What evidence exists to support the use of exposure therapy (or the therapeutic approach you would consider if you disagree with exposure therapy)?
Review the Levy Family video Episodes 1 through 5.
The Assignment
In a 2- to 3-page paper, address the following:
· After watching Episode 1, describe:
· What is Mr. Levy’s perception of the problem?
· What is Mrs. Levy’s perception of the problem?
· What can be some of the implications of the problem on the family as a whole?
· After watching Episode 2, describe:
· What did you think of Mr. Levy’s social worker’s ideas?
· What were your thoughts of her supervisor’s questions about her suggested therapies and his advice to Mr. Levy’s supervisor?
· After watching Episode 3, discuss the following:
· What were your thoughts about the way Mr. Levy’s therapist responded to what Mr. Levy had to say?
· What were your impressions of how the therapist worked with Mr. Levy? What did you think about the therapy session as a whole?
· Informed by your knowledge of pathophysiology, explain the physiology of deep breathing (a common technique that we use in helping clients to manage anxiety). Explain how changing breathing mechanics can alter blood chemistry.
· Describe the therapeutic approach his therapist selected. Would you use exposure therapy with Mr. Levy? Why or why not? What evidence exists to support the use of exposure therapy (or the therapeutic approach you would consider if you disagree with exposure therapy)?
· In Episode 4, Mr. Levy tells a very difficult story about Kurt, his platoon officer.
· Discuss how you would have responded to this revelation.
· Describe how this information would inform your therapeutic approach. What would you say/do next?
· In Episode 5, Mr. Levy’s therapist is having issues with his story.
· Imagine that you were providing supervision to this therapist, how would you respond to her concerns?
· Support your approach with evidence-based literature.
MALE SPEAKER: I’m not going to work. I’m sick.
FEMALE SPEAKER: Of course you’re sick. You’re hungover. I don’t want the boys to see you like this. Go back to bed.
MALE SPEAKER: See me like what? I told you, I’m sick.
FEMALE SPEAKER: Well, what do you call it when someone is sick almost every morning, because they drink every night while they sit in the dark watching TV?
MALE SPEAKER: You calling me a drunk?
FEMALE SPEAKER: What do you call it?
MALE SPEAKER: I call it, leave me the hell alone.
FEMALE SPEAKER: Baby, you need to stop this. It’s tearing us up. The drinking, the anger– you’re depressed.
MALE SPEAKER: You said, for better or worse.
FEMALE SPEAKER: My vows don’t cover this. You were never like this before. You’ve changed. I want us back, the way we used to be.
MALE SPEAKER: That way is dead. It died when I went to Iraq. Levy Family: Episode 1 Additional Content Attribution MUSIC: Music by Clean Cuts Original Art and Photography Provided By: Brian Kline and Nico Danks
Video2
Levy Family: Episode 2
Program Transcript
FEMALE SPEAKER: I want to thank you for getting me this Levy case. I think it’s so interesting. Just can’t wait to meet with the client.
MALE SPEAKER: What do you find interesting about it?
FEMALE SPEAKER: Well, he’s just 31. Usually the vets I work with are older. If they have PTSD, it’s from traumas a long time ago. But Jake, this is all pretty new to him. He just left Iraq a year ago. You know, I was thinking he’d be perfect for one of those newer treatment options, art therapy, meditation, yoga, something like that.
MALE SPEAKER: Why?
FEMALE SPEAKER: Well, I’ve been dying to try one of them. I’ve read a lot of good things. Why? What are you thinking?
MALE SPEAKER: I’m thinking you should really think about it some more. Think about your priorities. It’s a good idea to be open-minded about treatment options, but the needs of the client have to come first, not just some treatment that you or I might be interested in.
FEMALE SPEAKER: I mean, I wasn’t saying it like that. I always think of my clients first.
MALE SPEAKER: OK. But you mentioned meditation, yoga, art therapy. Have you seen any research or data that measures how effective they are in treatment?
FEMALE SPEAKER: No.
MALE SPEAKER: Neither have I. There may be good research out there, and maybe one or two of the treatments that you mentioned might be really good ideas. I just want to point out that you should meet your client first, meet Jake before you make any decisions about how to address his issues. Make sense? FEMALE SPEAKER: Yeah.
