Joe Fuller Psychology
PSYCHOLOGICAL REPORT
Of
Joe Fuller
I. Introduction and Identifying Information
Intelligence of a person somehow defines him/her. Through intelligence, a person will know his capacities and abilities and where he is good at. It boosts someone’s self- esteem and improves the confidence he had in himself. If you’re intelligent, you can possibly do and deal with anything especially if you have a very brilliant mind. An intelligent person knows how to deal with people and accept their mistakes and imperfections. Intelligence adds confidence but overconfidence that leads to mistrust and hostility is another issue. Intelligence must also be balanced with the emotional quotient which everyone must work hard for. Such is not the case at hand. …show more content…
The patient is a male whose name is Joe. He lived in a lower middle- class neighborhood in a large, northeastern city. His father is a steamfitter and his mother is a home maker. He had 2 older brothers and a younger sister. When Joe was 11 years old, his grandmother started living with them. His grandmother is already invalid and is not already capable to take care of herself after Joe’s grandfather died. Joe was exceptionally bright student. Yet, he had several chaotic relationships with his family, friends and other people around him. Later on, he developed anxiety and panic attacks that made him consult to a doctor. Then the doctor referred him to go to a psychiatrist.
II. Background Information
History and Course of the Present Problem
The patient is described to be exceptionally bright and overconfident. He was admitted to a prestigious high school and college. He was an “A” student and often made jokes about people who “couldn’t make the grade.” Whenever a teacher made a mistake in class, Joe was always the first to laugh and make a side comment. He avoided group activities and issues with relationships. He couldn’t trust everyone and he was very suspicious. He liked to work alone over his projects because he always thought that people will steal his ideas. Joe would always think that he was the best and nobody could compete with him.
The patient had argued with a teacher about a grade and after that he heard one of his classmates say, “I don’t know why some people have to work so hard for everything”. Joe took this comment as an insult to his family so Joe decided to get revenge. So while this student is attending a basketball game, Joe found his car and poured sugar in his gas tank. Suddenly, he started experiencing panic attacks that resulted him to go for a check-up.
Current and Past Medical History
The patient went to a doctor because he wanted a treatment for his anxiety and panic attacks. He had palpitations, sensations of shortness of breath, chest pain and nausea or abdominal stress. But his panic attacks are not associated with agoraphobia. Joe felt that he had no mental disorder at all. The doctor prescribed him Tofranil, an anti-depressant. But Joe had more knowledge on how this drug affected neurological mechanisms than the doctor. The said treatment was unsuccessful because Joe did not think that he has a personality disorder. The doctor, which he named as Dr. Fein, did not have any prior knowledge that Joe might have a paranoid personality disorder. Joe was not open to his life and Dr. Fein should have considered the possibility that Joe has a paranoid personality disorder that is why he behaved the way he did. Right now, Joe’s panic attacks still continued.
Social History
Joe is said to be rude and arrogant. His first steady relationship is with Carla but then later on, Carla broke up with him. Joe wanted to get revenge. Since then, he became extremely suspicious of women’s intentions. One time, Joe made fun of a guy talking to his date at a party. Joe always finds chaos with others. He argued with a professor for receiving a B+ instead of an A. Joe began to date his future wife Ruth. He also got his first job working with a drug company.
Joe on his first job
This is an ideal position for Joe. But he was asked by his boss to stop his independent research. Joe behaved with hostility towards his co-workers. Because of this continuous attitude, Joe was asked to resign after 3 years.
Joe on his second job
Joe took a job working in a university. Joe didn’t like his new job. He was asked again to curtail his independent research. He was asked to work in a new employee and suspected he was a spy. Joe accused the university in trying to kill him with radiation in the laboratory. Later on, Joe was fired and he took another job which is driving a taxi cab.
