Tuesday, September 6, 2016

Addiction treatment modalities

Outpatient Care

⋄ Techniques vary by clinician but typically include :
o cognitive-behavioral therapy
o problem-solving groups
⋄ Low success rate with heavily addicted individuals.
⋄ Moderate addicts may find that this level of treatment is enough to end their drug abuse problems.

12 Step Programs

⋄ Clients attend meetings.
⋄ Preferable after or in conjunction with some other form of drug treatment
⋄ There is the belief that they will never "recover" from their drug addiction.
⋄ This type of program may leave many feeling powerless (one of 12 steps is to accept powerlessness) over ever ending their battle with drug addiction.
⋄ This type of program may work for some, but has low success rate.

Inpatient Short-Term Rehabilitation

⋄ Substance abuse treatment that lasts typically for 30 days.
⋄ Overseen by medical professionals and trained counselors, often Certified Drug Addiction Specialist.
⋄ Goals are primarily physical stabilization, abstinence from all use, and lifestyle changes.
⋄ Primarily founded in a modified 12-step approach.

Inpatient Long-Term Rehabilitation

⋄ Inpatient long-term residential program is a 24 hour a day 7 days a week treatment.
⋄ Duration can be from several months to a year or more.
⋄ Residential treatment is conducted in non-clinical settings known as therapeutic communities.
⋄ May also include additional treatment strategies such as social education.

Methadone Maintenance Treatment

⋄ For clients with a dependence on heroin or other morphine like drugs.
⋄ Methadone decreases the feeling of pain and reduces emotional responses to withdrawal symptoms.
⋄ A dose typically suppresses an addict's symptoms for 24 hours.
⋄ Downside:
o Clients are physically dependent on
o They may find themselves using it for many years after they start treatment.
o Methadone may be more difficult to withdrawal from than heroin.
o Maintenance involves more time, pain, and expense than heroin withdrawal.

Thursday, September 1, 2016

Sexual abuse treatment for victims, perpetrators, and their families


Sexual assault is a traumatic event from which many victims never fully recover. Victims often develop problems with post traumatic stress disorder (PTSD), depression, poor self-esteem, interpersonal difficulties, and sexual disorders. PTSD is overwhelmingly the most common disorder related to sexual abuse.

Children may have some symptoms that are different from adults such as agitated behavior, repetitive play involving trauma, frightening non-specific dreams, and reenactment of the traumatic event.

Long Term Treatment Goals
Ensure safety from further victimization.
Help client understand and control the feelings and behavior that accompany the assault.
Build self esteem.

Short Term Treatment Goals
Establish therapeutic rapport and open communication with client.
Assess the level of symptomology.
Obtain medical assistance (forensic examination).
Obey child abuse laws (mandatory reporting)
Assess for suicidal tendencies.
Have client tell their story.
Identify and express feelings about the abuse.
Decrease feelings of guilt and shame.
Increase feelings of empowerment.

Therapeutic Interventions
Write out what happened including feelings.
Play Therapy
o Angry tower: build tower, then verbalize while throwing things at the tower, watching it topple, to allow feelings to emerge.
Mutual Story telling
o Client and therapist take turns telling stories (may use puppets dolls or stuffed animals).
Art Therapy
o Associate color with feelings
o Draw different scenes for different feelings
o Have client write letter to perpetrator that describes feelings about the abuse. Process the letter.
Develop personalized Safety Plan
o Self defense classes
o Safety escape routes.
o Who to call in cases of emergency
o Domestic violence safety plans can be searched for online.
Challenging Beliefs
o Discuss myths and realities
o Reduce feelings of shame and guilt
Encourage group work

Family Interventions
Encourage parents to reassure child that they are not angry at family member/victim.
The best things parents can do is believe the client.
Encourage the whole family to find support, as well as being a support for each other.
Establish safety for the whole family.
Have parents request and advocate.
Encourage the family to make sure client knows they are not to blame.
Discuss myths as a family.

Family Therapy for Couples


■ Behavioral couples therapy has been the most researched.
o Attempts to reduce substance abuse directly and through restructuring the dysfunctional couple interactions that frequently help sustain it

■ Integrative Couples therapy addresses some of the limitations of behavioral couples therapy.
o Helps couples to make arguments less harmful by teaching partners accept their differences.
o Therapy based on the importance of how a couple fights, not whether they fight or not.

