The Psychoanalytic Approach Paper

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The Psychoanalytic Approach Paper

  • The psychoanalytic approach emphasizes the importance of early childhood development and events.  Do you find that current problems are mostly rooted in early childhood events or influences?  To what extent do you believe people can resolve their adult problems that stem from childhood without exploring past events?  When you apply this basic psychoanalytic concept specifically to yourself, what connections between your own past and present are you aware? The Psychoanalytic Approach Paper

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he Place of Techniques and Evaluation in Counseling

Drawing on Techniques from Various Approaches

Techniques of Therapy

Applications of the Approaches

Contributions to Multicultural Counseling

Limitations in Multicultural Counseling

Contributions of the Approaches

Overview of Contemporary Counseling Models

Ego-Defense Mechanisms

Comparison of Freud’s Psychosexual Stages and Erikson’s Psychosocial Stages

The Basic Philosophies

Key Concepts

Goals of Therapy

The Therapeutic Relationship

Limitations of the Approaches

The Place of Techniques and Evaluation in Counseling

Drawing on Techniques from Various Approaches

 

Techniques of Therapy

Psychoanalytic therapy The key techniques are interpretation, dream analysis, free association, analysis of resistance, analysis of transference, and countertransference. Techniques are designed to help clients gain access to their unconscious conflicts, which leads to insight and eventual assimilation of new material by the ego.
Adlerian therapy Adlerians pay more attention to the subjective experiences of clients than to using techniques. Some techniques include gathering life-history data (family constellation, early recollections, personal priorities), sharing interpretations with clients, offering encouragement, and assisting clients in searching for new possibilities.
Existential therapy Few techniques flow from this approach because it stresses understanding first and technique second. The therapist can borrow techniques from other approaches and incorporate them in an existential framework. Diagnosis, testing, and external measurements are not deemed important. Issues addressed are freedom and responsibility, isolation and relationships, meaning and meaninglessness, living and dying. The Psychoanalytic Approach Paper
Person-centered therapy This approach uses few techniques but stresses the attitudes of the therapist and a “way of being.” Therapists strive for active listening, reflection of feelings, clarification, “being there” for the client, and focusing on the moment-to-moment experiencing of the client. This model does not include diagnostic testing, interpretation, taking a case history, or questioning or probing for information.
Gestalt therapy A wide range of experiments are designed to intensify experiencing and to integrate conflicting feelings. Experiments are co-created by therapist and client through an I/Thou dialogue. Therapists have latitude to creatively invent their own experiments. Formal diagnosis and testing are not a required part of therapy.
Behavior therapy The main techniques are reinforcement, shaping, modeling, systematic desensitization, relaxation methods, flooding, eye movement and desensitization reprocessing, cognitive restructuring, social skills training, self-management programs, mindfulness and acceptance methods, behavioral rehearsal, and coaching. Diagnosis or assessment is done at the outset to determine a treatment plan. Questions concentrate on “what,” “how,” and “when” (but not “why”). Contracts and homework assignments are also typically used.
Cognitive behavior therapy Therapists use a variety of cognitive, emotive, and behavioral techniques; diverse methods are tailored to suit individual clients. This is an active, directive, time-limited, present-centered, psychoeducational, structured therapy. Some techniques include engaging in Socratic dialogue, collaborative empiricism, debating irrational beliefs, carrying out homework assignments, gathering data on assumptions one has made, keeping a record of activities, forming alternative interpretations, learning new coping skills, changing one’s language and thinking patterns, role playing, imagery, confronting faulty beliefs, self-instructional training, and stress inoculation training.
Choice theory/ Reality therapy This is an active, directive, and didactic therapy. Skillful questioning is a central technique used for the duration of the therapy process. Various techniques may be used to get clients to evaluate what they are presently doing to see if they are willing to change. If clients decide that their present behavior is not effective, they develop a specific plan for change and make a commitment to follow through.
Feminist therapy Although techniques from traditional approaches are used, feminist practitioners tend to employ consciousness-raising techniques aimed at helping clients recognize the impact of gender-role socialization on their lives. Other techniques frequently used include gender-role analysis and intervention, power analysis and intervention, demystifying therapy, bibliotherapy, journal writing, therapist self-disclosure, assertiveness training, reframing and relabeling, cognitive restructuring, identifying and challenging untested beliefs, role playing, psychodramatic methods, group work, and social action. The Psychoanalytic Approach Paper
Postmodern approaches In solution-focused therapy the main technique involves change-talk, with emphasis on times in a client’s life when the problem was not a problem. Other techniques include creative use of questioning, the miracle question, and scaling questions, which assist clients in developing alternative stories. In narrative therapy, specific techniques include listening to a client’s problem-saturated story without getting stuck, externalizing and naming the problem, externalizing conversations, and discovering clues to competence. Narrative therapists often write letters to clients and assist them in finding an audience that will support their changes and new stories.
Family systems therapy A variety of techniques may be used, depending on the particular theoretical orientation of the therapist. Some techniques include genograms, teaching, asking questions, joining the family, tracking sequences, family mapping, reframing, restructuring, enactments, and setting boundaries. Techniques may be experiential, cognitive, or behavioral in nature. Most are designed to bring about change in a short time.

Techniques of Therapy

Applications of the Approaches

Psychoanalytic therapy Candidates for analytic therapy include professionals who want to become therapists, people who have had intensive therapy and want to go further, and those who are in psychological pain. Analytic therapy is not recommended for self-centered and impulsive individuals or for people with psychotic disorders. Techniques can be applied to individual and group therapy.
Adlerian therapy Because the approach is based on a growth model, it is applicable to such varied spheres of life as child guidance, parent–child counseling, marital and family therapy, individual counseling with all age groups, correctional and rehabilitation counseling, group counseling, substance abuse programs, and brief counseling. It is ideally suited to preventive care and alleviating a broad range of conditions that interfere with growth.
Existential therapy This approach is especially suited to people facing a developmental crisis or a transition in life and for those with existential concerns (making choices, dealing with freedom and responsibility, coping with guilt and anxiety, making sense of life, and finding values) or those seeking personal enhancement. The approach can be applied to both individual and group counseling, and to couples and family therapy, crisis intervention, and community mental health work.
Person-centered therapy Has wide applicability to individual and group counseling. It is especially well suited for the initial phases of crisis intervention work. Its principles have been applied to couples and family therapy, community programs, administration and management, and human relations training. It is a useful approach for teaching, parent–child relations, and for working with groups of people from diverse cultural backgrounds.
Gestalt therapy Addresses a wide range of problems and populations: crisis intervention, treatment of a range of psychosomatic disorders, couples and family therapy, awareness training of mental health professionals, behavior problems in children, and teaching and learning. It is well suited to both individual and group counseling. The methods are powerful catalysts for opening up feelings and getting clients into contact with their present-centered experience.
Behavior therapy A pragmatic approach based on empirical validation of results. Enjoys wide applicability to individual, group, couples, and family counseling. Some problems to which the approach is well suited are phobic disorders, depression, trauma, sexual disorders, children’s behavioral disorders, stuttering, and prevention of cardiovascular disease. Beyond clinical practice, its principles are applied in fields such as pediatrics, stress management, behavioral medicine, education, and geriatrics.
Cognitive behavior therapy Has been widely applied to treatment of depression, anxiety, relationship problems, stress management, skill training, substance abuse, assertion training, eating disorders, panic attacks, performance anxiety, and social phobias. CBT is especially useful for assisting people in modifying their cognitions. Many self-help approaches utilize its principles. CBT can be applied to a wide range of client populations with a variety of specific problems.
Choice theory/ Reality therapy Geared to teaching people ways of using choice theory in everyday living to increase effective behaviors. It has been applied to individual counseling with a wide range of clients, group counseling, working with youthful law offenders, and couples and family therapy. In some instances it is well suited to brief therapy and crisis intervention.
Feminist therapy Principles and techniques can be applied to a range of therapeutic modalities such as individual therapy, relationship counseling, family therapy, group counseling, and community intervention. The approach can be applied to both women and men with the goal of bringing about empowerment.
Postmodern approaches Solution-focused therapy is well suited for people with adjustment disorders and for problems of anxiety and depression. Narrative therapy is now being used for a broad range of human difficulties including eating disorders, family distress, depression, and relationship concerns. These approaches can be applied to working with children, adolescents, adults, couples, families, and the community in a wide variety of settings. Both solution-focused and narrative approaches lend themselves to group counseling and to school counseling. The Psychoanalytic Approach Paper
Family systems therapy Useful for dealing with marital distress, problems of communicating among family members, power struggles, crisis situations in the family, helping individuals attain their potential, and enhancing the overall functioning of the family.

