Levy Family case study – psychotherapeutic approaches to group therapy for addiction
To prepare:
Review this week’s Learning Resources and reflect on the insights they provide on group therapy for addiction.
View the media, Levy Family: Sessions 1-7, and consider the psychotherapeutic approaches being used.
The Assignment
In a 2- to 3-page paper, address the following:
Identify the psychotherapeutic approach that the group facilitator is using, and explain why she might be using this approach.
Determine whether or not you would use the same psychotherapeutic approach if you were the counselor facilitating this group, and justify your decision.
Identify an alternative approach to group therapy for addiction, and explain why it is an appropriate option.
Support your position with evidence-based literature. I’ll put a link to video Levy Family case study – psychotherapeutic approaches to group therapy for addiction
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Psychotherapeutic Approaches to Group Therapy for Addiction
Introduction
This paper focuses on group therapy for addiction, and specifically on a client named Levy. Levy suffers from alcohol addiction and post-traumatic stress disorder (PTSD). This paper will, therefore, identify the therapeutic approach the facilitator is using, and justify the reason. In addition, the paper will discuss an alternative approach to group therapy.
Approach the Group Facilitator is Using
The psychotherapeutic approach that was used was prolonged exposure therapy. According to Hendriks (2018), prolonged exposure therapy involves exposing the person to trauma reminders and allowing the client to process the imaginal exposure. Prolonged exposure therapy also involves educating the client about the trauma, fears and expected responses, and how to overcome the fears. In addition, clients are educated about different relaxation techniques aimed to reduce stress (McLean & Foa, 2014). In this video, the facilitator is seen using prolonged exposure therapy where Levy, the client is informed to memorize the traumatic event in Iraq, a process known as imaginal exposure. This allows Levy to experience the trauma once again imaginably which in turn gives him the courage to overcome his fears of the traumatic event. The group facilitator also taught Levy regarding relaxation exercises that involved breathing techniques to reduce stress and anxiety Levy Family case study – psychotherapeutic approaches to group therapy for addiction.
The rationale for using prolonged exposure therapy in Levy is to address the root cause of the client’s addiction problem. The root cause of the client’s addiction is the PTSD the client was due to the traumatic event within Iraq. According to Hendriks (2018), alcohol addiction is often a comorbidity of post-traumatic stress disorder.
Use of the same Psychotherapeutic Approach
I can use the same approach for a client with addiction and PTSD. This is because prolonged exposure therapy can help the client to overcome the fears, anxiety and other symptoms associated with PTSD. The client is taking alcohol to mask and avoid the symptoms of PTSD and thus exposure therapy can treat the PTSD symptoms and as a result, treat alcohol addiction as well. According to Hendriks (2018), prolonged exposure therapy has been shown to be effective in improving symptoms of PTSD. A study by McLean & Foa (2014) showed that exposure therapy assists the client to reduce avoidance associated with the trauma memories. Therefore, the approach will help Levy to stop taking alcohol in order to avoid the trauma memories because the PTSD will be treated. Levy Family case study – psychotherapeutic approaches to group therapy for addiction.
Alternative Approach to Group Therapy for Addiction
An alternative approach that I would use is motivational interviewing. Motivational interviewing is a short-term counseling intervention and patient-centered style that aims to improve and increase the motivation of the client to change substance or alcohol use (Korcha et al, 2015). Motivational interviewing involves empathic listening to the client and evoking individual reasons to change their behavior. The therapist should approach the client non-judgmentally in order to help the client to move to a higher level of readiness to change. According to Korcha et al (2015) motivational interviewing assists individuals to become motivated to change behaviors that prevent them from making healthy choices. It also prepares people for more specific therapies. This is supported by Satre et al (2016) who provides that motivational interviewing is effective in reducing alcohol use and can be very effective in addressing adverse effects of substance use in patients with comorbidities such as PTSD and depression. Therefore, motivational interviewing will motivate Levy to change and stop alcohol intake. Evidence shows that motivational interviewing works well with people who begin off without motivation and not being ready to change (Satre et al, 2016). Accordingly, Levy is unmotivated and unwilling to change the behavior of alcohol use. Therefore, motivational interviewing will help Levy to admit that he has a problem of alcohol intake and be willing to change.
