Abuse Counseling Essay, Research Paper
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Abstract
The consequences of substance abuse, domestic abuse, sexual abuse, and food abuse in the United States are enormously costly (Greeno, 1996). Although the costs can probably be evaluated in dollars, they are more readily understood in human terms: family discord, neglect of children, personal misery, financial straits, medical problems, HIV infection, legal problems, incarceration, job loss, the list goes on. Combating and reducing the source of these problems has proven to be difficult indeed, but one of the most straightforward and non-controversial ways is to offer effective treatment, through counseling, to the above-mentioned abusers and/or abused. Through the use of several different modalities, counselors have proven to be an effective tool for generating positive behavioral modifications (Capuzzi & Gross, 2001).
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Substance Abuse Counseling
By: Jennifer Reynolds
Substance abuse disorders across America are on the rise (Caplan, 1997). With the ever-increasing number of individuals being diagnosed with substance abuse disorders, it is important that substance abuse counseling persevere with an ever-increasing success rate. It is estimated that approximately 30% of the population will have a diagnosable substance abuse disorder in their lifetime (Caplan, 1997). The National Institute on Drug Abuse (1990) estimates that there are 5.3 million people with a diagnosable drug abuse or dependence problem at any given time. The institute also estimates that only 15% of the people in need of clinical intervention for substance abuse disorder ever receive it.
The lifetime prevalence rates for other mental disorders among persons diagnosed with substance abuse disorders range from 75% to 85% (Caplan, 1997). In addition, the symptoms of withdrawal and intoxication for many substances mimic the symptoms of other mental disorders. As a result, it is important that the clinician be able to distinguish between symptoms arising from, and related to, substance abuse disorders, and those related to other mental disorders. Failure to make this distinction can result in a misdiagnosis and poor treatment planning (Cappuzzi & Gross, 2001).
The DSM IV describes substance dependence in terms of the symptoms presented in three realms of functioning: cognitive, behavioral, and physiological (APA,
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1994). Before a counseling treatment plan is initiated it is important for clinicians to familiarize themselves with the criteria for dependency, tolerance, withdrawal, and
remission. Counselors should also have a basic understanding of the eleven classes of substances (APA, 1994), what the effects of these substances are and how they cause their effects. Problems associated with an individual’s drug addiction can vary significantly. People who are addicted to drugs come from all walks of life. Many suffer from mental health, occupational, health, or social problems that make their addictive disorders much more difficult to treat (Greeno, 1996). Even if there are few associated problems, the severity of addiction itself ranges widely among people. Correctly diagnosing substance abuse disorders at the earliest possible point in the course of the disorder, greatly improves the prognosis for the patient (Caplan, 1997). Once the clinician has properly diagnosed a patient, a variety of therapeutic techniques can be utilized.
There are many approaches to substance abuse counseling. These include community centers, family therapy, agonist therapy, one on one counseling, in patient treatment, vocational rehabilitation, and support groups such as Alcoholics Anonymous and Narcotics Anonymous. There are numerous other approaches that are also available, each utilizing its own techniques. Agonist therapy, for example, involves giving patients medication that actually mimics the drug the patient is addicted to. Whichever treatment option is used, it is important that the counselor be competent in their specific area of specialization.
The qualities and skills of the counselor that are generic to any counseling relationship must be present in the counselor working with persons diagnosed with
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substance abuse disorders (Capuzzi & Gross, 2001). These include the abilities to be direct in questioning and confronting, to self-disclose appropriately, to clarify, to be aware
of counter transference, and to be aware of the effects one s own beliefs may have on the counseling relationship. (Cappuzzi & Gross, 2001). The qualities necessary for the counselor to possess include empathy, genuineness, warmth, and non-judgmental acceptance (Caplan, 1997).
The assessment, diagnosis, and treatment of substance abuse disorders requires counselors to possess not only general counseling skills and abilities, but also specialized skills and abilities relative to this population. Knowledge of assessment instruments and techniques that facilitate the making of a DSM IV (APA, 1994) diagnosis is necessary for the counselor to communicate with other professionals and make treatment recommendations. The proper use of supervision will greatly enhance the counselor s effectiveness and comfort when working with clients. Accurate diagnosis at the earliest possible time in the counseling relationship greatly improves the prognosis for the client, no matter what type of treatment is being used.