Familial Relationship
According to the patient, his father is mentally ill and he believed that he was being disregarded by his family. He was estranged to his family and friends and he believes that “he had nothing”. As a middle child, he felt that he is being left out so he needs to step up in everything he must do. In an early age, he became hypersensitive to the evaluation of others and believed that the world is a hostile place persecuted for being different.
Later in his life, he married Ruth and they had a daughter. Their marital relationship has been putted on the rocks for a lot of times because of misunderstanding and Joe’s paranoia about his wife. Later on, Ruth recognized that Joe was overreacting to minor events. Joe then suggested that Ruth was a part of the conspiracy that people were trying to steal his ideas. After some years, Joe and Ruth divorced. Until now, he is still convinced that Ruth betrayed him.
Typical Problem
The patient’s life story stems up from his place in the family.
In an early age, he faced struggles that led him to become suspicious of the motives of people to him. Since he’s very intelligent, he assumes that he knows everything and people are trying to steal his ideas that led him to have poor relationships with others. He received a comment before that struck his ego and saw it as an insult, so he always wanted to have revenge with people. The patient thinks that he is the best and nobody can beat him. He developed anxiety and panic attacks, which is a manifestation of Paranoid Personality Disorder, but still he thinks that he is not ill and he is mentally …show more content…
stable.
A Misunderstanding of Some Sort
When Joe went to a psychiatrist whose name is Dr. Flein, he reported their for treatment of his anxiety and panic attacks. The doctor gave him an anti-depressant drug without considering the other manifestations in the personality of the patient. Dr. Flein just thought that it was only a simple anxiety disorder, but he never takes the regard to consider Paranoid Personality Disorder on Joe.
Anxiety and Panic attacks can be a contributing factor of his condition. But his paranoia must also been considered and gave him a proper intervention.
III. Abnormal Symptoms and Diagnosis Axis I Clinical Disorders The patient is said to be suffering from Panic Attacks. A Panic Attack is a discrete period in which there is the sudden onset of intense apprehension, fearfulness, or terror, often associated with feelings of impending doom. During these attacks, symptoms such as shortness of breath, palpitations, chest pain or discomfort, choking or smothering sensations, and fear of “going crazy” or losing control are present. Criteria for Panic Attack Note: A Panic Attack is not a codable disorder. A discrete period of iontense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes: 1. Palpitations, pounding heart, or accelerated heart rate 2. Sweating 3. Trembling or shaking 4. Sensations of shortness of breath or smothering 5. Feeling of choking 6. Chest pain or discomfort 7. Nausea or abdominal distress 8. Feeling dizzy, unsteady, lightheaded, or faint 9. Derealization (feelings of unreality) or depersonalization (being detached from oneself) 10. Fear of losing control or going crazy 11. Fear of dying 12. Paresthesias (numbness or tingling sensations) 13. Chills or hot flushes From the above mentioned criteria, the patient possessed four of them as he had earlier reported like having palpitations, sensations of shortness of breath, chest pain and nausea or abdominal stress. Joe only fall to the criteria of panic attacks because he doesn’t possess any manifestations that he has agoraphobia or any related panic/anxiety disorder. Axis II Personality Disorders and Mental Retardation The patient is said to be suffering from Paranoid Personality Disorder. DSM IV-TR code is 301.0. PPD is a pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: DSM IV-TR Criteria | Manifestations from Patient | (1) Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him/her | He couldn’t trust everyone and he was very suspicious. He thinks that others might hurt him and tries to deceive him in a way. He liked to work alone over his projects because he always thought that people will steal his ideas. | (2) Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates | In Joe’s second job, he was asked to work with an employee but then he thinks that the employee is a spy and he couldn’t trust him. | (3) Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her | During his first and second job, he always make an independent research and he doesn’t want to work with anyone. Reaching to the point, that the company is asking him to stop his independent research. | (4) Reads hidden demeaning or threatening meanings into benign remarks or events | | (5) Persistently bears grudges, i.e., is unforgiving of insults, injuries or slights | When Joe argued with a teacher about a grade, he heard his classmate commented something about him and he find it as an insult, so he took revenge by pouring sugar into the student’s gas tank. He also made fun of a guy talking to his date at a party. | (6) Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack | Joe accused the university in trying to kill him with radiation in the laboratory. | (7) Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner | Ruth (Joe’s wife) recognized that Joe was overreacting to minor events. Joe then suggested that Ruth was a part of the conspiracy that people were trying to steal his ideas. After some years, Joe and Ruth divorced. Until now, he is still convinced that Ruth betrayed him. He also became suspicious with woman’s intentions after him and Carla (his first girlfriend) broke up. | B. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With psychotic Features, or another Psychotic Disorder and is not due to the direct physiological effects of a general medical condition. Axis III General Medical Condition Since the patient’s condition is not relatively due to general medical condition, so the diagnosis is None. Axis IV Psychosocial and Environmental Problems Problems with the Primary Support Group The patient felt estrangement from his family. He seemed to be disregarded and was not given proper attention. He doesn’t have close relationships with his parents and other siblings that made him hypersensitive with the world. For him, he “had nothing”. Plus the fact that he had failed relationships and got divorced with his wife Ruth affected him.