Conclusion
The facilitator of the group used prolonged exposure therapy where Levy was exposed to the traumatic event by being instructed to relieve and describe the traumatic event in Iraq. This technique has been shown to help people with post-traumatic stress disorder to face the traumatic event and stop avoiding it. Levy uses alcohol as a coping mechanism in order to avoid and mask the traumatic memories. Therefore, treatment of PTSD will concurrently treat alcohol use. The alternative therapy I would use to address the client’s alcohol use is motivational interviewing in order to motivate Levy to change the behavior of alcohol use. Levy Family case study – psychotherapeutic approaches to group therapy for addiction.
References
Hendriks L, Kleine R, Theo B & Minnen A. (2018). Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts. Eur J Psychotraumatol. 9(1): 1425574.
Korcha R, Polcin D, Evans K, Bond J & Gantt G. (2015). Intensive Motivational Interviewing for Women with Alcohol Problems. Counselor (Deerfield Beach). 16(3),62–69.
McLean C & Foa E. (2014). The use of prolonged exposure therapy to help patients with post-traumatic stress disorder. Clin. Pract.11(2), 233–241.
Satre D, Amy L, Sterling S, Lu Y, Travis A & Weisner C. (2016). A Randomized Clinical Trial of Motivational Interviewing to Reduce Alcohol and Drug Use among Patients with Depression. J Consult Clin Psychol. 84(7), 571–579.
Psychotherapeutic Approaches to Group Therapy for Addiction
Today substance use disorders are considered a mental health illness. Substance abuse changes an individual’s behaviors and thought processes. Psychiatric mental health nurse practitioners are required to understand addiction and how to treat substance use disorders properly. The purpose of this paper is to explain the psychotherapeutic approach being used in the Levy Family Sessions: 1-7 video, explain whether I would use this approach as a group facilitator, and to identify an alternative approach to group therapy for addiction using reliable resources and evidence-based literature.
Psychotherapeutic Approach
To begin this paper is based on a video I have reviewed, “Levy Family Sessions: 1-7”. Clients with a history of trauma such as combat exposure during military service are at a high risk to develop mental health and substance use disorders. Substance abuse is a significant problem in military veterans and can be rehabilitating to these clients. In the Levy Family video, the group involves men with a history of combat exposure while serving in Iraq and Afghanistan. The group facilitator opened the group by informing the members that they each served in the military and asked how they are adjusting to being back home. Since all members of this group are military veterans, this suggests that the psychotherapeutic approach used is trauma-informed care (Wheeler, 2014). One out of five military veterans from the Afghanistan and Iraq wars has a diagnosis of depression or PTSD; these individuals also have a higher risk of developing a substance use disorder (Capone, Eaton, McGrath, & McGovern, 2014) Levy Family case study – psychotherapeutic approaches to group therapy for addiction.
According to Bodrog and Wittenberg (2014), trauma-focused psychotherapy is the treatment of choice for clients that have PTSD. Many individuals report that they use either drugs or alcohol to cope with their PTSD symptoms such as flashbacks, insomnia, night terrors or hypervigilance. It is critical for mental health professionals to focus on evidence-based treatment approaches to treat the underlying trauma and PTSD while also addressing substance use (Wheeler, 2017).
I believe that the trauma-informed approach is an excellent choice for the clients in this group. Trauma-specific interventions will recognize the following, the clients need to be respected, informed, and hopeful regarding their own recovery, the correlations between trauma and symptoms of trauma such as substance abuse, eating disorders, depression, and anxiety and the need to work collaboratively with the survivor, family and peers (Purkey, Patel & Phillips, 2018).
