Effective Treatment Plans for Couples: Mental Health Assessments
School
Capella University**We aren't endorsed by this school
Course
COUN 5225
Subject
Psychology
Date
Dec 12, 2024
Pages
6
Uploaded by KidCatPerson932
Case Study Treatment PlanTreatment PlanDiagnosisInstruments/Screens to Facilitate Diagnosis:Barb and Clay have several factors to address in their biopsychosocial currentsymptoms checklist. To provide mental health support for Barb and Clay's marriage,as well as individual issues that could be affecting their marriage, mental healthassessments and screenings do need to be implemented for better diagnosis andtreatment plans. For the marriage, Barb and Clay should both be administered theMarriage Expectation Inventories (Dixon, 1985). This assessment addressescommunication, sex, freedom, religious expectations, and money, among manyothers (Dixon, 1985). All of the listed categories have been indicated in Barb andClay's biopsychosocial assessment. Thus, this assessment could provide thecounselor with detailed information on the innermost relationship issues. Thisassessment also allows for self-disclosure and has even been noted to be a form ofcounseling in itself due to the nature of the assessment containing 58 statementquestions that each couple must personally elaborate on (Dixon, 1985). This coupleshould also be able to administer the Marital Satisfaction Inventory-Revisedassessment (Bernt & Frank, 2001). This assessment is appropriate because itmeasures the couple's distress in the relationship separately and identifies topicssuch as problem-solving, sexual dissatisfaction, roles, family history distress, andcommunication (Berent & Frank, 2001), which all align with the biopsychosocialassessment key points. Brarb and Clay should both individually take the DSM-5 Level1 Cross-Cutting Symptom Measure because it covers a wide range of mental healthissues such as anxiety, personality functioning, depression, etc. (Gibbons et al.,2023). It is vital that the counselor considers all possibilities and does not miss anysymptoms for both Barb and Clay individually. Barb has expressed that during hercancer diagnosis, she felt depression symptoms. The Depression Anxiety StressScales (DASS) would be appropriate to administor since Barb has expressed currentdrepressive symptoms such as being unsatisfied with her current life and wishes shewas someone else (Cellucci & Isenhart, 2021). This assessment will measure variousemotions and severity levels that are related to both anxiety and depression (Cellucci& Isenhart, 2021). These four assessments aid in providing a clearer picture of Barband Clay's mental health and emotions and thus aid in the diagnosis and treatmentplan for Barb and Clay moving forward.DSM-5 Diagnosis:A thorough analysis of Barb and Clay's scored assessments should be present beforethe confirmed diagnosis of Barb/Clay; below is a list of possible diagnoses that needfurther investigation. Barb and Clay are both experiencing a phase of life problem
(V62.89/Z60.0) (APA, 2022), as was referenced during Barb and Clay's reason for thevisit in the biopsychosocial assessment. Additionally, Barb has indicated the followingdiagnostic criteria for Female Orgasmic Disorder (F52.31): absence of orgasm thathas been present for longer than six months and has been an issue in all sexualactivity with her husband and with her partner (APA, 2022). Barb has alsoexperienced a great deal of distress in her personal and sexual life due to her lack oforgasm (APA, 2022). As indicated in the biopsychosocial assessment, Barb hasexperienced this issue with both current sexual partners, and this has been part of alifelong issue. Thus, Barb meets the DSM diagnostic criteria for Female OrgasmicDisorder: Lifelong, Generalized, Moderate/severe (APA, 2022). An accurate diagnosisof moderate or severe needs to be further evaluated. Clay did not indicate anydiagnostic criteria for a mental health diagnosis. However, further evaluation andassessment scores are still needed to determine if Clay is or is not experiencing amental health disorder.Differential Diagnosis:Focusing on Barb, who does meet the diagnostic criteria for Female OrgasmicDisorder, a differential diagnosis of a nonsexual mental disorder (APA, 2022) needsto be further evaluated for accurate diagnosis in totality. Female Orgasmic Disordercan sometimes be explained by a differential diagnosis of depression (APA, 2022).Barb has indicated in her following few sessions that she has been experiencing afeeling of emptiness, insomnia, feeling worthless, indecisiveness, and constant fear ofdying, as well as how these feelings have caused her to reevaluate her life and shebelieves this might have aided in her decision to have an affair. Five or more of thediagnostic criteria within category A and must be present for at least two weeks for apossible diagnosis of Major Depressive Disorder, and Barb currently does meet thefollowing five criteria: A.1, A.4, A.7, A.8., A.9, B, D, and E (ACA, 2022). However,further analysis and assessment results are needed to aid in an accurate andappropriate diagnosis of Barb. Again, Clay has not indicated any diagnostic criteria fora mental health diagnosis, but further analysis is still needed.Potential Legal Considerations Associated with the Client, Situation, or Diagnosis:Barb has disclosed that she has an STI from her partner but has not yet disclosed thisinformation