A 27-year-old married electrician complains of dizziness, sweating palms, heart palpitations, and ringing in the ears of more than 18 months duration. He has also experienced dry mouth and throat, periods of extreme muscle tension, and a constant "edgy" and watchful feeling that has often interfered with his ability to concentrate. These feelings have been present most of the time over the previous 2 years; they have not been limited to discreet periods. Although these symptoms sometimes make him feel "discouraged," he denies feeling depressed and continues to enjoy activities with his family.
Because of these symptoms the patient has seen a family practitioner, a neurologist, a neurosurgeon, a chiropractor, and an ear-nose-throat specialist. He had been placed on a hypoglycemic diet, received physiotherapy for a pinched nerve, and told he might have "an inner ear problem."
He also has many worries. He constantly worries about the health of his parents. His father, in fact, had a myocardial infarction 2 years previously, but is now feeling well. He also worries about whether he is a "good father," and whether his wife will ever leave him (there is no indication that she is dissatisfied with the marriage), and whether he is liked by co-workers on the job. Although he recognizes that his worries are often unfounded, he can't stop worrying.
For the past 2 years the patient has had few social contacts because of his nervous symptoms. Although he has sometimes had to leave work when the symptoms become intolerable, he continues to work for the same company he joined for his apprenticeship following high school graduation. He tends to hide his symptoms from his wife and children, to whom he wants to appear "perfect," and reports few problems with them as a result of his nervousness.
(For those of you who prefer a directive approach)
Please give the Axis I diagnosis; defend your diagnosis with three to five characteristic
symptoms/situations; possible etiology, onset and prognosis; and suggest a treatment.
Monday, September 22, 2008
Thursday, September 18, 2008
Wednesday, September 17, 2008
Using www.turnitin.com
Here is the link to turnitin.com
This is where you will be sending your written assignments. Because, this is only now available, you may turn in assignments in person or via email to me. Thank you.
This is where you will be sending your written assignments. Because, this is only now available, you may turn in assignments in person or via email to me. Thank you.
Monday, September 15, 2008
Evidence for Effective Treatment of PTSD
The Institute of Medicine (IOM) Committee on Treatment of Posttraumatic Stress Disorder (PTSD) was charged by the Department of Veterans Affairs (VA) to review and assess the evidence on the efficacy of pharmacologic and psychologic treatment modalities for PTSD
(see Box S-1 for the complete Statement of Task).
The committee was given five major tasks: review the scientific evidence and make conclusions regarding efficacy; note restrictions of the conclusions to certain settings, populations, and so on; comment on gaps and future research; answer several questions related to the goals, timing,
and length of treatment; and finally, note areas where the evidence base is limited by inadequate attention or poor quality.
This report contains the committee’s conclusions about the strength of the evidence regarding the efficacy of various treatment interventions.
http://www.nap.edu/catalog.php?record_id=11955
If you have any trouble getting this article post a comment.
(see Box S-1 for the complete Statement of Task).
The committee was given five major tasks: review the scientific evidence and make conclusions regarding efficacy; note restrictions of the conclusions to certain settings, populations, and so on; comment on gaps and future research; answer several questions related to the goals, timing,
and length of treatment; and finally, note areas where the evidence base is limited by inadequate attention or poor quality.
This report contains the committee’s conclusions about the strength of the evidence regarding the efficacy of various treatment interventions.
http://www.nap.edu/catalog.php?record_id=11955
If you have any trouble getting this article post a comment.
Case 1 - The Story of Maggie
Maggie is a 22 year old lady who has been diagnosed with cerebral palsy and severe mental retardation. Over her life, she has made great improvements in her ability to communicate and understand the world around her. She was very social as a child and young adolescent. Her cognitive and social growth, however, stalled in early adulthood. She began having angry outbursts, violent nightmares, and appeared to be fearful of things that did not bother her in the past. Her willingness to socialize also reduced. Her mother later found out that a family member sexually assaulted her. She pressed charges and ensured that Maggie would never interact with him again. Maggie’s behaviors did not improved and, after the ceiling in her bedroom fell while she was sleeping, they worsened. It was difficult to get Maggie to go anywhere without her mother. She would have bouts of crying and throwing “tantrums”. She refused to sleep in her bedroom, even after repairs were made to the ceiling. Maggie’s mother took her to a psychologist who diagnosed her with PTSD in relation to the sexual assault and falling ceiling. She is now takes Zoloft, an SSRI. Her behaviors are slowly improving.