Additional Psychotherapeutic Approaches
To continue, another psychotherapeutic approach that could be effective in the treatment of this client is 12 step peers support groups. Military veterans with PTSD are at a higher risk to develop a substance use disorder; many veterans will turn to alcohol to mask their symptoms of PTSD (2015). The consumption of alcohol can prolong PTSD symptoms and intensify them as well (Teeters, Lancaster, Brown, & Back, 2017). Since alcohol is a depressant, it can increase symptoms of depression, insomnia or anxiety. Alcoholics Anonymous is a 12-step peer support program that allows individuals to share their experiences, strength and hopes to assist in the recovery of alcoholism a common problem for each of the members (Wheeler, 2014).
An approach that was developed in the addiction field is motivational interviewing by motivating individuals to commit to living a drug-free and healthy lifestyle (Wheeler, 2014). Motivational interviewing focuses on the opportunity to guide the individual in change talk and increase the client’s motivation to make a difference. The motivation for a client to change is potentiated through the therapeutic alliance between the client, PMHNP and the group members with specific communication strategies that direct the discussion. Change talk with help the client become more confident and develop healthy solutions to everyday problems (Wheeler, 2014). The most successful approaches for clients that suffer from substance abuse are those that encourage self-efficacy. In the past fifteen years, the use of MI in group formats have grown significantly, but more research still needs to take place to determine the efficacy of MI in this setting for clients with SUD (Madson et al., 2016)
Couple and family therapy are an essential treatment component in assisting individuals, and their loved ones restore dysfunctional relationships related to substance abuse. Research shows that family and couple therapy is one of the most effective treatment options in adults that suffer from a substance use disorder (Wheeler, 2014). Substance abuse can cause many social complications in an individual’s life such as parenting skills, violence, depression, family conflict and unemployment, these can be addressed during family therapy (Lander, Howsare, & Byrne, 2013). The effectiveness of treatment is limited if only the individual is treated because it ignores the impact that the substance use disorder has on the family unit and it does not recognize the family as a potential system of support for change (Lander, Howsare, & Byrne, 2013). I believe that any time a client is suffering from a SUD the individuals loved ones should be involved in the treatment and recovery process.
Conclusion
In conclusion, there are many different psychotherapeutic treatment approaches to use when working with clients that suffer from a substance use disorder. It is up to the psychiatric mental health nurse practitioner to understand the different treatment approaches and can choose which will work best for each client.
References
Bodrog, B., & Wittenberg, E. (2014). Veteran readjustment: What we went through and how to help us. Presentation at HealthPartners, Bloomington, MN.
Capone, C., Eaton, E., McGrath, A. C., & McGovern, M. P. (2014). Integrated Cognitive Behavioral Therapy (ICBT) For PTSD and Substance Use in Iraq and Afghanistan Veterans: A Feasibility Study. Journal of Traumatic Stress Disorders & Treatment, 3(4), 1000134.
Kelly, U., Boyd, M. A., Valente, S. M., & Czekanski, E. (2014). Trauma-informed care: Keeping mental health settings safe for veterans. Mental Health Nursing, 35, 413-419. doi: 10.3109/01612840.2014.881941.
Koetting, C. (2016). Trauma-Informed Care HELPING PATIENTS WITH A PAINFUL PAST. Journal of Christian Nursing, 33(4), 206–213. https://doi-org.ezp.waldenulibrary.org/10.1097/CNJ.0000000000000315
Lander, L., Howsare, J., & Byrne, M. (2013). The impact of substance use disorders on families and children: from theory to practice. Social work in public health, 28(3-4), 194-205.
Madson, M. B., Schumacher, J. A., Baer, J. S., & Martino, S. (2016). Motivational Interviewing for Substance Use: Mapping Out the Next Generation of Research. JOURNAL OF SUBSTANCE ABUSE TREATMENT, 65, 1–5. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jsat.2016.02.003
Purkey, E., Patel, R., & Phillips, S. P. (2018). Trauma-informed care: Better care for everyone. Canadian family physician Medecin de famille canadien, 64(3), 170-172.
