Brief Description of the Client
Mrs. Lisa reported at the Psychiatric Health Center of a psychological condition she has been experiencing for over one month. The client was a female soldier who had arrived home in Louisiana, Baton Rouge, after a peacekeeping mission in Afghanistan. During the peacekeeping mission, she reported to have been involved in monitoring and observing peace processes, also assisted fellow combatants in executing peace missions, and at some point, they were involved in the restoration of peace amid calamities. This experience was the first in her career, and luckily, she managed to complete the mission with little physical damage. However, four months after leaving the camp, she had re-experiencing traumas that manifested themselves in the form of intrusive recollections of traumatizing events, nightmares, and flashbacks. She later suffered from emotional numbness that made her avoid events and activities that reminded her of the experience at the peacekeeping camp. Mrs. Lisa also experienced increased arousal that was characterized by difficulties in concentration and sleeping. And was easily irritated, angered and felt jumpy. These psychological disturbances led her to consider a clinical consultation with a psychiatrist. However, after a brief discussion and consultation with the patient, it was apparently clear that one incidence during her peace-keeping mission had adverse effects on her emotional and psychological statuses. For example, Mrs. Lisa reported psychological suffering when she experienced armed terrorists orchestrating inhumane actions of rape and tortured children in front of their parents. What is more, this terror group was involved in massive raiding activities which left homes and villages either torched or completely raided and destroyed by gunfire. The peacekeeping mission was a traumatic event. And although Lisa and her fellow colleagues managed to instill peace and restore order, she suffered from a number of stressors as outlined below:
a) Pre-deployment stressors – There was uncertainty on the duration of this peace-keeping engagement. Lisa reported further uncertainties on the date of departure, there were time pressures to solve both the personal and family-related issues, and there were critical uncertainties surrounding her exposure to a foreign culture and climate (Raju, 2014).
b) Deployment stressors – The client reported that deployment in an alien environment was quite traumatic to her since she had earlier been accustomed to traditional and conventional wars. The factors that affected her adjustment was such aspects as; ambiguity, isolation, boredom, danger, atrocities, perceived incompetent command, and the alien culture.
c) The Post-deployment stressors – Homecoming proved to be quite a stressful and difficult ordeal. Commonly known as transition stress, the client experienced a critical yearning for friends, her intimate closeness for work, and there were mismatched fantasies of reality. She yearned to pick up the threats of her old routine, and also found it difficult to cultivate lasting relations with neighbors and her children who she left under the care of her sister. This rapid re-integration with family, friends, and neighbors, troubled her (Raju, 2014).
The Content of the Initial Psychotherapeutic Consultation
The client's signs required an immediate psychotherapy combined with complementary medications. This form of therapy involved closed talks with a trained psychiatrist who would assist in one of the following ways. The consultation was meant to understand the behaviors, ideas and emotions that contributed to the mental disturbance and how to modify them. The consultation further sought to identify and understand major life problems like an accident, an illness, or even a career event that triggered the illness and consequently help the patient to identify some aspects of the problem that can either be solved or completely improved. The consultation aimed at helping the patient regain a sense of self-control and pleasure in life. The talk with the client also sought to help the client learn problem-solving skills and coping techniques. As part of this realization, as the clinical psychiatrist, it was important to administer interpersonal therapy. This form of therapy intended to focus strictly on the behaviors and social interactions of the client. The goal of this particular therapy was to help the client to improve communication skills and self-esteem in a short period. Sources establish that the interpersonal and psychodynamic therapies enable the patient to solve the emotional disturbances and illnesses caused by grief, role transitions, and relationship issues and problems.
The Psychological Intervention Approach
The Cognitive Behavioral Therapy
This type of psychological intervention and therapy help the clinician amend the right and wrong thoughts that a patient may have of themselves and others. The therapist enables the patient to achieve new ways of thinking, to direct attention to both the wrong and right ways of thinking and assumptions, and to adjust their lives accordingly. Finally, the cognitive behavioral therapy is tantamount to helping the client adjust her internal emotions with the outside or external pressures. For example, since the client was involved in activities and operations that interfered with her emotional and psychological well-being, the CBT sought to re-adjust her former living conditions. Through constantly consultations, it was further possible to align the client's internal feelings of trauma, disappointment, and anxiety (ADAA, 2017) with the existing realities that her career depended majorly on solving issues of war and peace-keeping. By working with a therapist, it was possible for the client to be aware of inaccurate and disturbing thoughts and to view the events in a clear way and respond to them accordingly.