Case Study Treatment Plan: The Assessment Process

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Case Study Treatment Plan: The Assessment Process

For this assignment, complete the Assessment Process sections of the treatment plan for your course project. This treatment plan is based on the case study you selected for your course project. You can review the case studies in the Case Study Treatment Plan media piece available in the resources.

The Assessment Process sections of the treatment plan that you will complete for this assignment consist of the following:

  • Identifying information.
  • Presenting problem.
  • Previous treatments.
  • Strengths, weaknesses, and social support systems.
  • Assessment.
  • Diagnosis.
  • References.

The sections of the treatment plan you submit for this assignment should be 4–5 pages in length, with a minimum of two references from current articles in the professional literature in counseling. Be sure to cite your references in current APA format. Case Study Treatment Plan: The Assessment Process

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To assist you in completing this assignment, please use the Case Study Treatment Plan Template (available in the resources) to organize your work. Each section of the template includes a description of the type of information you must include. You should type your paper directly into this template, save it as a Word document with your name, and then submit it to the assignment area.

For additional information, see the course project description.

Submit your paper to Turnitin before you post it to the assignment area so you can catch any areas that are showing up as possible plagiarism.

Note: Your instructor may also use the Writing Feedback Tool to provide feedback on your writing. In the tool, click on the linked resources for helpful writing information. Case Study Treatment Plan: The Assessment Process

 

THE CASE STUDY

Oscar is a 19-year-old Hispanic male who is the oldest of 5 children. His family has been farming the same land for 4 generations. Currently they grow vegetables for the regional grocery chain’s produce departments. They live in a rural area of the county. Three generations live in two separate houses on their land. They are fiercely independent and have little to do with people in town, although the family itself is extremely close knit.

Oscar is currently a freshman at the same college his father attended, majoring in agriculture. When he came home for spring break, his parents noticed significant changes in his appearance. He had lost weight, looked haggard, wasn’t sleeping and seemed irritable and argumentative. He told his parents that he did not want to return to college after the break. He went on to say that his roommate had placed cameras in the room so he could record everything Oscar did while the roommate was absent. His grades were poor and he expressed that he believed his instructors were prejudiced against him. This poor performance was in stark contrast to his performance in high school, where he was in the top 10% of his class. Within days of coming home he had stopped showering and began wearing multiple layers of clothes (3 pairs of jeans and 4 t-shirts). He became essentially non-communicative, responding to questions with one-word answers and not initiating conversation. Oscar seemed unhappy or irritable whenever he encountered a member of his family and began spending all his time in his room. He even refused to talk with his youngest brother, with whom he had always been close. He did not take meals with his family, a long-standing tradition in his family, and left his room only in the middle of the night. He could then be heard opening drawers in the kitchen, going into his siblings’ rooms and leaving the house for long periods of time. Case Study Treatment Plan: The Assessment Process

The family (parents and grandparents) became very disturbed and consulted their priest. The priest recommended that the parents take Oscar to see a fellow parishioner who is also a counselor. This counselor was also disturbed with Oscar’s presentation and recommended hospitalization. The family was very reluctant, but eventually agreed. By the time they got to the hospital, Oscar was essentially non-communicative, only nodding or shaking his head in response to direct questions.

The parents provided history that indicated Oscar had been a good student in high school and had participated in the school’s FFA club. He has always wanted to carry on the family tradition of farming. He did not have many friends, but the family attributed that to their living in the country.

The psychiatrist diagnosed Oscar with major depressive disorder, single episode, severe with psychotic features and prescribed anti-depressants. He was released three weeks later, with some improvement. One week later he was readmitted, with the same presentation he had at the previous admission. This time, though, his father reported that he had found a cache of knives in the barn, some from the house, some from the grandparent’s house and some from the barn itself. When he asked Oscar about them, Oscar responded that he needed them to protect himself from attacks. When his father asked from whom, Oscar responded that he had seen one of his college professors in the field of broccoli. That same day, Oscar’s mother found notes stuffed between Oscar’s mattress and box springs in Oscar’s handwriting. The content of them was Oscar arguing with someone about killing his younger siblings. One side did not want to do it and begged to not have to; the other side ordered the killings, saying that was the only way to keep them safe. In light of these two events, both parents were afraid for Oscar to remain at the house. Oscar swore that he would never hurt any of his family and said that was why he had been keeping away from them. His parents could not be sure that no harm would come and were unable to watch Oscar day and night. Therefore, they readmitted him to the hospital. Case Study Treatment Plan: The Assessment Process

During this admission, Oscar was more forthcoming with his treatment team. Once they had this additional information, the team realized that Oscar’s initial diagnosis had been wrong. They began a re-assessment. Oscar acknowledged that the problems began about the time of the new semester. He was unable to complete his school work, as he was “consumed” with the need to follow instructions that were being given to him. These instructions actually began with a buzzing in his head, which quickly evolved into specific directions. When pressed, he acknowledged that he did not know who was giving him the directions, though he sometimes thought it might be Jesus. These instructions were for him to keep a log of every time he heard a door close on his hallway in the dorm. Oscar came to believe that doing this was the only way to keep his family safe from dark angels. Oscar tried to keep these voices quiet by smoking marijuana on a daily basis. While this helped in the short term, it also made it more difficult for him to complete any of his school work. By the time for spring break, the messages had begun to change. He was no longer able to keep his family safe by keeping a list; the voices told him he would have to kill them. Oscar knew that he did not want to kill his family. He could also not avoid going home for spring break. Therefore, he devised the plan to isolate himself.

Once the family recovered from their initial shock and as Oscar began to show some improvement with his new, anti-psychotic, medication, his parents and grandparents wanted to take him home to the farm. They believed that life on the farm, being outside and with hard, physical labor would cure Oscar. Finally, Oscar agreed to tell them what has been happening with him. At that point, the family agreed to residential treatment for Oscar. When asked if anyone else in the family has ever had symptoms like this, the grandfather acknowledged that he had a brother (Oscar’s uncle) who had religious visions. This brother left the family and became a monk. Later the family heard that he had died under mysterious circumstances. One of the other monks at the monastery told Oscar’s grandfather that his brother had died from engaging in a prolonged fast. The family is very lucky on two counts: 1) they have their medical insurance through the farmer’s co-op and it includes coverage for residential treatment for up to a year, and 2) this hospital has a residential treatment unit for late adolescents and young adults. You are working as a counselor at the Residential Treatment facility where Oscar has been placed. He will be here for a minimum of 6 months and as long as one year. Professional staff at this facility includes 3 counselors, an addictions counselor, a social worker (currently on maternity leave), a psychologist, and 2 nurses on every shift. Oscar’s psychiatrist is also on staff and will continue to follow his care.

The social worker usually coordinates clients’ treatment plans; however she is currently away on maternity leave so you will be the lead therapist who is coordinating Oscar’s treatment during the next 45 days. Once she returns, you will collaborate with her for developing Oscar’s post-residential treatment and resources for him and his family. Case Study Treatment Plan: The Assessment Process

Psych 635 Ethics In Conditioning Research

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Psych 635 Ethics In Conditioning Research

Complete Parts 1 and 2 for this assignment.

Part 1

Watch “Pavlov’s Experiments on Dogs” and “Pavlov’s Experiments on Children” in the Week Two Electronic Reserve Readings.

Part 2

Prepare a research proposal for one of Pavlov’s research experiments involving children, adjusting it for current principles of ethical guidelines

  • Read the article ““The General Ethical Principles of Psychologists”
  • Identify one of the ethical violations and propose an alternative approach that would meet current ethical standards. Psych 635 Ethics In Conditioning Research

Format your paper consistent with APA guidelines.

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Ethics in Conditioning Research

Research and experimentation has changed tremendously over the decades. Earlier research and experiments had little to no regard for human safety or ethics. The American Psychological Association (APA) created ethical guidelines that now govern all professionals in the psychology field. Ivan Pavlov is known for his work in classical conditioning is most famous for his work salivating dogs. However, Pavlov also performed the same experiments with children using some of the same methods. In one of Pavlov’s experiment shown from Film Media Group (2010), Pavlov attached an instrument to the child’s arm and a tube above his mouth that dispense cookies when a lever was pressed. When the level was pressed causing pressure to the child’s arm, a cookie was released out of the tube directly into the child’s mouth. Over time whenever the lever was pressed the child would automatically start chewing whether there was a cookie present or not. This research proposal is designed to recreate the experiment that Pavlov did with children that were unethical by today’s standards.