Substance use disorders in the U.S. Armed forces. (2015). Military Medicine, 180(3), 243–245. https://doi-org.ezp.waldenulibrary.org/10.7205/MILMED-D-14-00517
Teeters, J. B., Lancaster, C. L., Brown, D. G., & Back, S. E. (2017). Substance use disorders in military veterans: prevalence and treatment challenges. Substance abuse and rehabilitation, 8, 69-77. doi:10.2147/SAR.S116720 Levy Family case study – psychotherapeutic approaches to group therapy for addiction
Critical evaluations of the patients’ primary characteristics is very essential while dealing with group therapies. The selection of the most appropriate approach while providing psychotherapeutic services to these groups posits a challenge to many facilitators. For the purposes of this paper, I will explore the various psychotherapeutic approaches utilized in group therapy for addition by utilizing levy’s family videos. The case study involves Mr. Levy who uses alcohol to fight his past traumatic experiences gained during the Iraq war. His use of alcohol has negatively impacted on his relationship with his wife whom blames levy for his alcoholic behavior (Laureate Education, 2013). Levy in return seeks aid to stop drinking so as to prevent the possibility of his wife divorcing him.
The therapist initiates the therapeutic session by applying individual therapy. The choice of this approach was informed by the idea that through understanding the clients primary characteristics and beliefs could reinforce the therapeutic approach success. The facilitator was able to identify that the war experiences, deteriorating family relationship and alcohol abuse were the key issues affecting Mr. Levy. The facilitator makes use of various behavioral therapy approaches to deal with Mr. Levy’s case. To begin with, the facilitator applies desensitization approach to help the client in managing his anger as well as his anxiousness (Steenkamp et al., 2015). The facilitator recommends him to be taking breathing techniques as the strategy of controlling his emotions. This technique was aimed at enabling the client to control and manage his anger which might negatively affect his relationship with others as well as to enhance his composure during the therapy Levy Family case study – psychotherapeutic approaches to group therapy for addiction.
Another method was the use cognitive behavioral therapy which helped in dealing with the client’s beliefs, thoughts and helping him deal with his challenges in a positive manner (Levi et al., 2016). This method was chosen as it would help the client have a positive attitude towards life and prompt self-treatment. Moreover, the approach would help Mr. Levy to face his past problems and find the solution of being able to live with the memories without any torture from them (Levi et al., 2016). The third approach is the use of the aversion therapy. This method helps the client to associate the use of alcohol to suicidal ideations among the military men (Neer et al., 2016). The client should be able to relate his traumatic experiences as a result of alcoholism as it is the case when he narrates on how his colleagues committed suicide and being informed that it is good he wasn’t drunk, he agrees proving his ability to generalize suicidal thought to alcoholism. Levy Family case study – psychotherapeutic approaches to group therapy for addiction.
Later, the facilitator adopts a group therapy where she applies the directive approach on Mr. Levy as well as his colleagues whom were in war with him. The application of this approach while dealing with group therapy is fundamental for it utilizes guidance on the topics and areas the group to concentrate in during the therapeutic process thereby achieving success at the initial stages of the group. The strategy enables the facilitator to control the clients’ participation and prevent domination by some group members which may make the session ineffective. Moreover, the facilitator utilized cognitive behavioral group therapy where each group member was help to resolve with the challenge memories and issues which were limiting their group participation (Steenkamp et al., 2015). This enables the member to aid each other and help one another to solve their challenges.
Being in the position of the facilitator, I would utilize the same strategies to help my clients deal with their challenges. Firstly, using the directive approach is essential in enhancing harmonious interactions as the clients are subjected to the same topics and goals which promotes cooperation and collaboration towards the identified goals (Corsini, 2017). Moreover, cognitive behavioral group therapy, will help my clients to come into terms with their past traumatic memories and thus participate fully in the group as well as develop a long lasting solution to their challenges (Steenkamp et al., 2015) Levy Family case study – psychotherapeutic approaches to group therapy for addiction.