Occupational Problems Joe lost two jobs. He liked his first job very much but he was asked to resign after three years. It also seems that he doesn’t have good social relationship with his co-workers and boss that result to his hostility towards them. Axis V Global Assessment of Functioning GAF is 60. There are moderate symptoms (e.g flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g no friends, conflicts with peers and co-workers). This is manifested when he had several panic attacks and his poor relationships with other people. IV. Recommendations and Prognosis for Intervention Recommendations for Intervention Medication Treatment for Panic attacks Medication can be used to temporarily control or reduce some of the symptoms of panic disorder. Medication is most effective when combined with other treatments, such as therapy and lifestyle changes, that address the underlying causes of panic disorder.
The medications used for panic attacks and panic disorder include: * Antidepressants. It takes several weeks before they begin to work, so you have to take them continuously, not just during a panic attack. * Benzodiazepines. These are anti-anxiety drugs that act very quickly (usually within 30 minutes to an hour). Taking them during a panic attack provides rapid relief of symptoms. However, benzodiazepines are highly addictive and have serious withdrawal symptoms, so they should be used with caution. * Anti-psychotic medication- such as thioridazine or haloperidol, may be appropriate if a patient decompensate into severe agitation or delusional thinking which may result in self-harm or harm to others. Psychotherapy It is likely that a therapy which emphasizes a simple supportive, client-centered approach will be most effective. Rapport-building with a person who has this disorder will be much more difficult than usual because of the paranoia associated with the disorder. Early termination, therefore, is common. As the therapy progresses, the patient will likely begin to trust the clinician more and more. The client then will likely begin disclosing some of his or her more bizarre paranoid ideation. The therapist must be careful to balance being objective in therapy and with regards to these thoughts, and of raising the suspicions of the client that he or she is not trusted. It is a difficult balance to maintain, even after a good working rapport has been established.
During times when the patient is acting upon his paranoid beliefs, the therapist's loyalties and trust may be called into question. Care must be used not to challenge the client too firmly or risk the individual leaving therapy permanently. Control issues should be dealt with in much a similar manner, with great care. Since the paranoid beliefs are delusion and not based in reality, arguing them from a rational point of view is useless. Challenging the beliefs is also likely to result in more frustration on both the part of the therapist and client, too.
Long-term prognosis for this disorder is not good. Individuals who suffer from this disorder often remain afflicted with prominent symptoms of it throughout their lifetime. It is not uncommon to see such people in day treatment programs or state hospitals. Other modalities, such as family or group therapy, are not recommended.
Cognitive Restructuring
In this stage, the identification and correction of mistaken thoughts that are related with the feelings of paranoia and depression are established. In this part of the therapy, the collaboration between the client and the therapist is imperative. This is to establish the usual erroneous ideas and beliefs and consequently change them into appropriate ones.
