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A Woman with Personality Disorder Assignment

A Woman with Personality Disorder AssignmentA Woman with Personality Disorder AssignmentAt each Decision Point, stop to complete the following:Decision #1: Antisocial Personality Disorder (APD)Which Decision did you select?Why did you select this Decision? Support your response with evidence and references to the Learning Resources.What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?Decision #2: Refer to psychodynamic psychotherapyWhy did you select this Decision? Support your response with evidence and references to the Learning Resources.What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.A Woman with Personality Disorder AssignmentExplain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?ORDER A PLAGIARISM-FREE PAPER HEREDecision #3: Refer to Group based cognitive behavior therapyWhy did you select this Decision? Support your response with evidence and references to the Learning Resources.What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?Also include how ethical considerations might impact your treatment plan and communication with clients and their family.A Woman with Personality Disorder AssignmentEnsure there is an introduction and a conclusion.SUBJECTIVERhonda is a 32-year-old Hispanic female who presents to your office for her initial appointment. When you ask what brought her to your office, she states: “I’m at the end of my rope, I don’t know what else to do.” She then bursts into tears. Rhonda explains that she has very few friends left, and everyone seems to have “abandoned” her. Rhonda explains that she goes out of her way to help other people, and to be nice to them, but this does not seem to help. Rhonda then stands up and begins to pace around your office at times using wild hand gestures to explain the circumstances that led up to her making the appointment with you. She describes the recent breakup with her boyfriend as traumatic and explains “when we first met, he was the best guy in the world. He treated me really well. But he just became a complete monster! A Woman with Personality Disorder Assignment. Even though he broke off the relationship with me, I was glad to see it end. I hate his guts!” Rhonda explains that her current financial situation is also precarious.A Woman with Personality Disorder Assignment.  She states that she recently purchased an automobile, and is not certain how she is going to pay for it. She states that she had a car that was repossessed last year at that time, and that she borrowed some money from a friend to help pay for the car; the friend later turned around and accused her of theft. “It was my friend’s fault. She told me she would loan me the money and then backed out. I only took the money because she said she would loan it to me … people just can’t go back on their word like that when other people are counting on them.” Rhonda reports that she was “always in trouble” as a kid. She states that people were always picking on her, to which she adds: “the other kids my age were just stupid. They didn’t know how to have fun.” She says “I have always been impulsive, but it’s fun. Sometimes people can be such prudes … you only go around life once, so you have to make the best of it.”A Woman with Personality Disorder AssignmentOBJECTIVERhonda is currently single. She has no children. Educationally, she had completed two semesters toward her bachelor of arts degree in fine arts. Rhonda currently works as a waitress at a local restaurant. She has held this job for about 2 weeks. Prior to this, Rhonda worked as a housekeeper for a local hotel chain. She states that she was fired from this job because her coworkers were jealous of her and “planted” evidence of her stealing from hotel patrons. She was also arrested for cashing checks under an alias, for which she spent 120 days in jail. Rhonda has a history of multiple incarcerations for offences ranging from larceny to possession of controlled substances to possession of an illegal firearm. She was also arrested several times for fighting and on at least one occasion, used a baseball bat to beat up a girl who she thought was trying to “set her up” with the police.A Woman with Personality Disorder AssignmentMENTAL STATUS EXAMRhonda is alert and oriented × 4 spheres. Her speech is clear, coherent, goal directed, and spontaneous. She reports her mood as “terrible!” Affect is labile and seems to change rapidly with the subject being discussed. Her eye contact is normal, but at times, she appears to stare at you. Rhonda is oriented to person, place, and time. She denies visual/auditory hallucinations, no overt paranoia or delusional thought processes noted. Rhonda denies any suicidal or homicidal ideation.A Woman with Personality Disorder AssignmentRESULTS OF DECISION POINT TWOClient returns to clinic in four weeks Rhonda states that the therapist she was referred to was “a complete waste of time. Do you know he wouldn’t even talk to me?” On further exploration, the PMHNP discovers that the psychotherapist asked Rhonda to talk, which she did, but he did not provide any feedback. Rhonda then states: “he told me that he wants to see me three times a week! Yeah, like that is going to happen!”A Woman with Personality Disorder Assignment A Woman with Personality Disorder Sample PaperIntroductionDiagnosis and treatment of psychiatric conditions is a challenging endeavor. That is because it is not a precise medical science, and relies on approximations. This is particularly true for antisocial personality disorder (APD) whose diagnosis relies on information provided by the client. Once diagnosis is conducted, treatment would follow although there is need for regular reviews to determine the treatment effectiveness and whether changes should be made to a particular therapy (Black, 2013). The present analysis conducts a case evaluation of the diagnosis and therapy options available for the management of APD.A Woman with Personality Disorder AssignmentDecision #1:Antisocial Personality Disorder (APD)Which Decision did you select?The client was diagnosed as having APD.Why did you select this Decision?The APD diagnosis was made because the client tended to violate or