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The vignette of Thomas and Anne

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The vignette of Thomas and Anne is influenced by the social, cultural and diversity that exists in the society. The couple has chosen to stay together out of a decision and not particularly because they love one another. The responsibilities that come with marriage such as children are all grown up, and one of the partners no longer sees the need to stay at home because there is a feeling of achievement of staying in the marriage for 40 years. Using the therapy model of Interpersonal Psychotherapy, one can be able to see the concerns raised by Anne on the reason why she feels unloved by her long time husband. Time-Limited Dynamic Psychotherapy model will help the couple to deal with maladaptive behaviour which seems to be the reason bringing conflicts in their relationship. Thomas says “if she wasn’t so negative and always complaining, maybe I’d want to be home more” which is a trait of maladaptive behaviour because he refuses to confront the issues that the couples face. Thus, Time-Limited Dynamic Psychotherapy will help the couple to effectively deal with dysfunction and pervasive issues that are negatively affecting their interpersonal relationship. The IPT can consist of the group or individualized session s that typically ranges with 12 to 16 weeks. When a therapist decides to use IPT to assess depressive symptoms of patients such as Anne and Thomas, who are having conflicts in their relationship. The IPT allows changes in relationship patterns, and this will be effective in examining patients social history by incorporating a time-limited that focus on interpersonal dynamics. The IPT is flexible and thus can allow the therapist to tailor the process according to his or her clients’ interpersonal issues and how better to address and rank them with their importance. Additionally, Time-Limited Dynamic Psychotherapy will also be effective when it comes to Thomas and Anne vignette because they are going through pervasive and dysfunctional interpersonal relation constraints. The therapy focuses on patients countertransference and symptom reduction, especially in understanding maladaptive behaviour that exists in close relationships.

evaluation and assessment of Anne and Thomas

The interpersonal deficit, such as isolation or unfulfilling relationship, may affect couples, especially when they have been married for a long time or one partner seems to be occupied by other things that may hinder communication. Interpersonal Psychotherapy model; will help Anne and Thomas to deal with the conflicting exp[ectations that they face as couples. The Interpersonal Psychotherapy can be used to treat the depressive disorder, and this will be effective when it comes to the issue of mood disorder and drug addiction which is applicable when it comes to Anne. Markowitz & Weissman (2004) claims that “IPT is based on the so-called common factors of psychotherapy: a treatment alliance in which the therapist empathically engages the patient, helps the patient to feel understood, arouses effect, presents a clear rationale and treatment ritual, and yields success experiences”(p.5). According to the author, Anne and Thomas are suffering from the failure of communication because Thomas accuses his wife of nagging and always being negative which has consequently led to lack of arousal that is needed in marriage. Additionally, being married for 40 years is culturally considered an achievement and Thomas is thus considered a role model in the society which has led him to spend more time in church. Culturally, marriage, especially in Christianity, is seen as a permanent reunion. In Interpersonal Psychotherapy, treatment can help in understanding how cultural and ethical factors have affected the patients in question. Dewan, Steenbarger & Greenberg (2018) “every patient’s culture is a unique combination of multiple influences associated with the various social groups represented in his or her cultural background (52). In this vignette, Anne and Thomas’s relationship has been influenced by cultural aspects such as friends and religious activities, which have been highlighted as a possible factor that has facilitated growing conflicts between the couple. The Interpersonal Psychotherapy will help change the couple relationship patterns and help solve the difficulties that are faced in the relationship. The therapy ensures that the targeted issues affecting the patients are addressed in terms of how they identify the interpersonal issues they want to address. The evaluation and assessment of Thomas and Anne situation can further be discussed on the corridors \of Time-Limited Dynamic Psychotherapy model, which provides a solution to the maladaptive behaviour that exist in their relationship. The couple is in denial that their romantic relationship is not working and instead both have resulted in the avoidance of both in confronting the issue first hand. Thomas has resulted in hanging out with his friends at the church, which is ethically and culturally acceptable while Anne has refused to confront the new situation by taking drugs. Thomas says Anne has been “taking those pills her doctor gave her more often” to illustrates that she is overdosing the prescribed drugs. The relationship dynamics have played an integral role when it comes to the conflicts present in their marriage.

 

Differential Diagnosis for both Anne and Thomas

Anne addictive disorder is apparent that is influencing the conflictive situation with her husband. The couple has been married for many years, and she has recently started having issues with her husband church company. The fact that she has been taking more drugs as prescribed means that she suffers from substance-related and addictive disorders, according to DSM-5. The most crucial aspect to consider in Anne diagnosis is the fact that she has been abusing drugs which have likely affected her relations with her husband. American Psychiatric Association (2018) states that “. The individual may continue substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance”(483). According to the authors, Anne diagnosis can be categorized as substance-related and addictive disorders which influences the moods of a person. Thomas argues that Anne has become cynical about everything, and she is always complaining, which shows that she is suffering from moods disturbances. The use of medication by Anne and the fact that she has been taking the drugs more frequently indicates that there is substance-induced disorder. American Psychiatric Association (2018) states that “Temporary but severe mood disturbances can be observed with a wide range of medications, including steroids, antihypertensives, disulfiram, and any prescription or over-the-counter depressant or stimulant-like substances (p.488). This is apparent when it comes to Anne situation and substance-induced disorder, as explained in DSM-5. Thus, Anne diagnosis can be considered to be substance-related through the sympto0ms that n can be derived from the overdose4 of using medication. Thomas says that Anne has been becoming negative about everything and this can also be attributed to the nature of their relationship where their marriage us not sealed by love but through a decision influenced by their tumultuous divorced homes. The diagnosis of Anne can be attributed to her use of medication which has changed her relationship pattern with her husband.