Problem

The American Psychological Association (APA) has created and place ethical guidelines that are for all professionals in the psychology field to follow that not only protect the professionals but also the individuals who participate in the experiments. Pavlov’s Experiment with the children has shown some ethical violations that violated the children’s rights according to the APA guidelines in place today. One of the Ethical Violations in Ivan Pavlov’s Experiment was the Principle A: Beneficence and Nonmaleficence (APA, 2015). This ethical principle states that the psychologist seeks to have safeguards for the welfare, rights and safety of those who interact professionally and those who are participating in the experiment including animals. Pavlov’s research experiment did not take the children’s safety, well-being and rights as a human being into consideration on how these children would be affected by the experiment. Pavlov had little regards to the human safety which was why Pavlov’s experiment violated the ethical guideline. Psych 635 Ethics In Conditioning Research

Recommendation

The way in which Ivan Pavlov performed his experiments on children in today’s ethical standards would be considered harsh, cruel, and inhumane. Children and dogs were treated unfairly and often times unnecessary surgical procedures were performed in the experiments. Ethically the experiments would not be permitted in society today because of the APA standards and guidelines that must be followed. Ethically by today’s standards of appropriateness Pavlov’s experiments on children can be recreated. The experiments would need to be modified to protect the physical welfare and psychological well-being of the participants. Pavlov believed that unlike animals, humans could learn conditioned responses more rapidly (Schunk, 2012).

The first recommendation to help with the experiment for Pavlov’s experiment with children would be to give the child a pat on the arm for a reflex, if the child response he or she would receive a treat. This would take the place of pressure to the arm, which may cause harm to the child. The second recommendation is for the researcher to have the child choose a good choice or bad choice behavior; if the child chooses the good choice he or she receives a treat, if the child chooses the bad choice behavior he or she does not receive the treat. This experiment does not reflect harm to the child in any way, but does teach the child the difference between good and bad choices. When the experiment is repeated the child learns to make good choices for the reward. The third recommendation is verbal praise and verbal prompts. Using the two together children can have a positive response to the request of the researcher. When the researcher gives the verbal prompt and the child response appropriately, the researcher responds with verbal praise. Instead of using food for rewards the researcher can use verbal praise to help the child with positive reinforcements. The action should be repeated to help the child remember what he or she is supposed to do and when. It is unclear if Pavlov received informed consent to do invasive procedures to children in his experiments. When conducting research on child under the age of 18, it is important to obtain verbal or written consent from a parent or legal guardian before carrying out any type of experiment (American Psychological Association, 2015). If consent is not obtained from the parent or guardian it is a violation of Principle B: Fidelity and Responsibility. Ethical standards must be met when working in the field of research in relation to animals and humans (American Psychological Association, 2015)Psych 635 Ethics In Conditioning Research.

Conclusion

This research proposal is designed to recreate the experiment performed by Ivan Pavlov that involved children. Pavlov’s treatment of the children was unethical by today’s standards. Pavlov is famous for his experiments in classical conditioning involving salivating dogs. Pavlov also performed the same experiments with children using similar methods to those used on the dogs. Pavlov’s experiment on a child is shown in a film from the Film Media Group (2010). The use of invasive surgery techniques has far-reaching implications involving the physical and psychological well-being of the subjects and participants for the remainder of their lives. Research and experimentation have changed greatly since Pavlov conducted his experiments. Pavlov’s research and experiments violated many of the ethical guidelines put in place to protect research participants according to the American Psychological Association (APA). There is a high probability that the surgically implanted tubes caused physical harm to the children and the dogs Psych 635 Ethics In Conditioning Research.

Discussion Aggressive Behavior

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Discussion Aggressive Behavior

Provide a substantive contribution that advances the discussion in a meaningful way by identifying strengths of the posting, challenging assumptions, and asking clarifying questions. Your response is expected to reference the assigned readings, as well as other theoretical, empirical, or professional literature to support your views and writings. Reference your sources using standard APA guidelines. Review the Participation Guidelines section of the Discussion Participation Scoring Guide to gain an understanding of what is required in a substantive response. Discussion Aggressive Behavior

Peer 1 Response: Cait

Anderson & Bushman (2001) conducted the meta-analysis, Effects of Violent Video Games On Aggressive Behavior, Aggressive Cognition, Aggressive Affect, Physiological Arousal, and Prosocial Behavior: A Meta-Analytic Review of the Scientific Literature, which determined that there was a correlation between playing video games and aggressive behaviors. In a set of 21 controlled experimental studies, Anderson & Bushman (2001) concluded that there was a correlation between playing video games (x) and engaging in the aggressive behavior (y). Table 1 determined that aggressive behavior was measured at r= .19, therefore concluding that the correlation was statistically significant due to a large number of participants that were involved in the research study. Aggressive behavior in conjunction with playing violent video games was tested with 3,033 participants. If there was a smaller sample size (in this case, less than 3,033 participants), the correlation r=.19 may not have been as large or as significant. This result also yielded significant results because r=.19 is positive, rather than negative. In Table 1 it can also be determined that the results displayed significant results because of the homogeneity test. The homogeneity test determined an outcome of x2(32)  23.25, p > .05 (Anderson & Bushman, 2001). It was measured that the p score was 23.25, compared to the normal value used by SPSS and researchers, which is .05. Because the p-value was larger than .05, it yielded significant results for this research study. If the p-value was smaller than .05, it would not hold the same level of significance.  Discussion Aggressive Behavior

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Reference

Anderson, C. A., & Bushman, B. J. (2001). Effects of violent video games on aggressive behavior, aggressive cognition, aggressive affect, physiological arousal, and prosocial behavior: A meta-analytic review of the scientific literature. Psychological Science, 12(5), 353–359.

Peer 2 Response: Teddick

A meta-analysis (Anderson & Bushman, 2001) reported that the average correlation between time spent playing video games (X) and engaging in aggressive behavior (Y) in a set of 21 well-controlled experimental studies was .19. This correlation was judged to be statistically significant. In your own words, what can you say about the nature of the relationship?

Warner (2013) explained that in a result of .19 will fall among the small (r<.10) and the medium (r<.30) and in less than the large (r<.50). This is an indicator that there is a compelling association, but this does not mean there is a causation between aggressive behavior and video games. Because of the insufficient information provided, we must consider every factor that contributes to the research, for example age of the gamer, time spent playing, time spent watching movies of violence, how much the parents are involved in their child’s life, if that person is involved with the wrong group of individuals, their surrounding neighborhood, and even their social and academic intellect. However, there still is a relationship of correlation on the meta-analysis, but does not necessarily means a causation. The meta-analysis shows a significant association on aggressive behavior being affected by playing violent video games, but does not prove or show that it causes the behavior. If anything it does encourage parents to look for more age appropriate video games and limit the access of violent-themed games for their kids (Anderson, C. & Bushman, B., 2001).

References:

Anderson, C. A., & Bushman, B. J. (2001). Effects of violent video games on aggressive behavior, aggressive cognition, aggressive affect, physiological arousal, and prosocial behavior: A meta-analytic review of the scientific literature. Psychological Science, 12(5), 353–359.

Warner, R. M. (2013). Applied Statistics: From Bivariate Through Multivariate Techniques (2nd ed.). Sage Publications Discussion Aggressive Behavior

Discussion Positive Psychology

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Discussion Positive Psychology

Chapter 9 Becoming and Being Wise Developing Wisdom

Many theorists argue that wisdom develops from knowledge, cognitive skills and personality factors. Understanding culture and the environment also considered vital. Mentors are believed to be an important mechanism for developing wisdom “Two heads are better than one”

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Wise People and Their Characteristics

Longitudinal studies have determined thatDiscussion Positive Psychology a person’s childhood does not determine the development of wisdom and that wise people achieve greater life satisfaction than the unwise. Orwell and Achenbaum suggest that women’s acts of wisdom typically occur in private whereas men’s acts of wisdom are more public Baltes and Staudinger report no age differences between 25 and 75 years but that the time between 15 and 25 is particularly important in developing wisdom. Some professions associated with higher levels of wisdom: clinical psychologists

a. Do you know a wise person? a) What kinds of characteristics make him/her a wise person?

b. Do you consider yourself a wise person b) How can we cultivate wisdom in everyday life?

Chapter 10 Forgiveness

· Defined by Thompson and colleagues, forgiveness is freeing from a negative attachment to the source of the transgression. This definition allows the target of forgiveness to be oneself, another person, or a situation.