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Domestic Abuse Counseling
By: Patricia Luna
The area of people abuse is such a broad area. For this reason, the focus will be narrowed to the area of domestic abuse. According to Emilio C. Viano’s book Intimate Violence research shows that violence and aggression are often used in marriage and family situations to enforce the will of the most powerful individual. This is generally a male over female, or female over child. (Viano, p. 4) Women in some societies are often given the message that they should be submissive, compliant, nurturing, and also sex objects. This gives (some) men the message that women are objects to be conquered. Women who prove their purpose is to serve and please men are rewarded with the grand prize of marriage. They can then take their subordinate place in society. (Viano, p. 5)
There are several different ways to approach the counseling of individuals who have been involved in domestic abuse. The counseling could be focused on the abuser or the batterer. Often the counselor will be seeing both in couple’s counseling. In the case the abuse affects the child, most research suggests that the child be seen individually. Sometimes, the child is seen in family counseling, and also individually.
Couples counseling is a potentially dangerous form of counseling. “The therapist must continually reassess the potential for danger in the relationship and not collude with either the man’s, woman’s, or couples denial and minimization of this potential. (Viano, p. 161) Terminating the relationship should not be a prerequisite for initial or continuing participation. Many couples turn to counseling in hopes of saving the relationship. In an interview with a former battered woman, Rose Goetz, she stated she turned to counseling
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in hopes of saving the marriage. She had a strong religious belief against divorce, and therefore felt she should do everything possible to try and save the relationship. In her case the counselor was able to convince her that she did not have to put up with the abuse. Her husband attended only three sessions, and Rose had to realize she could not help him if he would not help himself. Yet, without immediately giving up on the relationship, she was convinced that without becoming violent herself she could protect herself and her children. Along with the help of her eldest daughters Rose would restrain her husband when he became abusive. She once restrained him for thirty minutes. Eventually the marriage was dissolved. Rose has been divorced for 20 years. With the help of counseling and a strong religious faith, she has now become a much stronger person. She is remarried and all her children are grown. She is independent, happy, and well adjusted.
As stated before, children, especially those who have been severely traumatized, are encouraged to be seen individually. Robert Hampton states “Play is a child’s most natural form of communication, and a skilled therapist can facilitate an abuse child s symbolic expression of feelings and fantasies in a safe manner.” He also lists four phases of play therapy. Phase one involves Establishing trust and understanding the metaphors in the child s play. During phase two the child explores trauma through the process of disclosure. In Phase three the child is assisted in developing impulse control and self esteem. The abused child is aided in developing empathy, which can often times be a problem. They learn their own strengths. Phase four is the final phase and involves termination. (Hampton, p. 322-323)
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Family therapy can be effective only after the violence has been brought under control. During this time the parents should also be participating in their own treatment. (Viano, p. 170) Parents, and children would both be participating in their own therapy. After everyone puts together their own issues the family can begin work on their relationship as a family. Many times the counseling is not successful, or too much damage has been done and the couples seek to divorce. In these instances it would still be beneficial for abusers to seek counseling in hopes to prevent future abuse in future relationships. Those who have been battered should seek counseling to prevent finding themselves in similar types of relationships in the future. They also will be dealing with issues of low self-esteem and isolation. Children should also continue to explore their feelings in counseling.
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Sexual Abuse Counseling
By: Chris Hyatt
Counseling those affected by sexual abuse includes people who are victimized, those who abuse others, and those who abuse sexual experiences. In this report, the authors have chosen to deal specially with women who have been victimized by sexual assault or rape. Several studies have been conducted which shows the frequency of rape among women. Russell (1984) conducted interviews with 930 women and reported that 24% had experienced a complete rape and 31% an attempted rape. Many victims report problems with poor self-esteem, interpersonal struggles, depression and sexual dysfunctions. One of the most prevalent disorders that develops as a result of sexual assault is post-traumatic stress disorder (PTSD).
