Application of Clinical Psychology Paper

Case Study: James Experiences Bipolar Disorder (IndividualPsychotherapy)James is a 55-year-old biracial (Hawaiianand Caucasian) executive who lives alonefollowing the death of his wife seven yearsago. He has one adult daughter who has afamily of her own.Presenting Problem: James presents ina manic stage of bipolar disorder, havinghad a number of previous episodes. James’smaternal uncle and grandfather also hadbipolar illness. This episode involved Jamesdiscontinuing his lithium use, traveling toLos Angeles in the hopes of becoming anactor, spending thousands of dollars onextravagant merchandise, and finally beingarrested for drunk and disorderly conductat a nightclub. James was hospitalized inan inpatient unit briefly and is now seekingoutpatient treatment.Key Biopsychosocial Factors:Biological: There is a family (genetic) historyof bipolar disorder as well as researchsupporting a biological basis of bipolardisorder. Medication is an essential treat-ment component.Psychological: James’s lack of compliance withhis lithium regimen, denial regardingchronicity of his bipolar disorder, enjoy-ment of the manic high, need for controland independence, emotional losses per-taining to wife’s death, and a severechronic psychiatric condition all play arole in his illness.Social: Family and cultural traditions that(in James’s family) distrust Westernmedicine and cultural and general so-cial isolation also are likely to impact hisillness.Treatment Goals a nd Plan: James re-quires medication management in additionto individual therapy in order to achieveseveral immediate a nd long-term goals. Af-ter an initial consultation and assessmentperiod with James, the following treatmentgoals w ere determined. First, James will seekto work through the various impediments tohis reliable use of lithium medication. Theseinvolve not only his need to be in controland not dependent on drugs (or others), buthis family of origin’s negative feelings aboutWestern medicine. Second, James finds thatwhen he becomes depressed, he longs forthe ‘‘high’’ associated with mania. There-fore, the causes of his depression will bedetermined as well as improved coping skills.Third, James is lonely, misses his wife, andfeels isolated from the Hawaiian heritage hecherishes. Thus, treatment will also addresshis interpersonal, social, and cultural needs.The treatment plan involves the followingcomponents:1. Collaboration with James’s physician re-garding his lithium regimen.2. Behavioral contracting, which involvesJames’s commitment to maintain hislithium regimen for at least the first sixweeks of psychotherapy.3. Exploratory work to understand James’sdisdain for dependence and impedimentsto developing a more satisfying interper-sonal life.4. Psychoeducational materials regardingbipolar illness, lithium, and traditionalHawaiian healing techniques and ritualsto aid James in understanding the simi-larities, differences, and potential virtuesand liabilities of both traditions.5. Problem solving regarding increasing so-cial contacts and cultural identification.6. Developing improved awareness andskills for combating depression and cur-tailing future manic episodes.7. Examination of the transference relation-ship between James and his psychologistto better understand James’s interper-sonal issues as well as his need for controland independence.260 Roles and ResponsibilitiesCase Study (Continued)This case example illustrates how person-ality and culture impact compliance withmedical regimens such as medication, andthe need to work through a variety ofintrapsychic and social issues in managinga major psychiatric problem such as bipo-lar illness. The treatment by necessityis multidimensional and mindful of thebiopsychosocial influences on human func-tioning