Clinical and Counselling Psychology: Study of Case Scenario

The article analyzes a case scenario of a patient suffering from learning disability, intermittent explosive disorder, and depression. It suggests implementing cognitive behavioral therapy, dialectical behavioral therapy, and psychotropic medications to improve the patient's overall health and well-being.

Running head- CLINICAL AND COUNSELLING PSYCHOLOGY
Study of Case Scenario
Name of the Student
Name of the University
Author Note

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Part A
Analysis of the case scenario suggests that the person Jason, a 29 years aged male,
presents some variety of mental disorders. Upon his admission to the medium secure unit, a
thorough analysis of the patient’s history suggests that he suffers from learning disability, and
intermittent explosive disorder. Signs of depression are also observed in the patient. People with
mental illness are often subjected to social stigma and discrimination that worsen their situation
and make it difficult for them to recover. According to research studies, 1 in 4 people are likely
to experience mental health problems at some point of their lives (Fazel and Seewald 2012).
Furthermore, such mental health problems have also been found among 1 in 10 children globally
(Reupert and Kowalenko 2013). Learning disabilities are neurological problems that interfere
with the basic skills of learning suggest writing reading or calculating.
These disabilities are often found to interfere with higher mental faculties such his time
planning, organization, memory, abstract reasoning and attention (Cortiella and Horowitz 2014).
Such disabilities have been found to create a negative impact on the academic of a person in
addition to hampering his or her relationship with friends, family and workplace. Owing to the
fact that the patient Jason suffers from learning disability since childhood, it can be stated that
there is a gap between his potential and actual achievements (Geary 2013). Emotional regulation
can often be defined as a complex process that encompasses initiation, inhibition and modulation
of the mental state and behavior of an individual in response to a stimulus. These stimuli provoke
subjective experiences such as feelings or emotions, followed by cognitive processes such as
thoughts (Barlow, Allen and Choate 2016). An analysis of the case scenario suggests that Jason

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suffered from depression, which features emotional dysregulation. It makes him unable to
regulate his emotional response with regards to provocative stimuli.
This is established by his previous history of conflicts in relationship or perceived
abandonment. This often contributes to the sudden bursts of anger and passive aggressive
behavior that he manifests. According to the DSM-V criteria, emotional dysregulation is
considered as an essential feature of a large number of psychological disorders. Presence of
depressive symptoms in the person can be attributed to symptoms of loneliness and social
withdrawal (Strang et al. 2012). Loneliness often includes anxious feelings regarding lack of
communication or connection with other beans. Such lack of social connection can be directly
linked to his antisocial or hostile behavior towards others. Depressive symptoms are confirmed
by signs of social withdrawal and lack of interest to attend pleasurable activities (Martin,
Neighbors and Griffith 2013). The fact that Jason always carries a nice and gives repeated threats
to harm others can be correlated with presence of intermittent explosive disorder, which is
characterized by sudden outburst of violence and anger that is disproportionate to the situation
(Coccaro 2015). Such behavior is often triggered by inconsequential events and results in
disproportionate reactions to real or perceives provocation. Therefore, there is a need to
implement cognitive behavioral therapy, Dialectical behavioral therapy (DBT) and psychotropic
medications to improve the overall health and well-being of the person.
The therapy is aimed towards helping people suffering from borderline personality
disorder and mood disorders, by changing thoughts related to self harm to others or suicidal
ideations (Linehan et al. 2015). It will increase the cognitive and emotional regulation of the
person by gaining information about the triggers and underlying factors that contribute to search
inappropriate reactive states (McMain et al. 2012). It will further help in assessing the coping

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skills that need to be applied to avoid such undesirable behavior. On the other hand, cognitive
behavioral therapy such as cognitive relaxation and coping skills therapy will help in
counteracting panic anxiety and anger, thereby treating intermittent explosive behavior.
Part B
The intervention plan that will be device for the treatment of Jason will keep in
consideration his presenting signs and symptoms, and the predisposing factors that might have
increased his likelihood of getting affected with mental disorder. The common symptoms that he
manifests include escalating patterns of sudden aggressive behavior such as using a knife to
threat members of the community. Therefore, in order to treat presence of intermittent explosive
behavior and depression, cognitive behavioral therapy and dialectical behavioral therapy will
prove most effective. According to the DSM-5 diagnosis, depressed mood is characterized by
subjective reports of feeling sad, hopeless or empty throughout the day. It is also marked by
diminished pleasure or interest in daily activities, accompanied by psychomotor retardation or
agitation (Copeland et al. 2013).
DBT will focus on accepting and healthy and uncomfortable behavior and will help Jason
to acknowledge that most of his self-destructive or depressing behaviors are inappropriate. A
person suffering from major depressive disorder often experiences feelings of worthlessness,
which in turn creates an overwhelming atmosphere of sadness that invalidate all aspects of their
life (Harned et al. 2012). Therefore, the primary aim of this intervention is to reduce negative
behaviors and modulates extreme emotions, which contributes to depression (Miller, Carnesale
and Courtney 2014). Moreover, it will allow the patient to trust self-thoughts, emotions and
activities. The proposed intervention includes conduction of dialectical behavior therapy for 1
hour, twice a week for 8 months, and coping skills therapy for 6 months.