Does she meet the criteria for PTSD? Can you tell from this brief case study? If not, what is missing?
Does she meet the criteria for PTSD? Can you tell from this brief case study? If not, what is missing?
Post Traumatic Stress Disorder
by Erika Donaldson
Abstract
Posttraumatic stress disorder (PTSD) begins with exposure to a traumatic event. The disorder is marked by reexperiencing, avoidance of reminiscent stimuli, numbing of responsiveness, and increased arousal associated with the traumatic event. Traumatic events can be experienced directly, witnessed, or learned about. In addition, as with all mental disorders, the symptoms must also cause distress or impairment in areas of functioning to meet the diagnostic criteria. The prevalence of PTSD in adults is 8% over a lifetime (American Psychological Association, 2000). Many psychological, biological, and social factors appear to contribute the development of this disorder (Barlow & Durand, 2009). Other factors, such as the intensity and source (human design vs. nature) of the traumatic effect appear to affect the likelihood of PTSD development (American Psychological Association, 2000). Treatments for PTSD are relatively effective and include cognitive-behavioral therapy, eye movement desensitization and reprocessing (EMDR), and serotonin reuptake inhibitors (SSRIs) (National Center for PTSD, 2008). Special attention for this research review will be given to the experience of PTSD for individuals with developmental disabilities as it relates to the case study.
Diagnostic criteria for 309.81 Posttraumatic Stress Disorder
The traumatic event is persistently reexperienced in one (or more) of the following ways:
Abstract
Posttraumatic stress disorder (PTSD) begins with exposure to a traumatic event. The disorder is marked by reexperiencing, avoidance of reminiscent stimuli, numbing of responsiveness, and increased arousal associated with the traumatic event. Traumatic events can be experienced directly, witnessed, or learned about. In addition, as with all mental disorders, the symptoms must also cause distress or impairment in areas of functioning to meet the diagnostic criteria. The prevalence of PTSD in adults is 8% over a lifetime (American Psychological Association, 2000). Many psychological, biological, and social factors appear to contribute the development of this disorder (Barlow & Durand, 2009). Other factors, such as the intensity and source (human design vs. nature) of the traumatic effect appear to affect the likelihood of PTSD development (American Psychological Association, 2000). Treatments for PTSD are relatively effective and include cognitive-behavioral therapy, eye movement desensitization and reprocessing (EMDR), and serotonin reuptake inhibitors (SSRIs) (National Center for PTSD, 2008). Special attention for this research review will be given to the experience of PTSD for individuals with developmental disabilities as it relates to the case study.
Diagnostic criteria for 309.81 Posttraumatic Stress Disorder
The person has been exposed to a traumatic event in which both of the following are present:
- the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
- the person’s response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior
The traumatic event is persistently reexperienced in one (or more) of the following ways:
- recurrent and intrusive recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed
- recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable context
- acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur
- intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
- physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
- efforts to avoid thoughts, feelings, or conversations associated with the trauma
- efforts to avoid actual activities, places, or people that arouse recollections of the trauma
- inability to recall an important aspect of the trauma
- markedly diminished interest or participation in significant activities
- feeling of detachment or estrangement from others
- restricted range of affect (e.g., unable to have loving feelings)
- sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)
Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
- difficulty falling or staying asleep
- irritability or outbursts of anger
- difficulty concentrating
- hypervigilance
- exaggerated startle response
Duration of disturbance (symptoms in Criteria B, C, and D) is more than 1 month.
The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
Specify if:
Acute: if duration of symptoms is less than 3 months
Chronic: if duration of symptoms is 3 months or more
Specify if:
With Delayed Onset: if onset of symptoms is at least 6 months after the stressor.
Related Links
The Center for Trauma Recovery (CTR) www.umsl.edu/divisions/artscience/psychology/ctr/index.html
The National Institute of Mental Health (NIMH)
http://www.nimh.nih.gov/
US Department of Veteran Affairs
http://www.ncptsd.va.gov/
Know Your ABCs: Behavioral Assessment Basics
Behavioral assessment takes the mental status exam a step further by using direct observation to formally assess an individual’s thoughts, feelings, and overt behaviors in specific situations or contexts. This information is used to explain the maintenance of present problems in the here and now. Observations may occur in the therapy context, in the home, schools, the workplace, or in other real life situations.
The purpose of behavioral assessment is to identify target behaviors (problematic behaviors) and environmental events that may become targets of therapeutic intervention. This is accomplished via a functional analysis of antecedents, behaviors, and consequences (i.e., the ABCs of observation) following the behavior.
