For this discussion, you will compare the various professional activities common to clinical and counseling psychologists and assume the role of an advocate for a client in one of the case studies from Case Studies in Abnormal Psychology.
There is quite a bit of overlap when it comes to the professional activities carried out by clinical and counseling psychologists. This is likely primarily due to the fact that many psychologists work in a number of settings and clinical and counseling psychology practices are a part of their everyday work. Both specializations focus on counseling and psychotherapy. While it used to be that clinical psychologists explicitly dealt with patients with mental health disturbances and counseling psychologists dealt with providing assistance and guidance to relatively healthy individuals, these lines have blurred over time as the discipline of psychology has evolved. Nevertheless, both specialties participate in research, supervision activities, and teaching (Norcross, 2000).
Select a case study that has not been covered in this course or in the PSY645 course, and identify systemic barriers, sociopolitical factors, and multicultural issues impacting the client at the micro, meso, exo, and/or macro levels.
The case study I have selected for this assignment is Case 14 – Antisocial Personality Disorder. The patient in this case study is a single, 22-year-old male named Jack. Jack was admitted to a psychiatric hospital after complaints of depression and thoughts of suicide. Jack revealed to an on call psychiatrist that he couldn’t bear life any longer and was having thoughts of “ending it all.” When asked about what was leading to these thoughts, the patient replied by stating that he recently lost his job at both places of employment and his girlfriend, and also stated that his mother was severely ill. Jack expressed that if he didn’t get help he feared he was “going to go off the deep end” (Gorenstein & Comer, 2015, p. 221). After being admitted, Jack’s demeanor uncharacteristically changed. Jack did not appear depressed, but rather happy and friendly with staff and other patients. Though Jack did exhibit behaviors towards other patients that illustrated a disregard for the rights of others, this was seen when he took another patients food without permission. After meeting with Dr. Harris, Dr. Harris noticed some inconsistencies in Jack’s confessions when compared to his outward behavior. Moreover, at the end of their first session, she observed that Jack cunningly unlocked her door from the inside so that the room was accessible from the outside. At the next session this was addressed and Jack revealed that he didn’t like locked doors and felt that by Dr. Harris locking her door she didn’t trust him. He then asked if he could have ground privileges back because he hated being “cooped up.” When Dr. Harris explained that in order for any privileges to be given back Jack would have to open up about his situation, Jack revealed that he never was truly suicidal, but just wanted to gain admission. He talked about his failed jobs and relationship with his girlfriend due to not having a job, also about his mother and her worsening heart condition. Jack stated that after being kicked out by his girlfriend he went to a homeless shelter, but was run off by thugs and the hospital was his last resort. Dr. Harris informed Jack that he would need to go through a pretreatment evaluation, and his case conference would convene in five days. At this point, it would be decided whether or not Jack would be discharged or they were to proceed with treatment (Gorenstein & Comer, 2015). However, the day before the conference, Jack disappeared. Dr. Harris got a call from the police stating they had Jack and her car. Due to all Jack’s outstanding warrants, the police kept Jack even though Dr. Harris did not press charges.
Jack’s next of kin was contacted to come pick up his belongings. His next of kin was his mother who, to Dr. Harris’s surprise, was in perfect health when she came in. Jack’s mother spoke with Dr. Harris and gave her an extensive background on Jack. It was revealed that Jack had been engaging in extremely antisocial and delinquent behaviors from an extremely early age. He would steal things and then try to sell them, which led to his first arrest at 10 years old. Jack got involved with teenagers that also stole and sold items for cash, drugs, and alcohol. At 12, Jack lured a 10-year-old girl into the woods and tried to perform sex acts with her. The girl’s mother heard her screams and when confronted, Jack offered the mother $5.00 “to keep her mouth shut” and then threatened her that if she said anything she would get the same treatment. From there, Jack spiraled. It was concluded that Jack was afflicted with Antisocial Personality Disorder. This is a disorder that is characterized by a pattern of disregard for and violation of the rights of others. Patients with this disorder lack remorse, are deceitful, impulsive, reckless, irresponsible, and don’t conform to social norms (Gorenstein & Comer, 2015; Psychology Today, 2017). This is one of the single-most difficult disorder to treat. Treatment is largely ineffective because the person with the disorder does not recognize that their behavior is problematic.