disregard the rights of the people round. In this case, her personal behavior and experience showed clear deviation from what the society would consider normal behavior, with signs of inflexibility and pervasiveness. Besides that, the APD diagnosis is only presented for persons older than 18 years who consistently exhibit irresponsible behavior that violates social laws and do not show signs of changing even after being punished. Although there is no indication that she had the same behavior as a child (as would be expected for a classical diagnosis), it is undeniable that she appears charming yet is actually irresponsible, aggressive and irritable with manipulative tendencies that make it difficult to determine whether she is telling the truth or lying (Gilbert, 2015).A Woman with Personality Disorder AssignmentEvidence of this can be drawn from the case information. Firstly, she shows a disregard for society’s laws as evidenced by the fact that she remains unrepentant even after being arrested and incarcerated multiple times. For instance, she cashed checks under an alias, engaged in larceny, possessed controlled substance, had an illegal firearm, and fought in public. She would not have engaged in all these illegal activities if she had regard for society’s laws. Secondly, she violated the emotional and physical rights of others as evidenced by the fact that she beat up another girl on suspicion of being set-up for police arrest. Thirdly, she does not have stability in both her home life and work as evidenced by the fact that her financial situation is precarious and yet she bought a car and is expected to make payments even though she recently had another car repossessed. Additionally, she has been unable to hold jobs for long and is typically fired for some form of misconduct (Gilbert, 2015).A Woman with Personality Disorder AssignmentFourthly, she is aggressive and irritable as evidenced by the fact that she beat another girl using a bat without first confirming whether that girl had actually set her up. Fifthly, she is not remorseful as seen when she talks of taking money from her friend without permission and justifying this action that her friend had promised to loan her the money. Sixthly, she is consistently irresponsible as seen when she only completes two semesters and buys a car without money. Seventhly, she is impulsive and reckless, a confession that she makes when talking about her childhood antics. Eighthly, she is impulsive as evidenced by the fact that she bought a car but is unsure of how she will make payments. Finally, she had conduct disorder as a child. This is evidenced by the fact that she was always getting into trouble as a child (Black, 2013). In this respect, the behavioral problems support the APD diagnosis.A Woman with Personality Disorder AssignmentWhat were you hoping to achieve by making this Decision?The diagnosis was based on the results from the client’s psychological assessment, noting her conduct and how she relates with others in the society. It identified the disorder that best matched the existing symptoms. The intention is to facilitate treatment and management of the disorder by matching the symptoms to known disorders then extrapolating the management using established treatment standards (Clarkin, Fonagy&Gabbard, 2010). As such, the APD diagnosis is intended to identify and apply a standardized treatment plan that relieves the existing symptoms while allowing the client to be free from the disorder.A Woman with Personality Disorder AssignmentExplain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?The expectation from decision #1 was to identify the best differential diagnosis that matched all (if not most of) the client’s symptoms. The decision matches all the symptoms to APD thus showing that there was no difference between expectations and actual results.A Woman with Personality Disorder AssignmentDecision #2: Refer to psychodynamic psychotherapyWhy did you select this Decision?The decision was made to refer the client to psychodynamic psychotherapy. This decision was made for three reasons. Firstly, there is no FDA approved medication for treating the disorder. That is because research has not identified an effective medication. Rather, medication is only prescribed if the client presents a concurrent psychiatry issue for which medication exists for management. Secondly, subjecting her to inpatient care would help in effectively managing the condition, but it is expensive. The inpatient care program focus on addressing the possible criminal activity with the possible loss of freedom acting as a motivation. The program uses a strict behavioral approach that places the client on a token economy based on progress in treatment. The focus is on feelings, and how the antisocial behavior link with the feelings.A Woman with Personality Disorder Assignment.  The hospitalization option was not selected since the client was unable to pay the high treatment expenses as she is already facing financial difficulties and does not have a steady job or source of income. In addition, she is not facing any prison time or loss of freedom so that she is not motivated to seek hospitalization (Sperry, 2016). Finally, psychodynamic psychotherapy was selected because it is an effective treatment approach that is not expensive. The approach puts emphasis on the significance of therapeutic relationshipbuilding that permitscountertransference and transference. It would use both expressive and supportive elements to allow the client to identify how past experiences have built up to cause the personality disorder thereby allowing her to comprehend and change future outcomes (Widiger, 2012). As a result, the decision to subject the patient to psychodynamic psychotherapy that is both effective (when compared to medication) and inexpensive (when compared to hospitalization).A Woman with Personality Disorder AssignmentWhat were you hoping to achieve by making this Decision?The decision was intended to ensure that the client is subjected to an effective and inexpensive therapy. Medication is ineffective since there is no FDA approved medication against APD. Hospitalization is effective against APD but expensive thus making it unrealistic for this client