Psychological Treatment Plan It is recommended that students review the e-book The Complete Adult Psychotherapy Treatment Planner (Jongsma, Peterson, & Bruce, 2014) for additional assistance in comple

Julia’s Treatment Plan

Heather Yant

PSY 650 Introduction to Clinical and Counseling Psychology
Adam Quinn
9/6/18

Behaviorally Defined Symptom

The report addresses issues raised during my time with Julia who had symptoms that resembled depression, Bulimia Nervosa and Anorexia nervosa. According to Julia, she felt pressurized to meet a certain standard in her life. She constantly feared the possibility of gaining weight and this led her to eating less and exercising frequently. She did not notice that she was getting underweight just to prove to everyone that she could keep her weight in check. Julia seems to showcase Anorexia Nervosa disorder that is characterized by poor eating habits that results to loss of weight and challenges in managing one’s body weight (Zipfel, Giel, Bulik, Hay, & Schmidt, 2015).

Julia continue to explain her current situation and how it was negatively impacting her life. She claimed that she constantly has the urge to continue losing weight despite advices from her peers and coach to keep her weight in check. She has portrayed some characteristics associated with Anorexia disorder where she tends to withdraw herself from social settings that involve eating with others such as family gatherings or friends. This is because she is afraid of getting noticed and been limiting the amount of food she can take in. She claimed that this behavior began shortly after joining States University when her friends and coach started pressurizing her after she started gaining weight affecting her sporting activities. As a result, she came with a timetable that she strictly followed. She further realized that she was sort of a out cast when the coach advised her that she need to reduce her weight to about 115 pounds. When she drastically cut her weight, this raised some concerns from her mother who called the school dean to determine what was wrong with her daughter. On further investigation from her friend Rebecca, Julia’s mother learnt that she had started isolating herself and it was then that it was deemed necessary to have some interventions.

To analyze Julia’s case scenario, the manual used to get the necessary information pertaining her disorder and possible diagnosis is “Treatment Manual for Anorexia Nervosa - A Family- Based Approach” by Lock, Grange, Agras and Dare as well as the “DSM-5 made easy: The clinician’s guide to diagnosis.” After analysis of the issues presented by Julia, do meet the criteria for the Anorexia Nervosa disorder according to the information provided from the book.

According to Erikson there are various stages of psychological development that impacts the growth of an individual. First, social interactions play a role in the development and growth of people and any conflict experienced at this point acts as a turning point. This can be identified from our client since almost her entire high school days, Julia used be chubby and was often made fun of but this did not hinder her from prospering in her studies. She had pressure to make her parents proud by excelling in her studies as well as making her coach proud. She did not know that this would end up affecting her psychologically and mentally, to a situation of developing this disorder. She later began withdrawing herself from social events and this further resulted to more weight loss.

Taking into account the DSM-5 criteria, Julia suffers from anorexia nervosa disorder since she has indicated signs of giving excuses that it is not wrong becoming underweight (Morrison, 2014). To conduct symptoms evaluation, we opted to test Julia for any physical symptoms that may contribute to the situation. Through this approach, the psychiatrist can get information about environmental contribution towards the behavior and how the coach and parents played a role towards the disorder.

Julia is very interested in learning ways that she can adopt to manage her disorder and as a result, we have agreed to develop a treatment plan that she will have to adhere to in her efforts to achieving her goals.

The treatment plan developed will be in stages where within the stages, there will be several milestones that Julia will partake as she pursues her goals.

The Short-Term Goals:

Problem/Symptom: Eating disorder resulting to reduced weight loss.

Julia will have to agree to the treatment plan and the goals that will be set for her. We will discuss the goals and ensured that they are tailored according to her ability to achieve them. In this phase, Julia will have to design a list of situations that results to feeling out casted and end up isolating herself since she first experienced the urge. Further, we will try to identify the negative impacts associated with this type of behavior and understand what exactly she feels before and after the feeling. Psychodynamic theory of therapy is applied for the diagnosis of patient where they are viewed using a model of illness that begins in early childhood and progresses through life.