It is important to realize that individuals suffering from paranoia display misrepresented thoughts with themselves, their immediate environment and possibly what lies ahead in the future. What Joe thinks of these elements would be helpful in going against the said misrepresented thoughts. Similarly, individuals with paranoia are often constricted with reference to their movement. Their motion tends to be limited because of their doubts and fears regarding their environment. This then may trigger a cycle where, like in the case of Joe, he experienced unjustified suspicions and paranoia and suddenly panic attacks.
Behavioural Activation
This part of the therapy points to the rectifying the descent on which paranoia is implicating in the individual. This is done simply by providing positive reinforcement to the client. Such reinforcement may come in the form of rewarding activities and other encouraging words that would rectify the feelings of paranoia. It has been stated that in instances where the patients are paranoid, such as in the case of Joe, the daily tolls of living is increased exponentially. It is at this point that the therapist has to step up and pinpoint the specific strategies that should be taken in solving the predicament of the client.
Continuing Care as a Sustaining Mechanism
The final stage of the patient’s therapy will involve support and maintenance. He will see the health care provider on a scheduled regular basis to check his physical and psychological well being.
Prognosis and Summary
The long-term projection for people with paranoid personality disorder is bleak; people with this disorder tend to resist treatment.
Most patients experience predominant symptoms of the disorder for the duration of their lifetime and require consistent therapy. Without treatment this disorder will become chronic. PPD is not curable but it can be prevented given with proper interventions. The participation and the cooperation of the patient towards the treatment is highly needed. The outlook usually depends on whether the person is willing to accept help. Therapy and medications can reduce paranoia and limit its impact on the person's daily
functioning.
Besides attending therapy sessions, the patient must also take his medications for his panic attacks. If possible, the family can also be a part of helping Joe by motivating and supporting him in his therapy. The patient must learn to build lasting relationships with others and trust his counselor/doctor.
With enough tools and lots of motivation, the patient will have been given the opportunity to have better outlook in his life, one that paves the way for a better future for him and for his family.
Of
Joe Fuller
I. Introduction and Identifying Information
Intelligence of a person somehow defines him/her. Through intelligence, a person will know his capacities and abilities and where he is good at. It boosts someone’s self- esteem and improves the confidence he had in himself. If you’re intelligent, you can possibly do and deal with anything especially if you have a very brilliant mind. An intelligent person knows how to deal with people and accept their mistakes and imperfections. Intelligence adds confidence but overconfidence that leads to mistrust and hostility is another issue. Intelligence must also be balanced with the emotional quotient which everyone must work hard for. Such is not the case at hand. …show more content…
The patient is a male whose name is Joe. He lived in a lower middle- class neighborhood in a large, northeastern city. His father is a steamfitter and his mother is a home maker. He had 2 older brothers and a younger sister. When Joe was 11 years old, his grandmother started living with them. His grandmother is already invalid and is not already capable to take care of herself after Joe’s grandfather died. Joe was exceptionally bright student. Yet, he had several chaotic relationships with his family, friends and other people around him. Later on, he developed anxiety and panic attacks that made him consult to a doctor. Then the doctor referred him to go to a psychiatrist.
II. Background Information
History and Course of the Present Problem
The patient is described to be exceptionally bright and overconfident. He was admitted to a prestigious high school and college. He was an “A” student and often made jokes about people who “couldn’t make the grade.” Whenever a teacher made a mistake in class, Joe was always the first to laugh and make a side comment. He avoided group activities and issues with relationships. He couldn’t trust everyone and he was very suspicious. He liked to work alone over his projects because he always thought that people will steal his ideas. Joe would always think that he was the best and nobody could compete with him.
The patient had argued with a teacher about a grade and after that he heard one of his classmates say, “I don’t know why some people have to work so hard for everything”. Joe took this comment as an insult to his family so Joe decided to get revenge. So while this student is attending a basketball game, Joe found his car and poured sugar in his gas tank. Suddenly, he started experiencing panic attacks that resulted him to go for a check-up.