· Defined by McCullough and colleagues, forgiveness is an increase in prosocial motivation, in that there is less of a desire to avoid or seek revenge against the transgressor and an increased desire to act positively towards the transgressing person. This definition is only applicable when another person is the target of the transgression. Discussion Positive Psychology

· Defined by Enright and colleagues, forgiveness is the willingness to give up resentment, negative judgment, and indifference towards the transgressor and give undeserved compassion, generosity, and benevolence to the transgressing person. This definition is limited to people and does not include situations.

· Defined by Tangney and colleagues, giving up negative emotions is the core of forgiveness.

How does one learn forgiveness?

· According to the model developed by Gordon, Baucom, and Snyder, three steps are needed for achieving forgiveness toward another person. The initial impact stage includes negative emotions such as fear, anger and hurt. The search for meaning stage investigates why the incident happened. And the recovery stage is when the people move forward in their lives.

· The REACH model developed by Everett Worthington is a five-step process to forgiveness regarding infidelity. The acronym stands for Recall the hurt and the nature of the injury caused; Empathy promotion in both partners; Altruistic gift giving of forgiveness between partners; Committing verbally to forgive partner, and; Holding onto the forgiveness for each other.

· Self-forgiveness is aimed at lessening the feelings of shame or guilt. The individual is encouraged to take responsibility for the action and to let go and to move forward. The goal is to prevent the individual from letting the negative feelings interfere with positive living.

· Thought stopping and examination of thinking behind negative situations are needed to forgive situations and inanimate objects. The individual will learn that they should not blame happenings in their lives for their problems.

Why forgive? Discussion Positive Psychology

· An evolutionary advantage to forgiveness is that it may break the violence cycle in human beings and the survival chances will be increased. With lower levels of hostility and aggression and higher levels of positive feelings, the social order may be stabilized.

· Forgiveness requires a sense of self, which is often damaged due to problems requiring the forgiveness. If one learns to forgive, one will build the sense of self up and it may become stronger.

· Forgiveness creates positive emotions.

Think about a situation in which you forgave someone.  a) Explain how you felt before and after forgiving.  b) Do you think that this forgiveness was true forgiveness and why? (Link your comments to one or more of the forgiveness theories presented in the chapter.) Discussion Positive Psychology

Human Responsibility for the Environment

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Human Responsibility for the Environment

Assignment

 

In Module/Week 5, you must write a 1,000–1,200-word ethical argument essay from the thesis/outline that you submitted in Module/Week 4. Your assignment is to develop an ethical essay following the Rogerian Model of argument. The research sources for this essay have been provided for you in our course. Any additional sources that you may choose to use must be credible academic sources. You must include at least 4 quotations, 1 summary, and 1 paraphrase (6 total) into your essay from at least 3 credible sources to support your thesis statement and provide opposing arguments acknowledging common ground as emphasized in Rogerian argument. Be sure to document your sources correctly according to your documentation style (Current APA, MLA, or Turabian). You may include biblical support, but it does not count in the required citations. Human Responsibility for the Environment

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Ethical Essay Prompt

 

Topic: Human Responsibility for the Environment

 

Prompt: Write an ethical essay using the Rogerian Model of argument in which you address the question, “How far should humans go to protect the environment?”

 

 

Helpful Hints

· Chapter 4 in last week’s textbook readings includes a general outline for the Rogerian Model of Argument.

· Chapter 14 in last week’s textbook readings includes sample student outlines and student essays for an ethical (Rogerian) essay written in each of the documentation styles (APA, MLA, and Turabian).

· Review the Proofreading Checklist (below) to understand the content that you must include in your essay assignment this week.

· Review the Essay 2 Grading Rubric in the course before submitting your essay assignment. Human Responsibility for the Environment

 

Proofreading Checklist

 

Read through your paper and check the appropriate boxes on the chart below. If any area of your paper needs revision, make sure you correct it before submitting your essay.

 

Reading & Study Application Successful Needs Revision
1. Introduction: Establishes the ethical principle and states the essay’s thesis    
2. Background: Gives an overview of the situation and provides necessary information about the topic    
3. Ethical analysis: Explains the ethical principle and analyzes the particular situation on the basis of this principle    
4. Evidence in support of the thesis: integrates a total of at least 6 quotes, summaries, and/or paraphrases from at least 3 credible sources    
5. Finds common ground as required by Rogerian model of argument    
6. Refutation of opposing arguments: Addresses objections and refutes them in a clear and respectful way    
7. Conclusion: Restates the ethical principle as well as the thesis (not in the exact words); includes a strong concluding statement    
8. Contains pathos (emotional) appeals, (values/belief) appeals, and/or logos (factual) appeals- as appropriate    
9. Title reflects issue and ethics    
10. Uses only third person pronouns (all first and second person pronouns have been removed)    
11. If using current APA format, contains properly formatted, title, abstract, and references page

If using current MLA format, contains a properly formatted Works Cited page

If using current Turabian format, contains a properly formatted title page and bibliography page

    
12. Double spaced; 12-point Times New Roman font    
13. Uses signal phrases and appropriate transitions    
14. References/Works Cited/ Bibliography page includes all sources cited within the body of the essay    
15. Checked spelling, grammar/mechanics    

 

 

Submitting the Assignment

 

When you are satisfied with the quality of your essay, submit in the course via the SafeAssign link for grading. Do not forget to write your degree program and whether you are using current MLA, APA, or Turabian in the “Submission Title” field when submitting your essay.

 

IMPORTANT: Fully cite all quotations, summaries, and paraphrases used within your essay, or those excerpts will be regarded as plagiarism and will result in a “0” on your essay and possible course failure Human Responsibility for the Environment

Understanding human behavior and the social environment

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Understanding human behavior and the social environment

Respond to at least two colleague’s post in one of the following ways:

o   From a strength’s perspective, critique your colleague’s approach to addressing Francine’s case. Provide support for your critique.

 o   Critique your colleague’s strategy for applying knowledge of the aging process to work with older clients. Discuss how cultural, ethnic, and societal influences might affect the application of this strategy.

Be sure to support your responses with specific references to the resources. If you are using additional articles, be sure to provide full APA-formatted citations for your references. Understanding human behavior and the social environment

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Colleague 1:BM

 

As individuals enter the stage of late adulthood, their previous experiences, lifestyle and relationships help determine what, indeed, this stage will entail (Zastrow and Kirst-Ashman, 2016).  In this week’s case study, 70- year-old Francine sought counseling for symptoms of depression, directly related to the loss of her partner of thirty years, Joan (Plummer, Makris and Brocksen, 2014).  Since Francine’s family and  loved ones were unaware of the extent of the the relationship between Francine and Joan, Francine did not have the necessary support as she navigated her way through her grieving process.  She started drinking alcohol more often, after several years of sobriety (Plummer, et. al., 2014)Understanding human behavior and the social environment.

It can be assumed that Francine’s relationship with Joan, spanning thirty years, has certainly influenced her aging process.  In long-term relationships, such as this one, individuals identify as being half of a partnership, as opposed to their individual beings (Zastrow and Kirst-Ashman, 2016).  These defining relationships allow for individuals to feel supported and share experiences throughout their daily lives.  This relationship is at the crux of Francine’s being, and although her partner has passed, its value can be utilized to help Francine cope with the loss and navigate through the remainder of her life.  Additionally, Francine’s extensive experience within the workforce will also positively contribute to her aging process.  Throughout these years, Francine’s interaction with people, both professionally and socially, have helped to promote a healthy inner being.  While she may not be feeling sociable after Joan’s passing, referencing her forty year career will be a helpful tool for her clinician.

The case study mapped out the positive aspects in Francine’s life beautifully.  Despite the depression she is currently experiencing, employing a Strength Based Perspective, focusing on her resiliency, would be an appropriate and effective method to help Francine achieve her most positive outcomes (Zastrow and Kirst-Ashman, 2016)Understanding human behavior and the social environment. Francine has shown a tremendous capacity throughout her life in identifying and removing the triggers causing harmful behaviors; this awareness resulted in many years of sobriety (Plummer, et. al., 2014).  Furthermore, Francine, despite her current depressive state, has identified the need to combat these harmful behaviors yet again in her later adult life.  Additional strengths possessed by Francine include her willingness to seek treatment, her desire to engage socially within her environment and her involvement in the entire process.  Francine is a prime candidate to achieve the outcomes she is working toward.  It remains the role of the clinician to highlight even the smallest achievements throughout the process, thus emphasizing Francine’s resiliency.