Short term goals will be effectively attainable by allowing Julia keep daily journals on her day experiences and how many times the urge to isolate herself have occurred. In addition, we will have a direct contact line through which she can contact me at any time to discuss various unexplainable changes in behavior. We will agree on the phone communication time for the first month and later depending on the urgency we shall review the topic later on. According to cognitive behavioral theory, her parents played a role in impacting Julia’s behavior of adding and losing weight through learning. To understand and try to resolve her issues, it is recommendable we have a sit-in on a weekly basis for the first six months and evaluate the progress of the treatment. Further, it is crucial to learn the art of self-appreciation and this will be very instrumental in building her self-esteem. We will come up with activities that she will have to undertake in case of the urge to isolate herself creeps in and she will have to record her concentration level. Behavioral approaches have been identified to greatly impact various aspect of treat various disorder to address TTM (Lock, Le Grange, Agras, & Dare, 2001).

In the short term goal phase, we will keenly observe changes in her weight loss and analyze her ability to minimize her denial of eating disorder behavior as well as distorted self-perception of body image. Further, we shall analyze some behaviors that are often portrayed by similar patients of self-induced vomiting, fasting and excessive exercising. This aspect will be monitored daily through check ins and telephone conversation.

Long- Term Goals Explanation

In her treatment, we shall employ behavioral therapy techniques to help Julia attain her long-term goal through the use of Cognitive behavioral therapy. Cognitive behavioral therapy is the most preferred evidence-based treatment advocated for the treatment of adults that have shown symptoms of eating disorders. The theory general assumes that the human body is intertwined from their thoughts to their behavior. As a result, Cognitive Behavioral Therapy strives to restructure a person’s body by providing a foundation for various forms of therapies. Further, Cognitive Behavioral Therapy ensures that people are able to focus and determine the various relationship between their feelings, thoughts and behaviors (Murphy, Straebler, Cooper, & Fairburn, 2010).

Once we have identified her triggers, in the short term goals phase, we incorporate the therapy and restructure Julia’s pattern of thought that are associated with negative behaviors. The theory will strive to turn such behaviors into positive thoughts where she will train her mind to always have positive thoughts hence changing her behavior. When the behavior has been turn into positive thoughts then over time her ability to constantly have negative thoughts will be the past. Further, we shall use enhanced cognitive behavioral therapy is founded on the trans-diagnostic theory that is derived from CBT-BN (Walsh, 2013). The theory is designed to treat eating disorder psychopathology and is referred to as “enhanced” since it incorporates a range of strategies to improve the outcome as well as tackle issues associated with low self-esteem (Schneruch & Gibbons, 2014). There are two types of CBT-E where the first one exclusively addresses eating disorder psychopathology. The second type of CBT-E addresses external obstacles to change as well as the core eating disorder psychopathology.

The reason why I opted to use behavior therapy is because it covers a various area and I am confident that they will play a huge role in the treatment plan for Julia. She will study new coping skills and understand strategies she can adopt to ensure that she is able to manage her weight without going overboard. We shall constantly evaluate this through various demonstrations skills in our therapy sessions. In addition, we often take a look at her journal and understand how could have a caused a relapse in case of a change in behavior (Murphy, Straebler, Cooper, & Fairburn, 2010). Julia will also learn methods of identifying her negative thoughts and develop ways to replace such thought with positive thoughts.

Intervention/Action

Individual therapy will be incorporate in the intervention phase to further make Julia’ goals attainable. In addition, the therapy session will assist in developing her self-esteem. Enhanced cognitive behavioral therapy will be implemented to teach Julia how to change her pattern of thinking that has indicated the possibility of associating every aspect of life negative. The theory shall assist her turn the negative thoughts into positive ones (Walsh, 2013). According to DSM-IV, a generalized anxiety disorder can be classified as an independent impaired disorder. Thus many researchers have continued to disagree on the status of the disease. However, one method that can be used is re-labeling the disorder to recognize it as an independent status that facilitates its proper detection and treatment (Comer, Pincus, & Hofmann, 2012).

