In this way, he receives in-depth education on the drug, meets other people who are on the meds that he can interact with, and further his understanding without costing the agency increased dollars billed for medical treatment by the psychiatrist or nurse. Another example might look like this: A client is having continued anger issues, and the therapist places him in an anger management group as part of his individualized treatment plan to decrease his angry outburst to one time per month or until he demonstrates improvement in anger management skills.

The different types of therapy groups with founders and theories are as follows:

• Psychoanalytical
  • Freud
    • Inner conflicts
    • Psychological issues
    • Memory, fear, dreams
    • Transference
  • Adlerian
    • Adlerian
      • Inferiority
      • Dependence on adults
      • Social factors
      • Four stages
    • Psychodrama
      • Moreno
        • Acting out past emotional experiences
        • Two theories
          • physically acting is more involving than discussion
          • dramatic enactment decreased discomfort with discussing
        • Gestalt
          • Perls
            • Integration of mind and body
            • Increased clarity about wants, values, goals
            • Greater awareness of oneself
            • Resolution of unfinished business
            • Methods: Empty chair; reversal experiment
          • Cognitive-behavioral
            • Skinner, Bandura
              • Changes in behavior without analyzing origins of actions of psychodynamics of person
              • Modeling, rehearsal, feedback reinforce, self-management
            • Person-centered
              • Rogers
                • Humans naturally move towards self-actualization and healing
                • Limited involvement from counselor
                • Counselor facilitates warm, genuine, safe climate
              • Facilitating Treatment
              • Once the goals are set and the objectives are clear, it is time for hands-on treatment. Most CBT groups and psychoeducational groups are preplanned and have everything you need at your fingertips. Process groups, however, take more expertise. Process groups, or psychotherapy groups, will be discussed because they give an excellent example of the therapeutic style. Whether you are using this style for addictions or not, the ground rules are the same. Usually, the therapist selects participants for the group based on an initial interview. Clients need to exhibit motivation as well as a need for this type of group. Clients in this type of group are also engaged in individual counseling. This helps the client further process what happens in the group. There is an initial group agreement that details the ground rules. For example, confidentiality, group safety, participation, consistency, attendance, substance use, appropriate contact with others in the group (whether it is outside or inside the group), and how and why termination occurs are topics that can be covered. Respect for others is also a key issue, and this is one way safety for group members is obtained. Once the first session begins, introductions are in order. This is similar to any group whether it is therapeutic or not. After introductions, goals are discussed, getting input from each member. It is important to have buy-in from each member for the group to be successful and retain the members throughout the process. What you do in the first few weeks is critical to providing a safe space for the members to process difficult situations that provoke intense emotions later in the group process. The initial forming of the group will dictate future success or failure. The role of the therapist is to facilitate or guide the group along a path of healing for all members. Intervening only takes place intermittently and is used to model positive behavior. For example, if one group member negatively confronts another member, the therapist may intervene to illustrate a positive frame for the same interaction, thus modeling an appropriate exchange and furthering the growth of the group. On the other hand, if the group has been meeting for a while, the therapist may ask another member to model the appropriate behavior. It is wise to keep in mind that this type of group is a microcosm of the members outside social network. They will find the same difficulties in the group as they find outside the group. The group becomes the learning environment they should have experienced growing up but did not. Here in the safe haven of group therapy, they have a chance to redo inappropriate behaviors and enact positive ones. These groups are peer oriented, and the selection of members is key to a successful group.