Current and Past Medical History
The patient went to a doctor because he wanted a treatment for his anxiety and panic attacks. He had palpitations, sensations of shortness of breath, chest pain and nausea or abdominal stress. But his panic attacks are not associated with agoraphobia. Joe felt that he had no mental disorder at all. The doctor prescribed him Tofranil, an anti-depressant. But Joe had more knowledge on how this drug affected neurological mechanisms than the doctor. The said treatment was unsuccessful because Joe did not think that he has a personality disorder. The doctor, which he named as Dr. Fein, did not have any prior knowledge that Joe might have a paranoid personality disorder. Joe was not open to his life and Dr. Fein should have considered the possibility that Joe has a paranoid personality disorder that is why he behaved the way he did. Right now, Joe’s panic attacks still continued.
Social History
Joe is said to be rude and arrogant. His first steady relationship is with Carla but then later on, Carla broke up with him. Joe wanted to get revenge. Since then, he became extremely suspicious of women’s intentions. One time, Joe made fun of a guy talking to his date at a party. Joe always finds chaos with others. He argued with a professor for receiving a B+ instead of an A. Joe began to date his future wife Ruth. He also got his first job working with a drug company.
Joe on his first job
This is an ideal position for Joe. But he was asked by his boss to stop his independent research. Joe behaved with hostility towards his co-workers. Because of this continuous attitude, Joe was asked to resign after 3 years.
Joe on his second job
Joe took a job working in a university. Joe didn’t like his new job. He was asked again to curtail his independent research. He was asked to work in a new employee and suspected he was a spy. Joe accused the university in trying to kill him with radiation in the laboratory. Later on, Joe was fired and he took another job which is driving a taxi cab.
Familial Relationship
According to the patient, his father is mentally ill and he believed that he was being disregarded by his family. He was estranged to his family and friends and he believes that “he had nothing”. As a middle child, he felt that he is being left out so he needs to step up in everything he must do. In an early age, he became hypersensitive to the evaluation of others and believed that the world is a hostile place persecuted for being different.
Later in his life, he married Ruth and they had a daughter. Their marital relationship has been putted on the rocks for a lot of times because of misunderstanding and Joe’s paranoia about his wife. Later on, Ruth recognized that Joe was overreacting to minor events. Joe then suggested that Ruth was a part of the conspiracy that people were trying to steal his ideas. After some years, Joe and Ruth divorced. Until now, he is still convinced that Ruth betrayed him.
Typical Problem
The patient’s life story stems up from his place in the family.
In an early age, he faced struggles that led him to become suspicious of the motives of people to him. Since he’s very intelligent, he assumes that he knows everything and people are trying to steal his ideas that led him to have poor relationships with others. He received a comment before that struck his ego and saw it as an insult, so he always wanted to have revenge with people. The patient thinks that he is the best and nobody can beat him. He developed anxiety and panic attacks, which is a manifestation of Paranoid Personality Disorder, but still he thinks that he is not ill and he is mentally …show more content…
stable.
A Misunderstanding of Some Sort
When Joe went to a psychiatrist whose name is Dr. Flein, he reported their for treatment of his anxiety and panic attacks. The doctor gave him an anti-depressant drug without considering the other manifestations in the personality of the patient. Dr. Flein just thought that it was only a simple anxiety disorder, but he never takes the regard to consider Paranoid Personality Disorder on Joe.
Anxiety and Panic attacks can be a contributing factor of his condition. But his paranoia must also been considered and gave him a proper intervention.
