Therapeutic Intervention for a Beautiful Mind Case Study, Case Study Example

Choosing the appropriate therapeutic intervention for clients suffering from Schizophrenia is key component to a successful program. There are many theories for the cause of Schizophrenia, yet we know very little about why the disease afflicts some people. This case study explains how cognitive therapy is utilized for clients diagnosed with Schizophrenia.

Jim is a 32 year old man who was diagnosed with schizophrenia 3 years ago. Although Jim is a very attractive young man, he has never been able to maintain long-term relationships.  This has been an issue with Jim ever since he was in high school. In high school, Jim’s fear of germs caused him to be unable to trust the cleanliness of others and often ends relationships after 2-3 months. As a result, Jim became very uncooperative with teachers, coaches and friends and dropped out of high school at the age of 16.

At the age of 28, Jim’s twin brother was randomly shot while walking to a local bar. The police have not been able to identify or charge anyone for Jim’s twin brother’s murder. The crime has been labeled as random and the police are continuing in their search for the killer. Jim maintained a close relationship with his brother even though they were over 600 miles apart. After losing their mother to a mysterious lung disease, Jim and his brother committed to speaking on the phone often and visiting whenever possible. Since Jim’s brother’s death, Jim has been hearing voices coming from different appliances in his home. These voices are telling Jim that he will soon die a horrible death, just like his mother and brother. Jim believes that there are little people living inside of these appliances and that they are there to kill him in a slow and painstaking death. Although Jim lives on his own, he has been hospitalized over 7 times due to depression and extreme behaviors.

Jim is unable to keep a job, not only because he did not finish school, but because he is often seen speaking to the appliances at his workplace and running out of his workplace for no apparent reason.   As a result, Jim’s psychiatrist has recommended Jim to my program called “The Connectors”. The program is designed to place individuals into educational and employment programs who are suffering from schizophrenia.  People living with schizophrenia are at a severe disadvantage in the competitive job market and must seek a support agency that can help the client manage their symptoms through therapy and other behavioral strategies.

Case Records and Observations

The Connectors utilizes techniques that develop support systems for clients. The support network includes a therapist, work supervisors, family members and a friendships network. Like many clients diagnosed with schizophrenia, Jim does not have regular contact with many people. Jim’s father, Ralph, has not seen or talked to him for over two years. In fact, the last time they talk was at his mother’s funeral. Jim talks about some of the problems he and his father have between them. He claims his father does not understand him and as a result pushes Jim out of his life. However, at Jim’s request, I have contacted his Father to discuss the potential of his inclusion in the therapy. Jim will be working at The Xtra Company. The Xtra Company provides a supportive working environment and supervisory support for our mental health clients. Jim’s supervisor sends weekly reports to our office. So far Jim is fitting in nicely his working environment. He tells me that he feels more relaxed working for Xtra and the people he works with understand him better than in other workplaces.

Through case records and talking with Dr. Shema, the psychiatrist that first diagnosed Jim with schizophrenia, we believe Jim suffers from a form of the disease that responds very well to environmental support. The environment does not cause the disease, but environmental events can heighten the effects of schizophrenia. Research of the disease helps us recognize that genetics play an important role in the development of the disease. Schizophrenia may be exacerbated by environmental events such as viral infections, stressful life events, and hormonal changes during puberty (Connor, nd).

Intervention Therapy

Jim responds well to a combination of behavioral therapies. Cognitive Behavioral Therapy (CBT) has been widely used by therapists, but has limited application in the treatment of people suffering from Schizophrenia. The neglect [of CBT techniques used for the treatment of schizophrenic patients] may be due to the dominance of pharmacological treatment and the decline of psychotherapy, the severity of the disorder, or the inadequacies of previous attempts to understand and manage schizophrenia from a cognitive behavioral framework (Birchwood & Preston, 1991; Goggin, 1993, Bradshaw, 1998 p. 13). Dr. Harding (2002) writes, “Many can be symptom-free without medication. They improve without fanfare and frequently without much help from the mental health system, many recover because of sheer persistence at fighting to get better, combined with family or community support.”   The psychological community is beginning to question the effectiveness of pharmacological therapies. World Health organization’s gathered data on the effectiveness of cognitive-behavioral therapies for schizophrenia and five year follow-ups found that 64% of patients in third world countries  were symptom-free and functioning well, compared to 18% of patience in Western developed countries (Whitaker, 2002).