Strategies for Cognitive Behavioral Therapy
a) The Identification of Troubling Conditions – This step of the CBT involved focused and structured talks that sought to troubling conditions in the life of the client (Mayo Clinic, 2017). Based on a series of one-to-one talks, it was clear the patient was suffering from a unique form of post-traumatic stress disorder. The troubling conditions were recurring thoughts of events, difficulties in sleeping and concentrating, and definitely an outburst of emotions.
b) Being aware of the emotions, thoughts, and believes about the above conditions – The second step in the CBT is the identification of specific beliefs and thoughts about a particularly troubling condition (Mayo Clinic, 2017). The client would identify the specific emotions she experiences as a consequence of larger events [in this case the peace-keeping mission]. This strategy will include;  observing what the client tells her self about the experience otherwise referred to as self-talk,  the client’s interpretation about the meaning of a tragic event or situations, and  the client’s beliefs about themselves and others.
c) Identification of Inaccurate and Negative Thinking – This strategy of the CBT will involve a keen scrutiny of the client’s life to help identify patterns of behavior and thinking. In this realization, as the therapist, it was advisable to ask the client to pay attention to her behavioral, physical, and emotional responses in varying situations.
d) Reshaping Inaccurate and Negative Thinking – The goal of this particular session was to ask the client to take a deep scrutiny of their thoughts and determine whether they are based on realistic or inaccurate perceptions (Mayo Clinic, 2017). Further, it was important to establish long-thinking ways of the client’s life in efforts to differentiate between inaccurate and negative thinking. This meant the client had to properly scrutinize her thoughts on a regular basis to ensure they fully differentiated and identified negative and the inaccurate thoughts.
The Dialectical Behavioral Therapy
The dialectical behavioral therapy is a complementary approach to the CBT. The only difference is that dialectical therapy is used for tough-to-treat, high-risk patient. Indeed, the word ‘dialectical’ is formed by bringing together two opposites sides of therapy which are;  acceptance and  change. The DBT approach is strongly considered as a complementary therapy as it assists the patient to alter unhealthy behaviors like self-injury, lying about realistic events, and emotional disturbances caused by past and historic events. This case study analysis notes that the dialectical behavior therapy relies on fundamental strategies and techniques. The four ways seek to enhance life skills and life approaches after a shock that affected one's psychological stability.
Strategies for Dialectical Behavioral Therapy
a) Distress Tolerance – An important part of the DBT would be to achieve a complete distress tolerance. This form of tolerance is geared towards containing intense feelings like anger and disappointment without necessarily taking drugs or resulting in self-injury (WebMD, 2017). The goal of distress tolerance would be to counter the post-traumatic stress in the client which was characterized by; being easily frightened or startled, self-destructive behaviors like driving fast and drinking too much, and troubles in concentrating and sleeping. Further, distress tolerance would be of significance in helping the patient counter aggressive behaviors, angry outbursts, and general irritability.
b) Mindfulness – This strategy would seek to help the client be more attentive to the present. Mindfulness further seeks to enable the patient to be more mindful of themselves and others in efforts to contain both the internalizing behaviors [anxiety, withdrawal, and stress] and the externalizing feelings [anger, outbursts, and irritability towards others].
c) Emotional regulation – This strategy of the dialectical behavioral therapy sought to properly contain and regulate the client’s emotions and feelings (WebMD, 2017). The steps involved in emotional regulation was recognizing, labeling, and re-adjusting feelings and emotions based on present and past circumstances. As part of this realization, the therapist would schedule regular talks that seek to enable the patient regular any traumatic behavior or conduct that results from traumatic events.
d) Interpersonal Effectiveness – The goal of this strategy would be to enable the patient to interact assertively and navigate conflict in her interactions with friends and workmates. Further, interpersonal effectiveness would seek to contain any talks, associations, and interactions that may arise the client's anger and irritability – and how to deal with the latter emotional during conversations and interactions with others (WebMD, 2017).
Theories in Exercise Psychology
It is important to note a number of theories underpin the above psychological interventions. For example, the social cognitive theory fundamentally known as the self-efficacy model stipulates that any exercise of psychological intervention is influenced by both the external stimuli and the human cognition. The external stimuli refer to factors such as social pressures, personal responsibilities, and work schedules. On the other hand, the human cognition reflects aspects like attitudes, beliefs, intentions, and expectations. This means that the client, in this case, may intend to be physically active to attain recovery and emotional stability as a result of the PTSD condition, but fail to do so due to external conditions [external stimuli] like experiences and social pressures. The self-efficacy and self-cognitive theory explain how individuals and patients form perceptions about their ability to undertake specific activities and to focus on specific behaviors. This means that the practitioner or the therapist will organize, develop, and present their psychological intervention program in a manner that aims to cultivate efficacy beliefs and values to the patient (Anshel, 2006). Hence, the psychological intervention programs will be designed to increase the participant’s positive perception – so that she is enchanted and motivated to continue with both the cognitive behavioral and the dialectical behaviors therapies.