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Establishing a good rapport with the patient is the primary criteria of providing the
intervention as it will help in fostering an efficient therapeutic relationship. The background of
the patient including his job information, his childhood, education and personal history will be
collected, in order to formulate a better diagnosis plan. Effective communication can be initiated
by making direct eye contact, and using appropriate hand gestures and nonverbal communication
skills (Morse et al. 2012). Showing an authentic interest in the concerned patient and picking up
on cues from his responses will also help in identification of issues other than the main problem.
In addition to using appropriate communication skills, active listening will also facilitate
establishment of a good rapport. Furthermore, it will help in miscommunication or
misinterpretation.
The dialectic behavioral therapy includes the following steps-
Mindfulness- This is the basic foundation of the therapy as it assists an individual to
tolerate and accept all powerful emotions that appear while challenging certain habits or getting
exposed to upsetting situations. The therapist will assist Jason to pay attention to the present
moment, in a non-judgmental manner, while experiencing his senses and emotions to the
maximum level. Jason will also be made more aware of senses related to smell touch taste sight
and sound (Mehlum et al. 2014).
Emotional regulation- This skill will create opportunities for identifying obstacles that
prevent demonstration of appropriate emotion. It will also help in reducing vulnerability to the
emotion mind and will increase mindfulness and positive approach to emotional events. It will
help the patient to correctly interpret an event with appropriate use of body language sensation
and action. A counselor will also be required while conducting this module of the therapy (Essau

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et al. 2012). The counselor will provide assistance in making the patient understand the ill effects
of the drugs on physical and mental health.
Distress tolerance- This is the third module of the therapy, which will allow the patient to
respond or deal appropriately to distressing circumstances such as serious illness, traumatic
events, financial loss, or death of beloved people. It will help the patient to learn the way of
bearing pain skillfully. This in turn will enhance the ability to accept such situations in a non-
judgmental and non-evaluative manner.
Interpersonal effectiveness- This will focus on enhancing problem solving skills and
increasing assertiveness. All the patients suffering from intermittent explosive disorder or
depression possess good interpersonal skills. However, they often fail to apply these skills in
current situation. The module will focus on situations related to changing an objective or to
resisting changes. It will make Jason show an inclination to contact his family members, rather
than avoiding them (Bedics et al. 2012).
Jason will be provided with homework when he would have to pick specific problem sir
behaviors from the provided list, and will have to identify the pros and cons of either acting on or
resisting the urges. This will help in determining effectiveness of the therapy.
Due to the fact that aggressive behavior can lead to an intended or serious consequences,
coping skills therapy will be implemented in this case scenario to help Jason adapt himself to
cope or mitigate with his reactions. Jason’s aggressive behavior can be attributed to his
upbringing, relationship with family, being bullied at school and work difficulties. These results
in the explosive behavior that makes him demonstrate harm towards self and others. Such overtly
confrontational antisocial behavior can be correlated with his previous history of stealing and

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physical aggression (Coccaro 2012). Lack of proper parenting is also another major contributing
factor.
The coping skills therapy will focus on the following skills-
Practicing relaxation techniques- This will help Jason to manage his anger by
participating in techniques such as diaphragmatic breathing, progressive muscle relaxation and
meditation. Involving the diaphragm muscle of the abdomen while breathing, will help in
reducing stress and anxiety. Progressive muscle relaxation will make the person coordinate
between relaxing and sensing a variety of muscle groups in the body. Meditation will also help in
achieving equilibrium, thereby balancing between emotions and gaining a mastery over thoughts
and feelings (Meuret et al. 2012).
Self-monitoring thoughts- This will help the patient to closely monitor thoughts and
feelings with regards to the determined standard, which in turn will help in correlating the
actions. It will also involve homework when Jason will be made to measure his thoughts in
relation to social circumstances, and then compare them with behavior that should be displayed
during such instances.
Setting and managing goals- Having a goal or objective in life helps in giving a purpose
or direction. This skill will motivate the patient to focus on improving his life and accomplish his
goals in future. It will help him in setting appropriate objectives with a directed vision, without
getting stressed. This in turn will improve his mood, and quality of life, by reducing hostile
attitude and anger.
Cognitive restructuring- This module will help in identifying and learning maladaptive
or irrational thoughts, commonly referred to as cognitive distortions. It will focus on emotional
reasoning, magical thinking and all or none thinking. This will help in preventing extreme