Observational assessment is usually focused on the here and now. Therefore, the clinician's attention is usually directed to the immediate behavior, its antecedents (what happened just before the behavior), and its consequences (what happened afterward) (Hersen 2006)
Behavioral observation may be either formal or informal. In formal observation, the observation procedures are usually structured and systematic, and involve behavior rating scales or checklists (such as the Brief Psychiatric Rating Scale) and clear operational definitions of target behaviors. Informal observation is less standardized and systematic.
People may also be asked to observe their own behavior using a technique called self-monitoring or self-observation (e.g., recording the number of cigarettes smoked per day). Self-monitoring may be formal (e.g., using scales, coding sheets, checklists) or informal (e.g., recording overall mood each day).
Reactivity can distort observational data, and refers to changes in behavior as a result of knowing that one is being observed. Anytime you observe how people behave, the mere fact of your presence may cause them to change their behavior (Hersen 2006) Reactivity can occur while being observed by others or when self-monitoring. Behaviors tend to shift in the desired direction with reactivity.
The purpose of behavioral assessment is to identify target behaviors (problematic behaviors) and environmental events that may become targets of therapeutic intervention. This is accomplished via a functional analysis of antecedents, behaviors, and consequences (i.e., the ABCs of observation) following the behavior.
Observational assessment is usually focused on the here and now. Therefore, the clinician's attention is usually directed to the immediate behavior, its antecedents (what happened just before the behavior), and its consequences (what happened afterward) (Hersen 2006)
Behavioral observation may be either formal or informal. In formal observation, the observation procedures are usually structured and systematic, and involve behavior rating scales or checklists (such as the Brief Psychiatric Rating Scale) and clear operational definitions of target behaviors. Informal observation is less standardized and systematic.
People may also be asked to observe their own behavior using a technique called self-monitoring or self-observation (e.g., recording the number of cigarettes smoked per day). Self-monitoring may be formal (e.g., using scales, coding sheets, checklists) or informal (e.g., recording overall mood each day).
Reactivity can distort observational data, and refers to changes in behavior as a result of knowing that one is being observed. Anytime you observe how people behave, the mere fact of your presence may cause them to change their behavior (Hersen 2006) Reactivity can occur while being observed by others or when self-monitoring. Behaviors tend to shift in the desired direction with reactivity.
The Importance of Empathy
The Importance of Empathy in the Therapeutic Alliance.
by Candi P. Feller , R. Rocco Cottone
In this investigation of the construct of empathy, the authors report that the literature reflects strong evidence that empathy is an essential component of the therapeutic alliance across theories and that empathy is necessary in the counseling process. The concept of empathy continues to be a central component of new forms of counseling and therapy.
Rogers (1957) conceptualized and specified six conditions that he considered to be both necessary and sufficient for therapeutic client change to occur. Rogers hypothesized that these six conditions apply to all psychotherapy, not just to client-centered therapy. These conditions require counselor congruence or genuineness in the therapeutic relationship, unconditional positive regard for the client (warmth), the ability of the counselor to empathize with the client in this relationship, and communication of empathy and unconditional positive regard to the client. Of the conditions defined by Rogers as both necessary and sufficient, empathy is the construct that has evoked the most attention from psychotherapy theorists and researchers.
An exerpt from The Importance of Empathy in the Therapeutic Alliance. Journal article by Candi P. Feller, R. Rocco Cottone; Journal of Humanistic Counseling, Education and Development, Vol. 42, 2003
by Candi P. Feller , R. Rocco Cottone
In this investigation of the construct of empathy, the authors report that the literature reflects strong evidence that empathy is an essential component of the therapeutic alliance across theories and that empathy is necessary in the counseling process. The concept of empathy continues to be a central component of new forms of counseling and therapy.
Rogers (1957) conceptualized and specified six conditions that he considered to be both necessary and sufficient for therapeutic client change to occur. Rogers hypothesized that these six conditions apply to all psychotherapy, not just to client-centered therapy. These conditions require counselor congruence or genuineness in the therapeutic relationship, unconditional positive regard for the client (warmth), the ability of the counselor to empathize with the client in this relationship, and communication of empathy and unconditional positive regard to the client. Of the conditions defined by Rogers as both necessary and sufficient, empathy is the construct that has evoked the most attention from psychotherapy theorists and researchers.
