Medical Model Approach A medical model practitioner would likely be diagnosing Alvins symptoms in the categories of mental disorders following the diagnostic systems, like DSM-5 or ICD-11.

Medical Model Approach

A medical model practitioner would likely be diagnosing Alvins symptoms in the categories of mental disorders following the diagnostic systems, like DSM-5 or ICD-11. As such, the focus would be on categorizing Alvins experiences into common occurrences of patterns of psychopathology and coming up with an evidence-based treatment plan depending on those diagnoses (Milton, 2012).

The practitioner would likely focus on the following:

His current symptoms, such as difficulty getting out of bed, loss of appetite, sleep disturbance, and loss of motivation, can be related to symptoms of depression.

His anxiety symptoms include feeling tense and having a racing heart, difficulty breathing, and jittery legs.

His interpersonal difficulties include being with people in his workspace and becoming emotionally detached from people he is intimate with.

Relevant assessment tools might include:

The DASS-21 scale is a widely used measure in Australia for measuring symptoms of depression, anxiety and stress (Crawford et al., 2011)

A systematic assessment of potential diagnoses can be performed using the Structured Clinical Interview for DSM-5 (SCID-5).

The Kessler Psychological Distress Scale (K10) is a simple evaluation tool for the measurement of the level of psychological distress and as an indicator of outcomes for prevalent mental health conditions.

Based on the case information, potential diagnoses for Alvin could include:

Major Depressive Disorder (MDD): Several of Alvins symptoms are indicated in MDD, such as depressed mood, lack of interest in all or almost all his activities, unplanned weight gain and loss, sleep disturbances and fatigue, and his inability to concentrate (American Psychiatric Association, 2013).

Generalized Anxiety Disorder (GAD): Signs of persistent worry and difficulty to relax are some of the mental symptoms Alvin shows in the study. Coupled with physical manifestations like a racing heart and dry mouth, they conform to the criteria for GAD (American Psychiatric Association, 2013).

Post-Traumatic Stress Disorder (PTSD): Although Alvin does not explicitly show signs of PTSD, his childhood experiences of bullying and emotional neglect can contribute to PTSD symptoms, which start to show through in his emotional detachment and his difficulties maintaining intimate relationships.

Admittedly, it is essential to note that these diagnoses would need to be confirmed with a full clinical assessment and that comorbidity is common in mental health presentations (Milton, 2012). The medical model practitioner would suggest a mix of pharmacological and psychological interventions. Depression and anxiety medications might be prescribed, such as Selective Serotonin Reuptake Inhibitor or SSRI, commonly used as a first line of treatment in Australia (Royal et al., College of Psychiatrists, 2015). Cognitive behaviour therapy (CBT) is also backed by solid evidence for treating both depression and anxiety (Australian et al., 2018).

This systematic and evidence-based approach must accommodate the intricate nature of Alvin's life experiences and the relational dimensions of his issues (Milton, 2012). If it does not, the complexity of Alvins life story will be reduced to a list of symptoms and diagnoses, which will preclude him from making sense of his experiences.

Part B

Person-centred Model Approach

As a person-centred psychotherapist in training, with knowledge and insights from attachment theory, trauma, and interpersonal neurobiology, I would have evaluated Alvins subjective experience, his relational patterns, and their effect on his current life circumstances.

If his behaviours were indicative of a disorder, I would question, instead, why he is responding to his life experiences in such a manner. His emotional detachment, lack of emotional history, and experiences of depression and heightened anxiety may be interpreted as coping mechanisms (Seigel, 2012) for his early encounters with bullying, emotional neglect, and cultural displacement.

Alvin's interactions with his cousin Joseph created an unpredictable living environment, likely resulting in a life characterized by uncertainty and apprehension and may have cultivated an insecure attachment style (Bowlby, 1988). His interactions with his aunt, who consistently disregarded his emotional needs, reinforced a pattern of emotional suppression and instilled self-doubt. Alvin's subsequent emotional expression and intimacy challenges may partially stem from these early relational experiences, and his cultural imperatives may have inhibited his ability to express gratitude and evade conflict.

Treatment Approach and Focus:

Treatment would focus on establishing a safe and accepting therapeutic relationship with Alvin, allowing him to begin exploring and expressing his bottled-up emotions. Alvins sense of self has been tarnished. The goal of treatment would be to help Alvin create a more integrated understanding of himself by improving his ability to regulate emotions, which could start helping him develop more secure attachment patterns (Seigel, 2012).

Key areas of focus would include:

Setting up a safe and trusting environment in the therapeutic relationship.