 

 

Plummer, S. -B., Makris, S., & Brocksen, S. M. (Eds.). (2014). Social work case studies: Foundation year. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].

 

Zastrow, C. H., & Kirst-Ashman, K. K. (2016). Understanding human behavior and the social environment (10th ed.). Boston, MA:  Cengage Learning.

 

Colleague 2: SK

 Zastrow & Kirst-Ashman (2016) put forward later adulthood is the last segment of the life span; where, aging is an individual process that occurs at different rates in different people. The case of Francine looks at the life changing event of Francine a 70 years old who lost her partner, Joan, who she didn’t quite clarify their relationship to her family and friends because it would label her as being a lesbian. She was experiencing a number of challenges included depression due to her grief, lack of support because her family was not aware of impact that losing her friend caused and alcohol abuse which she had issues with in her early years and have now resurfaced (Plummer, Makris & Brocksen 2014).

Francine’s environment have definitely influenced her aging process as she has spent most of her time with Joan who has been taken from the equation so she is left by herself to adjust to the new norm of being alone, which, may not be healthy for her emotionally and by extension physically. Not having Joan to talk to on a day to day basis will have a psychological impact on her which may contribute to her state of depression and stress; the fact that her relationship was not recognized on a legal or social level for most of her life puts a burden on her as well (how to act). Her environment has changed drastically from having her partner where they were like one to being alone also puts pressure on her as she needs to find different ways to cope and identify as being an individual again. Environmental factors influence the aging process; having no one to talk to and being in a strange environment tend to accelerate this process (Zastrow & Kirst-Ashman 2016)Understanding human behavior and the social environment.

In working with older clients in general I would need to employ strategies that will allow them to use their strengths to aid them in overcoming their problems. Due to the fact that these clients are older one would have to take in account that they have years of knowledge under their belt and that should be merited so as the social worker assess their clients situation they should employ the strength base perspective which would yield more. Active listening should also be applied as it is important that clients see your interest in their case and also restating and confirming important information provided by them. It is often said that with age comes wisdom so it is imperative that social workers use this to their advantage and not build a barrier between them and their client even if their clients seem to act as if they have all the answers but they are sitting in the seat that requires help. Zastrow & Kirst-Ashman (2016) states as people age, their reserve capacities decrease, as a result, older people cannot respond to stressful demands as rapidly as young people..

References

Zastrow, C. H., & Kirst-Ashman, K. K. (2016). Understanding human behavior and the social environment(10th ed.). Boston, MA:  Cengage Learning.

Plummer, S. -B., Makris, S., & Brocksen, S. M. (Eds.). (2014). Social work case studies: Foundation year. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader]Understanding human behavior and the social environment.

Applying Critical Thinking Reflections

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Applying Critical Thinking Reflections

Title of Paper

Triple click your mouse anywhere in this paragraph to replace this text with your introduction. Often the most important paragraph in the entire essay, the introduction grabs the reader’s attention—sometimes a difficult task for academic writing. When writing an introduction, some approaches are best avoided. Avoid starting sentences with “The purpose of this essay is . . .” or “In this essay I will . . .” or any similar flat announcement of your intention or topic. Applying Critical Thinking Reflections

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Elements of Critical Thinking

Triple click your mouse anywhere in this paragraph to replace this text with your 1st body paragraph. In this section, you will focus on the elements of critical thinking apparent in the case. Replace the text with a well-developed paragraph (including a topic sentence and transitions) that considers the following questions: What barriers to critical thinking were apparent? How were they presented? Do you believe that Sally possesses characteristics of a good critical thinker? Why or why not?

Reason, Emotion, and Communication

Triple click your mouse anywhere in this paragraph to replace this text with your 2nd body paragraph. In this section, you will focus on the role that reason, emotion, and communication play in the case. Replace the text with a well-developed paragraph (including a topic sentence and transitions) that considers following questions: How is the concept of reason presented? How did emotion affect Sally’s critical thinking? What type of communication style does Sally use while at dinner with her colleagues? Why do you believe this? Applying Critical Thinking Reflections

Fallacies and Argument

Triple click your mouse anywhere in this paragraph to replace this text with your 3rd body paragraph. In this section, you will explain the fallacies and arguments presented in the case. Replace the text with a well-developed paragraph (including a topic sentence and transitions) that considers the following questions: What fallacies, if any, are present in the scenario? What is the main argument presented? Do you believe the argument is valid? Why or why not?

Conclusion

Triple click your mouse anywhere in this paragraph to replace this text with your conclusion. The closing paragraph is designed to bring the reader to your way of thinking if you are writing a persuasive essay, to understand relationships if you are writing a comparison/contrast essay, or simply to value the information you provide in an informational essay. The closing paragraph summarizes the key points from the supporting paragraphs without introducing any new information Applying Critical Thinking Reflections.

Person-Centered Interviews: Coping Strategies

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Person-Centered Interviews: Coping Strategies

Eight categories of coping strategies were identified: avoidance behavior, utilizing supportive others, taking medications, enacting cognitive strategies, controlling the environment, engaging spirituality, focusing on well-being, and being employed or continuing their education. The 16 individuals who identified strategies typically identified multiple strategies. Use of strategies varied, with some used consistently and others used only when the person was faced with a particular symptom. Illustrative quotes are provided below. [Additional quotes are available in an online supplement.]

Avoidance behavior.

Participants discussed avoiding specific behaviors or situations to maintain stability. Individuals discussed avoidance of alcohol and illegal drugs to circumvent symptom exacerbation. Participants also mentioned avoiding situations that could be personally stressful or interpreted as chaotic. If such situations arose without their effects being anticipated, the situation was abandoned. For example, one individual said, “If I’m seeing something that is frightening . . . I can’t watch the sci-fi channels ‘cause if it’s gory and bloody I know it’ll start my symptoms, so I get away from that.” Avoidance of specific behaviors or situations most often was the result of a trial-and-error process over the individual’s lifetime rather than a result of education or instruction that these should be avoided. Typically, the individual experienced the situation multiple times, always or often followed by an exacerbation of symptoms, and then decided that it was best avoided. Person-Centered Interviews: Coping Strategies

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Utilizing supportive others.

Most participants described connecting with family, friends, or professional supports as an important strategy to provide objective insights into symptom exacerbation (for example, psychotic thoughts and odd behavior) and nonjudgmental support during those times. One participant said, “I think, ‘Who can I talk this [symptom] out with?’ and generally it’s [a friend]. It is not to fix what’s going on [symptoms] but to restore me to where I am comfortable.” Several discussed participating in therapeutic groups (for example, NAMI) that provided considerable peer support. Some participants highly valued working or being involved in a recovery-oriented group or organization, where they were with like-minded individuals and felt implicitly understood.

Taking medications.

Most participants discussed medications as a key part of their regimen to maintain or regain stability. For some there was a distinct point (for example, a specific hospitalization or achieving a desired life goal) at which they recognized the necessity of medication, and for others it was knowledge gained after many medication trials. One individual stated, “I realized that I felt better on the medication. . . . A light bulb went off on my head. And then after that I pretty much understood the importance of taking the medication, which became more fully engrained into me.” Individuals discussed the challenge and frustration of finding the medication that best addressed symptom reduction and dealing with troublesome side effects (for example, lethargy and weight gain). Participants explained that medication adherence did not mean disappearance of symptoms, but rather enhanced stability. Medication adherence was varied, with a few participants saying they had always been adherent, whereas others said they had been nonadherent intentionally at times during their lives. Person-Centered Interviews: Coping Strategies

Enacting cognitive strategies.

Participants discussed specific cognitive strategies that they used in the face of symptoms—some self-taught and others learned from a professional. These strategies involved ways to systemically reason through their problematic thinking, its basis in reality, and possible alternative interpretations. For example, one person said about hearing derogatory comments from voices when driving alone down the road, “I think to myself is this—is this logical. I mean, we both have our windows closed, we’re on opposite sides of the freeway . . . that couldn’t be possible.” The cognitive strategies mentioned are similar to those taught and practiced as part of evidence-based cognitive-behavioral therapy (CBT) for psychosis (26), and although individuals did not specifically speak of engagement in CBT, they discussed how professionals had taught them cognitive techniques.

Controlling the environment.

Participants described adjusting their surroundings to help prevent, minimize, or address symptom exacerbation. One participant said, “I have to kinda prep my environment around me to be able to be the way I am because I don’t like to be alone in my bedroom when I’m symptomatic. It just freaks me out, ya’ know.” Some participants preferred quiet, calming environments that are clear of clutter or distraction, and others liked to drown out the thoughts and voices with environments filled with sounds and activity.