Intervention Strategy

The first phase of CBT therapy called the socialization phase is designed to educate the client concerning his type of disease and correct some of the misunderstandings about the disease. In this type of therapy the client works with the therapist to own the process. Jim agreed to the treatment goals and we talked about stress reduction and coping techniques. In the early phase Jim began to recognize patterns of his behavior that lead up to an episode. He learned to identify the early stages of an episode and practices stress reduction techniques such as deep breathing techniques and a combination of Yoga and Tai Chi. During the middle phase Jim sees his tendency to over-generalize, worry and ruminate about a worst case scenario. He is learning to face his fears with self-talk and his energy talking about the most likely outcome and using self-control methods. We have not reached the ending phase, but Jim agrees to an ending point for the therapy. We have a clear understanding of what success markers look like along the way. Jim knows what to do in case of emergency and we agree to certain guidelines for phone calls, respecting social boundaries.

The second therapy technique called Learning Based Therapy (LBT) and is very supportive of other cognitive behavioral therapies. This technique is effective in modifying schizophrenia behavior. Behavior is modified in three ways. First, behavior is modified through selective reinforcement of behavior by focusing on appropriate behavior. In therapy Jim and I talk about how he responds to situations. He is not able to distinguish between an inappropriate social behavior and appropriate response. The second way behavior is modified through this technique is the reward system. Jim gives himself positive verbal reinforcement when he chooses an appropriate behavior. This action is followed up by receiving a token that goes into a jar on Jim kitchen counter. As he sees the jar fill up with tokens Jim is encouraged by his progress. The third way behavior is modified is through social skill training and language development. Jim struggles to engage in conversation with others, because he fears others will “think badly of him.” Through conversational skill development Jim is gaining confidence to enter into social settings without fear. “Based largely on social learning theory, these approaches posit that organisms are not just the passive recipients of stimuli that impinge on them but instead interpret and try to make sense out of their worlds.(Psychiatry.HealthSE, 2005 p. 1) .

Conclusion

The appropriateness of the CBT and LBT as therapies for Jim is shown in the resulting intervention. Jim’s social development is observed at work by his supervisors. Reports of his behavior reveal that Jim is choosing to socialize more often with other employees. His reaction to situations is considered more appropriate by his supervisors. Jim shares that he feels more relaxed and thinks about his actions an event, lessening the frequency of his episodes.

The appropriateness of the therapy for The Connection is consistent with the modification of behavior. The agency believes that with reinforcement the client can learn to trust his therapist and develop a lifestyle of appropriate action into his environment.  Jim expresses his gratitude to the agency for helping him find work and to have such a strong support network.

The therapy will continue on the same course. As we approach an end of the counseling sessions Jim will demonstrate independent action for what he has learned in the therapy. The program does not work this well for everyone.  Effectiveness of cognitive behavioral therapy depends on the type of schizophrenia that a client suffers from and how advanced it is for a particular client.  Jim is able to control the effects of the disease through by modifying his behavior, however, if his behavior is prompted by chemical imbalance that creates a dysfunction in the brain cognitive therapy may still be the appropriate therapy in combination with psycho pharmaceuticals. At this time Jim will not need drugs for his intervention program.

Reference

Bradshaw, W. (1998). Cognitive-behavioral treatment of schizophrenia: A case study. Journal of Cognitive Psychotherapy: An International Journal, 12, (1) 13-25, 1998

Conner, M. (nd). Understanding and dealing with schizophrenia. Retrieved on 05/02/2010 from http://www.oregoncounseling.org/Handouts/Schizoph.htm

Harding, C. M. (2002). Beautiful minds can be recovered. Retrieved on 05/02/2010 from http://www.successfulschizophrenia.org/articles/bmreview.html

Napoli, M. (2002). A beautiful mind: movie misrepresents recovery of John F. Nash. Retrieved on 05/02/2010 from http://findarticles.com/p/articles/mi_m0815/is_2002_April/ai_84312123/

Psychiatry Health (2005). Behavioral and cognitive behavioral interventions. Retrieved on 05/02/2010 from http://psychiatry.healthse.com/psy/categories/C9/

Whitaker, R. (2002). Mad in america; Bad science, bad medicine, and the enduring mistreatment of the mentally ill. Cambridge, MA. Perseus Books Group.