to Clay due to fear that he will want to leave their marriage, even thoughshe wants to work on their marriage and stay together. Barb and Clay reside in thestate of Texas. Following Texas law, no law requires Barb to disclose to Clay that shehas an STI (even if she has sexual relations with Clay after her confirmed diagnosis)(Penal Code, n.d.). However, if Clay contracts the STI from Barb, he could take Barbto court for spousal assault for recklessly, intentionally, and knowingly causing bodilyharm to Clay (Penal Code, n.d., Title 5, Chapter 22, Section 22.01). In addition, Barbhas been having a secret affair, which she has not disclosed to Clay as of yet. PerTexas state law, Clay does have legal grounds to file for divorce (Family Code, n.d.,Title 1, Subtitle C, Chapter 6, Subchapter A, Section 6.001). These legal issues couldcause increased distress in each individual and increase the severity of Barb's (notyet confirmed) depression symptoms. Clay does have the legal grounds to take Barbto court on two accounts; however, the counselor will encourage Clay to haveindividual sessions to allow for a thorough evaluation of his feelings and emotions sothat he can proceed with court proceedings (if he so chooses) in a way that promotesthe well-being of both parties. Barb will also be encouraged to have individualcounseling sessions to address her feelings and emotions and find acceptance inClay's choices. If Barb does have a confirmed diagnosis of depression (after furtheranalysis and assessment results), then the counselor should closely monitor Barb's
symptoms in case (if Clay chooses court proceedings) her symptoms increase or shebecomes suicidal.GoalsShort-Term Goals to Address the Diagnosis:*At this point in the sessions, Barb has disclosed her affrair to Clay. Clay has soughttreatment for his STI. Barb and Clay have decided to stay married and work on theirrelationship through counseling*Barb, Clay, and the counselor have throughly discussed and agreed on two healthyshort-term goals. Barb and Clay stated that they wish to work on their relationship butare not ready to address their sexual aspect of their relationship. Barb states that shewould like to work towards repairing her relationship and thus wishes to address hersexual dysfunction in the long-term goals. The counselor agreed to Barb and Claysappraoch.1.) Barb and Clay will take accountability by openly communicating the distress theyfeel in the relationship. Both partners wish to explore open communication withouthiding true feelings and thoughts.-According to CBT in couples counseling, there is a strong emphasis of accountabilityand open communication to work through cognitive distortions, and problematicbehavior (Gregory, 2021).2.) Barb and Clay wish to reconnect to eachother. Both have stated that at this pointin their lives they no longer really know eachother and feel like their lives are going indifferent directions. Barb and Clay have agreed to begin journalling with the subjectmatter pertaining to the acronym DEEP- Differences noticed, emotions, externalcircumstances, and patterns of interactions as it pertains to their relationship (Barraca& Polanski, 2021).-According to integrative behavioral couple therapy, the acronym DEEP helpsexamine orgins of relational distress, including infidelity (Barraca & Polanski, 2021).Long-Term Goals to Address the Diagnosis:Barb and Clay stated that they would like to increase their satisfaction with their sexlife, and address Barb's Female Orgasmic Disorder, after their short term goals havebeen meet and they connected emotionally. The counselor agreed.1.) Barb would like to have a more positive outlook on sexual activity, and notpressure herself to "have to have an orgasm".-According to CBT, client thought restructuring to have a more positive outlook canhelp with sexual disfunctions because many sexual disorders are caused by negativethoughts (Hyde, 2019).2.) Both partners indicated there is no sexual variations in their sex life, and they bothwish to try new things. Sex therapy will be implemented such as discussion andhomework for sexual variation, i.e. sensate focus exercises, sexual fantasy, anddifferent intercourse positions that put an emphysis on stimulation for Barb (Hyde,2019).Treatment Plan
Strategies to Promote Optimal Sexual Functioning:Many sexual dysfunctions can be attributed to distracting thoughts as well as a lack ofemotional intimacy (Hyde, 2019). Barb and Clay express a mutal desire to increasethe emotional aspect of their relationship before moving towards the sexual element.According to the DSM-5, Female Orgasmic Disorder often depends on many factorsoutside of the bedroom, including struggling with mental health, gender roles (suchthat Barb has incidacted that she no longer wants to be a stay at home wife), religiousfactors, and, most commonly, relationship distress (APA, 2022). Thus, using CBT andintegrative behavioral couple therapy to explore Clay and Barb's feelings, emotions,and personal dissatisfaction could play a significant role in rediscovering theirmarriage bond. Decreasing relational distress and aiding in the treatment of Barb'sorgasmic disorder. CBT has a significant emphasis on restructuring unhealthythoughts and behaviors, which could break relational patterns that are hindering themarriage and Barb's sexual function (Hyde, 2019). Additionally, in the lens of anintegrative behavioral