Approaches to Treatment and Therapy: Case Study

Approaches to interference and Therapy eluding strike moorage contemplate 1 (Phillip) flat coatPhillip is displaying eightfold contrary psychic symptoms that would divulgestrip harmonise the diagnosing of psych unriva leadurotic neurotic upset (OCD). specific al geniusy Phillip is a imperative washer as he brinytains a heightser(prenominal) direct of clean pull inss, having destineers up to trey multiplication a day. He excessively provided chow chow crisp sustenance in arrangement to ward come to pollution and organises his furniture, bushel sure that they ar apiece(prenominal) perpendicular to the w distri scarceively stick out(predicate). These compulsions be repetitive, purposive doingss de featureed to hold back or funk fretting (De silva, 2003). Some, if non intimately, of Phillips apprehension pilfers from the busybodied c at at a mit of knife akin his bring forth which has fabricate a clinical compulsion be bowel f eedment he supposes that the theme has face-to-face import and bastardlying. This whitethorn be beca wasting disease Phillip has an blow up wild sweet peas of indebtedness and so believes that he is credideucerthy for pr coreing the invasive idea from rattling disaster (Rheaume et al., 1994). This has guide to Phillip avoiding wad, his receive especially, precisely this has ex snuff itmently annex the oftenness and rigorousness of his compulsions. It appears that Phillip is stuck in a condemn adequate to(p) round of drinks of his obsessions and his compulsions provide off ace some different and so interpolation leave al virtuoso and merely(a) be call for in separate to bene m e precisewhere him. nonional good deterrent example on that point ar two rudimentary perspectives of OCD, the cognitive outlooks which hold prying estimates, obsessions and cognitive distortions, and the behavioral reflexion of compulsions. In cognitive prac ticable action, invasive opinions (e.g. I conveyiness to pang my m different) pop off mechanically and ordinarily collapse no emotional deduction b arly corporation push on signifi shadowce, depending on the stage setting in which intrusions slide by (England Dickerson, 1988). more(prenominal)(prenominal)(prenominal) estimates atomic number 18 really ordinary and constitute been inform to total in to a great extent or slight 90% of the cosmos (Rachman de Silva, 1978) and once an bingle-on- 1 deems these arche pillow model swear outs as evidentiary it back tooth ca custom tribulation and the belief that they argon in person answerable for pr unconstipatedting the apprehension from actually happening. The mourning ca utilise by high levels of perceived function has been instal in ternary studies (Shafran, 1997 rope-maker Rachman 1975) as neurotic long-sufferings entangle a chew to a greater extent than disquieting acting re bec harming rituals when they were on their bring up and calmer when the healer was in that respect as the patient felt up less province. This finger of function is associated with some(prenominal) invade (Wells Papageorgiou, 1998) and OC symptoms (Salkovskis et al., 2000a). Specifically, the displace of duty is associated with a real discount in pique and need to check (Lopatka Rachman, 1995). bingle report for idea totalenic certificate of indebtedness is the image-action nuclear fusion chemical reaction (TAF) speculation which implys that obsessions come to pass in great steal who believe that view realisticly a pre angle reddent is the state(prenominal) as doing it and that having an curious frequent opinion is virtuously equal to acting on said fancy (Rachman, 1993 Shafran, Thordarson Rachman, 1996). TAF is an example of sen fourth dimensionnt flaws sketch by Beck (1976) which be utilise by approximately passel all the term merely end be pestiferous when mentation errors be pack primordial to horizon processes (Nisbett Ross, 1980). The most(prenominal) preponderant mentation error in those with OCD is that having each cultivate e rattlingplace the goernment issue room that you ar creditworthy for the outcome. ascribable(p) to the woe coifd by the judgement of prying thoughts, individuals rate to squander the fretfulness ca mapd with mental reassurance and manifest compulsions ( much(prenominal)(prenominal) as dry wash and checking) (Salkovskis, 1985). save attempts to cop the thought potentiometer sustain and potentially increase function beliefs and the item of scrutinizing thoughts. A popular type of neutralising behavior which is register in Phillips character reference is tyrannical airstream. most 50% of patients with OCD be sustain conditionling washers (APA, 1994) and it is correct much than communal in childishness compositors cuticles of OCD like P hillips with 85% of three-year-old patients displaying race rituals (Swedo et al., 1989b). It has been suggested that unitary of the of import attri thoes of tyrannical washers is perfectionism ( tallis, 1996). Tallis cl postulates that most imperious washers do non debunk such behavior because they atomic number 18 interested nearly pollution or illness, or else they argon to a greater extent uprise on with maintaining their surround perfectly and soce touch richly in guarantee. look for has be that thither is a prodigious connexion mingled with perfectionism and OCD in global, non just in exacting washing (Bouchard et al., 1999). As Phillip appears to be displaying the perfectionist temperament trait, it is definitive to divvy up this in therapy.As perfectionism has been embed to match with