Assignment 2: Essay

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Assignment 2: Essay

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DueSep 16by5pm

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Teaching Period 2, 2024

PSY20001 Theories of Counselling

Assignment 2: Essay

Word/time limit: 1500 (+/- 10%) (not including reference list)

Weighting: 40%

Due date: 5pm AEST Monday 16 September 2024 (Week 10)

Team/Individual: Individual task

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Assignment details

For this assignment you are required to choose one (1) of the theories of counselling studied in this unit; critically evaluate how this particular approach could be utilised for treatment with a client presenting with an anxiety disorder, and write an essay on the topic.

This assignment supportsunit learning outcomes 3 and 4.

For this assignment you are required to write an essay on the following topic: Choose one (1) of the theories of counselling studied in this unit. Critically evaluate how this particular approach could be utilised for treatment with a client presenting with an anxiety disorder. Consider the key concepts and interventions associated with the chosen approach, and critically evaluate the strengths and limitations of the approach when treating the chosen anxiety disorder. Please ensure your response is based on a critical evaluation of the literature.

In deciding on which of the above anxiety disorders to focus on, you should review the diagnostic criteria and other information contained in the Diagnostic and Statistical Manual (DSM-5; APA, 2013). Refer to the list of Supporting resources for more information on where to find this.

Please note that some of the approaches covered are quite broad (e.g., Cognitive and Behavioural Approaches) so you might consider being more specific and evaluating a specific example of the umbrella approach (e.g., for cognitive and behavioural approaches, you might evaluate CBT, Dialectic Behavioural Therapy or Acceptance and Commitment Therapy etc). It is suggested that you conduct an initial literature review to examine what approaches have been most widely studied concerning the chosen disorder. Once you have a better idea of which approaches have received research attention, you can choose one to evaluate.

In assessing the essay, we will be looking to see how well you have:

identified the disorder, including symptoms, prevalence etc.

identified the counselling approach, including the key concepts of the approach, and critically reviewed the literature including highlighting the strengths and limitations of the approach

applied the particular approach to the chosen disorder, including how the approach treats the symptoms of the disorder and any evidence in support of or against its efficacy

provided conclusions that flow logically from the literature you have reviewed

demonstrated how theory, process and research are intertwined.

Research

When you begin your research, use the textbook as a starting point to help you locate some of the key references. The textbook should not be used as the basis for your essay, but it does contain many references that you could look up and read yourself.Consider reviewing the DSM-5 (APA, 2013) diagnostic criteria for your chosen disorder. You must have a good understanding of these presentations as they provide the context for your evaluation.

Make sure you critically evaluate the material it is not enough just to describe the counselling approach. Consider the strengths and limitations carefully. Again, the text can be a starting point for this but it should not be the only source you consult. Good essays will demonstrate an in-depth analysis of the theory, not just generic or surface-level issues. Make it clear to the reader the clinical issue you are considering (i.e., which psychological disorder). You may choose to integrate a discussion of how the counselling approaches apply to this issue throughout the description/evaluation of the theory, or you might choose to do this separately. This is a decision for you to make in the process of structuring your essay.

You are expected to be critical in YOUR evaluation of the topic, assessing the strengths and weaknesses of the research. Findat least 6 referencesand refrain from using the textbook. References may be academic books, professional journal articles, or book chapters. References may be obtained from the internet as long as they are from professional sources and are cited appropriately according to APA style. Do not download unreferenced material from the internet.

Structure

Your essay must be well-organised and structured. As in all good psychology essays, a judicious use of subheadings can help the reader follow an essay plan, but headings are not compulsory. Ensure that you include an introduction that sets the scene for your essay: outlines the context, the aim of the essay and how you will structure your response. You also need a conclusion that summarises the findings.

Include an abstract at the beginning of the essay. This is a concise (100150 words) summary of the aims, findings and conclusions. When reading your abstract, your OLA should get a clear picture of what your essay will contain. The essay should conform to APA guidelines for both the structure of the essay and the referencing.

Ensure that you include an introduction thatsets the scene for your essay. It should outline the context, the aim of the essay and how youwill structure your response.

Make it clear to the reader the clinical issue you are considering. You may choose to integrate a discussion of how the counselling approaches apply to this issue throughout the description/evaluation of the theory, or you might choose to do this separately. This is a decision for you to make in the process of structuring your essay.

You also need a conclusion that summarises the findings.

The essay should conform to APA guidelines for both the structure of the essay and referencing.

