Respond to the initial discussion post of below peers. What reactions do you have to the ideas the learner has presented? Include examples from your own experience to support your perspective, and raise questions to continue the dialogue.

Jeremiah is a 57-year-old single, unemployed, white male. He still lives with his 83-year-old mother and is embarrassed about this living arrangement. He was previously diagnosed with dysthymia and has undergone psychotherapy treatment for the past two years. He changes counselors often and claims that most were "no good" because he felt he knew more than they did. This counseling appointment was made as a last effort to find someone competent enough to appreciate his problems.

Jeremiah previously worked as an insurance broker. He explained, "It's ridiculous. I was the best broker they had ever seen, but they won't rehire me. I think the problem is that the profession is filled with big egos, and they don't know excellence when it's right in front of them."

Despite encouragement from several counselors, Jeremiah has not pursued employment or volunteer work. He views positions with lower salaries as beneath him. He reports that any truly worthy opportunities would easily find him.

Peer 1 Response

Although Jeremiah doesn't meet the criteria for a type of personality disorder known as narcissistic personality disorder, he has various traits that are similar to those that are considered to be traits of the disorder. For instance, according to the APA, one of the criteria that is used to describe a narcissist is that he or she has a grand sense of importance and is expected to be regarded as superior (APA, 2013). Due to his achievements as a broker, Jeremiah claims that he's owed a superior position at his previous job. He also refuses to look for work elsewhere, and he won't consider positions that he believes are beneath him.

Since he's not able to meet the criteria for a diagnosis of narcissistic personality disorder, a counselor might have to conduct a comprehensive assessment to gain more information about Jeremiah. One of the most common assessments that I would use for this type of disorder is the PID-5. The APA claims that the PID-5 is a 220-item self-assessment scale that can be used by adults 18 and older (APA, 2019). It features 25 distinct character attributes, and it can be used to identify traits such as perfectionism and grandiosity.

References

American Psychiatric Association. (2013). Personality Disorders. Diagnostic and Statistical Manual of Mental Disorders. https://doi.org/10.1176/appi.books.9780890425596.dsm18

American Psychiatric Association. (2019).Online Assessment Measures. Psychiatry.org.https://www.psychiatry.org/psychiatrists/practice/dsm/educational-resources/assessment-measures

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• Discuss the advantages of integrating treatment compared to treating each disorder separately.
• What are some of the barriers to implementing an integrated approach and how can they be addressed?

Peer 2 Response

Integrated treatment for co-occurring disorders, as advocated by the Substance Abuse and Mental Health Services Administration (SAMHSA), offers several advantages over treating each disorder in isolation. Firstly, it fosters a comprehensive understanding of the interplay between substance abuse and mental health issues, allowing for tailored interventions that address the unique needs of individuals facing both challenges. This holistic approach promotes better treatment outcomes and reduces the risk of relapse. Moreover, integrated treatment facilitates enhanced coordination between mental health and substance abuse professionals. This collaboration ensures a cohesive and streamlined delivery of care, minimizing the fragmentation that often occurs when disorders are treated separately. By addressing both issues concurrently, individuals can experience improved symptom management, increased treatment engagement, and a higher quality of life. Despite the evident benefits, implementing an integrated treatment approach faces certain barriers. One primary obstacle is the existing fragmentation in healthcare systems, with separate funding streams and treatment modalities for mental health and substance abuse. Overcoming this barrier requires policy changes and organizational restructuring to encourage a more unified and patient-centered approach. Another challenge lies in the need for comprehensive training for healthcare professionals to equip them with the skills necessary to address both substance abuse and mental health issues effectively. Educational programs and ongoing training initiatives can help bridge this gap, ensuring that providers are well-prepared to deliver integrated care.

Peer 3

Using an integrated treatment approach rather than a single treatment approach can have many benefits including a better outcome for the patient (SAMHSA). If we look at the use of one treatment approach for a single disorder, this can be very effective but when a person displays symptoms of a couple different diagnoses then it can be very beneficial to use an integrative approach. An integrative approach can address the disorders from multiple angles/combined approaches. If we look at one of the examples that the book gives us is Alcohol Use Disorder and depression, these are often times co-occuring disorders (Morgen, 2016) . When using an integrative approach, it allows us to address both disorders instead of just one at a time especially because the symptoms of both are very similar. In a way I think that using an integrative approach can shorten the need for therapy, instead of addressing the disorders one at a time, addressing both at the same time allows for shorter for a shorter time in therapy. Using Cognitive Behavioral Therapy and other more short term therapy options then becomes a good option for clients that have co-occuring disorders.

What are some of the barriers to implementing an integrated approach and how can they be addressed?

Some barriers to implementing an integrated approach are that clients may not have any co-occuring disorders or the disorders that they do have might present in completely different ways and there may not be an overlap of the two disorders. When there is not an overlap of disorders and they present themselves in different ways, there is no way to treat them with the integrative approach. This can be addressed by using a single approach for each disorder.

References

Morgen, Keith J.. Substance Use Disorders and Addictions, SAGE Publications, Incorporated, 2016. ProQuest Ebook Central,https://ebookcentral-proquest-com.library.capella.edu/lib/capella/detail.action?docID=5945438

Substance Abuse and Mental Health Services Administration. (2016). Co-occurring disorders. https://www.samhsa.gov/disorders/co-occurringLinks to an external site.