who has financial difficulties. Psychodynamic psychotherapy offers an acceptable option since it is both effective and inexpensive (Sperry, 2016).A Woman with Personality Disorder AssignmentExplain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?The psychodynamic psychotherapy was applied in anticipation that it would ease the previously identified symptoms. In this case, the therapy is applied in an outpatient setting to explore the antisocial issues that include lack of connections between feelings and behavior. For that matter, it was expected that applying psychodynamic psychotherapy in an outpatient setting would result in symptoms reduction and management of the condition. But this was not the case. In fact, a follow up assessment with the client four weeks after the start of the therapy noted that it had been ineffective. The client reported that the therapy had been a waste of her time since the therapist was non-communicative. A Woman with Personality Disorder Assignment. Consultation with the therapist noted that there was communication with the client, although no feedback was provided. In addition, the client had been resistant to increasing the number of therapy sessions to three times every week. Based on these circumstances, it is not surprising that the therapy had been ineffective since there was a communication difficulties between the client and therapy. Also, the therapist identified a need to increase the number of weekly sessions and yet the client was not amenable to the changes. Besides that, it is acknowledged that although the treatment was applied, its effectiveness is limited since it links feelings to antisocial behavior.A Woman with Personality Disorder Assignment.  A more effective treatment would reinforce the suitable behaviors while strengthening the link between feelings and actions. That is because treating the disorder must focus on emotions since clients would typically have limited emotionally rewarding relations as has been exemplified by the present case. The communication difficulty between the client and therapist can be explained that the client may have been overwhelmed and become intolerant of the therapeutic relationship since trust was not implicit and there was no rapport (Yakeley et al., 2016). Based on this reasons, it was thought prudent to change the treatment modalities by applying a different psychotherapeutic approach to include group therapy.A Woman with Personality Disorder AssignmentDecision #3: Refer to Group based cognitive behavior therapyWhy did you select this Decision?Given that psychodynamic psychotherapy had turned ineffective even after four weeks of use, the decision was made to subject the client to group based cognitive behavior therapy. The social interactions within the group would allow the client to open up emotionally and share experiences and opinions with other clients. The group would be devoted exclusively to APD management thus giving the client greater reason to share with others with the same condition and contribute towards the discussions. That is because persons with the disorder are more at ease in discussing their behaviors and feelings in front of peers since the group presents a supportive modality. This is based on the assumption that the client would overcome her initial hesitation and fears (Clarkin, Fonagy&Gabbard, 2010).A Woman with Personality Disorder AssignmentWhat were you hoping to achieve by making this Decision?The decision to apply group based cognitive behavior therapy was anticipated to improve APD management outcomes for the client. That is based on the reason that it creates an environment exclusively comprised of APD patients thus giving them greater reason to share experiences and opinions with others with the group presenting a supportive modality (Beck, Davis & Freeman, 2015).A Woman with Personality Disorder AssignmentExplain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?The expectation was that the client would report some treatment progress after attending the group based cognitive behavior therapy for four weeks with marked improvement in how she interacts with others, and greater respect for the law and societal norms (Beck, Davis & Freeman, 2015). As such, the outcome matched the expectations.ConclusionOne must accept that as the name would suggest, APD results in a tendency to break the law and disrupt social relationships. This is seen through evaluating its symptoms that include arrests and incarceration, and an inability to form close social relationships accompanied with violent behavior among adults. To facilitate treatment, psychodynamic psychotherapy is applied as a more effective and inexpensive therapy when compare to medication and hospitalization. Still, the strategy turned out to be ineffective when even after using it for four weeks. This resulted in a therapy change with group based cognitive behavior therapy applied as a better alternative that caused marked improvement in how the client interacts with others, and greater respect for the law and societal norms.A Woman with Personality Disorder Assignment  ReferencesBeck, A. T., Davis, D. D. & Freeman, A. (2015). Cognitive therapy of personality disorders (3rded.). New York, NY: The Guilford Press.Black, D. W. (2013). Bad boys, bad men: confronting antisocial personality disorder (sociopathy). New York, NY: Oxford University Press.Clarkin, J. F., Fonagy, P. &Gabbard, G. O. (ed.) (2010). Psychodynamic psychotherapy for personality disorders: a clinical handbook. Washington, DC: American Psychiatric Publishing, Inc.Gilbert, M. (2015). The mind of a sociopath: your guide to understanding the anti-social personality disorder of sociopaths. New York, NY: CreateSpace Independent Publishing Platform.Sperry, L. (2016). Handbook of diagnosis and treatment of DSM-5 personality disorders: assessment, case conceptualization, and treatment (3rded.). New York, NY: Routledge.Widiger, T. A. (2012). The Oxford handbook of personality disorders. Oxford: Oxford University Press.Yakeley, J., Johnston, J., Adshead, G. & Allison, L. (2016). Medical psychotherapy. Oxford: Oxford University Press. A Woman with Personality Disorder Assignment  

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