To gain understanding over their experience, rape victims often blame themselves and suffer from guilt (Prendergast, 1993). They also look for ways they can change their normal behavior as a means for future protection. This desire to maintain control may seem odd, but it is often the means by which a victim gains a feeling of well-being, comfort, and consolation. For example the victim may say to herself, I won t go out on dates anymore, or I won t wear a specific type of clothing again. This will keep it from happening again (Resick & Schnicke, 1993). Since post-traumatic stress disorder (PTSD) is a major effect of rape, it is a major focus in treatment. Though PTSD is treated in various forms, Resnick and Schnicke (1993) state that the therapist s overall goal must be to encourage the client to remember the rape, accept that it happened, and come into contact with their emotions regarding the event. The goal is help the client establish a
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balance in the way they see themselves and world, avoiding the pull to see everything in respect to the rape.
Understanding that various theories may be introduced to help rape victims, the authors have chosen to focus on one such theory, the Cognitive Processing Theory (CPT), espoused by Resnick and Schnicke (1993). They believe that though there are many different types of therapies, CPT combines both the cognitive and exposure-based therapies with material especially tailored for rape victim. This approach is supported by Kilpatrick and Calhoun (1988) who recommended that it might be far more productive to develop new treatments specifically tailored to the needs of victims than to continue attempting to find effects of existing treatment procedures that may be weak at best (p. 427). In the end, CPT was developed to help victims of rape:
(1) understand how thoughts and emotions are interconnected, (2) accept and integrate the rape as an even that actually occurred and cannot be ignored or discarded, (3) experience fully the range of emotions attached to the rape, (4) analyze and confront maladaptive beliefs, and (5) explore how prior experiences and beliefs both affected reactions and were affected by this trauma (Resick & Schnicke, p. 19)
The skills a counselor must have to help rape victims are not just specific to this type of counseling. As promoted by Capuzzi and Gross (2001) they include good attending skills, such as good eye contact; attentive body language; appropriate distance between counselor and client; a warm, pleasant, caring voice; and attention to verbal tracking. They also include basic listening and self-attending skills. It is also very
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important for watch for transference and counter transference, both major hazards in any counseling situation.
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Food Abuse Counseling
By: Marco Reyes
Food abuse or addiction is another area that counselors need to be knowledgeable about when dealing with clients who want to stop their addiction or food abuse. There are several types of eating disorders. Let us briefly describe each. Anorexia Nervosa is distinguished by unwillingness to keep normal body weight for their age and height. Anorexics habitually avoiding food because they have an excessive fear of gaining weight, when in fact they are15 percent below the normal weight (DSM-IV-TR, 2000). Anorexics will either fast, exercise to extremes, or self-induce vomiting, or abuse laxatives (DSM-IV-TR, 2000). Although anorexia nervosa is not an addiction to food per se, it is an abuse of food and the body.
Persons with bulimia nervosa will binge uncontrollably on large amounts of food in a very short period of time, usually until their stomach is painfully filled. They will either self-induce vomiting, abuse laxatives, or fast or exercise excessively (DSM-IV-TR, 2000). Bulimics are usually normal to slightly overweight and are afraid to gain weight (DSM-IV-TR, 2000). Some outward signs of bulimia may be worn teeth enamel from excessive vomiting (Mc Gilley & Pryor, 1998). Whereas anorexics tend to be perfectionist, need to be in control, and have impulse-control problems, bulimics tend to be depressive and have low-self esteem and are anxious about their body weight (p.585, DSM-IV-TR, 2000).
Binge-Eating Disorder (BED) is an addiction to food (Weir, 2001). BED sufferers will binge on large amounts of food in a short amount of time; however, they do no vomit,
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use laxatives, or fast to compensate for bingeing (DSM-IV-TR, 2000). The majority of people with BED are obese or have had some form of overweight problem before (Bruce & Wilfley, 1996; Walsh & Devlin, 1998; Agras & Telch, 1998; and Kensinger et al., 1998). A person with BED cannot control their binge attacks that usually occur twice a week for about six months (DSM-IV-TR, 2000). They will usually eat alone and sometimes when not even hungry, bingeing for about an hour or two until their stomach is distended to an uncomfortable level, having eaten thousands of calories, with personal feels of guilt, shame, and depression afterwards (DSM-IV-TR, 2000; Anonymous, 1997). There are several presumed causes for of BED such as, depression and anxiety (DSM-IV-TR, 2000; and Agras & Telch, 1998) childhood sexual abuse (Deep, et al., 1997; Everill & Waller, 1994; and Wonderlich et al., 1996), and negative body image (O Connor, 1998). In my interview with Weir (2001), an LPC, who is the contact person for Food Addicts (FA) Anonymous, a support group for over eaters and people with eating disorders, Weir stated that 90 percent of women who are over eaters in FA Anonymous and in her private practice were sexually abused.