An exerpt from The Importance of Empathy in the Therapeutic Alliance. Journal article by Candi P. Feller, R. Rocco Cottone; Journal of Humanistic Counseling, Education and Development, Vol. 42, 2003
Don't Stress when it comes to DSM Diagnosis!
Providing a DSM diagnosis can seem complex, can be frustrating, or even seem "just not right." As clinicians, we want to provide the best possible care for our clients and often a diagnosis is necessary.
Just remember:
Just remember:
- "diagnostic categories are just a convenient format for organizing observations that help professionals communicate, study and plan. If we reify a category (such as depression), we literally make it a 'thing', thus assuming that 'it' has meaning that, in reality, does not exist."(Barlow and Durand 2009)
- This is a young science and the science is changing rapidly. If your client fits two or more categories, that's OK. Don't expend too much energy trying to get a unique client to fit into a category.
- And most importantly, there is strong evidence, that despite your theoretical approach and system of organization, the service that you provide as a clinician is of psychological benefit and the therapeutic alliance contributes to positive outcomes. (See Empathy next)
Resources
Therapeutic alliance perceptions and medication adherence in patients with bipolar disorder.
The Clinical Interview and the Mental Status Exam
The clinical interview is the core of most clinical work and is used primarily to gather information about past and present behavior, attitudes, emotions, and a history of the person's problem(s) and life circumstances. Other important points to cover include precipitating events, family composition and history, sexual development, religious beliefs, cultural concerns, educational achievement, and social-interpersonal history.
To organize information obtained during an interview, many clinicians will use a mental status exam; an exam that involves the systematic observation of a client’s behavior across five domains:
a. Appearance and behavior
b. Thought processes (e.g., rate and flow of speech, clarity, and content of speech and ideas)
c. Mood and affect (e.g., is affect and mood appropriate of inappropriate?)
d. Intellectual functioning (e.g., does the client have a reasonable vocabulary and memory?)
e. Sensorium (i.e., general awareness of surroundings such as date, place, time, knowledge of self).
Clinical interviews may be structured or semistructured.
Unstructured clinical interviews are not standardized with respect to procedure and content and follow no systematic format.
Semistructured clinical interviews contain questions that have been carefully phrased and tested to elicit useful information in a consistent manner, but also allow room for clinicians to depart from the format with additional questions of interest (e.g., Anxiety Disorders Interview Schedule, 4th ed., or the Structured Clinical Interview for DSM).
Clinicians often recommend a physical examination, particularly if the patient has not been seen by a medical doctor in the past year. The reason for the physical exam is to rule out medical conditions that are associated with psychological disorders and those that may masquerade as psychological disorders. Examples of physical conditions that may lead to psychological problems include toxic states, hyperthyroidism (anxiety), hypothyroidism (depression), brain tumor, and drug ingestion.
There are a variety of ways to conduct a clinical interview. The best way is the one that values your client's input and systematically records your clinical observations for later evaluation. It is important to conduct the clinical interview in a way that elicits the patient’s trust and empathy in order to facilitate communication. Alway remember, information provided by patients to psychologists and psychiatrists is protected by laws of confidentiality.
To organize information obtained during an interview, many clinicians will use a mental status exam; an exam that involves the systematic observation of a client’s behavior across five domains:
a. Appearance and behavior
b. Thought processes (e.g., rate and flow of speech, clarity, and content of speech and ideas)
c. Mood and affect (e.g., is affect and mood appropriate of inappropriate?)
d. Intellectual functioning (e.g., does the client have a reasonable vocabulary and memory?)
e. Sensorium (i.e., general awareness of surroundings such as date, place, time, knowledge of self).
Clinical interviews may be structured or semistructured.
Unstructured clinical interviews are not standardized with respect to procedure and content and follow no systematic format.
Semistructured clinical interviews contain questions that have been carefully phrased and tested to elicit useful information in a consistent manner, but also allow room for clinicians to depart from the format with additional questions of interest (e.g., Anxiety Disorders Interview Schedule, 4th ed., or the Structured Clinical Interview for DSM).
Clinicians often recommend a physical examination, particularly if the patient has not been seen by a medical doctor in the past year. The reason for the physical exam is to rule out medical conditions that are associated with psychological disorders and those that may masquerade as psychological disorders. Examples of physical conditions that may lead to psychological problems include toxic states, hyperthyroidism (anxiety), hypothyroidism (depression), brain tumor, and drug ingestion.