Cognitive behavioral therapy is the most preferred evidence-based treatment advocated for the treatment of adults that have shown symptoms of eating disorders. The theory general assumes that the human body is intertwined from their thoughts to their behavior. It involves acquainting patients with the beliefs and feelings that they can associate. Julia will be required to attend group therapy sessions at least once a month as it will help her learn as well as share techniques learned with other people. Group therapy has for many years been used by psychologist to create a sense of belonging and can help patients help and grow each other positively.

Further, we have designed a session where both her parents will be involved in the family therapy sessions. However, in this case, we shall have an outsider psychologist that will take them through the sessions to understand the issues that Julia is suffering and understand the various way through which they can play a part in helping her overcome her challenges. To continue with our check ins with Julia we will often have a sit in with their group therapy at least once in a month and check on her progress and identity areas that require more attention

I will make sure that Julia’s privacy is kept protected and confidential as stipulated by the code of ethics. Before the onset of the treatment plan Julia will have to sign an informed consent form to safe guard her privacy.

Evaluation

The projected results of each planned treatment intercession will ensure that Julia learns some new on ways of coping so as to stop having negative behavior when she is stressed, anxious or upset. We will ensure that she is able to deal with every situation that may arise in a positive manner and this will promote her health. Julia will be taught tailored skills that can assist her manage high-risk situations such as distractions and self-talking.

Julia could benefit from the program that will assist her understand better ways to interact and socialize include creating a better relationship with her parents. Finally is the cognitive behavior therapy that includes education patients with Anorexia Nervosa on various strategies of managing their behavior such as reflective problem solving. This could be beneficial to Julia as cognitive behavioral therapy is a combination of psychotherapy and behavioral therapy. Julia is faced with different behavioral challenges such as inability to socialize and the need to exercise to ensure that she keeps her weight in check (Gorenstein & Comer, 2014).

Analyze and describe potential ethical dilemmas that may arise while implementing this treatment plan. There is a certain degree of risks when creating this plan.

1.01 Misuse of Psychologists' Work

1.02 Conflicts Between Ethics and Law, Regulations, or Other Governing Legal Authority

1.03 Conflicts Between Ethics and Organizational Demands

1.04 Informal Resolution of Ethical Violations

1.05 Reporting Ethical Violations

1.06 Cooperating with Ethics Committees

1.07 Improper Complaints

1.08 Unfair Discrimination Against Complainants and Respondents

Conclusion

In conclusion, the treatment plan addresses issues raised during my time with Julia who had symptoms that resembled depression, Bulimia Nervosa and Anorexia nervosa. Julia continue to explain her current situation and how it was negatively impacting her life. She claimed that she constantly have the urge to continue losing weight despite advices from her peers and coach to keep her weight on check. She has portrayed some characteristics associated with Anorexia disorder where she tends to withdraw herself from social settings that involve eating such as family gatherings. According to DSM-5 indicates that the client should showcase restrictive of energy intake relative to a requirement which leads to significant low body weight. Julia also meets these criteria because she does not recognize that she is underweight or when she had added weight. Julia has that urge of reducing her body weight even when her weight is below the average required weight.

References

Gorenstein, E., & Comer, R. J. (2015). Case studies in abnormal psychology (2nd ed.). New York, NY: Worth Publishers.

Lock, J., Le Grange, D., Agras, S., & Dare, C. (2001). Treatment Manual for Anorexia Nervosa,

Morrison, J. (2014). DSM-5 Made Easy: The Clinician's Guide to Diagnosis. New York: The Guilford Press.

Murphy, R., Straebler, S., Cooper, Z., & Fairburn, C. (2010). Cognitive Behavioral Therapy for Eating Disorders. The Psychiatric Clinics of North America, 611-627.

Schneruch, R., & Gibbons, H. (2014). Neurocognitive Mechanisms of Social Conformity. Social Psychology, 466-478.

Walsh, T. (2013). The Enigmatic Persistence of Anorexia Nervosa. American Journal of Psychiatry, 477-484.