III. Abnormal Symptoms and Diagnosis Axis I Clinical Disorders The patient is said to be suffering from Panic Attacks. A Panic Attack is a discrete period in which there is the sudden onset of intense apprehension, fearfulness, or terror, often associated with feelings of impending doom. During these attacks, symptoms such as shortness of breath, palpitations, chest pain or discomfort, choking or smothering sensations, and fear of “going crazy” or losing control are present. Criteria for Panic Attack Note: A Panic Attack is not a codable disorder. A discrete period of iontense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes: 1. Palpitations, pounding heart, or accelerated heart rate 2. Sweating 3. Trembling or shaking 4. Sensations of shortness of breath or smothering 5. Feeling of choking 6. Chest pain or discomfort 7. Nausea or abdominal distress 8. Feeling dizzy, unsteady, lightheaded, or faint 9. Derealization (feelings of unreality) or depersonalization (being detached from oneself) 10. Fear of losing control or going crazy 11. Fear of dying 12. Paresthesias (numbness or tingling sensations) 13. Chills or hot flushes From the above mentioned criteria, the patient possessed four of them as he had earlier reported like having palpitations, sensations of shortness of breath, chest pain and nausea or abdominal stress. Joe only fall to the criteria of panic attacks because he doesn’t possess any manifestations that he has agoraphobia or any related panic/anxiety disorder. Axis II Personality Disorders and Mental Retardation The patient is said to be suffering from Paranoid Personality Disorder. DSM IV-TR code is 301.0. PPD is a pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: DSM IV-TR Criteria | Manifestations from Patient | (1) Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him/her | He couldn’t trust everyone and he was very suspicious. He thinks that others might hurt him and tries to deceive him in a way. He liked to work alone over his projects because he always thought that people will steal his ideas. | (2) Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates | In Joe’s second job, he was asked to work with an employee but then he thinks that the employee is a spy and he couldn’t trust him. | (3) Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her | During his first and second job, he always make an independent research and he doesn’t want to work with anyone. Reaching to the point, that the company is asking him to stop his independent research. | (4) Reads hidden demeaning or threatening meanings into benign remarks or events | | (5) Persistently bears grudges, i.e., is unforgiving of insults, injuries or slights | When Joe argued with a teacher about a grade, he heard his classmate commented something about him and he find it as an insult, so he took revenge by pouring sugar into the student’s gas tank. He also made fun of a guy talking to his date at a party. | (6) Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack | Joe accused the university in trying to kill him with radiation in the laboratory. | (7) Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner | Ruth (Joe’s wife) recognized that Joe was overreacting to minor events. Joe then suggested that Ruth was a part of the conspiracy that people were trying to steal his ideas. After some years, Joe and Ruth divorced. Until now, he is still convinced that Ruth betrayed him. He also became suspicious with woman’s intentions after him and Carla (his first girlfriend) broke up. | B. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With psychotic Features, or another Psychotic Disorder and is not due to the direct physiological effects of a general medical condition. Axis III General Medical Condition Since the patient’s condition is not relatively due to general medical condition, so the diagnosis is None. Axis IV Psychosocial and Environmental Problems Problems with the Primary Support Group The patient felt estrangement from his family. He seemed to be disregarded and was not given proper attention. He doesn’t have close relationships with his parents and other siblings that made him hypersensitive with the world. For him, he “had nothing”. Plus the fact that he had failed relationships and got divorced with his wife Ruth affected him.
Occupational Problems Joe lost two jobs. He liked his first job very much but he was asked to resign after three years. It also seems that he doesn’t have good social relationship with his co-workers and boss that result to his hostility towards them. Axis V Global Assessment of Functioning GAF is 60. There are moderate symptoms (e.g flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g no friends, conflicts with peers and co-workers). This is manifested when he had several panic attacks and his poor relationships with other people. IV. Recommendations and Prognosis for Intervention Recommendations for Intervention Medication Treatment for Panic attacks Medication can be used to temporarily control or reduce some of the symptoms of panic disorder. Medication is most effective when combined with other treatments, such as therapy and lifestyle changes, that address the underlying causes of panic disorder.