Engaging spirituality.

A few participants described ways in which they found support through religion and spirituality, including one who said, “I [use] my Buddhist meditations.” Use of spirituality was for some a form of social support and for others a place to avoid stress and find solitude.

Focus on well-being.

A few participants talked about the importance of exercise, diet, or wellness as a component of staying psychiatrically stable or combatting symptoms. One participant said, “I started working out like five days a week and that helped immensely . . . with symptoms, and like everything . . . like my head is so clear.” Person-Centered Interviews: Coping Strategies

Being employed or continuing their education.

A few participants discussed the benefits of education or employment, especially because of its absorbing and distracting nature but also for providing a sense of belonging. One participant said, “I work on the weekends too because it’s just distraction, it’s good, it’s what I call the distraction factor.”

Discussion

During the course of in-depth interviews, 16 participants with a diagnosis of schizophrenia identified coping strategies that helped them with their symptoms. Most participants described knowledge and use of multiple strategies—a menu of coping strategies. Typically, strategies were discussed in relation to positive symptoms of the disorder (for example, hallucinations) rather than negative symptoms (for example, avolition). Four participants did not identify any specific strategies, perhaps because they were not aware that they were using strategies.

Participants articulated active strategies to combat symptom exacerbation; they did not describe passive acceptance of symptoms, as found in the Cohen and Berk (12) study. Furthermore, many strategies were preventive to keep symptoms from occurring. As in the sample in the Corin (13) study, participants described the value of routine, the role of spirituality, and the importance of recovery-oriented language. We surmise that the use of strategies in a preventive fashion, the effectiveness of the identified strategies, and the fact that individuals were comfortable with several different strategies supported these individuals in achieving their occupational goals.

It is important to note that although participants identified strategies for coping with symptoms, they experienced life challenges that related, at least in part, to their illness. Half the sample did not feel close to another person in the past week. Many reported difficulty managing day-to-day life and experienced recent hallucinations or delusions or both. These findings highlight the fact that having ongoing symptoms and struggles does not mean that individuals cannot pursue occupational and educational goals that are important to them. If fact, the results indicate that at least some participants felt that being employed or continuing their education was an important coping strategy, contributing to quality of life (27).Person-Centered Interviews: Coping Strategies

The study had some limitations. Data were collected in only one city, and recovery was defined solely through occupational functioning. Despite these limitations, the study revealed unique perspectives on how individuals cope with symptoms of schizophrenia while maintaining occupations that require a high degree of responsibility, productivity, and accountability. The legitimacy of the findings is strengthened by the gold-standard diagnostic approach, the careful and systematic operationalization of functioning, and the phenomenological method used to elicit participants’ experiences.

Although there are a considerable number of evidence-based practices for treating people with schizophrenia, these practices are limited in terms of long-term symptom reduction, psychosocial rehabilitation, and overall recovery. Most patients continue to face symptoms throughout their lifetime and, in order to achieve their goals, will need a menu of coping strategies to draw upon. Some of the coping strategies identified in this sample align with the skills taught in evidence-based practices, but some are unique. This is the benefit of gathering information directly from recovered individuals. We propose that the next wave of revisions to evidence-based practices would benefit from the incorporation of consumer input, particularly from consumers who have developed successful strategies to manage symptoms and lessen their impact on functional roles.

Conclusions

The shift of mental health services to a recovery orientation has been slow, and the social stigma associated with psychiatric illnesses, such as schizophrenia, continues, perpetuated by popular culture and media. This research demonstrates that individuals with serious mental illness can articulate numerous ways in which they manage their symptoms while also achieving their goals. Service providers, consumers, caregivers, and researchers can reflect and expand on the strategies shared by our participants in order to reconceptualize and advance what is possible in mental health recovery, especially when consumer voices and lived experiences are prioritized.

Dr. Cohen and Dr. Marder are with the Desert Pacific Mental Illness Research, Education and Clinical Center, Dr. Hamilton and Ms. Glover are with the Center for the Study of Healthcare Innovation, Implementation, and Policy, and Dr. Glynn is with the Research Service, all at the Greater Los Angeles Department of Veterans Affairs Healthcare System, Los Angeles (e-mail: ancohen@ucla.edu). Dr. Cohen, Dr. Hamilton, Dr. Glynn, and Dr. Marder are also with the Department of Psychiatry and Biobehavioral Sciences, The David Geffen School of Medicine, University of California, Los Angeles. Ms. Glover is also with the California School of Professional Psychology, Alliant International University, Alhambra, California. Dr. Saks is with the Gould School of Law and Dr. Brekke is with the School of Social Work, University of Southern California, Los Angeles.

Dr. Cohen reports receipt of research support from Ameritox. Dr. Saks reports serving as a consultant to Alkermes. Dr. Marder reports serving on advisory boards of or as a consultant to Allergan, Forum, Lundbeck, Otsuka, Takeda, and Teva and receipt of research support from Forum, Neurocrine, and Synchroneuron. The other authors report no financial relationships with commercial interests.

References

1Farkas M: The vision of recovery today: what it is and what it means for services. World Psychiatry 6:68–74, 2007Medline, Google Scholar

2Kane JM, Robinson DG, Schooler NR, et al.: Comprehensive versus usual community care for first-episode psychosis: 2-year outcomes from the NIMH RAISE early treatment program. American Journal of Psychiatry 173:362–372, 2016Link, Google Scholar

3Achieving the Promise: Transforming Mental Health Care in America. Pub no SMA-03-3832. Rockville, Md, Department of Health and Human Services, President’s New Freedom Commission on Mental Health, 2003Google Scholar Person-Centered Interviews: Coping Strategies

4Council of Representatives: Resolution on APA Endorsement of the Concept of Recovery for People with Serious Mental Illness. Washington, DC, American Psychological Association, 2009Google Scholar

5Liberman RP, Kopelowicz A, Ventura J, et al.: Operational criteria and factors related to recovery from schizophrenia. International Review of Psychiatry 14:256–272, 2002Crossref, Google Scholar

6Liberman RP, Kopelowicz A: Recovery from schizophrenia: a concept in search of research. Psychiatric Services 56:735–742, 2005Link, Google Scholar

7Deegan PE: The importance of personal medicine: a qualitative study of resilience in people with psychiatric disabilities. Scandinavian Journal of Public Health Supplement 66:29–35, 2005Crossref, Medline, Google Scholar

8Jose D, Ramachandra, Lalitha K, et al.: Consumer perspectives on the concept of recovery in schizophrenia: a systematic review. Asian Journal of Psychiatry 14:13–18, 2015Crossref, Medline, Google Scholar Person-Centered Interviews: Coping Strategies

Achieving Individuals With a Diagnosis of Schizophrenia Manage Their Symptoms

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Achieving Individuals With a Diagnosis of Schizophrenia Manage Their Symptoms

Abstract

Objective:

The study objective was to elucidate coping strategies utilized by individuals recovered from schizophrenia.

Methods:

This qualitative study enrolled individuals with schizophrenia who had reached a level of recovery defined by their occupational status. Diagnosis of schizophrenia was confirmed with the Structured Clinical Interview for DSM-IV. Current symptoms were objectively rated by a clinician. Surveys gathered information on demographic characteristics, occupation, salary, psychiatric history, treatment, and functioning. Audio-recorded person-centered qualitative interviews gathered accounts of coping strategies. Transcripts were summarized and coded with a hybrid deductive-inductive approach Achieving Individuals With a Diagnosis of Schizophrenia Manage Their Symptoms.

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Results:

Twenty individuals were interviewed, including ten men. The average age was 40 years. Sixty percent of participants were either currently in a master’s-level program or had completed a master’s or doctoral degree. Eight categories of coping strategies were identified: avoidance behavior, utilizing supportive others, taking medications, enacting cognitive strategies, controlling the environment, engaging spirituality, focus on well-being, and being employed or continuing their education. Some strategies were used preventively to keep symptoms from occurring; others were used to lessen the impact of symptoms. Strategies were flexibly utilized and combined depending on the context.

Conclusions:

Use of strategies in a preventive fashion, the effectiveness of the identified strategies, and the comfort individuals expressed with using several different strategies supported these individuals in achieving their occupational goals. The findings contribute to an overall shift in attitudes about recovery from schizophrenia and highlight the importance of learning from people with lived experience about how to support recovery.