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thoughts in the person. A counselor will play an important role while implementing this module,
by helping Jason identify his irrational beliefs that affect his behavior as well as emotions
(Salloum and Overstreet 2012).
The homework for this therapy would include coping skills exercise where Jason will be
made to list a minimum of 5 instances when he felt like procrastinating, comforting himself, or
showing violent behavior towards the receiver. He will be made to circle the coping skills that he
considers counterproductive or an healthy, and will also be made to suggest healthier
alternatives. This will determine positive implications of the administered therapy. In addition,
physician will be consulted for administration of atypical antidepressant drugs such as
aripripazole, citalopram or bupropion for preventing recurrence of his depressive symptoms.
Several challenges and ethical considerations that might arise while caring for Jason
include his low self esteem and unwillingness to participate. Presence of depressive symptoms
often makes a person show apathy, which might make him reluctant to get treated. He might fail
to understand the rational of the aforementioned two therapies, and may resort to violence
attitude. Therefore, effective interpersonal skills and showing sensitivity towards the patient is
needed.
Part C
The primary strength of dielectric behavioral therapy lies in the fact that several
randomized control trials have been conducted which have determined its effectiveness for
treating borderline personality disorder and depression. The aforementioned mental diseases are
severe and persistent in most people. Implementation of this therapy among such patients has
shown long-term adherence and compliance in the target population. Recent findings have
suggested that this behavioral therapy is successful in addressing the problematic behaviors

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manifested by patients, and help in elimination of abnormal mental state (Pistorello et al. 2012).
According to research findings, use of DBT in combination with medication produces even
better results. According to several research studies, combining the therapy with atypical
antipsychotic medications such as olanzapine helps in reducing depression, impulsivity, and
anxiety among patients, and also shows and improvement in treatment adherence. Effectiveness
of the therapy has been established by other studies conducted in outpatient settings as well,
where the therapy has shown significant positive impacts in reducing suicidal ideation, and
depression (Bedics et al. 2012).
Similar findings have been reported other randomized control trials, where the therapy
has been proved effective in eliminating signs and symptoms of hopelessness, social withdrawal,
and para-suicidal behavior. However, the major limitation is associated with the fact that most of
the available research that investigated effectiveness of the therapy had been conducted on small
sample sizes, and focused on specific sectors of mental health population. Therefore, there is a
need to evaluate whether the therapy is effective for people suffering from different mental
health disorders. Moreover, most studies were conducted by doctoral level students or highly
educated professionals, which indicate an intensive training is required before implementing the
therapy on patients (Mehlum et al. 2014). Furthermore, there is a lack of follow-up interview in
the trials that have been conducted. Hence, long-term benefits of the therapy are not yet
established. Moreover, the therapy is a demanding process and required patients to spend several
hours during his conduction. Patient suffering from depression shows reluctance to its
implementation. In addition, the therapy focuses on the approach that can be implemented up on
patients who are ready to acknowledge their illness and show compliance during the therapy
sessions. Hence, any form of hesitance from the patient might lead to misleading results.

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On the other hand, several studies have been carried out that have established
effectiveness of the coping skills therapy. It has proved effective in increasing the ability to
tolerate various forms of uncertainty during explosive disorder or depression. According to
research trials, this therapy often leads to avoidance of situations that can make a person
procrastinate or delay taking action. Another benefit is associated with the fact that it impacts the
ability to recognize rumination or repeated botherations about a thought, by influencing the
person to attempt problem solving (Hayes 2016). Research findings also suggest that this therapy
helps in blocking out distressing thoughts, reduce intensity, and lower rates of intermittent
explosive behaviour.
Further benefits are related with the ability to identify thought distortions, such as,
negative predictions or personalizing, which often contribute to such explosive attitude. The
skills employed by this therapy have shown positive impacts in increasing will power, reducing
avoidance coping, and preventing violent behavior (Rector and Beck 2012). Research studies
also suggest that the therapy not only eliminates anxiety and panic behaviour, but also enhances
self-improvement motivation. However, the major limitation is associated with the fact that not
much research trials have been conducted to determine effectiveness of this therapy among
people suffering from mental problems, in addition to learning disability. Furthermore, at times it
may often overlook troubling issues, related to personal history or family (Collins, Woolfson and
Durkin 2014).
While the administration of atypical antidepressants might help in preventing recurrence
of depressive disorder, certain side effects such as, insomnia, blurred vision, dry mouth, weight
gain, increased appetite, fatigue, and nausea may be observed. Thus, a critical evaluation of
Jason's case scenario suggests that dielectric behavioral therapy and coping skills cognitive

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behavioral therapy will be most effective in providing relief and improving his mental health
status.

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