Levy Family: Episode 3
Program Transcript
JAKE LEVY: We’d be out on recon in our Humvees, and it would get so hot. We used to put our water bottles in wet socks and hang them right outside the window just so the water would cool off of a bit, and maybe then you could drink it. Man, it was cramped in there. You’d be drenched, nowhere to breathe. It’s like riding around in an oven. And you’d have your helmet on you, 100 pounds of gear and ammo. I swear, sometimes I feel like it’s still on me, like it’s all still strapped on me.
FEMALE SPEAKER: How many tours did you do in Iraq?
JAKE LEVY: Three. After that last recon, I just– There were 26 of us. Five marines in the Humvee I was in. I remember I was wearing my night vision goggles. We passed through a village and everything was green, like I was in a dream or under water. And then there was a flash, bright light just blinded me. There was this explosion. I can’t– I can’t
FEMALE SPEAKER: It’s OK, Jake. Take it easy. I understand this is difficult. There’s something I;d like to try with you. It’s called exposure therapy, and it’s a treatment that’s used a lot with war veterans, especially those struggling with anxiety and PTSD.
JAKE LEVY: Exposure therapy?
FEMALE SPEAKER: Yes. It’s to help someone like yourself to confront your feelings and anxieties about a traumatic situation that you’ve experienced. It’s aIt’s meant to help you get more control of your thoughts, to make sense of what’s happened, and to not be so afraid of your memories.
JAKE LEVY: Put that in a bottle and I’ll buy 10 cases of it. FEMALE SPEAKER: Well, one part of it is learning to control your breathing. And when you practice that, you can learn to manage your anxiety, to get more control of it, not let it control you, to protect yourself. Do you want to try it?
JAKE LEVY: Right now?
FEMALE SPEAKER: Sure.
JAKE LEVY: Why not? 1 Levy Family: Episode 3
FEMALE SPEAKER: OK. Well, I know this sounds crazy, but a lot of people don’t breathe properly. And it really comes from bad habits. When they inhale and exhale, all the effort is here in their chest and shoulders. And the problem with that is you get a really short, shallow breath. And that really increases the stress and anxiety in your body. Instead, a more natural breath should always involve your diaphragm, right here in your abdomen. When you breath in, your belly should expand. And when you breath out, your belly should fall. OK?
JAKE LEVY: OK. FEMALE SPEAKER: So, let’s practice. Close your eyes. Now, I want you put one hand on your abdomen and the other across your chest. Good. Good. Now, I just want you to take a few breaths, just like normal. What are you feeling?
JAKE LEVY: I feel my chest moving up and down. But my belly, nothing.
FEMALE SPEAKER: OK. So that’s what I was just talking about. That’s OK. Let’s try this. I want you take a breath. And this time, I only want you to allow your abdomen to expend when you breathe in and to fall when you breathe out. OK, let’s try it. Breathe in. Breathe out. Breathe in. Breathe out. You feeling better? More relaxed?
JAKE LEVY: Yes.
FEMALE SPEAKER: And the more you practice it the easier it will become. So when you find that stress and anxiety coming on, just do your breathing. You can keep yourself from getting swept by all those bad thoughts. OK?
JAKE LEVY: Yes. Thank you.
FEMALE SPEAKER: So, do you want to try to go back to what you were telling me about before?
JAKE LEVY: I can try. It was night. We were out on recon. It was my third tour in Iraq.
Levy Family: Episode 4 Program Transcript
FEMALE SPEAKER: So do you want to try to go back to what you’re telling me before?
LEVY: I can try. It was night. We were out on patrol. I remember it was so hot packed in our vehicle. Suddenly there was an explosion. We got tossed into a ditch. And somehow I made it out, and I could see it was the Humvee behind us. It’s whole front end was gone. It had hit a roadside bomb. Our vehicle had just driven past it, just mistriggering it. But not them. They didn’t make it.
FEMALE SPEAKER: Remember how we practiced. Slow your breathing down. Inhale and exhale from your abdomen.
LEVY: Thank you.
FEMALE SPEAKER: And just take your time. Whenever you are ready.
LEVY: So the bomb went off. I managed to get out. I had my night vision goggles on. And I could see the Humvee, the one that got hit. It’s whole front end was gone. And there’s this crater in the road. And inside it I could see– I could see Kurt’s– our platoon Sergeant, he was lying there everything below his waist was gone, blown off. And he was screaming. Screaming like nothing you’d ever heard.