However, the use of group psychodynamic approach while dealing with this group would also be essential. This method makes use of the process sensitive approach as well as the directive approach making it more effective in enhancing the participation of individual members as well as enhancing members’ empowerment in dealing with their challenges (Levi et al., 2016). This method goes a step further in facilitating group goal setting, setting expectations as well as appraisals of the members’ contributions (Levi et al., 2016). Consequently, all members in the group can freely participate in the group’s activities and appraise each other on one’s effort towards the achievement of their problems thus promoting change in attitude and behaviors.
In conclusion, primary characteristics plays a major role in assisting the facilitators in the selection of the most appropriate therapeutic approach to utilize. The use of individual therapy is essential in the identification of issues that are disastrous in the clients’ life. The ability to identify these issues informs the facilitator on the how to help their clients overcome these challenges. Group therapies success depends on the use of shared vision and goals thus application of group therapy proved essential in helping Mr. Levy and his colleagues deal with their challenges collaboratively. Levy Family case study – psychotherapeutic approaches to group therapy for addiction.
References
Corsini, R. (2017). Role playing in psychotherapy. Routledge.
Laureate Education (Producer). (2013). Levy family: Sessions 1-7 [Video file]. Baltimore, MD; Author.
Levi, O., Bar‐Haim, Y., Kreiss, Y., & Fruchter, E. (2016). Cognitive–Behavioural Therapy and Psychodynamic Psychotherapy in the Treatment of Combat‐Related Post‐Traumatic Stress Disorder: A Comparative Effectiveness Study. Clinical psychology & psychotherapy, 23(4), 298-307.
Neer, S. M., Trachik, B., Munyan, B. G., & Beidel, D. C. (2016). Comprehensive Treatment: Intensive Exposure Therapy for Combat-Related PTSD and Comorbid Conversion Disorder. Clinical Case Studies, 15(5), 343-359.
Steenkamp, M. M., Litz, B. T., Hoge, C. W., & Marmar, C. R. (2015). Psychotherapy for military-related PTSD: a review of randomized clinical trials. Jama, 314(5), 489-500 Levy Family case study – psychotherapeutic approaches to group therapy for addiction.
The purpose of this paper is to examine a client with addictive disorder and analyze the therapeutic approach for treating the client.
Episode 1
Mr. Levy’s perception of the problem is that he just is sick. He becomes confrontational and aggressive when his perception is questioned by his wife. Mr. Levy also wants other to share his perception, because when his wife asked him to go up stairs so the children don’t see him hungover he replies that he is only sick. Mr. Levy also perceives that the problem started when he went to war in Iraq.
Mrs. Levy’s perception of the problem is that her husband is depressed, angry, and drinks excessively. Her perception of her husband is that he is am alcoholic and he is tearing their family apart.
Mr. Levy’s alcoholism, anger, and depression can have a devastating impact for his whole family. Each member in the family will be affected uniquely in their own way, for the children there is a higher risk of developing issues with substance abuse or being abused themselves (Lander, Howsare, & Byrne, 2013). The family could face financial, psychological, and developmental strain and the potential for domestic violence (Lander, Howsare, & Byrne, 2013). Levy Family case study – psychotherapeutic approaches to group therapy for addiction.
Episode 2
Mr. Levy’s social suggested the use of art therapy, meditation, and yoga, these therapies can relieve stress, but this should not be at the forefront of the therapeutic plan. The Veterans Affairs (VA) has set a policy for the treatment of alcohol abuse for veterans. The policy requires the client to participate in two therapies, CBT for relapse prevention, 12-step facilitation, community reinforcement approach, substance use disorder focused behavioral couples/family therapy, and motivational enhancement therapy (Allen, Crawford, & Kudler, 2016). Mr. Levy’s social worker should focus on the VA’s suggested therapies first and then add in the holistic therapies.