Treatment of schizophrenia is undergoing transformation. Outpatient clinical services are transitioning from a medical model with an illness focus to a patient-centered model with a holistic emphasis on well-being and functioning (1,2). Recovery from serious mental illness has various operational definitions, but there is consensus around definitions that emphasize the ability to live a fulfilling and productive life in spite of symptoms (3,4). Recovery has been defined in both objective and subjective ways, incorporating concepts beyond symptom stabilization to include well-being, quality of life, functioning, and a sense of hope and optimism (5–11)Achieving Individuals With a Diagnosis of Schizophrenia Manage Their Symptoms.

This study adds to a small but growing number of qualitative studies that have examined how individuals manage their schizophrenia. For example, Cohen and Berk (12) reported on 86 low-income patients with schizophrenia “who could tolerate a 30-minute interview.” Participants were asked how they coped with each of 29 symptoms across the categories of anxiety, depression, psychotic symptoms, and interpersonal stress. Explanation of coping was limited to brief responses. The most frequent coping used across all categories was “fighting back,” an active response, followed by a passive response of “doing nothing,” either in a helpless or an accepting way. In a study with 47 low-income males with schizophrenia, Corin and colleagues (13,14) categorized participants by the number of psychiatric hospitalizations after the initial hospitalization. The authors found that those who were never rehospitalized frequented public spaces (for example, restaurants) often and on a schedule that kept a routine and some social interaction, had an active spiritual life, and had a particular way to restructure demeaning language (for example, “lazy”) into something more constructive (for example, “relaxed approach”)Achieving Individuals With a Diagnosis of Schizophrenia Manage Their Symptoms.

To the best of our knowledge, no studies have addressed how individuals with schizophrenia who also meet some definition of recovery manage their symptomatology. Occupational functioning is one objective measure of recovery. The unemployment rate among individuals with serious mental illness is around 80% (15), and thus gainful employment connotes a considerable degree of stability and recovery. The objective of this analysis was to provide first-person accounts of coping strategies utilized by recovered individuals with schizophrenia.

Methods

Study Participants

The study used purposive and snowball sampling methods to identify eligible individuals in Los Angeles. Study clinicians distributed letters and flyers to local National Alliance on Mental Illness (NAMI) groups and community clinicians. In addition, a study investigator who is also a consumer (ERS) made several presentations to various groups about her own recovery and scholarly work, which generated referrals. Interested individuals contacted the study clinical psychologist (ANC), who explained the study goals and methods. If the individual indicated a willingness to participate, eligibility criteria were assessed.

Eligibility criteria were 21 years or older; diagnosis of schizophrenia; experience of at least one persisting psychotic symptom in the past month at the level of 3 (mild) or higher on the Positive and Negative Syndrome Scale (PANSS) (16); employed in an occupation categorized as professional, technical, or managerial (per the Dictionary of Occupational Titles) or responsible as a stay-at-home caretaker of children or elderly family or engaged as a full-time student; maintained occupation for six continuous months within the past two years; and available to be interviewed in person and willing to have the interviews recorded.

Forty-eight individuals responded, and 21 enrolled. Of the 27 not enrolled, some did not meet the study criteria for diagnosis (N=4) or employment (N=15). Others chose not to enroll because they lived too far away (N=2) or were not interested after hearing the methods (N=2). Four individuals called about the study but were then unreachable for screening. Of the 21 individuals who were enrolled, one completed the study procedures but later requested that the data be excluded. Therefore, the analytic sample comprised 20 participantsAchieving Individuals With a Diagnosis of Schizophrenia Manage Their Symptoms.

The study was approved by the institutional review boards (IRBs) of the University of California, Los Angeles, and the University of Southern California. Interviews were conducted from 2007 to 2010. Participants were compensated $100 per hour.

Procedures

Up to three in-person meetings were held with each participant.

First meeting.

At the first meeting, the study psychologist explained the study procedures and consent form and completed the Structured Clinical Interview for DSM-IV (SCID) (17,18) to confirm the diagnosis of schizophrenia and assess current and lifetime psychiatric symptoms. The PANSS was also completed. Eight items from the Brief Psychiatric Rating Scale (BPRS) (19) were completed, including delusions, conceptual disorganization, hallucinations, blunted affect, social withdrawal, lack of spontaneity, manners and posturing, and unusual thought content. The diagnostic interview session lasted approximately 1.5 hours. The psychologist was trained to a standard of reliability on the SCID, PANSS, and BPRS and met annual reliability and quality assurance standards. Individuals who consented and met criteria for schizophrenia were scheduled for the second meeting Achieving Individuals With a Diagnosis of Schizophrenia Manage Their Symptoms.

Second and third meetings.

At the second meeting, participants completed a brief background survey and the Behavior and Symptom Identification Scale–24 (BASIS-24) (20). The BASIS-24 assesses current symptoms and functioning. After these brief measures were completed, the study psychological anthropologist (ABH) conducted the person-centered interview.

Person-centered interview.

Derived from a psychotherapeutic, Rogerian model (21), person-centered interviewing is a phenomenological approach that avoids imposing a preset structure on the way in which the participant describes his or her experiences (22,23). As such, the method elicits what the participant, rather than the researcher, perceives to be important or salient (24). In this study, as required by the IRB, a list of key domains of interest was used to guide the content of the interview so that consistent types of information would be gathered across interviews. However, participants were encouraged to describe their experiences and perspectives extemporaneously, with minimal structure imposed by the interviewer, and for some participants thorough coverage across key domains was not possible.

The first interview generally addressed family of origin, illness history, education, and social functioning. The second interview generally addressed current life, views of illness and treatment, career, living situation, and daily life. Throughout both interviews, past and present coping strategies were noted and highlighted. It is important to note that although these general domains were proposed for the two interviews, participants were not prohibited from talking about present-day experiences during the first interview or historical experiences during the second interview. Instead, participants were encouraged to discuss their lives and coping strategies in ways that made sense and felt comfortable to them as each aspect of their development and illness course was discussed.

Data Analysis

The interviews were recorded and professionally transcribed. Transcripts were reviewed and edited against the recordings by the study anthropologist as they were generated. ATLAS.ti was used for management and analysis. All transcripts were read by the psychologist, anthropologist, and three research assistants (RAs), who summarized each interview. A preliminary codebook was developed collaboratively, focused on key domains and subdomains. Transcripts were then independently coded by the RAs who were trained in ATLAS.ti. During the coding process, the RAs, psychologist, anthropologist, and a study investigator (ERS) met regularly in order to elaborate and adjust the codebook by using the constant-comparison analytic approach (25)Achieving Individuals With a Diagnosis of Schizophrenia Manage Their Symptoms.

After coding of the interviews, multiple queries were conducted to examine the relationships between the codes, and axial coding was used to link categories. For purposes of this analysis, all text segments coded as “compensatory strategies,” “important quotations,” “medication compliance,” or “mental health treatment routine” were reviewed by the psychologist to ensure that coding was representative of the category and the sample and to facilitate a visual depiction (via Excel) of the connections between coded segments, topics, and participants. Although the codes of interest appeared in all 20 transcripts, we found upon careful review that four individuals did not mention any specific coping strategies. The four individuals were not different in demographic or psychiatric characteristics from the other participants; there was no difference in the severity of their hallucinations or delusions, degree of unusual thought content, or level of education achieved.

Results

Of the 20 participants, 13 completed all three sessions, and seven completed two sessions. Of the seven individuals who did not complete a third session, two were lost to follow-up, three moved, one died, and one completed all components in two sessions because scheduling a third was anticipated to be difficult. The mean±SD time between the initial and the second meeting was 23±14 days (range four to 69 days). The mean time between the second and the third meeting was 48±54 days (range ten to 188 days).

Sample Characteristics

All participants had a confirmed diagnosis of schizophrenia. Demographic information is presented in Table 1. Half the participants were men, the average age was about 40 years, and participants were from various racial-ethnic groups. Sixty percent of the sample was either currently in a master’s-level program or had completed a master’s or doctoral degree. Across the sample, most participants were employed full-time, and most made less than $50,000 a year. Information about psychiatric and psychosocial functioning is presented in Table 2. Most participants had a history of at least one psychiatric hospitalization and were currently prescribed psychotropic medications. In the past week, on average, participants experienced a moderate level of hallucinations and delusions Achieving Individuals With a Diagnosis of Schizophrenia Manage Their Symptoms.

TABLE 2. Symptoms and functioning of 20 individuals with schizophrenia

Person-Centered Interviews: Coping Strategies

Eight categories of coping strategies were identified: avoidance behavior, utilizing supportive others, taking medications, enacting cognitive strategies, controlling the environment, engaging spirituality, focusing on well-being, and being employed or continuing their education. The 16 individuals who identified strategies typically identified multiple strategies. Use of strategies varied, with some used consistently and others used only when the person was faced with a particular symptom. Illustrative quotes are provided below. [Additional quotes are available in an online supplement.]