Make sure your work:

is typed, double-spaced (between lines) and has appropriate margins.

is numbered page by page. Note that there are conventions for numbering psychology reports.

has on its front page the title of the assignment, your name, and student id; the unit code and unit title.

has a statement declaring that the assignment has not been copied or plagiarised.

has been copied before submission. Make and keep a copy of your assignment in case your original is lost or misplaced. It is your responsibility to make available a copy of any work, which you claim to have submitted.

Supporting resources

The following resources will assist you with completing this assignment:

Check out the Student Hub's range of usefulStudy ResourcesLinks to an external site., specifically the 'Academic practiceLinks to an external site.' and 'Academic writing and presenting'Links to an external site.pages.

The chapter of your eText that relates to the theory youselect is a good place to start to help you understand the issues.The eText shouldnot be usedas the basis for youressay, but it does contain many references that you could look up and read yourself.

TheDiagnostic and statistical manual of mentaldisordersLinks to an external site.(American Psychiatric Association, 2013) will help you review the DSM-5 diagnostic criteria for your chosen anxiety disorder. You must have a good understanding of these presentations as they provide the context for your evaluation.

TheDiagnostic and statistical manual of mentaldisordersLinks to an external site.(American Psychiatric Association, 2013) will help you review the DSM-5 diagnostic criteria for your chosen anxiety disorder. You must have a good understanding of these presentations as they provide the context for your evaluation.

Case example

Adolescent Shyness

Barbara L.MilrodNadine was a 15-year-old girl whose mother brought her for a psychiatric evaluation to help with her long-standing shyness.

Although Nadine was initially reluctant to say much about herself, she said she felt constantly tense. She added that the anxiety had been really bad for several years and was often accompanied by episodes of dizziness and crying. She was generally unable to speak in any situation outside of her home or school classes. She refused to leave her house alone for fear of being forced to interact with someone. She was especially anxious around other teenagers, but she had also become too nervous to speak to adult neighbors she had known for years. She said it felt impossible to walk into a restaurant and order from a stranger at the counter for fear of being humiliated. She also felt constantly on her guard, needing to avoid the possibility of getting attacked, a strategy that really only worked when she was alone in her home.

Nadine tried to conceal her crippling anxiety from her parents, typically telling them that she just didnt feel like going out. Feeling trapped and incompetent, Nadine said she contemplated suicide all the time. In the month before her mother finally brought her in for a psychiatric evaluation, Nadine had begun to cut herself on her thighs to feel pain and relieve stress. No one in the family was aware of this development.

Nadine had always been shy and had been teased at recess since she started kindergarten. The teasing had escalated to outright bullying by the time she was in seventh grade. The bullying took on a cultural/racially motivated undertone; Nadine and her family were of a different ethnicity than the vast majority of her schoolmates. For 2 years, day after difficult day, Nadines peers turned on her like a snarling wolf pack, calling her stupid, ugly, and crazy. Not infrequently, one of them would stare at her and tell her she would be better off committing suicide. One girl (the ringleader, as well as a former elementary school chum) hit Nadine on one occasion, giving her a black eye. Nadine did not fight back. This event was witnessed by an adult neighbor, who told Nadines mother. When Nadines mother asked her about the incident, Nadine denied it, saying she had fallen on the street. She did, however, mention to her mother in passing that she wanted to switch schools, but her delivery was so offhand that at the time, her mother casually advised against the switch. Nadine suffered on, sobbing herself to sleep most nights and wishing that she would not wake up.

Full of hope and ideas of escape from the bullies and their narrowness, Nadine transferred to a specialty arts high school for ninth grade. Although the bullying ceased, her anxiety symptoms paradoxically worsened. She felt even more unable to venture into public spaces and felt increasingly embarrassed by her inability to develop the sort of independence typical of a 15-year-old. She said she had begun to spend whole weekends trapped in her home and had become scared to even read by herself in the local park. Nadines social anxiety had evolved into true agoraphobia. She had nightly nightmares about the bullies in her old school. Her preoccupation with suicide grew.

Her parents had thought she would outgrow being shy and sought psychiatric help for her only after a teacher remarked that her anxiety and social isolation were keeping her from making the sort of grades and doing the sort of extracurricular activities that were necessary to get into a good college.

Nadine described her mother as loud, excitable, aggressive, and a little frightening. Her father was a successful tax attorney who worked long hours. Nadine described him as shy in social situations (Hes more like me). Nadine said she and her father sometimes joked that the goal of any evening was to avoid tipping the mother into a rage. Nadine added that she never wanted to be anything like her mother.