And then he was looking at me. And he was screaming for me to kill him. To stop his suffering. He was yelling, please. Please. And someone tried putting tourniquets on him. But the ground just kept getting darker with his blood. And I was staring into his face.
I had my rifle trained on him. I was going to do it. You know. He was begging me to. I could feel my finger on the trigger. And I kept looking into his face. And then I didn’t have to do nothing. Because the screaming had stopped. He’d bled out. Died right there.
And all I could think was I’d let him down. His last request, and I couldn’t do it. I couldn’t put a bullet in him so he could die fast not slow.
FEMALE SPEAKER: I can see and hear how painful it is for you to relive this story. Thank you for sharing it. Do you think this incident is behind some of the symptoms you’ve been telling me about?
LEVY: When I go to sleep at night, I close my eyes, and I see Kurt’s there staring at me. So I don’t sleep too good. That’s why I started drinking. It’s the only way .
Levy Family: Episode 4 can forget about that night. So I drink too much. At least that’s what my wife yells at me. We’re not doing too well these days. I’m not exactly the life of the party. I left Iraq 10 months ago. But Iraq never left me. I’m afraid it’s never going to leave me
Levy Family: Episode 5 Program Transcript
FEMALE SPEAKER: It was such an intense story. I just kept seeing things the way he did, you know. The weird green of his night-vision goggles, his sergeant screaming for Jake to kill him. I just keep seeing it all in my head. [MUSIC PLAYING]
MALE SPEAKER: Why, do you think? FEMALE SPEAKER: Why what?
MALE SPEAKER: Why do you think you keep thinking about this story, this particular case?
FEMALE SPEAKER: I don’t know, maybe because it’s so vivid. You know, I went home last night, turned on the TV to try to get my mind off it. And a commercial for the Marines came on, and there was all over again– the explosion, the screams, the man dying. Such a nightmare to live with, and he’s got a baby on they way.
MALE SPEAKER: Could that be it, the baby?
FEMALE SPEAKER: Maybe. That’s interesting you say that. I mean, the other vets I work with are older, and they have grown kids. But Jake is different. I just keep picturing him with a newborn. And I guess it scares me. I wonder if he’ll be able to deal with it
The last video above is like 23 minutes and I think is the summary or so
Sample
Levy Family: Assessing Client With Addictive Disorder
An addictive disorder can be defined as a chronic disease which has no cure but can be managed. It deals with a complex meshing of the physical, spiritual and psychological, therefore it can be surmised that an addictive disorder can be synonymous with a chronic disease which is best controlled rather than cured (Rizeanu, 2015). Alcohol is one of the most commonly abused substances. The rate of alcohol use disorder ranged from 4% to 92% (Stasiewicz et al, 2007). It is important for the healthcare provider to be knowledgeable about diagnosing and treating individuals with alcohol abuse. The purpose of this paper is to assess and recommend a treatment approach for Mr. Levy.
Episode 1
My perception of Mr. Levy in the beginning, is someone in denial of having drinking issues. This is seen when he told his wife that he is sick when his wife asked him to get dressed for work and he stated “I am not going to work, I am sick”. Also, I feel like Mr. Levy is depressed and might be suffering from PTSD from Trauma due to what he went through in Iraq and as such he is using alcohol to numb his feelings. Mrs. Levy knew something is wrong with her but she doesn’t know how to help him, she seems fed up with his nightly drinking and worries about their relationship. Mr. Levy, on the other hand seems to have given up on himself and their relationship when he stated “That way is dead. It died when I went to Iraq”. Some of the implications of this is an imminent divorce which is evidenced by Mrs Levy stating “My vows don’t cover this. You were never like this before. You’ve changed”. My levy might also lose his job if he continues down this path.
Episode 2:
I think the social worker was so excited about this case, and therefore has already mapped out a treatment plan even before meeting with the Client. She formulated the plan based on her experience with previous clients with PTSD. I think the first step would have been for her to research different therapies/treatments and also meet with Mr. Levy first before concluding which therapy will be best for him. It is important for a therapist to work with his/her patient and formulate a treatment plan together. Get to know your patients first before jumping to conclusions.
