Wk5 Psychotherapy open discussion: Copy and paste this link on your browser to see the Thompson family case study. https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6640/05/mm/academic_year_in_residence_thompson_family_case_study/index.html
· Please follow the bullet points. At least 3 citations with evidence base literature and refs.
· Post an explanation of your observations of the client William in Thompson Family Case Study,
· including behaviors that align to the PTSD criteria in DSM-5.
· Then, explain therapeutic approaches you might use with this client, including psychotropic medications if appropriate.
· Finally, explain expected outcomes for the client based on these therapeutic approaches.
· Support your approach with evidence-based literature.
Week 5 Discussion Initial Post
The Thompson family case is remarkably compelling with multicultural, multilingual, and personality character interferences. The family is full of incredibly talented people that are going through a form of dysfunction. The father, who is a television producer and has been married twice, is involved in cheating. The daughter, adopted at age five from China and is 22 years old, identifies as a lesbian. Furthermore, the 14-year-old daughter, Zora Thompson, who is already dating older senior high school boys-increasing risky sexual exposure, probably using hard drugs, suffers from alcohol use and eating disorder (Laureate Education, 2012a). The younger brother, William, is 38 years old was one time an Iraq veteran and a lawyer. Williams bought a home but was not able to maintain the mortgage after losing his job. Williams and his newly wedded wife live in the same house with his brother because of job loss due to alcohol use and Posttraumatic Stress Disorders (PTSD)-related concerns per diagnosis (Laureate Education, 2012a).
In this scenario, the identified patient that is the target of concern is Williams. His move from new jersey to Pasadena, California to recuperate from homelessness has not been able to resolve his post-traumatic stress syndrome. He is medicating on alcohol and substance and has not been able to sustain a job and is recently married, adding the demands of a new relationship to the mix.
Therapeutic Approaches for PTSD
PTSD is a chronic psychological disorder that can affect all kinds of individuals, dysregulating and disconnecting them from reality after being exposed to a traumatic event. The syndrome is a conglomeration of various cognitive, behavioral, and physiological disturbances characterized by three symptom clusters, i.e., intrusion, avoidance, and arousal (Kar N. (2011).
The affected individuals may be disconnected emotionally, spiritually, cognitively, socially, and physiologically and this may affect their daily activity, and these traumatic events may be overwhelmingly resulting in experiences of memory distortion stored in the brain (Wheeler, 2014). Some clients can cope with traumatic events, however for some, adaptive coping does not occur, as physiological arousal remains, and recurring memories of the aversive event persist, strengthen, and disrupt normal functioning (Cain, Maynard & Kehne, 2012).
The DSM-5 describes PTSD as the result of having been exposed to, witnessing, and or common vulnerability to horrifying circumstances taking place in the life of a friend, family member or one or more of the following events like exposure to severe physical, emotional or mental abuse; violent sexual exposure or the death of a family member (Wheeler, 2014). Many members of the Thompson family have symptoms, as mentioned above, like intrusive thoughts, avoidance behaviors, negative thoughts, and mood could be diagnosed with PTSD.
Then, explain therapeutic approaches you might use with this client, including psychotropic medications, if appropriate.
Once post-traumatic stress disorder (PTSD) is diagnosed, treatment may involve psychotherapy, pharmacotherapy, or both. Many psychotherapists utilize CBT to treat clients with PTSD (Pai, et ai, 2017). Also, psychotherapists can utilize or apply PTSD in treating or managing other individuals with vulnerable or horrifying encounters (Wheeler, 2014). Treatment modalities include reducing triggers that flare up symptoms, decreasing intensity of symptoms, preventing or reducing other possible conditions or complications that are present or may arise. Treatment modalities also include developing flexible working strategies to function normally, intellectually develop a sense of trust, safety, and skills on how to prevent relapse and incorporating the painful experience into a positive, productive and practical source of risks, putting in place safety and protection measures; as well as preventing recurrence (Wheeler, 2014).
William is the identified patient and the person who is at the most considerable risk. Exposure therapy is a psychological treatment to help people confront their fears (Society of Clinical Psychology, 2017). This provider will use the exposure strategy to encourage William to narrate about the trauma incidence and talk about the mental and emotional tortures involved or experienced. This approach will help William to decrease avoid confronting the past traumatic event. This approach will best take place in a safe, controlled environment between the client and the therapist and when the client is comfortable in doing so (Society of Clinical Psychology, 2017). The outcome of the exposure therapy is to enable the client to regain freedom, confidence to self, thereby decrease avoiding the past (“Cognitive-Behavioral Therapy [CBT] for Treatment of PTSD,” 2018).
Since this provider has no information as to William’s prior involvement in therapy, this provider would initiate a dialogue for a possible trial of medications including the selective serotonin reuptake inhibitor (SSRI) sertraline (Zoloft) and paroxetine (Paxil) which are presently the only Food and Drug Administration (FDA) approved medications for PTSD (Alexander, 2018). This provider will also recommend attendance at the group to expose the family to psychoeducation and supportive therapy.
SSRIs with psychotherapy may improve outcomes (Cain et al., 2012). Other classes of medications used to treat PTSD are mood stabilizers, such as carbamazepine, and antipsychotics such as Zyprexa, glutamate, glucocorticoids, and neuropeptides (Bisson, 2018). By combining drug treatment with memory-specific psychotherapy may offer the best route to permanent recovery (Wheeler, 2014). This helps the client return the pathological memory to a state amenable to change, inducing new learning to correct the dysfunction, and facilitating the underlying neuroplasticity processes with drugs targeting key (Cain et al., 2012). As a rule, pharmacological treatment of PTSD must be projected as a long-term therapy (Kapfhammer, 2014).
Finally, explain expected outcomes for the client based on these therapeutic approaches. Support your approach with evidence-based literature.
Indications of successful recovery include the ability to talk about the experience with pain or getting upset. Ability to function normally, perform daily living activities, and derive pleasure in activities one loves to enjoy previously. Developing a sense of confidence and security in self, others, the surroundings, or environment. Most importantly, they can control emotions, avoid segregating themselves from the incident, feel loved, cherished, and surged ahead with life and future (Wheeler, 2014).
Cain, C. K., Maynard, G. D., & Kehne, J. H. (2012). Targeting memory processes with drugs
to prevent or cure PTSD. Expert Opinion on Investigational Drugs, 21(9), 1323–1350.
Cognitive Behavioral Therapy (CBT) for Treatment of PTSD. (2018). Retrieved from
Kapfhammer, H.-P. (2014). Patient-reported outcomes in post-traumatic stress disorder Part II:
Focus on pharmacological treatment. Dialogues in Clinical Neuroscience, 16(2), 227–
237. Retrieved from the Walden Library databases
Kar N. (2011). Cognitive behavioral therapy for the treatment of post-traumatic stress disorder: a
review. Neuropsychiatric disease and treatment, 7, 167-81.
Laureate Education (Producer). (2012a). Academic year in residence: Thompson family case
study [Multimedia file]. Baltimore, MD: Author.
Pai, A., Suris, A. M., & North, C. S. (2017). Posttraumatic Stress Disorder in the DSM-5:
Controversy, Change, and Conceptual Considerations. Behavioral sciences (Basel,
Switzerland), 7(1), 7. doi:10.3390/bs7010007
Society of Clinical Psychology (2017). What is exposure therapy? Retrieved from https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to