■ Insight Oriented couples therapy and emotionally focused couples therapy have also been subjected to clinical trail investigations and found to be superior to no treatment.
o Is a combination of behavioral therapy and helping couples understand power struggles, defense mechanisms, and other negative behaviors.

■ Emotionally focused couples therapy maintains that relationship difficulties stem from the disowning of feelings and attachment needs, creating negative Interactional cycles and ineffective communication patterns.
o It has shown greater efficacy than no-treatment await-list controls.
o Enables couples to identify and break free of their destructive emotional cycles such as when one person criticizes and the other withdraws.
o The therapy helps couples build trust in each other.

■ Evidence for the use of Strategic therapy techniques in the context of couples therapy found an integrated systemic therapy model was equally effective as emotionally focused couples therapy and more effective than await-list control in alleviating relationship distress and improving target complaints and conflict resolutions.

Group Counseling Theory

Theoretical approaches to group therapy and dynamics conveniently depend on what the group is and who’s doing the research, perhaps putting the lie to social science as the road to Shangri La. Cartwright and Zander gamely argue that many disparate theories merely validate each and propose (with the confidence of their Victorian forebears) that one day when we know more, a unifying theory will show us to the broad sunlit uplands of useful improvement.

Toseland and Rivas list the following five theories important to group practice:

psychoanalytic theory (Freud, et al.)
learning theory (Bandura)
field theory (Lewin)
social exchange or interaction theory (Blau; Homans; Thibaut and Kelly)
systems theory (Anderson; Olsen)

Cartwright and Zander add four others:

sociometric orientation (Jennings; Moreno)
general psychology orientation (looking at individual group members)
empericist-statistical orientation, or group syntality theory (Cattell)
formal models orientation (French & Snyder; Harary, Norman, & Cartwright; Simon)

Shaw includes the FIRO theory of interpersonal relationships (Schutz), along with group congruence theory (Benoit-Smullyan). While emphasizing the interworking of theory and research, Shaw quite sensibly sees each theory as adding its unique part to understanding group behavior.

Eclectic approach -- Corey & Corey suggest therapists take parts from various theoretical models to create a personal approach in tune with their own philosophies of helping and leadership.

Whole Group and Individual

Therapists choose between working with the group as a whole and working with individual members in the group.

Whole group -- This approach attends to group setting, relationship building, task, and process. According to Yalom, process comments serve to keep the group in the moment and help members appreciate how they relate to one another. This should maintain group awareness and goal orientation.

Individual -- As basically individual therapy in a group setting, this approach is sometimes called vertical intervention (as opposed to whole group, horizontal intervention). Kissen suggests that the same therapist may use whole group or the individual approach depending on a group’s internal dynamics.

Outcome and Process

Research into outcome seeks to find out how well groups work, while research into process investigates how they work. What studies there are suggest the heartening result that group therapy is better than no therapy at all, but there’s not enough research out there to definitively compare group to other therapy outcomes. From a research standpoint, it’s uncertain exactly how and why groups work as treatment.


Child Custody


⋅ Therapy Contract
o Foundation based on court order.
o Frequency must be determined prior to counseling process; many will only participate for court minimum requirements.
o Specific confidentiality contract and explanation of confidentiality limitations in essential.

Alliance Building
o Any alliance can be experienced as an alliance against the other in these families
o Extra effort is necessary to establish a multipartial alliance in which the therapist is experienced as caring but also fair.
o Counselor must be honest, provide direct feedback about the behavior occurring but reframe changes sought in the most positive light.
o Problematic behaviors related to the conflict are directly confronted, but the positive intent of each client is always underscored.

o Begin with a form of evaluation that involves:
⋅ Separate meetings with each parent (with or without new spouses, depending on the issues involved) and children
⋅ A review of records of filings in court and other relevant reports available
⋅ Consultations with other therapists involved.
o Identify family strengths and weaknesses.

Treatment Plan
o Should include not only the traditional goals but also:
⋅ Format of future sessions of who will participate
⋅ In what combinations, at what time, and focused on what issues.