The medications used for panic attacks and panic disorder include: * Antidepressants. It takes several weeks before they begin to work, so you have to take them continuously, not just during a panic attack. * Benzodiazepines. These are anti-anxiety drugs that act very quickly (usually within 30 minutes to an hour). Taking them during a panic attack provides rapid relief of symptoms. However, benzodiazepines are highly addictive and have serious withdrawal symptoms, so they should be used with caution. * Anti-psychotic medication- such as thioridazine or haloperidol, may be appropriate if a patient decompensate into severe agitation or delusional thinking which may result in self-harm or harm to others. Psychotherapy It is likely that a therapy which emphasizes a simple supportive, client-centered approach will be most effective. Rapport-building with a person who has this disorder will be much more difficult than usual because of the paranoia associated with the disorder. Early termination, therefore, is common. As the therapy progresses, the patient will likely begin to trust the clinician more and more. The client then will likely begin disclosing some of his or her more bizarre paranoid ideation. The therapist must be careful to balance being objective in therapy and with regards to these thoughts, and of raising the suspicions of the client that he or she is not trusted. It is a difficult balance to maintain, even after a good working rapport has been established.
During times when the patient is acting upon his paranoid beliefs, the therapist's loyalties and trust may be called into question. Care must be used not to challenge the client too firmly or risk the individual leaving therapy permanently. Control issues should be dealt with in much a similar manner, with great care. Since the paranoid beliefs are delusion and not based in reality, arguing them from a rational point of view is useless. Challenging the beliefs is also likely to result in more frustration on both the part of the therapist and client, too.
Long-term prognosis for this disorder is not good. Individuals who suffer from this disorder often remain afflicted with prominent symptoms of it throughout their lifetime. It is not uncommon to see such people in day treatment programs or state hospitals. Other modalities, such as family or group therapy, are not recommended.
Cognitive Restructuring
In this stage, the identification and correction of mistaken thoughts that are related with the feelings of paranoia and depression are established. In this part of the therapy, the collaboration between the client and the therapist is imperative. This is to establish the usual erroneous ideas and beliefs and consequently change them into appropriate ones.
It is important to realize that individuals suffering from paranoia display misrepresented thoughts with themselves, their immediate environment and possibly what lies ahead in the future. What Joe thinks of these elements would be helpful in going against the said misrepresented thoughts. Similarly, individuals with paranoia are often constricted with reference to their movement. Their motion tends to be limited because of their doubts and fears regarding their environment. This then may trigger a cycle where, like in the case of Joe, he experienced unjustified suspicions and paranoia and suddenly panic attacks.
Behavioural Activation
This part of the therapy points to the rectifying the descent on which paranoia is implicating in the individual. This is done simply by providing positive reinforcement to the client. Such reinforcement may come in the form of rewarding activities and other encouraging words that would rectify the feelings of paranoia. It has been stated that in instances where the patients are paranoid, such as in the case of Joe, the daily tolls of living is increased exponentially. It is at this point that the therapist has to step up and pinpoint the specific strategies that should be taken in solving the predicament of the client.
Continuing Care as a Sustaining Mechanism
The final stage of the patient’s therapy will involve support and maintenance. He will see the health care provider on a scheduled regular basis to check his physical and psychological well being.
Prognosis and Summary
The long-term projection for people with paranoid personality disorder is bleak; people with this disorder tend to resist treatment.
Most patients experience predominant symptoms of the disorder for the duration of their lifetime and require consistent therapy. Without treatment this disorder will become chronic. PPD is not curable but it can be prevented given with proper interventions. The participation and the cooperation of the patient towards the treatment is highly needed. The outlook usually depends on whether the person is willing to accept help. Therapy and medications can reduce paranoia and limit its impact on the person's daily
functioning.
Besides attending therapy sessions, the patient must also take his medications for his panic attacks. If possible, the family can also be a part of helping Joe by motivating and supporting him in his therapy. The patient must learn to build lasting relationships with others and trust his counselor/doctor.
With enough tools and lots of motivation, the patient will have been given the opportunity to have better outlook in his life, one that paves the way for a better future for him and for his family.