couple therapy approach, affairs are often a sense of escapefrom the relationship pattern the couple is stuck in but is not discussing (Barraca &Polanski, 2021). The use of DEEP to explore each person as an individual as well asidentify the roots of marital dissatisfaction (Barraca & Polanski, 2021) might aid Barbin the cognitive aspect of her sexual dysfunction. Lastly, there is a direct link betweendecreased sexual satisfaction and decreased marital satisfaction; thus, addressingsexual variations, desires, needs, and Barb's sexual dysfunction is critical not only toBarb but also to the marriage as well (Hyde, 2019). Sex therapy needs to beaddressed with this couple.Evidence-Based Treatment Interventions to Support Strategies:Mental health research pertaining to intimacy typically includes a treatment plan thataddresses cognitive reframing, creating new behaviors, and facilitating a bondbetween the couple (Barraca & Polanski, 2021). Integrative behavioral couple therapyhas several strategies specifically addressing intimacy, such as tolerance strategies,rebuilding trust, joining, and a more intimate understanding of each other (Barraca &Polanski, 2021). In a research study of 134 couples in the same age range as Barband Clay engaged in IBCT, these couples had significantly improved maritalsatisfaction two years later than those in the control group (Jorge, 2015). CBT is notonly well documented to address mental health issues such as depression (a possiblediagnosis for Barb) but also has been shown to be effective in the treatment ofvarious forms of female sexual disorders (Stephenson et al., 2021). CBT is alsohelpful in the emotional dynamics of a relationship, such as taking accountability inincreasing communication (Gregory, 2021). Therefore, using both CBT and IBCTwould be appropriate to address Barb and Clay's emotional and sexual relationship.Lastly, sex therapy should be incorporated into Barb and Clay's treatment for not onlythe relationship but also for Barb's sexual dysfunction. Studies have concluded thatsex positions (and sex therapy, i.e., education, training, and encouragement) have adirect impact on sexual dysfunction, especially among females (Tekgunduz et al.,2023). It has been noted that as couples attend counseling for their relationship,sexual issues also improve over time (Hyde, 2019). Such interventions as Mastersand Johnson's therapy, where performance and expectations are removed from thesexual experience, and techniques such as sensate focus exercises areimplemented, can significantly change the dynamics of the couple's sex life (Hyde,2019). Sex therapy techniques such as this also increase the couple's communicationregarding sex and aid in cognitive interference by changing the behavior andcognitive aspects of the sexual relationship (Hyde, 2019).
ReferencesList references according to current APA style here and also incorporate references via in-textcitations into the fields where they are used.Barraca, J., & Polanski, T. X. (2021). Infidelity treatment from an integrativebehavioral couple therapy perspective: Explanatory model and intervention strategies.Journal of Marital and Family Therapy, 47(4), 909–924.https://doiorg.library.capella.edu/10.1111/jmft.12483Bernt, F. M., & Frank, M. L. B. (2001). Marital Satisfaction Inventory--Revised. TheFourteenth Mental Measurements Yearbook.Cellucci, T., & Isenhart, C. (2021). Depression Anxiety Stress Scales. The Twenty-First Mental Measurements Yearbook.Dixon, D. N. (1985). Marriage Expectation Inventories (The). The Ninth MentalMeasurements Yearbook.Family Code. Family code chapter 6. suit for dissolution of Marriage. (n.d.).https://statutes.capitol.texas.gov/Docs/FA/htm/FA.6.htmGibbons, A. B., Farmer, C., Shaw, J. S., & Chung, J. Y. (2023). Examining the factorstructure of the DSM―5 Level 1 cross―cutting symptom measure. InternationalJournal of Methods in Psychiatric Research, 32(2), 1–10. https://doi-org.library.capella.edu/10.1002/mpr.1953Gregory, V. L., Jr. (2021). Cognitive-behavioral therapy for relationship distress: Meta-analysis of RCTs with social work implications. Journal of Evidence-Based SocialWork, 18(1), 49–70. https://doi-org.library.capella.edu/10.1080/26408066.2020.1806164Hyde, J. (2019). Understanding Human Sexuality (14th ed.). McGraw-Hill HigherEducation (US). https://capella.vitalsource.com/books/9781260394597Isenhart, C., & Kavan, M. G. (2017). Morel Emotional Numbing Test for PosttraumaticStress Disorder. The Twentieth Mental Measurements Yearbook.Jorge, B. M. (2015). Integrative Behavioral Couple Therapy (IBCT) as a Third-WaveTherapy. [La Terapia Integral Conductual de Pareja (TICP) como terapia de tercerageneración.] Psicothema, 27(1), 13-18. https://doi.org/10.7334/psicothema2014.101Penal Code. Penal code Chapter 22. assaultive offenses. (n.d.).https://statutes.capitol.texas.gov/Docs/PE/htm/PE.22.htm#22.01Stephenson, K. R., Zippan, N., & Brotto, L. A. (2021). Feasibility of a cognitivebehavioral online intervention for women with Sexual Interest/Arousal Disorder.Journal of Clinical Psychology, 77(9), 1877–1893. https://doi-org.library.capella.edu/10.1002/jclp.23137
Tekgunduz, S., Ozturk Altinayak, S., Ejder Apay, S., Ozdemir, F., & MohammadAlipour, M. (2023). The relationship of females with sexual dysfunctions to differentsex positions. Journal of Sex & Marital Therapy, 49(1), 56–64. https://doi-org.library.capella.edu/10.1080/