The second theory that complements the above psychological intervention approaches is the self-determination theory. This theory contends that individuals and persons will pursue challenges that help them achieve one of the following needs  social interactions and associations  demonstration of competence, and  for self-determination (Anshel, 2006). Intrinsic and extrinsic motivations are identified as drivers for achievement behaviors and motivation by itself is seen as the degree of drive or desire through which individual approaches or even avoids certain actions. This case study supports that the self-determination theory and model has three phases or continuums. The first phase 'amotivation' which indicates the absence of motivation and push about an exercise. The second phase is extrinsic motivation which refers to the ability of the individual to engage in an exercise or a psychological program for the sole purpose of receiving an award or completely avoiding a punishment. Under this case, the external motivation stems from the client's PTSD signs and symptoms like irritability, intense fear, and trauma, also difficulties in concentration and sleeping (ADAA, 2017). The third phase of the self-determination theory is intrinsic motivation which refers to the fact that an individual engages in a psychological program for the pleasure it provides or for its own sake. While both the CBT and the DBT psychological interventions are well-tailored for the needs of the client, self-determination is a classic theory to assist the client to undertake specific exercises advised by the psychiatrist. Although both interventions are geared to generate helpful talks that suppress the feeling of irritability and mental disturbances, the psychiatric will rely fundamentally on self-determination to ensure the client has the intrinsic and extrinsic motivation to pursue the recommended actions and the prescribed measures for fast recovery.
The Personal Investment Theory
Finally, the personal investment theory is a classic model to explain and assist in the efficacy of the aforementioned psychological intervention. The personal investment theory is primarily based on three components and these include personal incentives, perceived options and a sense of self. A sense of self-reflects the client's ability for social identity through the identification of how they are to a society or a group of people (Anshel, 2006). Personal incentives include task motives, reward motives, ego motives, and social motives like the desire to associate or affiliate with a group of people like relatives, friends, and work and classmates. Finally, the perceived options state that opportunities must and should be availed in overcoming any potential barriers (Anshel, 2006). This case study supports that the personal investment theory is critically underpinning in developing a sense of identity to the client or patient. Without understanding their significance to their spouses, children, and relatives, it is not possible to realize the fundamental promises of both types of psychological therapies. This means while resources and time will put to counter the adverse emotional effects of the post-traumatic, the full outcomes of these approaches will not be realized with personal investment on the client’s side. Hence, as part of this realization, the aspects of personal investment will assist in the full realization of the above interventions.
Effectiveness and Efficacy of the Therapies
This part of the case study seeks to highlight conditions and tips that may necessitate the effectiveness of the aforementioned therapy. It is important to note that the post-traumatic stress condition has a great potential for self-destructive and reckless behavior (Mayo Clinic, 20170. It may further cause exaggerated startle responses and trigger irritability and aggressiveness. The effectiveness of the aforementioned psychological interventions and theories of psychology depends primarily on the client’s effort and time. It also depends on the ability to adhere strictly to the recommended and prescribed clinical measures. This case study supports that the therapies will work best when the client attends to all the scheduled psychiatric appointments. The effectiveness of the therapy will further rely on the client’s active participation. As part of the therapy, the client will identify the sources of stress by keeping a journal of characterizations, signs, and a note of stressful responses or improvements in her psychological condition(s) (Mayo Clinic, 2017). The client will further require restructuring her priorities by emphasizing more on both effective and helpful behavior. The client will be required to make time for pleasurable and recreational activities to enable her to reconnect with past life’s experiences. The psychical activities may include; hiking, traveling, visiting museums, and libraries. If possible, pleasurable activities may capture attending shows, live comedy, and constructive forums. A crucial part of ensuring the efficacy of the aforementioned therapies would be to communicate and convey information to a trusted person and keep a journal of any improvements. Communication helps to share information and in the process ease the underlying emotional and psychological burden that results from experiencing both the internalizing feelings.
The Post-Traumatic Stress Disorder is a common psychological condition that affects both veterans and individuals. The PTSD occurs when individuals experience a critically traumatizing experience or event. This experience affects their way of thinking, causes emotional arousals, distress, and negative perceptions about the reality. As discussed, Mrs. Lisa PTSD condition was earmarked by signs of emotional numbness and inability to contain completely traumatizing thoughts and emotions. The psychological intervention that was deemed fit for her recovery was both the cognitive behavioral therapy and the dialectical behavioral therapy. Both therapeutic interventions would necessitate talks and enable the psychiatrist identify the underlying symptoms, stressors, and causative factors. For example, the cognitive behavioral therapy involved structured talks with the client, counselling, and exercises. These exercises would gradually detach the patient from her past experiences and enable her manage emotional outbursts and distress. The dialectical approach was a complementary approach between acceptance and reality. As part of supporting the above psychological interventions, three theories were critically underpinning. These included; the personal investment theory, the self-determination, and the self-efficacy theory. The premise of the three theories is to assist the patient or client navigate through the therapeutic intervention. Also, the theories act as models to support recovery which can be leveraged in the full realization of positive psychological outcomes. The above analysis surmises the study and adds knowledge of an intervention as a result of a pre-determined condition which is the post-traumatic disorder.nursing assignment, nursing assignment writers, nursing assignment writing service, nursing homework help, nursing homework assignments, do my nursing assignment, help with writing nursing assignments, online nursing assignment help, nursing research paper writing service, nursing assignment help gumtree, nursing assignment writing help