Episode 3:
My thoughts about this video today reviewed about Mr. Levy‘s therapist and how she responded I would say that my impression is that the therapist answered Mr. Levy‘s questions and guided him through a relaxation exercise. They exhibited empathy. She walked him through multiple symptoms some of which were hyperventilation uneasiness increased heart rate and fear as these are typically experiences of people who suffer trauma we’re going through some type of anxiety attack. She mentioned that proper breathing techniques would be very helpful for these types of symptoms. The suggestion of exposure therapy by the therapist was well received by Mr. Levy. Exposure therapy has been proven effective in the treatment of patients with PTSD (Coffey et al, 2016).
Episode 4:
The therapeutic approach of deep breathing exercises worked with the client’s signs and symptoms of fear, doom, and hyperventilation. The therapist was successful and exhibiting empathy, reasons were gathered that led the clients distractive behavior which was drinking and other associated symptoms of PTSD including insomnia, ruminating thought, and mood swings. The exposure therapy technique was successful as it was coupled with deep breathing exercises. This enabled the patient to verbalize his experience and how he faced, without actively reliving the particular trauma. This technique provides for the therapist to obtain subjective and object of information and see the holistic view of the patient to write a more descriptive and individualized treatment plan. I would consider utilizing similar therapy as well. Empathy is the understanding of a particular experience that the person has gone through, and working to see situations from another person‘s perspective, and encouraging ways to deal with the problem in a healthy aspect. I would consider working with the client to devise an individualized treatment plan which would include cognitive reconstruction therapy (CRT). CRT such as Cognitive Behavioral Therapy (CBT) is used to correct alterations in
thinking and behavioral patterns (Ellis, 2003). A randomized study on the effect of CBT on PTSD patients showed that CBT Clients improved significantly post treatment assessment (Mueser, 2008). This technique can change Mr Levy‘s thanking from and his irrational state to a rational state.
Episode 5: If I were providing supervision to this therapist I felt that her concern was valid however; I think there is a possibility of counter-transference on the part of therapist. I will encourage the therapist to be confidence and show her support. According to Hayes et al (2011), self insight, integration, anxiety management, empathy and conceptualizing ability are qualities of good therapist. Summary There are many different ways to cope with family, one common way to cope is with substance abuse. As a therapist to thoroughly assess the problem can you guide successfully to an individualized treatment plan. The plan should be patient centered and patient focused. The healthcare provider that implements to plan should take time to research the treatment plan of choice and give evidence-based treatment that has been successful in the past. The very first patient encounter could precipitate the appropriate treatment options. Treatment should be patient focused individualized and holistic. Being aware of counter transference on the part of the healthcare provider can make the treatment more patients focused and effective.
References:
Stasiewicz, P. R., Nochajski, T. H., & Homish, D. L. (2007). Assessment of alcohol use
disorders among court-mandated DWI offenders. Journal Of Addictions & Offender
Counseling, (2), 102
Hayes, J. A., Gelso, C. J., & Hummel, A. M. (2011).Managing
countertransference. Psychotherapy, 48(1), 88-97. doi:10.1037/a0022182
Rizeanu, S. (2015). Psychotherapy for addictive disorders.
Romanian Journal Of Cognitive-Behavioral Therapy & Hypnosis, 2(4), 42-46
Mueser, K. T., Rosenberg, S. D., Jankowski, M. K., Bolton, E. E., Lu, W., Hamblen, J. L., &
McHugo, G. J. (2008). A randomized controlled trial of cognitive-behavioral treatment
For posttraumatic stress disorder in severe mental illness. Journal Of Consulting And
Clinical Psychology, 76(2), 259-27
Ellis, A. (2003). Similarities and differences between rational emotive behavior therapy and
cognitive therapy. Journal of Cognitive Psychotherapy, 17(3), 225-240. doi:
https://doi.org/10.1891/jcop.17.3.225.52535
Coffey, S. F., Schumacher, J. A., Nosen, E., Littlefield, A. K., Henslee, A. M., Lappen, A., &
Stasiewicz, P. R. (2016). Trauma-focused exposure therapy for chronic
posttraumaticstress disorder in alcohol and drug dependent patients: A randomized
controlled trial. Psychology Of Addictive Behaviors, 30(7), 778-790.
doi:10.1037/adb0000201
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