There are a variety of ways to conduct a clinical interview. The best way is the one that values your client's input and systematically records your clinical observations for later evaluation. It is important to conduct the clinical interview in a way that elicits the patient’s trust and empathy in order to facilitate communication. Alway remember, information provided by patients to psychologists and psychiatrists is protected by laws of confidentiality.
Heisman Trophy Winner Ricky Williams overcame Social Anxiety Disorder
Ricky Williams had it all - fame, fortune, but a treatable problem almost ruined him.
Here is his story as told by Leslie Anderson.
Here is his story as told by Leslie Anderson.
Interactive Tutorial on Stress Management
This tutorial will provide you with basic information regarding stress management.
http://www.makingthemodernworld.org.uk/learning_modules/psychology/07.TU.09/?section=1
http://www.makingthemodernworld.org.uk/learning_modules/psychology/07.TU.09/?section=1
The Comorbidity of Anxiety and Eating Disorders
Here is a link to a paper on the association between Anxiety and Eating Disdorders.
http://www.vanderbilt.edu/AnS/psychology/health_psychology/AnxietyandEatingDisorders.html
http://www.vanderbilt.edu/AnS/psychology/health_psychology/AnxietyandEatingDisorders.html
What is Stress?
Here is a link to an interactive website from the Modern World Museum that covers stress.
http://www.makingthemodernworld.org.uk/learning_modules/psychology/02.TU.01/
http://www.makingthemodernworld.org.uk/learning_modules/psychology/02.TU.01/
DO A CLIENT MAP
DO A CLIENT MAP is a Mnemonic device for therapists to recall the basics of a diagnostic interview. The diagnostic interview is one of the therapists best tools for organizing clinical information pertinent to future diagnosis and treatment.
DO A CLIENT MAP
Diagnosis
Objectives of treatment
Assessments needed (e.g. neurological, personality)
Clinician characteristics viewed as therapeutic
Location of treatment (e.g. hospital, outpatient)
Interventions to be used
Emphasis of treatment (level of directiveness; level of supportiveness; cognitive, behavioral, affective emphasis)
Nature of treatment (individual, couple, family, group)
Timing (frequency, pacing, duration)
Medications needed
Adjunct services (e.g. support groups, legal advice, education)
Prognosis
excerpted from "Selecting Effective Treatments" Linda Seligman 1990
DO A CLIENT MAP
Diagnosis
Objectives of treatment
Assessments needed (e.g. neurological, personality)
Clinician characteristics viewed as therapeutic
Location of treatment (e.g. hospital, outpatient)
Interventions to be used
Emphasis of treatment (level of directiveness; level of supportiveness; cognitive, behavioral, affective emphasis)
Nature of treatment (individual, couple, family, group)
Timing (frequency, pacing, duration)
Medications needed
Adjunct services (e.g. support groups, legal advice, education)
Prognosis
excerpted from "Selecting Effective Treatments" Linda Seligman 1990
Types of Anxiety Disorders
Here is a link to anxietyconnection.com (sponsored by the ADAA) for
types of anxiety disorders
http://www.healthcentral.com/anxiety/disorder-types.html?ic=4025
types of anxiety disorders
http://www.healthcentral.com/anxiety/disorder-types.html?ic=4025
Social Anxiety Disorder Interactive Website
Here is a link to a interactive website covering Social Anxiety Disorder (SAD).
http://www.adaa.org/socialanxietydisorder/default.asp
http://www.adaa.org/socialanxietydisorder/default.asp
Anxiety Disorder Association of America
The website contains general information on anxiety disorders and a comprehensive listing of ADAA-affiliated groups.
http://www.adaa.org/
http://www.adaa.org/
National Mental Health Self-help Clearinghouse
The Center For Mental Health Services hosts this website for those with questions about mental health issues.
http://www.mhselfhelp.org/
http://www.mhselfhelp.org/
Thursday, September 11, 2008
Depression and Career Development By Roger Wilcoxen
As a Regional Career Advisor, who is also involved in the religious community, I have found congruence between counseling those in career development and the religious community concerning depression. Three key principles, Focus, Realization and Acceptance are creating a difference between feeling trapped and becoming successful. These principles lay a foundation toward career growth and most importantly, personal growth. Preparing clients for success can be challenging yet fulfilling, even if depression is a factor.
FOCUS: A person’s ability to focus on strengths instead of weaknesses is crucial during career development, and more crucial for an individual with depression. For the depressed, it is easy to permit cognitive distortions, obscure thoughts, and even obstruct the ability to clarify strengths. Individuals who attend to positive attributes of their achievements and goals generate confidence and the ability to progress forward in career growth.
