Advanced Treatment Therapy, Essay Example

GARF

The GARF scale offers therapists a softer, less clinically intrusive means for assessing family functionality.  The utilization of metaphorical assessments by family members is extremely beneficial in clinical scenarios.  Each individual is asked to select a metaphorical representation for his or her family, which does much to lessen the psychological impact of therapy and puts each generation on more or less equal footing when it comes to treatment.

“The family’s process of consensus building or sharing different views can be a very helpful task for the outside rater to observe in order to make a more valid GARF assessment.  Metaphorical language is nonthreatening to adult family members and can be understood by children” (Yingling, 12, 1998).

There is a balanced blend of self-assessment and clinical intervention, which creates a collaborative environment for the therapist and patients.  Intervention therapies can be arrived at in a collegial spirit.  Self-reporting helps establish a basis for honesty between family member and therapist.

However, the GARF scale was designed to be an informal tool, easy for therapists to use without much training to support it.  It would also seem to place excessive emphasis on symptoms and signs of mental disorder and assign somewhat less weight to arriving at an in-depth understanding of a patient’s problems.  Taken altogether, it may convey the impression that there is a more quantitative system for assigning diagnoses than actually exists.

Including the GARF scale in therapy situations holds great potential for creating a systemic functioning…including the therapist, treatment team, and supervision systems…” (Yingling, 13, 1998).  Assessing for relational functioning can provide important baseline data for making impactful decisions based on therapy outcomes.

Family Genogram

A family genogram can aid in therapy by developing a better overall understanding of the strengths and values of a family’s positive patterns.  Families and therapists can identify “problem concepts in order to avoid repeating negative behaviors” (Joy, 2010).   Genograms can produce a wide range of valuable family data, including social behaviors, the nature of family relationships, emotional relationships and social relationships.  Information on family disorders can be particularly valuable.  These might include alcoholism, depression and dysfunctions in living situations.

Genograms include as much descriptive information as possible.  From this list, family rules and patterns of organization may be gleaned, including spoken and unspoken rules, expected career rules for men and women, expectations for religion, economics factors, marriage and other aspects of family life.

Genograms can also help identify family strengths.  This is a much more useful and productive tool for therapy than finding fault and assigning a system of blame.  Rather, a genogram can help identify a list of family strengths that facilitate therapy.  Spirituality, extended family networks and effective coping mechanisms are some of the strengths that may be identified in a genogram.

Five Axis Diagnosis

A & B: Jack would appear to be suffering from a mood-related disorder, quite possibly a case of chronic depression.  The fact that he feels that everyone is against him would tend to point toward a paranoid personality disorder.  There wouldn’t seem to be a direct physical factor relating to his condition, aside from a moderate lack of nutrition occasioned by Jack’s tendency to avoid eating supper due to his depression.  His habit of leaving his relationships about the same time he has trouble at work sounds like occupational problems are eliciting problems with his primary support group.  Jack seems to be functioning at between a 60 or 70 level.  Clearly, he is having problems in an occupational and social setting, the one (occupational) probably being directly related to the other (social).

C: Another therapist might assign an anti-social personality disorder in Jack’s case.  It could explain his difficulties at work where, presumably, he has difficulty fitting into a team environment

D: Therapy which seeks to identify and isolate problems in Jack’s family background may help him address his tendency to isolate his wife and family when other problems arise. For instance, Jack may have been involved in a triangulation scenario, which “becomes problematic when it is chronic and the original dyad never resumes communication to resolve its difficulties” (Gehart and Tuttle, 2003, 153).

1.  Given Szasz’ decrying of mental illness as “a euphemism for behaviors that are disapproved of” (Szasz, 2006), I would deconstruct the widely accepted psychiatric terminology.  As a problem rooted in Jack’s past, it would seem likely that as Szasz points out, “The transition from childhood dependence to adult independence is often experienced as depressing.  It is dangerous to frame this in psychiatric terms” (Szasz, 2006).  and, rather than attempting to categorize Jack and his condition,
2. One of L’abate’s most resonant ideas is the on in which he declares that ideas of perfection or, more specifically, the notion that imperfection equates to “badness,” needs to be rejected. Jack clearly has a problem he needs help with, but L’abate’s view would lead me to treat his case less as a “cure” situation than an opportunity to show empathy in an attempt to relieve a persistent depression.
3. Sample case
4. A 48-year-old mechanic named Arthur sexually assaulted a young woman while under the influence of drugs and alcohol.  He had been dealing with substance abuse problems for two years since the death of his young son in a drive-by shooting.  He had been treated for chronic stomach problems.  It turned out that he had a history of violence, including domestic violence.  He was not sorry for having assaulted the young woman.

B and C: Since Arthur was diagnosed with alcohol dependence, he was diagnosed with a substance-related disorder, and was assessed as having antisocial personality disorder.  A medical exam showed that he had sustained damage to his stomach from excessive alcohol abuse.  He had problems stemming from interaction with the legal system and was assessed a score of 40 on the Axis V scale.

D: An alternative Axis II diagnosis could be paranoid personality disorder.  Arthur’s persistent violent behavior could be symptomatic of a paranoid personality, aggravated by chemical dependencies and a personal tragedy.

E: Obviously, a deeper, more intensive form of therapy is called for in this case.  One facet of treatment might take a narrative form, delving into Arthur’s past through a narrative approach that places the events that shaped him into context.  In this way, he might develop a better understanding of the source of his behaviors.

F:  This is, to a large extent, an issue for the authorities.  However, a Szasz-influenced outlook might point to the danger of labeling.  If we automatically begin labeling such people as “mentally ill” without taking into account multiple factors, we run the risk of creating a self-fulfilling prophecy.

An acceptance of L’Abate’s views, though not readily applicable in this instance, would lead me to conclude that a stress- and conflict-reducing therapy plan might be employed. The paradox intervention theory, which posits that no two realities are the same, may place patient and therapist on ground that makes sense to the patient.

References

Gehart, Diane & Tuttle, Amy.  Theory-Based Treatment Planning for Marriage and Family Therapist

Luciano L’abate.  The Relational Roots of Dysfunctional Behavior.  New York: Guilford Press.  1998.

Szasz, Thomas.  “The Therapeutic Temptation.”  The Foundation for Economic Education.  (http://www.szasz.com/freeman16.html)

Yingling, Lynelle.  GARF Assessment Sourcebook: Using the DSM-IV Assessment of Relational Functioning.  Washington: Taylor & Francis.  1998.