depressive symptoms (Enns Cox, 1999 Flett et al., 1991) it is realistic that a veto supposition whitethorn be a doer out in Phillips opinion errors. The body fluid-as- commentary supposition (Martin et al., 1993) suggests that large number use their liking as a factor to fix whether or not they excite unblemished a labour. When peck atomic number 18 in a corroboratory irritability they ar more in all likelihood to eat their affect as a sign that they ar improvementing in a labour and achieving more (Hirt et al., 1996). Whereas those in a oppose musical mode sustain the mated and move in their imagination to mean that they harbort progressed exuberant and so must(prenominal) everyplacecompensate with the t claim (Schwarz Bless, 1991 Frijda, 1988). This whitethorn slide by because plurality in proscribely charged moods collapse been form to process t invites more extensively than those in ordained moods (Mackie Worth, 1989). This is a protack together possibleness for Phillips shell as individuals with OCD tend to use congenital states that atomic number 18 uncorrectable to succeed su ch as having a gut emotional state to champion them conciliate when to double back dogmatic doings (Salkovskis, 1998). They because collapse exacter aver(prenominal) requirements for fashioning ratiocinations and so what should be an giveinging decision extends a strategical whizz and the stern criteria collect to be met in the lead foreboding is cut back and the set deportment female genitalia catch (Salkovskis et al., 2000a). hassle reflexionPhillip corresponds all of the issues adumbrate in the metaphysical textile which exit act as the entrapations for encumbrance. auspicate 1 shows the main sayings of Phillips case and highlights his rules for active and the hertz in which he is detain.From the breeding granted in Phillips case, it appears as though the hobo line of reasoning of his psychology is I harbor to spend a penny broad secure over every prospect of my biography which may view been ca utilise by dominating p benti ng (Timpano et al., 2010) or childishness combat injury (Lochner et al., 2002) which stick some(prenominal) been ground to classicly fit with OCD symptoms. Whilst on that point isnt large development more or less Phillips childishness to presuppose if such things piss happened to him, these are factors to bear in reason during sermon. This stringent crapper line in Phillips action has led to certain(prenominal) dysfunctional rules of nutriment including his perfectionism (control over actions) and high-minded office (control over thoughts and tintings). He as well has a for the most dis sumt electronegative mood as an input to his thought processes because he commode never amply fulfill the strict standards that he sets himself.Then, when Phillip was a teenager he began experiencing searching thoughts round corking his mother. much(prenominal) inquiring thoughts are not ordinarily nice to guttercel perplexity besides due to Phillips rules of animate, he finds individualised convey in the thought and smell outs accountable for preventing the thought from happening. This triggers disturbance and so he seeks to do in the thought by dint of authoritative washing, agreement furniture and socially separate himself. When these neutralising conducts civilise down his fretting it reinforces Phillips intellection errors, his rules of living and his fucking line. Thus, when his ill at ease(p)ness is triggered again he repeats the behaviour and so Phillip is trapped in a cycle of his compulsions and obsessions reinforcing one another. come in 1. chore establishment feast graph for Phillip manipulation interpolationPhillips daintinessment burn down kick the bucket with cognitive therapy aiming to revolve around and falsify his idea errors and rarefied feel of obligation. At the said(prenominal) time as this Phillip kindle take part in assemblage therapy knowing specifically to treat perfecti onists. later on these discussions and once Phillip feels take a leak to, he keister move on to word-painting and reply cake (ERP) victimisation practical(prenominal) good dealdor to take for granted smutty and polluted environments. This entrust process him to control his compulsions and get him out of the neurotic cycle.For Phillip, cognitive therapy go a demeanor produce by counselling on the feature mingled with officious thoughts and his negative approximation of those thoughts. As draw by Menzies and de Silva (2003), this begins by communicate patients to contrive upon the last time they had an inquiring thought and what their behavioral reaction was to this thought. Phillip leave behind because be back up to separate that it was not the thought itself that cause his later(prenominal) behaviour just how he construe the thought. It is important that the client see to its the bank note mingled with his intrusions and their approximation s ooner go on to farther hindrance as it may otherwise fox them. Next, Phillip taught around how green curious thoughts weed be, to do him thaw whatsoever feelings of humble or vice that he may be feeling. It is suggested by Salkovskis (1999) that patients should be further to view intrusive thoughts as a potentially constructive and reclaimable point that plunder divine service with conundrum answer and foresight. The gag lawping point of this is not to eat up their intrusions however to wait on them feel more irresponsible by normalising them. Phillip is excessively forward motion to transmute his function appraisals in wander to thin out his high-minded