As professionals, extending a fresh outlook on employment processes and offering positive feedback regarding the client’s abilities often provides the assurance clients need. Through the process of resume development, client’s are able to highlight positive aspects of their abilities and create opportunity for personal growth and positive outlook. The use of tools indicating transferable, soft, and hard skills provides opportunity to examine the full spectrum of one’s abilities. Individuals succumbed with depression generally are aware of their weaknesses; focusing on strengths challenges thinking and refocuses one’s attention.
REALIZATION: There are some realizations individuals need to accept during the process of career development.
1. Rejection doesn’t mean elimination. Numerous times I have witnessed individuals coming back from an interview feeling rejected. Applicants need to understand that the employment “pool” is large and unless there are obvious aspects of the interview process needing to be refined, what they are experiencing may be completely natural. In large pools of applicants, it is tough for employers to formulate hiring decisions. Feelings of rejection, especially continual rejection that can be experienced in the job search, can lead to depressive issues. Guiding individuals through this process may be difficult, yet very rewarding. Reassuring clients of their abilities and character strengths often times conveys further hope toward success.
2. Failing doesn’t equal failure. Just because one has not successfully ascertained an interview, or has had character issues, does not mean they are a failure. People generally struggle with the interview process, and some even feel like failures after “bombing” an interview. I remember a colleague who has been in career development over 35 years once telling me, “Roger I have interviewed and been interviewed hundreds of times and I still get nervous and mess up. The important thing isn’t that you have messed up or have flawed your character in the past. The crucial lesson is that we learn from those shortcomings by finding solutions and then moving forward.”
Yet how do we guide clients dealing with failure? This is one of the hardest components of career development and a strong self-sabotaging tool people use. It is important that continual follow up, opportunity for mock interviews and educational interviews be utilized. Once a client appears to be self-sabotaging, immediate intervention is important to help the client refocus and be assured. Help the client see that they can be successful in their career and not doomed for failure.
ACCEPTANCE: Acceptance of abilities, accomplishments and employment availability are crucial in successful establishment of a career.. Generally this is done fairly easy for individuals seeking career transformations, yet, difficult for depressed individuals. Career Counselors guiding people toward realistic expectations need to focus on two main goals:
1. Acceptance of abilities and accomplishments; own them.
Clients wanting to discredit their abilities and overlook their accomplishments may find it complicated to develop a resume and accomplish successful interviewing skills. An important feature of career development is how to “own” abilities and accomplishments in a way that demonstrates self-confidence and professionalism. What may seem as a small accomplishment to one may be huge in the eyes of an employer who desires those abilities.
Professionals provide not only guidance in discovering abilities and accomplishments, but helping a client recognize personal attributes and how to reward oneself. Too many people discredit themselves and therefore cut themselves short. When counselors offer guidance in this area, it opens the door toward confidence and personal growth.
2. Acceptance of character; live it.
Character is critical in career development. Employers often ask for referrals and one question asked is, “Are they a person of character?” Character is the ability to be professional and to exhibit integrity and respect. I have had employers tell me: “Give me a person of character, and I can teach them anything. Give me a person with no character with tremendous abilities, and they will destroy my company.”
Character has become known as “soft skills” throughout most industries. The development of these skills can be challenging and extremely frustrating for professionals who observe individuals self-sabotaging. There is a question of consideration for clients: Would I hire myself based on my character, and why? Once this question is examined, opportunity avails itself for professionals to direct individuals in accepting shortcomings and working toward positive solutions. This process develops not only career success, but allows people the opportunity to grow individually as well.
Depression can be overwhelming during career change, yet career change can be a very positive experience as well. Focus, Realization, and Acceptance are powerful attributes needed to develop a successful and positive experience during career change and also decrease the characteristics of depression.
Roger Wilcoxen holds a MA in Counseling Psychology, serves as a State Board Member for Kansas Association of Master’s in Psychology, is a Regional Career Advisor for Johnson County Workforce Partnership, and serves in various ministry capacities. You may contact him at: roger.w.wilcoxen@hotmail.com.
FOCUS: A person’s ability to focus on strengths instead of weaknesses is crucial during career development, and more crucial for an individual with depression. For the depressed, it is easy to permit cognitive distortions, obscure thoughts, and even obstruct the ability to clarify strengths. Individuals who attend to positive attributes of their achievements and goals generate confidence and the ability to progress forward in career growth.