Avoidance behavior.

Participants discussed avoiding specific behaviors or situations to maintain stability. Individuals discussed avoidance of alcohol and illegal drugs to circumvent symptom exacerbation. Participants also mentioned avoiding situations that could be personally stressful or interpreted as chaotic. If such situations arose without their effects being anticipated, the situation was abandoned. For example, one individual said, “If I’m seeing something that is frightening . . . I can’t watch the sci-fi channels ‘cause if it’s gory and bloody I know it’ll start my symptoms, so I get away from that.” Avoidance of specific behaviors or situations most often was the result of a trial-and-error process over the individual’s lifetime rather than a result of education or instruction that these should be avoided. Typically, the individual experienced the situation multiple times, always or often followed by an exacerbation of symptoms, and then decided that it was best avoided.

Utilizing supportive others.

Most participants described connecting with family, friends, or professional supports as an important strategy to provide objective insights into symptom exacerbation (for example, psychotic thoughts and odd behavior) and nonjudgmental support during those times. One participant said, “I think, ‘Who can I talk this [symptom] out with?’ and generally it’s [a friend]. It is not to fix what’s going on [symptoms] but to restore me to where I am comfortable.” Several discussed participating in therapeutic groups (for example, NAMI) that provided considerable peer support. Some participants highly valued working or being involved in a recovery-oriented group or organization, where they were with like-minded individuals and felt implicitly understood.

Taking medications.

Most participants discussed medications as a key part of their regimen to maintain or regain stability. For some there was a distinct point (for example, a specific hospitalization or achieving a desired life goal) at which they recognized the necessity of medication, and for others it was knowledge gained after many medication trials. One individual stated, “I realized that I felt better on the medication. . . . A light bulb went off on my head. And then after that I pretty much understood the importance of taking the medication, which became more fully engrained into me.” Individuals discussed the challenge and frustration of finding the medication that best addressed symptom reduction and dealing with troublesome side effects (for example, lethargy and weight gain). Participants explained that medication adherence did not mean disappearance of symptoms, but rather enhanced stability. Medication adherence was varied, with a few participants saying they had always been adherent, whereas others said they had been nonadherent intentionally at times during their lives.

Enacting cognitive strategies.

Participants discussed specific cognitive strategies that they used in the face of symptoms—some self-taught and others learned from a professional. These strategies involved ways to systemically reason through their problematic thinking, its basis in reality, and possible alternative interpretations. For example, one person said about hearing derogatory comments from voices when driving alone down the road, “I think to myself is this—is this logical. I mean, we both have our windows closed, we’re on opposite sides of the freeway . . . that couldn’t be possible.” The cognitive strategies mentioned are similar to those taught and practiced as part of evidence-based cognitive-behavioral therapy (CBT) for psychosis (26), and although individuals did not specifically speak of engagement in CBT, they discussed how professionals had taught them cognitive techniques.

Controlling the environment.

Participants described adjusting their surroundings to help prevent, minimize, or address symptom exacerbation. One participant said, “I have to kinda prep my environment around me to be able to be the way I am because I don’t like to be alone in my bedroom when I’m symptomatic. It just freaks me out, ya’ know.” Some participants preferred quiet, calming environments that are clear of clutter or distraction, and others liked to drown out the thoughts and voices with environments filled with sounds and activity.

Engaging spirituality.

A few participants described ways in which they found support through religion and spirituality, including one who said, “I [use] my Buddhist meditations.” Use of spirituality was for some a form of social support and for others a place to avoid stress and find solitude.

Focus on well-being.

A few participants talked about the importance of exercise, diet, or wellness as a component of staying psychiatrically stable or combatting symptoms. One participant said, “I started working out like five days a week and that helped immensely . . . with symptoms, and like everything . . . like my head is so clear.”

Being employed or continuing their education.

A few participants discussed the benefits of education or employment, especially because of its absorbing and distracting nature but also for providing a sense of belonging. One participant said, “I work on the weekends too because it’s just distraction, it’s good, it’s what I call the distraction factor.”

Discussion

During the course of in-depth interviews, 16 participants with a diagnosis of schizophrenia identified coping strategies that helped them with their symptoms. Most participants described knowledge and use of multiple strategies—a menu of coping strategies. Typically, strategies were discussed in relation to positive symptoms of the disorder (for example, hallucinations) rather than negative symptoms (for example, avolition). Four participants did not identify any specific strategies, perhaps because they were not aware that they were using strategies.

Participants articulated active strategies to combat symptom exacerbation; they did not describe passive acceptance of symptoms, as found in the Cohen and Berk (12)Achieving Individuals With a Diagnosis of Schizophrenia Manage Their Symptoms study. Furthermore, many strategies were preventive to keep symptoms from occurring. As in the sample in the Corin (13) study, participants described the value of routine, the role of spirituality, and the importance of recovery-oriented language. We surmise that the use of strategies in a preventive fashion, the effectiveness of the identified strategies, and the fact that individuals were comfortable with several different strategies supported these individuals in achieving their occupational goals.

It is important to note that although participants identified strategies for coping with symptoms, they experienced life challenges that related, at least in part, to their illness. Half the sample did not feel close to another person in the past week. Many reported difficulty managing day-to-day life and experienced recent hallucinations or delusions or both. These findings highlight the fact that having ongoing symptoms and struggles does not mean that individuals cannot pursue occupational and educational goals that are important to them. If fact, the results indicate that at least some participants felt that being employed or continuing their education was an important coping strategy, contributing to quality of life (27)Achieving Individuals With a Diagnosis of Schizophrenia Manage Their Symptoms.

The study had some limitations. Data were collected in only one city, and recovery was defined solely through occupational functioning. Despite these limitations, the study revealed unique perspectives on how individuals cope with symptoms of schizophrenia while maintaining occupations that require a high degree of responsibility, productivity, and accountability. The legitimacy of the findings is strengthened by the gold-standard diagnostic approach, the careful and systematic operationalization of functioning, and the phenomenological method used to elicit participants’ experiences.

Although there are a considerable number of evidence-based practices for treating people with schizophrenia, these practices are limited in terms of long-term symptom reduction, psychosocial rehabilitation, and overall recovery. Most patients continue to face symptoms throughout their lifetime and, in order to achieve their goals, will need a menu of coping strategies to draw upon. Some of the coping strategies identified in this sample align with the skills taught in evidence-based practices, but some are unique. This is the benefit of gathering information directly from recovered individuals. We propose that the next wave of revisions to evidence-based practices would benefit from the incorporation of consumer input, particularly from consumers who have developed successful strategies to manage symptoms and lessen their impact on functional roles.

Conclusions

The shift of mental health services to a recovery orientation has been slow, and the social stigma associated with psychiatric illnesses, such as schizophrenia, continues, perpetuated by popular culture and media. This research demonstrates that individuals with serious mental illness can articulate numerous ways in which they manage their symptoms while also achieving their goals. Service providers, consumers, caregivers, and researchers can reflect and expand on the strategies shared by our participants in order to reconceptualize and advance what is possible in mental health recovery, especially when consumer voices and lived experiences are prioritized.

Dr. Cohen and Dr. Marder are with the Desert Pacific Mental Illness Research, Education and Clinical Center, Dr. Hamilton and Ms. Glover are with the Center for the Study of Healthcare Innovation, Implementation, and Policy, and Dr. Glynn is with the Research Service, all at the Greater Los Angeles Department of Veterans Affairs Healthcare System, Los Angeles (e-mail: ancohen@ucla.edu). Dr. Cohen, Dr. Hamilton, Dr. Glynn, and Dr. Marder are also with the Department of Psychiatry and Biobehavioral Sciences, The David Geffen School of Medicine, University of California, Los Angeles. Ms. Glover is also with the California School of Professional Psychology, Alliant International University, Alhambra, California. Dr. Saks is with the Gould School of Law and Dr. Brekke is with the School of Social Work, University of Southern California, Los Angeles.

Dr. Cohen reports receipt of research support from Ameritox. Dr. Saks reports serving as a consultant to Alkermes. Dr. Marder reports serving on advisory boards of or as a consultant to Allergan, Forum, Lundbeck, Otsuka, Takeda, and Teva and receipt of research support from Forum, Neurocrine, and Synchroneuron. The other authors report no financial relationships with commercial interests Achieving Individuals With a Diagnosis of Schizophrenia Manage Their Symptoms.