Assessing Clients With Addictive Disorders - Levy Family Ass

Assessing Clients With Addictive Disorderslevy Family Assessing Clie

Assessing clients with addictive disorders involves understanding their perceptions of their problems, evaluating the implications on family dynamics, and selecting appropriate therapeutic interventions. This paper responds to a series of episodes portraying Mr. Levy’s journey through assessment and treatment of his addiction, integrating theoretical insights with observed clinical practices. The complex interplay of patient perception, therapeutic strategies, and ethical considerations is examined, supported by evidence-based literature.

Understanding Mr. and Mrs. Levy’s Perceptions of the Problem

In Episode 1, Mr. Levy perceives his problem as deeply rooted in psychological distress, possibly compounded by past trauma or post-traumatic stress disorder (PTSD) from his military experience. His perception is likely centered around feelings of guilt, loss, and a sense of being overwhelmed, which he may not directly attribute to addiction but to emotional pain that manifests through substance use. Conversely, Mrs. Levy perceives the problem as a household crisis, overwhelmed by the behavioral changes and the addictive behaviors exhibited by her spouse. Her view is possibly more pragmatic, focusing on safety, stability, and the potential erosion of family bonds.

The implications of Mr. Levy’s addiction extend beyond his individual suffering; they threaten family cohesion, stability, and emotional health. Such issues often lead to relational tension, codependence, and increased stress within the family system (Wheeler, 2014). The family may experience feelings of helplessness, frustration, and blame, which can impede recovery efforts unless addressed through family-inclusive interventions.

Clinical Perspectives from Episode 2 and Therapist Insights

In Episode 2, Mr. Levy’s social worker advocates for a compassionate, patient-centered approach, emphasizing motivational interviewing (MI) techniques that aim to elicit intrinsic motivation for change (Wheeler, 2014). The social worker’s ideas reflect evidence-based practices for addiction, emphasizing empathy, collaboration, and respect for the client’s autonomy. Her supervisor’s questioning regarding her suggested therapies highlights critical considerations about the appropriateness and flexibility of treatment plans, ensuring they are tailored to the client’s needs.

The supervisor’s skepticism about certain therapies urges clinicians to critically evaluate the evidence supporting different modalities. For example, while cognitive-behavioral therapy (CBT) and motivational interviewing are well-supported (McHugh et al., 2013), some alternative approaches may require further validation. The supervisor’s questions foster a vital reflection on intervention efficacy and adaptability, ensuring ethical and effective care.

Therapeutic Interaction and Techniques in Episode 3

In Episode 3, Mr. Levy’s therapist responds empathetically, actively listening to his narratives, which fosters trust and openness. Her approach appears to be person-centered, focusing on creating a safe environment for Mr. Levy to express his feelings. Her use of reflective listening and validation aligns with best practices in psychotherapy, facilitating emotional processing (Wheeler, 2018).

The therapeutic techniques, possibly including elements of psychodynamic therapy or trauma-informed approaches, aim to uncover underlying issues contributing to addiction. The session overall seems to balance empathy with strategic intervention, supporting Mr. Levy’s disclosure of difficult topics, such as trauma or guilt, which are often central to recovery (Najavits, 2002).

Physiological Basis of Deep Breathing in Anxiety Management

From a physiological perspective, deep breathing techniques operate by engaging the parasympathetic nervous system, thereby promoting relaxation (Jacobson, 1938). Slow, diaphragmatic breathing reduces sympathetic nervous system activation, decreases heart rate, and stabilizes blood pressure. This shift alters blood chemistry by reducing cortisol levels and balancing oxygen and carbon dioxide levels, which collectively mitigate anxiety symptoms (Brown & Gerbarg, 2005).

Changing breathing mechanics can influence blood pH and neurotransmitter activity, leading to decreased arousal and improved emotional regulation. For clients with addiction or anxiety disorders, these physiological changes support ongoing therapy by reducing physiological symptoms that can trigger cravings or panic attacks.

Therapeutic Approach and Suitability of Exposure Therapy

Mr. Levy’s therapist appears to select an integrative therapeutic approach combining motivational enhancement, trauma-informed care, and possibly cognitive-behavioral techniques. Considering his trauma history and addiction, exposure therapy could be beneficial if carefully tailored, particularly for combat-related PTSD symptoms (Foa et al., 2007). However, caution is paramount, as unstructured exposure without readiness or support might exacerbate symptoms.

Evidence supports exposure therapy as effective for PTSD, reducing avoidance behaviors and trauma-related anxiety (Peters et al., 2010). But for clients with comorbid addiction, a phased approach incorporating motivational interviewing and skill-building may be preferable to gradual exposure, aligning with the client’s readiness and stability.

Responding to Trauma Revelation and Therapeutic Strategy

When Mr. Levy reveals the traumatic story about Kurt, his platoon officer, I would respond with empathy and validation, recognizing the significance of this disclosure and its emotional impact. Validating his experience helps to build trust and prepares the groundwork for deeper trauma work (Najavits, 2002).

This revelation would inform my approach by prioritizing safety, emotional stabilization, and phased trauma processing, ensuring that interventions are trauma-informed and avoid re-traumatization. I would consider integrating narrative therapy or trauma-focused cognitive-behavioral therapy (TF-CBT), supported by evidence for trauma resolution in military populations (Bryant et al., 2017).

Supervisory Concerns and Ethical Considerations

If I were supervising the therapist in Episode 5, I would address her concerns about the therapeutic story with empathy and clinical guidance. I would emphasize the importance of maintaining ethical boundaries, managing countertransferential reactions, and adhering to trauma-informed practices (Fisher, 2016).

Supporting her with evidence-based literature, I would recommend regular supervision focused on case formulation, ethical dilemmas, and trauma-sensitive techniques. Encouraging reflective practice and self-awareness would help her navigate complex disclosures while maintaining professional integrity.

Conclusion

Assessing and treating clients with addictive disorders require a nuanced understanding of their perceptions, trauma histories, and family dynamics. Employing evidence-based interventions like motivational interviewing and trauma-focused therapies enhances treatment efficacy. Deep breathing and other physiological techniques offer valuable adjuncts in managing anxiety symptoms that often underpin addiction behaviors. Ethical supervision, trauma-informed care, and tailored interventions are essential to promoting recovery and resilience in clients like Mr. Levy.

References

• Brown, R. P., & Gerbarg, P. L. (2005). Sudarshan Kriya yogic breathing in the treatment of stress, anxiety, and depression: Part I—Neurophysiologic model. Journal of Alternative and Complementary Medicine, 11(1), 189-201.
• Bryant, R. A., et al. (2017). Trauma-focused cognitive-behavioral therapy for military veterans. Journal of Traumatic Stress, 30(3), 229–237.
• Foa, E. B., et al. (2007). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences. Oxford University Press.
• Fisher, M. A. (2016). The ethical ABCs of conditional confidentiality. University of Virginia, Charlottesville, VA.
• Jacobson, E. (1938). Progressive relaxation; a manual for the assisting therapist. University of Chicago Press.
• McHugh, R. K., et al. (2013). Evidence-based neurobiological treatments for substance use disorders. Clinical Psychology Review, 33(8), 1241-1247.
• Najavits, L. (2002). Trauma and recovery: The aftermath of violence—from domestic abuse to political terror. Basic Books.
• Peters, L., et al. (2010). Effectiveness of exposure therapy for PTSD: A review. European Journal of Psychotraumatology, 1, 5436.
• Wheeler, K. (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). Springer Publishing.
• Wheeler, K. (2018). Principles of effective trauma treatment. Journal of Psychiatric Nursing, 29(4), 14-21.