Patiently explore Alvin's early experiences and how they have contributed to his current functioning in his day-to-day activities.

Integrating dissociated aspects of Alvins experiences.

Building on Alvin's ability for self-reflection and mentalisation.

Investigating and re-evaluating his relational dynamics, potentially utilizing psychodynamic or cognitive-behavioural therapy techniques.

How I Would Be and Relate to Alvin:

In line with person-centred therapy principles, I will attempt to embody Rogers's (1957) valued core conditions: empathy, unconditional positive regard, and congruence. This would involve:

Without judgment, I actively listen to Alvins experience.

Validating his emotions and his experiences.

Showing up and connecting genuinely and authentically in our relationship interactions.

Helping Alvin gently challenge self-perceptions when necessary.

Relating to Alvin under these core conditions, I will also be paying close attention to the therapeutic relationship to explore Alvin's relational patterns and as an opportunity to help him with new relational experiences (Wallin, 2007).

Assessment Approach:

In a person-centred approach, assessments are more qualitative and continue during the therapeutic process, unlike in the medical model. Instead of diagnosing disorders, the focus is on understanding Alvins subjective experiences and relational patterns arising from his attachment history.

Assessment methods might include:

Obtaining his life history in detail, especially about early relationships and significant life events.

Continuous evaluation of Alvins current emotional experiences and relational patterns.

Examination of Alvins in-session behaviors and our developing therapeutic relationship.

Use of projective techniques or expressive arts to access less conscious material.

The Adult Attachment Interview (AAI) can be used to evaluate Alvin's attachment patterns (Hesse, 2008).

While formal diagnostic tools might not be the primary focus, some measures could be used to track progress and inform treatment, such as:

The Difficulties in Emotion Regulation Scale (DERS) to assess Alvin's emotion regulation capacities

Using The Reflective Functioning Questionnaire (RFQ) to measure mentalization abilities

Treatment Process:

The treatment process would likely involve the following phases:

Establishing safety and stability: The starting point would be to help Alvin build resources for emotion regulation and then to build trust. It might include psychoeducation about the effects that trauma and attachment have on the nervous system and the teaching of grounding techniques.

Processing early experiences: Once he becomes familiar with me, I will slowly help him touch, connect, and talk about the problematic and heavy emotions that affected his life. Alvin will determine the pace and readiness of this process based on his comfort level.

Integrating experiences: I would work with Alvin to help him build an empathetic view of his experiences by constructing a more graceful narrative of his life and creating a more fluid sense of self. Such techniques could include narrative therapy, cognitive behaviour therapy, or internal family systems therapy.

Developing new relational patterns: In time, the therapeutic relationship would serve Alvin as a secure base to experiment with new ways of relating within and outside therapy. One type of work would be slowly escalating emotional intimacy, inviting Alvin into a greater sense of closeness, tearing down the castle walls, and discovering his fears and defences around closeness.

Consolidation and future planning: While therapy would help stabilize Alvin, I would continue to work with him to help him maintain and build relationships but see him less frequently in hopes that he uses his relational and emotional skills himself without the guidance of therapy.

At every phase of this procedure, I will be attuned to Alvin's nervous system activation and apply principles from interpersonal neurobiology to inform these interventions. For example, when Alvin feels overwhelmed, we could employ co-regulation strategies to restore his window of tolerance (Siegel, 2012).

The person-centred model stands in striking contrast to the medical model in its emphasis on relational processes, subjectivity, and self-development, which are not included in symptom reduction. While the changes may take longer than a symptom-focused approach, the person-centred model deals with the underlying forces generating Alvins troubles, which may provide longer-lasting change.

Part C

Reflection on the Two Approaches

Alvin's Experience of Each Approach

Medical Model:

The medical model can provide Alvin with an initial sense of relief and validation. Putting a name and categorizing his diagnosis into a recognized and structured label can appeal to Alvins analytical mindset and give him a sense of relief and hope for a clear path forward.

However, due to his complex life experiences, Alvin may find this approach reductive. The focus may need to go further to address his relational difficulties or the effects of his cultural experiences. This could make Alvin feel that many parts of his story are not being validated or heard.

Person-centred/attachment-informed approach:

Alvin may initially perceive this methodology as unfamiliar and possibly uncomfortable, likely due to his habitual tendency to suppress his emotions in favour of logical problem-solving. Exploring emotions and early experiences might be too much for him.

However, in the long term, such a strategy might be liberating and fulfilling for Alvin because he will get the acknowledgment he needs. If he focused on the therapeutic relationship, he would get a new experience of emotional attunement and acceptance. It may constitute a practical way of helping Alvin develop a more 'joint' rather than divided sense of self, thereby enhancing his potential for emotional intimacy that will deal with his essential relational problem.