As professionals, extending a fresh outlook on employment processes and offering positive feedback regarding the client’s abilities often provides the assurance clients need. Through the process of resume development, client’s are able to highlight positive aspects of their abilities and create opportunity for personal growth and positive outlook. The use of tools indicating transferable, soft, and hard skills provides opportunity to examine the full spectrum of one’s abilities. Individuals succumbed with depression generally are aware of their weaknesses; focusing on strengths challenges thinking and refocuses one’s attention.
REALIZATION: There are some realizations individuals need to accept during the process of career development.
1. Rejection doesn’t mean elimination. Numerous times I have witnessed individuals coming back from an interview feeling rejected. Applicants need to understand that the employment “pool” is large and unless there are obvious aspects of the interview process needing to be refined, what they are experiencing may be completely natural. In large pools of applicants, it is tough for employers to formulate hiring decisions. Feelings of rejection, especially continual rejection that can be experienced in the job search, can lead to depressive issues. Guiding individuals through this process may be difficult, yet very rewarding. Reassuring clients of their abilities and character strengths often times conveys further hope toward success.
2. Failing doesn’t equal failure. Just because one has not successfully ascertained an interview, or has had character issues, does not mean they are a failure. People generally struggle with the interview process, and some even feel like failures after “bombing” an interview. I remember a colleague who has been in career development over 35 years once telling me, “Roger I have interviewed and been interviewed hundreds of times and I still get nervous and mess up. The important thing isn’t that you have messed up or have flawed your character in the past. The crucial lesson is that we learn from those shortcomings by finding solutions and then moving forward.”
Yet how do we guide clients dealing with failure? This is one of the hardest components of career development and a strong self-sabotaging tool people use. It is important that continual follow up, opportunity for mock interviews and educational interviews be utilized. Once a client appears to be self-sabotaging, immediate intervention is important to help the client refocus and be assured. Help the client see that they can be successful in their career and not doomed for failure.
ACCEPTANCE: Acceptance of abilities, accomplishments and employment availability are crucial in successful establishment of a career.. Generally this is done fairly easy for individuals seeking career transformations, yet, difficult for depressed individuals. Career Counselors guiding people toward realistic expectations need to focus on two main goals:
1. Acceptance of abilities and accomplishments; own them.
Clients wanting to discredit their abilities and overlook their accomplishments may find it complicated to develop a resume and accomplish successful interviewing skills. An important feature of career development is how to “own” abilities and accomplishments in a way that demonstrates self-confidence and professionalism. What may seem as a small accomplishment to one may be huge in the eyes of an employer who desires those abilities.
Professionals provide not only guidance in discovering abilities and accomplishments, but helping a client recognize personal attributes and how to reward oneself. Too many people discredit themselves and therefore cut themselves short. When counselors offer guidance in this area, it opens the door toward confidence and personal growth.
2. Acceptance of character; live it.
Character is critical in career development. Employers often ask for referrals and one question asked is, “Are they a person of character?” Character is the ability to be professional and to exhibit integrity and respect. I have had employers tell me: “Give me a person of character, and I can teach them anything. Give me a person with no character with tremendous abilities, and they will destroy my company.”
Character has become known as “soft skills” throughout most industries. The development of these skills can be challenging and extremely frustrating for professionals who observe individuals self-sabotaging. There is a question of consideration for clients: Would I hire myself based on my character, and why? Once this question is examined, opportunity avails itself for professionals to direct individuals in accepting shortcomings and working toward positive solutions. This process develops not only career success, but allows people the opportunity to grow individually as well.
Depression can be overwhelming during career change, yet career change can be a very positive experience as well. Focus, Realization, and Acceptance are powerful attributes needed to develop a successful and positive experience during career change and also decrease the characteristics of depression.
Roger Wilcoxen holds a MA in Counseling Psychology, serves as a State Board Member for Kansas Association of Master’s in Psychology, is a Regional Career Advisor for Johnson County Workforce Partnership, and serves in various ministry capacities. You may contact him at: roger.w.wilcoxen@hotmail.com.
DSM Multiaxial Model
DSM Multiaxial Model
The disorders in the DSM are grouped in terms of a multiaxial model.
Multiaxial literally means multiple axes. Each axis represents a different kind or source of information. Later, we concentrate on exactly what these sources are; now, we just explain their purpose.
The multiaxial model exists because some means is required whereby the various symptoms and personality characteristics of a given patient can be brought together to paint a picture that reflects the functioning of the whole person.