Thomas DSM-5 diagnosis falls through Depersonalization/derealization disorder because he has been detached from his surrounding, including his wife. Thomas has increasingly been detached from his wife because Anne claims that “I feel he’d rather be with his friends at church then spend time at home with me” which authenticate that he has recently been detached from his family. The dissociative disorders are apparent when it comes to Thomas because it has disrupted the relationship patterns of the couple. American Psychiatric Association (2018) states that “Adult males with dissociative identity disorder may deny their symptoms and trauma histories, and this can lead to elevated rates of false-negative diagnosis (295). According to the authors, it is apparent that Thomas is suffering from dissociative disorder because he has preferred to stay away from Anne for most of the time and he refuses to acknowledge that there is a problem in his marriage. DSM-5 highlights the dissociative disorder as a post-trauma situation which seems to be a significant factor when it comes to the relationship between Thomas and Anne. Dissociative disorder “involves an ongoing or episodic sense of detachment or being outside yourself observing your actions, feelings, thoughts and self from a distance as though watching a movie (depersonalization)” (Mayo Clinic Staff (2017). Thomas refuses to confront the reality of the situation they are in with Anne, where their interpersonal relationship is conflictive, which has been attributed to the dissociative disorder by Thomas. The most impactful aspect is the fact that Thomas and Anne’s relationship is not based on mutual feeling but by cultural and past instances where their past experiences have profoundly influenced their decision and the fact that Thomas knows this that is why he spends little time with his wife which as subsequently affected their relationship patterns. Dewan (2018) states that “The cultural and spiritual elements are obvious when dealing with grief and loss, but they also play significant roles with disputes and transitions” (224). In this statement, it is evident that Thomas detachment has been influenced by disputes that arise from the negative attitude and complains from Anne. The relationship is also transitioning from unreal phase because their marriage is held together from their past experiences and not solemnly on love. Anne complains are valid because Thomas dissociative disorder is fueled by the fact that he does not enjoy his wife company because their union is based on their parents’ failure in marriage.

The Interpersonal Psychotherapy and Time-Limited Dynamic Psychotherapy will be able to help the couple to deal with conflicts in their marriage relationship. The most important aspect of these therapies is the ability to change the relationship patterns positively. The differential diagnosis using the DSM-5 will help in individually understanding how Thomas and Anne individually disorders. The Depersonalization/derealization and dissociative disorder are present in this couple and coming up with a treatment plan will be effective in changing their interpersonal relationship. The therapies used will consider the cultural and ethical aspects of the couple, which is essential in making the right diagnosis and treatment plan. Hoop (2008) claims that “To achieve cultural competence, a clinician uses these three qualities therapeutically by being aware of how cultural issues affect the therapeutic role and relationships, including transference and countertransference” (p.355). According to the author, it is essential to consider the cultural aspect when it comes to using a particular therapy. Thus, DSM-5 diagnosis helps in making sure that the right diagnosis of patients is possible, which helps in making sure that the right therapies can be applied. When coming up with a therapy for a depressive patient, a therapist should consider the DSM-5 diagnosis to make sure that they apply the right treatment plan. Thomas and Anne’s diagnoses differ, and this will require both individualized and group therapy sessions. The relationship dynamics will also play an integral part when it comes to setting short and long term goals in therapy sessions. DSM-5 will ensure that Thomas and Anne descriptions and symptoms criteria are considered when it comes clinicians in making a consistent and reliable diagnosis. The formulation of differential diagnosis facilitates making the right treatment for the couple by considering cultural aspects and their relationship dynamics. The classification of individual symptoms, according to DSM-5 diagnosis, will help in determining the right therapy for Thomas and Anne, respectively. Reliable diagnosis ensures that the patients suffering from mental disorders can easily be treated using individual or group therapy that best suits their diagnosis.

Thomas and Anne Treatment Plan

Problem Statements

Depersonalization/derealization and dissociative disorder as manifested by detachment, conflicts and negative attitude.

Long Term Goal: The symptoms of Depersonalization/derealization disorder and dissociative disorder will be reduced, and they will no longer interfere with Anne and Thomas relationship. The reduction will be measured through a score of 70 or below on the Withdrawn/Depressed scale at the end of the treatment.

Expected completion date: 7-4-20

Short Term Goals:

  1. Thomas and Anne will develop a no self-harm contract.
  2. Thomas and Anne will have to be involved in interpersonal activities
  3. Anne will have to report no negative attitude for two consecutive weeks
  4. Thomas and Anne will learn communication skills, interpersonal relations and attachments
  5. Thomas will have to learn about maladaptive behaviour and negative attitude towards Anne and replace them with positive and adaptive behaviour

Objectives

Thomas and Anne will have to state their personal feelings when the therapist requires the information. The couple will do this often to increase interpersonal relations.

Interventions

Interpersonal Psychotherapy to help Thomas and Anne learnt and implement interpersonal skills and to help them resolve marital conflicts by identifying, processing and resolving personal feelings and concerns.

Time-Limited Dynamic Psychotherapy helps the couple to learn interpersonal approach to curbing the increasingly pervasive and dysfunctional of relating to each other.

General Checklist.

The treatment plan fits the client based on their abilities, personal beliefs and years of marriage and culture.

Thomas and Anne’s strengths are incorporated into the plan

Thomas and Anne involvement in making the plan was incorporated

Sign the treatment plan

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