My Reaction to Each Approach

Medical Model:

As a psychotherapist trainee, I appreciate the systematic, empirical scientific approach to the medical model's approach to clients. It offers straightforward and reassuring guidelines for those treating complex diagnoses.

However, this approach can sometimes make things too simplistic and ignore contextual issues. The danger is in pathologizing normal human responses to difficult life situations and not permanently resolving the relational aspects of mental health.

Person-centred/attachment-informed approach:

This approach is closer to what aligns with my understanding of why humans are distressed and how they heal. It also allows for a more holistic view of the individual and emphasizes the healing power of the therapeutic relationship (Milton, 2012). It centers more on validating people's experiences and giving validation, value, and truth to their life stories.

This method would require a longer duration to establish a therapeutic relationship. Because clients can take time to navigate this approach, the therapist's skill set requires a high level of self-awareness, which can be demanding in its way.

Key Learnings:

Integration of approaches: I have learned that both methods have value and that combining them could lead to better care. For example, standardized measures from the medical model can supplement the more qualitative, person-centred approach.

Importance of context: The person-centred approach emphasizes understanding a person's symptoms within a cultural background and as a response to their life experiences.

Power of the therapeutic relationship: I have a deepened appreciation for the therapeutic relationship as a vehicle of change that arguably alone surpasses the application-specific techniques we are trained in applying.

Client-Led Process: The person-centred approach has reminded me that the client should lead and have the pace, as opposed to the practitioner imposing a predetermined treatment plan, unless when cases specifically require an immediate treatment plan.

Holistic view: I have come to view symptoms as adaptations or communications to be understood rather than problems to be fixed.

Moving forward, I plan to approach my work with clients with curiosity. I can build a trustworthy relationship by being curious and nonjudgmental about their experiences. I believe in fully accepting a person for who they are. Through this level of curiosity and open-mindedness, I plan to explore my clients life stories to create a balanced and structured assessment plan. The therapeutic relationship is the healing tool for the client, and paying close attention to this relationship will be a priority with my clients. I also believe that symptoms are not black and white but should be considered within the framework of the clients life experiences and cultural background. I can give my clients the best possible care by bringing together knowledge from various theoretical perspectives to work holistically with them and regularly reflecting on my reactions and biases with my supervisor and peers.

Examining Alvin's case study has increased my commitment to a holistic, person-centred approach while recognizing the value of structured, evidence-based interventions when necessary.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596Australian Psychological Society. (2018). Evidence-based psychological interventions in the treatment of mental disorders: A literature review (4th ed.). https://psychology.org.au/getmedia/23c6a11b-2600-4e19-9a1d-6ff9c2f26fae/evidence-based-psych-interventions.pdfBowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. Basic Books.

Crawford, J., Cayley, C., Lovibond, P. F., Wilson, P. H., & Hartley, C. (2011). Percentile norms and accompanying interval estimates from an Australian general adult population sample for self-report mood scales (BAI, BDI, CRSD, CES-D, DASS, DASS-21, STAI-X, STAI-Y, SRDS, and SRAS). Australian Psychologist, 46(1), 314. https://doi.org/10.1111/j.1742-9544.2010.00003.xHesse, E. (2008). The Adult Attachment Interview: Protocol, method of analysis, and empirical studies. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (2nd ed., pp. 552598). Guilford Press.

Milton, M. (Ed.). (2012). Diagnosis and beyond: Counselling psychology contributions to understanding human distress. PCCS Books.

Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21(2), 95103. https://doi.org/10.1037/h0045357Royal Australian and New Zealand College of Psychiatrists. (2015). Clinical practice guidelines for mood disorders. Australian & New Zealand Journal of Psychiatry, 49(12), 1087-1206. https://doi.org/10.1177/0004867415617657Siegel, D. J. (2012). The developing mind: How relationships and the brain interact to shape who we are (2nd ed.). Guilford Press.

Wallin, D. J. (2007). Attachment in psychotherapy. Guilford Press.

Webb, A. (2022). WELF7014: Case study of Alvin [Assessment 3 handout]. School of Social Sciences, Western Sydney University.

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Student Details

Full Name Jay David Singh

Student Number 2214 8882

Email Address 22148882@student.westernsydney.edu.auSubject & Assessment Details

Subject Code & Name WELF7014 (2nd Half 2024) Integrated Practices 2: Afflictions and Recovery

Assessment Number/Title A3 / Case Study Assessment

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