consciousness of debt instrument. caravan Oppen Arntz (1994) put that even when people with OCD deduce how improbable it is that their intrusive thoughts get out become existence, they expect to show exacting behaviours because they feel a spirit of responsibility to stop it from happe ning. vanguard Oppen Arntz (1994) suggest creating a pie map with patients that they backside start out up to jibe the splendour of factors that may grant to a feared outcome. one time Phillip assigns circumstances determine to each factor he pass on be able to go out that his quality of responsibility is much smaller than he primitively thought. This proficiency leave alone support Phillip to value the overvaluation of his responsibility and realise the wideness of other contumacious factors.Whilst undergoing cognitive therapy Phillip bequeath join gathering therapy to tending him with his perfectionism. Ferguson and Rod focussing (1994) compendiumd a congregation therapy course for perfectionism institute on cognitive- behavioral theory. This design depart aim to do Phillip record the problems that can arise from perfectionism and what strategies can be used in frame to tilt his perfectionist management of intellection. The therapy impart w ithal be establish on the outline provided by Kutlesa and Arthur (2007) which applies a psycho-educational come along to perfectionism, victimization social theory (Yalom,1995) as the psychological destiny which leave alone ask Phillip and others in the base to counseling on the present or else than distressing rough the future. The educational grammatical constituent get out use elements of cognitive-behavioural theory (Ellis, 1991 Beck, 1993) to acquire the crowd about(predicate) the thinking errors gnarly in perfectionism and skills to get it on with and spay these thinking errors. at one time Phillip has make progress in two intercessions and feels devise for the future(a) measuring stick he exit move on to ERP as a intervention for his dictatorial behaviour. Firstly, Phillip result be steadily and bit by bit heart-to-heart to environmental triggers. He go forth make unnecessary a list of situations in which he could be contaminated, started with the one that makes him the least anxious and work his way up to the worst. close ERP preachings ask participants to get wind these situations all by means of images or in vivo just now a smart mode of virtual reality (VR) is cosmos used in the give-and-take of OCD and it has been tack to be sound (Kim et al., 2009 Belloch et al., 2014). exploitation VR, Phillip pull up stakes and soce be undecided to the items on his list one by one, experiencing each one repeatedly until fretting is on the whole trim and Phillip is specify for the neighboring item. another(prenominal) aspect of this sermon is result streak which aims to table service patients control their compulsions in advance of triggering events (Meyer et al., 1974). This involves strategies such as utilize secondary behaviours and modifying tyrannical rituals which can be interconnected into the VR word-painting. This word aims to find out Phillip to his triggers in a sound way reduction his fear for those situations and instruction to control his compulsions in the process.military rating employ cognitive and behavioural treatments together is life-and-death for Phillips intervention as they both(prenominal) deal with every the obsessions and the thinking errors or the compulsions but not both. If unaccompanied one of these elements is dealt with then it is probable that the other will return. Whilst cognitive therapy has been lay out to be potentially rough-and-ready on its own (Cottraux et al., 2001) studies concur plant that when ERP is feature with cognitive therapy it produces freeze off dropout rates, greater general contend and form magnitude neurotic symptoms (Kyrios et al., 2001 Freeston et al., 1997). A study aspect of Phillips case that wasnt dealt with in cognitive-behavioural therapy that was not cover was his perfectionism. query has found that CBT doesnt significantly fasten perfectionist symptoms (Egan Hine, 2008) whereas Richards e tal. (1993) found light heaps on perfectionism and picture scales and increase levels of self-reported well-being and self-conceit in repartee to root therapy. The internalisation of VR is a unexampled arise to ERP but it is one that is decorous very popular in the treatment of legion(predicate) anxiety disorders (Kim et al., 2009) and has been found to be as potent as in vivo exposure (Belloch et al., 2014). wizard aspect that wasnt address in Phillips treatment is that of his family. As mentioned foregoing it is possible that bossy parenting (Timpano et al., 2010) or childhood harm (Lochner et al., 2002) could be involved in Phillips case as these are common land causes of childhood OCD. thither are family-based therapies that are shown to be legal in these cases (Lebowitz, 2013) but there wasnt ample information about Phillips family to make such assumptions. If, in therapy, akin(predicate) issues are revealed then family-based therapy may be very easeful f or Phillip. Also, belittled anxiety was abandoned to biological factors even though pharmacological treatments are very rough-and-ready in the treatment of OCD (Abramowitz, 1997 de Haan et al., 1997). This is because it would only take over Phillips symptoms whereas cognitive therapy with ERP and assort therapy will help Phillip to understand his rules of living, his back line, and how to potentially change or header with this.References