There are several treatment plans for eating disorders like BED. Because binge eating is a behavior, it can be treated with cognitive behavioral modification (Lee & Miltenberger, 1997). Cognitive behavioral therapy (CBT) seems to be one of the most effective treatments for BED in for the long-term (McGilley & Pryor, 1998). CBT is used to set up a regimen of eating 3 nutritional meals daily, being cognizant of trigger factors of binge eating, and to change negative irrational beliefs to positive rational ones (Bruce & Wilfley, 1996; Nauta, et al., 2000; Jansen, 1998; and Parrott, 1998). The anti-depressant
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fluvoxamine appears to be effective in treating BED (Hudson, et al., 1998; Greeno & Wing, 1996) and in treating anorexia and bulima (Kaye, et al., 1999). Twelve-step programs that mimic Alcoholics Anonymous (AA), such as Food Addicts Anonymous, treat eating disorders as an addiction (Johnson & Taylor, 1996). Indeed, Weir (2001) stated food is a physiological addiction (e.g. to sugar). FA anonymous uses a life-long regimen plan of abstinence from flower and sugar, three meals a day, no bingeing, no caffeine, have a sponsor, and to attend 2 AA meetings replacing alcohol in the Big Book for food (Weir, 2001). Weir claims binge eaters escape or zone-out from feelings of anxiety, stress, pain, or depression, by bingeing. Food is the only thing the binge eater can control, and foods (such as sugars) are mood altering (Weir, 2001). Weir a former binge eater recounted her withdrawal from food as several weeks of crying, headaches, anger, apathy, and finally no more cravings, respectively. Weir says that she cannot treat a binge eater until they have overcome their addiction. Otherwise, they are non-responsive to psychotherapy. Weir (2001) explained that sponsors and the 12-step program (that uses personal inventory) helps keep the binge eater cognizant of relapse and switching to other addictions, such as shopping or sex. Weir pointed out that most men in FA anonymous have either hit rock bottom medically (diabetics or are on several medications) or are recovered alcoholics compensating the sugar in food addiction for lack of alcohol (alcohol is a form of sugar). Finally, the recovery rate for all eating disorders is approximately fifty percent (Herzong, et al., 1996; McGilley & Pryor, 1998). Little information exists on the long-term recovery rate regarding effectiveness of treatments
conducted.
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References
Agras, Stewart, W., & Telch, Christy F. (1998). The effects of caloric deprivation and negative affect on binge eating in obese binge eating disordered women. Behavior Therapy, 29, 491-503.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th edition.). Washington, DC: Author.
Anonymous. (1997). Binge eating disorder comes out of the closet. Tufts University Diet & Nutrition Letter, 14, 4-5.
Bruce, Bonnie, & Wilfley, Denise. (1996). Binge eating among the overweight population: A serious and prevalent problem. Journal of American Dietetic Association, 96, 58-?..
Caplan, G. (1997) Support Systems and Community Mental Health. New York: Behavioral Publications.
Cappuzzi, D., & Gross, D.(Eds.) (2001). Introduction to the Counseling Profession (3rd edition). Boston: Allyn & Bacon.
Deep, Amy, L., Lilenfeld, Lisa, R., Plotnicov, Katherine, H., Pollice, Christine, & Kaye, Walter H. (1999). Sexual abuse in eating disorder subtypes and control women: the role of comorbid subtance dependence in bulimia nervosa. International Journal of Eating Disorders, 25, 1-10.
Everill, Joanne, T., & Waller, Glenn. (1995). International Journal of Eating Disorders, 18, 1-11.