The supervisor’s questions were appropriate for this situation. He wanted Mr. Levy’s social worker to think about the suggested therapies and are they evidence based. The supervisor did not want the social worker to use a therapy because she finds it interesting, but one that is backed by evidence to be effective. The supervisor was correct by telling her that she needs to meet the client before making his treatment plan so that it can be customized to his needs. Levy Family case study – psychotherapeutic approaches to group therapy for addiction.
Episode 3
Mr. Levy’s therapist allowed him to speak freely about his encounters in Iraq and analyzed his emotional state. She responded appropriately by interjecting when Mr. Levy showed extreme emotional distress re-enforcing that he is in a safe place. The therapy session at this point has gone well. The therapist allowed the client to talk freely, identified his emotional distress, explained her treatment plan, and taught the client deep breathing to reduce stress.
Deep breathing exercise starts with the contraction of the diaphragm, the expansion of the abdomen, and deep expansive inhalation and exhalation (Ma et al., 2017). Deep breathing reduces the frequency of needed respirations and maximizes the amount of gas dissolved in the blood (Ma et al., 2017). Deep breathing can improve cardiorespiratory fitness, enhance pulmonary function, reduce sympathetic nervous system activity (Ma et al., 2017).
Exposure therapy helps people confront their stressors in a safe environment by exposing them to the stressor physically or through imagery (American Psychological Association, 2018).
Exposure therapy is endorsed by the VA as one of the best treatments for PTSD and consider it to be the best supported treatment (VA.gov, 2016). The research done by the VA and Department of Defense in the efficacy of exposure therapy for the treatment of PTSD leads me to believe that this would be my choice in treatment.
Episode 4
I would have responded in a sympathetic tone enforcing that the client is in a safe place. I would also express that even though the memory was stressful to relive it was therapeutic to do so. The exposure therapy should focus on the situation Mr. Levy described, this was the major traumatic event that caused him to spiral out of control.
Episode 5
I would respond by sympathizing with the therapist do to the difficult story the client told her. The therapist should be told that she needs to maintain emotional boundaries to avoid countertransference that could negatively affect the therapeutic relationship (Colli & Ferri, 2015). I would suggest that the therapist involve the client’s family in therapy. Support for the client and his family can reduce the likelihood of more damaging consequences in the future (VA.gov, 2016). Levy Family case study – psychotherapeutic approaches to group therapy for addiction.
References
Allen, J. P., Crawford, E. F., & Kudler, H. (2016). Nature and Treatment of Comorbid Alcohol Problems and Post-Traumatic Stress Disorder Among American Military Personnel and Veterans. Alcohol Research: Current reviews, 38(1), 133-140. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4872608/
Colli, A., & Ferri, M. (2015). Patient personality and therapist countertransference. Current Opinion in Psychiatry, 28(1), 46-56. doi:10.1097/yco.0000000000000119
Lander, L., Howsare, J., & Byrne, M. (2013). The Impact of Substance Use Disorders on Families and Children: From Theory to Practice. Social Work in Public Health, 28(3-4), 194-205. doi:10.1080/19371918.2013.759005 Levy Family case study – psychotherapeutic approaches to group therapy for addiction
Ma, X., Yue, Z., Gong, Z., Zhang, H., Duan, N., Shi, Y., … Li, Y. (2017). The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults. Frontiers in Psychology, 8. doi:10.3389/fpsyg.2017.00874
Treatment of the Returning Iraq War Veteran – PTSD: National Center for PTSD. (2016, February 23). Retrieved from https://www.ptsd.va.gov/professional/treatment/vets/treatment-iraq-vets.asp
What Is Exposure Therapy? (2018). Retrieved from http://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy.aspx Levy Family case study – psychotherapeutic approaches to group therapy for addiction