When it comes to systemic barriers, there are significant issues at every level. Because of the complexity of this disorder, obtaining treatment at the individual, family, community, and national level is almost hopeless. Effective treatment largely depends on the overall willingness and cooperation of the patient. However, people with antisocial personality disorder do not recognize or acknowledge the flaws in their pattern(s) of behavior. Moreover, they do not regard the opinions and advice from professionals as useful and/or important. Additionally, psychological treatment holds no value for people with this disorder. Thus, I believe a prominent barrier is the resistance to treatment and the lack of evidence-based research supporting efficacious treatment of the disorder. In regards to sociopolitical factors, one of the biggest issues is that the cause of this disorder is still unknown. Although environment and genetics has been implicated in its inception. We know that social conditions can contribute to the development of personality disorders, and typically people with personality disorders come from lower socioeconomic backgrounds, but this isn’t true for all cases. Because of the extreme lack in information and research on this condition, policies at every level are almost non-existent. This is particularly problematic when it comes to antisocial personality disorder patients engaging in criminal behavior. Typically, the answer is to serve time in prison for criminal acts carried out by the individual; however, time in prison does nothing to combat the underlying issue and if anything, exacerbates the antisocial behaviors. This is where local, state, and national policy would be beneficial, because not only does this condition impact the individual, it impacts family, work environments, so on and so forth. Finally, there do not seem to be any multicultural issues present within this case other than the patient does not follow any set of cultural or societal norms.
Develop an action plan that outlines how you might advocate for the client at each appropriate level of the ecological model.
Advocacy is a great way to bring awareness to a number of issues, especially within fields like psychology. But what exactly is advocacy? In general terms, advocacy refers to public support or recommendations of specific causes and/or policies. Advocacy within psychology is similar, but it is a means through which advocates inform and assist decision-makers who endorse the interests of patients, healthcare organizations, and public and welfare concerns (Cohen, Lee, & McIlwrath, 2012). There are many ways to advocate at every level. I would begin advocating at the individual and family level (micro) through empowerment advocacy. This would take place with the patient and their immediate family. This kind of advocacy would assist the patient and the family to see the patient as a person with rights, and as someone who has the resources to find solutions to their issues if they are truly willing. Moreover, it would allow the patient and family to see that in spite of the disorder, the patient harnesses skills and strengths that can be nurtured and then applied in a variety of settings. Finally, it would be a way for the patient and the family to recognize me as an advocate and someone to help find solutions and drive/promote change. At the meso level, I would become a member of a non-profit organization designed to spread awareness and educate communities about this condition and other personality disorders. Such advocacy could promote shifts within the working environment, which is greatly needed since most individuals with antisocial personality disorder often find it difficult to maintain steady employment due to their patterns of behavior. Advocating for the patient at the exo and marco levels would involve political advocacy. This could be done at the local, state, and legislative ranks through the organization of rallies, public education through community forums, annual and semi-annual educational conferences, as well as through lobbying if applicable.
I think one of the biggest issues is that there needs to be more funding provided for research into this condition. There is still yet to be any known treatment that is effective in helping people with antisocial personality disorder lead healthy and productive lives. We know that this is a severe mental condition, and more attention to its epidemiology and possible ways to treat it are necessary. In the long run, it will cost more to let patients with this condition go untreated, than it would be to pass legislation requiring that more funds be given for research. It costs more to keep patients locked in prison, than it would be to find effective treatment so that these patients can successfully maintain employment and through their labor, give back to their communities.
Identify two potential partnerships that you would establish in order to support your client and those like him or her outside of the therapeutic environment.
Two partnerships that I would establish order to support my client would be with other professionals (interdisciplinary) within the community and local legislatures.
References:
Cohen, K. R., Lee, C. M., & McIlwraith, R. (2012). The psychology of advocacy and the advocacy of psychology. Canadian Psychology/Psychologie Canadienne, 53(3), 151-158. doi:10.1037/a0027823
Gorenstein, E., & Comer, R. J. (2015). Case studies in abnormal psychology (2nd ed.). New York, NY: Worth Publishers.
Norcross, J. C. (2000). Clinical versus counseling psychology: What’s the diff? Retrieved from http://www.csun.edu/~hcpsy002/Clinical%20Versus%20Counseling%20Psychology.pdf
Psychology Today. (n.d.) Antisocial personality disorder. Retrieved from https://www.psychologytoday.com/conditions/antisocial-personality-disorder
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