⋅ Goal Setting
o Main goal is to reduce the damaging aspects of custody disputes:
• high conflict
• triangulation
• broken family structure
• lack of safety
• Impact on daily functioning


The diagnosis typically assigned for clients and families dealing with divorce is depression. The symptoms are usually the same for children, adolescents, and adults.
Persistent sadness
Inability to enjoy favorite activities
Increased irritability
Physical problems such as headaches and stomach aches
Poor school performance
Poor work performance
Persistent boredom
Low energy
Poor concentration
Changes in eating and or sleeping patterns

Long-term Treatment Goals for Treating Depression due to Divorce
Improved mood and stability
Prevent further episodes of depression
Help the client become well established in a new family living arrangement

Short Term Objectives
Develop therapeutic rapport
Identify feelings and anxieties about divorce
Increase social contacts and create a support system
Develop coping skills to deal with depressive thoughts and feelings
Discuss the feelings about the loss of the family relationship is it was
Help client adapt to new situation

Verbal therapy to discuss feelings
Play/ Art therapy:
o Pairing emotions and colors
o Draw different representations of emotions symbolically
o Use clay or other materials to recreate story
o Puppets to tell a story
o Board games designed to discuss feelings
o List positive and negative emotions or changes
o Journal feelings
o Unsent letters
Parent Education
o Teach parents about typical emotional reactions they will see in their children and how to handle them.
o Encourage parents to make teachers aware of the situation.
o Have parents engage in an activity with the children each week, teach dyadic techniques.

Infertility- inability to conceive during one year of sexual intercourse without the use of contraception, or the inability to carry a pregnancy to live birth.
There are two kinds of infertility diagnoses:
Primary infertility - couples who have never had a child
Secondary infertility - couples who are unable to conceive or to achieve a live birth after having previous children.
Male infertility

Lifestyle habits can markedly affect the quality of the semen.
o Alcohol can damage sperm-producing tissue.
o Tobacco decreases sperm survival and function.
o Diet and vitamins have been researched to affect sperm production.
o Sexual practices can be altered to increase fertility.
• Abstinence periods of three to four days produce larger semen quantities and greater viability.
• Certain common lubricants such as KY jelly, lotions, and oils can kill sperm and decrease fertility.


Female Infertility
Can often lead to profound distress for women and may affect sexual functioning in couple’s relationship and is associated with a wide range of factors:
o Physical- hormonal, anatomical, genetic, immune system
o Psychological- denial, grief, helplessness, anger, anxiety, and guilt
o Environmental- work related stress, family issues, gender role expectations.

Goals of Therapy
Explore their beliefs about creating a family
Identify and explore feelings and reactions to infertility
Create a support system
Provide educational materials related to medical procedures
Assist partners in communication about sexual relationship

Human sexual anatomy, physiology, and development


- Organizing effects during a sensitive period of early development permanently influence genital anatomy and the brain.

* The genital organs begin to form identically until the second trimester of pregnancy during which the genetic components of the fetus dictate which parts of the anatomy will grow to develop male or female patterns.
- Activating effects are transient and may occur at any time.

* Sexual arousal can be controlled by altering hormone levels.
~ Some sex offenders have been treated this way by being given cyproterone, a drug that blocks the binding of testosterone to receptors in cells.
~ They experience decrease in sexual fantasies and offensive sexual behaviors.
~ Side effects include depression, breast growth, weight gain, and blood clots.
~ They also wear off quickly if offender stops taking daily pill.

o Sex hormones activate specific sexual and parental behaviors.

o Female initiated sexual activities during the monthly cycle are similar, showing biological impact of hormone levels, typically peaking during ovulation.

- The onset of sexual maturity

- Menarche
* A girls first menstruation
- Puberty starts when the hypothalamus begins to release lutenizing hormone releasing hormone at the rate of one burst per hour.

* Hormone stimulates the pituitary to send signal to gonads to release either estrogen or testosterone.

* The sex hormones stimulate growth spurts in secondary sexual characteristics such as breast development and broadening of hips in women and lowering voice and broadening of shoulders in men.

- The time when women permanently stop menstruating.
- Estrogen replacement therapy shows better performance in memory tasks.