For example, depression in a narcissistic personality is different from depression in a dependent personality. Because narcissists consider themselves superior to everyone else, they usually become depressed when confronted with objective evidence of failure or inadequacy too profound to ignore. Their usually puffed-up self-esteem deflates, leaving feelings of depression in its wake.
In contrast, dependent personalities seek powerful others to take care of them, instrumental surrogates who confront a cruel world. Here, depression usually follows the loss of a significant caretaker. The point of the multiaxial model is that each patient is more than the sum of his or her diagnoses: Both are depressed, but for very different reasons. In each case, what differentiates them is not their surface symptoms, but rather the meaning of their symptoms in the context of their underlying personalities.
By considering symptoms in relation to deeper characteristics, an understanding of the person is gained that transcends either symptoms or traits considered separately. To say that someone is a depressed narcissist, for example, conveys much more than does the label of depression or narcissism alone.
The multiaxial model is divided into five separate axes (see Figure 1.1), each of which gets at a different source or level of influence in human behavior.
Axis I, clinical syndromes, consists of the classical mental disorders that have preoccupied clinical psychology and psychiatry for most of the history of these disciplines. Axis I is structured hierarchically. Each family of disorders branches into still finer distinctions, which compose actual diagnoses. For example, the anxiety disorders include obsessive-compulsive disorder, posttraumatic stress disorder, and generalized anxiety disorder. The mood disorders include depression and bipolar disorder. Other branches recognize sexual disorders, eating disorders, substance abuse disorders, and so on. Finally, each disorder is broken down into diagnostic criteria, a list of symptoms that must typically be present for the diagnosis to be given.
Axis II, personality disorders, is the subject of this text.
Axis III consists of any physical or medical conditions relevant to understanding the individual patient. Some influences are dramatic, and others are more subtle. exerpt from Personality Disorders in Modern Life By Theodore Millon Carrie M. Millon Sarah Meagher Seth Grossman Rowena Ramnath John Wiley & Sons ISBN: 0-471-23734-5
The disorders in the DSM are grouped in terms of a multiaxial model.
Multiaxial literally means multiple axes. Each axis represents a different kind or source of information. Later, we concentrate on exactly what these sources are; now, we just explain their purpose.
The multiaxial model exists because some means is required whereby the various symptoms and personality characteristics of a given patient can be brought together to paint a picture that reflects the functioning of the whole person.
For example, depression in a narcissistic personality is different from depression in a dependent personality. Because narcissists consider themselves superior to everyone else, they usually become depressed when confronted with objective evidence of failure or inadequacy too profound to ignore. Their usually puffed-up self-esteem deflates, leaving feelings of depression in its wake.
In contrast, dependent personalities seek powerful others to take care of them, instrumental surrogates who confront a cruel world. Here, depression usually follows the loss of a significant caretaker. The point of the multiaxial model is that each patient is more than the sum of his or her diagnoses: Both are depressed, but for very different reasons. In each case, what differentiates them is not their surface symptoms, but rather the meaning of their symptoms in the context of their underlying personalities.
By considering symptoms in relation to deeper characteristics, an understanding of the person is gained that transcends either symptoms or traits considered separately. To say that someone is a depressed narcissist, for example, conveys much more than does the label of depression or narcissism alone.
The multiaxial model is divided into five separate axes (see Figure 1.1), each of which gets at a different source or level of influence in human behavior.
Axis I, clinical syndromes, consists of the classical mental disorders that have preoccupied clinical psychology and psychiatry for most of the history of these disciplines. Axis I is structured hierarchically. Each family of disorders branches into still finer distinctions, which compose actual diagnoses. For example, the anxiety disorders include obsessive-compulsive disorder, posttraumatic stress disorder, and generalized anxiety disorder. The mood disorders include depression and bipolar disorder. Other branches recognize sexual disorders, eating disorders, substance abuse disorders, and so on. Finally, each disorder is broken down into diagnostic criteria, a list of symptoms that must typically be present for the diagnosis to be given.
Axis II, personality disorders, is the subject of this text.
Axis III consists of any physical or medical conditions relevant to understanding the individual patient. Some influences are dramatic, and others are more subtle. exerpt from Personality Disorders in Modern Life By Theodore Millon Carrie M. Millon Sarah Meagher Seth Grossman Rowena Ramnath John Wiley & Sons ISBN: 0-471-23734-5
Thursday, September 4, 2008
Welcome to the Adult Diagnosis Blog
The purpose of this weblog is to aggregrate information for the education of graduate students studying abnormal behavior, diagnosis and treatment.
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