Assume the role of Trudy’s therapist and discuss how you would therapeutically address Trudy’s rape | Describe, compare and contrast psychoanalytic therapy, cognitive behavioral therapy, and psychodynamic therapy in the treatment of obsessive-compulsive disorders. Be sure to include the strengths, limitations, and effectiveness of each, and support your ideas with references.

Introduction
Understanding illnesses associated with obsessive-compulsive disorder (OCD) helps in understanding a client who feels compelled to perform self-destructive acts. A number of other psychiatric acts resemble OCD, including alcoholism, drug abuse, compulsive sex, gambling, and eating disorders.
Obsessive-compulsive disorder is an anxiety disorder that has attracted the attention of experts. The criteria for obsessive-compulsive personality disorder are perfectionism, excessive devotion to work and productivity, overconscientiousness and inflexibility, reluctance to delegate tasks, inability to discard worthless objects, indecisiveness, rigidity, and stubbornness.
The dynamics and internalized shame of obsessive-compulsive disorders can prohibit treatment progress if not identified and incorporated into treatment planning. Behavioral therapy must play a role in treatment of these disorders as well as consideration for psychiatrist’s evaluation for SSRI medication. In this unit, psychodynamic and cognitive-behavioral approaches for obsessive-compulsive disorder will be explored.
Eating Disorders
Eating disorders focus on a form of obsessive-compulsive behavior centered on a morbid preoccupation with food. Food becomes the vehicle for self-abusive behaviors to obtain control and order in an individual’s life. Eating disorders can take many forms, including body dysmorphic disorder and hoarding. Anorexia nervosa and other eating disorders can be viewed as obsessive-compulsive behavior centered on a preoccupation with food or body image.
Anorexia nervosa is a form of obsessive-compulsive behavior and hoarding that is centered on a morbid preoccupation with food and thinness. It has severe symptoms of obsessive-compulsive disorder in addition to symptoms of eating disorders. Not only do a high rate of patients have another Axis I diagnosis, they can have medical problems and a high rate of recidivism.
Psychological understanding of the eating-disorder patient who has other psychiatric difficulties is often quite difficult. Characteristics of body dysmorphic disorder come from sociocultural attitudes about thinness, children’s books emphasizing the little girl appearance, the Barbie image, the thinness of actresses and actors in movies and on TV, and the everyday lives of children, especially girls, growing up. These images make thin the ideal and can lead to difficulties with body image.
Pathological Gambling
According to the DSM-IV-TR, a client must meet at least five of the listed criteria to meet the diagnosis for pathological gambling. Generally, gambling urges and needs increase with stress. According to Jenike, Baer, and Minichiello (1998), by the time the gambler presents for help, she or he often is anywhere from $55,000 to $92,000 in debt (p. 125). Pyles (as cited in Jenike, Baer, & Minichiello, 1998) reports that the therapist’s initial dilemma is how to work with a patient who denies any problem except not having money. A therapist must have knowledge of the signs and symptoms of pathological gambling as well as the DSM-IV-TR criteria.
Other Disorders
Additionally, there are disorders that can be classified as impulse control disorders, including kleptomania, pathologic gambling, pyromania, and trichotillomania. Compulsive shopping and nail biting are also in this category. According to Jenike, Baer, and Minichiello (1998), neurotic excoriations are lesions produced by patients as a result of repetitive picking. Several studies have described patients suffering from neurotic excoriations as “perfectionist or having obsessive-compulsive traits, depressive symptoms, anxiety, hysteria, and hypochondrias” (p. 123). Clients with choking phobia (globus hystericus) are obsessed with a fear that they are intermittently choking and unable to breathe. Bowel or bladder obsessions can change daily living functioning and routines. Compulsive water drinking (psychogenic polydipsia) is related to severe psychiatric conditions and chronic institutionalization; the majority of individuals who have this condition are women.
Reference
Jenike, M. A., Baer, L., & Minichiello, W. E. (1998). Obsessive-compulsive disorders: Practical management (3rd ed). New York: Mosby.

Behavioral Therapy and the Compulsive Behavioral Model
Objectives
To successfully complete this learning unit, you will be expected to:
1. Identify and describe the psychological models of addiction and compulsive behavior.
2. Develop a working knowledge of cognitive behavioral therapy and psychodynamic treatment for obsessive-compulsive disorder.
3. Understand the etiology and nature of obsessive-compulsive disorders.
Learning Activities
Readings
Complete the following:
• In your Addiction Treatment: A Strengths Perspective text, review Chapter 5, “Eating Disorders, Gambling, Shopping, and other Behavioral Addictions,” pages 255–309.
• In your coursepack, read March’s “Cognitive-Behavioral Psychotherapy for Pediatric Obsessive-Compulsive Disorder,” pages 400–420.
• Read Bram and Björgvinsson’s 2004 article, “A Psychodynamic Clinician’s Foray into Cognitive-Behavioral Therapy Utilizing Exposure-Response Prevention for Obsessive-Compulsive Disorder,” from American Journal of Psychotherapy, volume 58, issue 3, pages 304–320.
• Read Kempke’s and Luyten’s 2007 article, “Psychodynamic and Cognitive-Behavioral Approaches of Obsessive-Compulsive Disorder: Is it Time to Work Through Our Ambivalence?” from Bulletin of the Menninger Clinic, volume 71, issue 4, pages 291–311.

Treating Obsessive-Compulsive Disorders
Assignment 1: 1 page needed with 3 references.
Describe, compare and contrast psychoanalytic therapy, cognitive behavioral therapy, and psychodynamic therapy in the treatment of obsessive-compulsive disorders. Be sure to include the strengths, limitations, and effectiveness of each, and support your ideas with references.
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Addictive Behavior Treatment – Case Study
Assignment 2: 1 page needed with 3 references.
On page 147 of your Miller text, read Case Study 6.1, of Trudy, a 22-year-old female client who has come for outpatient chemical dependency treatment.
Assume the role of Trudy’s therapist and discuss how you would therapeutically address Trudy’s rape. What clinical strategies would you utilize to aid her in dealing with trauma from her rape? What concerns would you have for Trudy in her recovery because of her being raped?

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