Discussion

Nadine appears to have an underlying shy temperament. Unfortunately, with sandbox logic, shy children are often picked on. If they never learn adequate ways to defend themselves, bullying can escalate, particularly during their middle and high school years. This pattern can lead these anxiety-prone and already high-risk adolescents to be traumatized by their peers. In Nadines case, the added element of cross-cultural discrimination and intimidation heightened her sense of helplessness and shame. The intensity of her anxiety symptoms, her increasing social isolation, and her sense of having no one to whom she could turn combined to increase her risk of suicidal thoughts and behaviors.

By the time Nadine saw a psychiatrist, her distress had persisted for years and she appears to have developed a cluster of three DSM-5 diagnoses that are frequently comorbid. First, she has marked and excessive anxiety about multiple social situations, including those with her peers. These situations always invoke fears of embarrassment and a sense of her incompetence, again partially fueled by the culturally loaded bullying. Nadine tries to avoid these situations as best she can. She therefore meets the symptomatic criteria for DSM-5-TR social anxiety disorder, which is her primary diagnosis.

As is common among children and adolescents, Nadines fears took on a life of their own after the bullying experience. She initially avoided anxiety-provoking social situations, which is an aspect of her social anxiety disorder. That anxiety gradually expanded and exploded, however, and she began to have panic attacks if she even tried to leave her house by herself. When she became persistently unable to even go alone to a nearby park, she would be said to have a second DSM-5 diagnosis, agoraphobia. Such expansion is so common among children and adolescents that contemporary treatment studies tend to focus interventions on a range of DSM-defined anxiety disorders rather than on a single disorder.

Nadine should also be considered for a third diagnosis: DSM-5-TR posttraumatic stress disorder (PTSD). She has experienced intense and prolonged bullying, which constitutes trauma according to DSM-5-TR Criterion A, especially when a child is socially isolated and going through a vulnerable period of development. To meet DSM-5-TR criteria for PTSD, Nadine would need to manifest clinically significant symptoms for at least 1 month in four different areas: intrusion (the nightmares, which she reported nightly), avoidance (of peers), negative alterations of cognitions and mood (exaggerated and negative views about herself, panic attacks when she fears reexposure to her trauma, i.e., bullying by her neighborhood peers), and alterations in arousal and reactivity (being always on her guard). Because some of these symptoms can also refer to Nadines social anxiety disorder, clinical judgment is required to avoid overdiagnosing PTSD. Nevertheless, it does appear that these two conditions are comorbid in Nadine. It is also important to explore the possibility that these anxiety symptoms might be attributable to a nonpsychiatric medical condition or to the use of medications or substances, but none of these appear to be involved in Nadines case.

When evaluating adolescent trauma, it is useful to recall that although other children are generally the bullies, teachers and administrators can contribute to the problem by paying inadequate attention to schoolyard dynamics or by tacitly tolerating them. This appears to be true in Nadines case. As she reported, There is no way that my teachers did not know what was happening to me. In addition, Nadines parents seem to have been able to ignore her desperate situation until they became concerned about her college admissions.

It is also useful to recognize that Nadines mother is a loud, explosive woman whom Nadine has avoided upsetting since very early childhood. This tenuous motherchild relationship (or dysregulated attachment relationship) likely played a formative role in Nadines shyness. Fear of her mothers explosions might have contributed to Nadines persistent sense that she was not safe, for example, and might have prevented her from developing the tools that she needed to be successfully assertive. As the psychiatric evaluation evolves, it might be reasonable to discuss with Nadine the possibility that her failure to defend herself against the bullying might be related to her intense desire not to be anything like her loud and frightening mother.

Diagnoses

Social anxiety disorder, severe

Posttraumatic stress disorder, moderate

Agoraphobia, severe

Suggested Reading

Busch F, Milrod B, Chen C, Singer M: Trauma-Focused Psychodynamic Psychotherapy: Bringing Evidence-Based Psychodynamic Treatment to Patients With PTSD. New York, Oxford University Press, 2021

Google ScholarMilrod B: Separation anxiety disorder and other anxiety disorders, in Separation Anxiety Disorder: A Guide to the Clinical Syndrome. Edited by Pini S, Milrod B. Berlin, Springer, in press

Resources:

Chapter 10 Reading: Cognitive Behavior Therapy

https://ng.cengage.com/static/nb/ui/evo/index.html?deploymentId=5984212391542986424695824274&eISBN=9780357435861&id=2050484523&nbId=3908281&snapshotId=3908281&dockAppUid=16&https://www.youtube.com/watch?v=rAAFVtar-oo