NRNP 6645 Therapy for Clients With Personality Disorders

NRNP 6645 Therapy for Clients With Personality Disorders

DSM-V describes personality disorders as disorders that have an onset in adolescence or early adulthood characterized by an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture. The behaviors are pervasive and inflexible, stabilize over time, and lead to distress or impairment. The purpose of this paper is to describe antisocial personality disorder, its diagnostic criteria, therapeutic approach and modality, and how to maintain a therapeutic relationship.

DSM-V Description of Antisocial Personality Disorder

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Antisocial personality disorder (ASPD) is one of the cluster B personality disorders characterized by a pervasive pattern of disregarding or violating others’ rights that often begins in childhood or early adolescence continuing into adulthood. The individuals affected fail to express or show interest in the feelings of others, use deceit and manipulation, and are often referred to as psychopaths. DSM-V criteria for ASPD diagnosis include a set of seven behaviors where at least three of the symptoms must have begun by the age of 15 years to form criteria A of the diagnosis (Marzilli et al., 2021). The behaviors are characteristic of a pervasive pattern and they include deceitfulness, impulsivity, irritability and aggressiveness, failure to conform to social norms and lawful behaviors, disregard for the safety of self and others, irresponsibility, and lack of remorse. Lastly, criteria B of the diagnosis requires the individual to be at least 18 years while in criteria C there must be evidence of conduct disorder that began by the age of 15 years.

The most common conduct disorder behaviors seen in this disorder include aggression toward people and animals, destruction of property, deceitfulness or theft, or serious violation of rules. The risk factors for this disorder have been associated with a lack of parental warmth, emotional support, and behavioral control in the individual’s adolescent years(Marzilli et al., 2021). However, impulsivity and lack of empathy are the two common symptoms evident in adulthood. The disorder impacts the individual’s social life due to the dishonesty characterized byincreased manipulation and deceit. Lastly, the individuals may fail to maintain friendly and romantic relationships due to a lack of empathy, irresponsibility, and failure to conform to social norms.

Therapeutic Approach and Modality

I would use group therapy for the affected patients. Group therapy in ASPD helps reduce the sense of isolation while promoting togetherness in the persons affected. Cognitive-behavioral therapy (CBT) can be utilized in these sessions where the therapist helps individuals within the group to identify negative thought patterns that are impacting their behaviors or emotions (Morken et al., 2022). The therapist then aims to engage the group to identify solutions that can help solve various problems that face different individuals in the group. In addition, the therapists give several behavioral intervention options that aim to divert attention to positive aspects and help patients plan and provide a structure in their lives. The therapists may also help the individual patients identify negative thoughts and behaviors such as lack of empathy, irresponsibility, and impulsivity and their association with unpleasant emotions to others. Eventually, the therapy requires every patient to summarize what they have learned and how to mitigate future problems while providing togetherness as a group. Lastly, group therapy can form a basis for the formation of self-help groups that can provide continued support to the patients after the CBT sessions are completed.

Therapeutic Relationship in Psychiatry

The therapeutic relationship in psychiatry is bi-directional mainly built on trust, empathy, and confidentiality. The relationship aims to help the patient in attaining psychological well-being through the creation of a safe and understanding environment. While breaking the news to the patient about their diagnosis, it is crucial to engage the patient in a conversation where you as the therapist openly express empathy and compassion (El-Abidi et al., 2024). In addition, the nurse should ensure the patient trusts you while maintaining a non-judgmental space for the patient. The patient has to also feel safe to express his or her concerns regarding the diagnosis by asking questions regarding the disorder. As the therapist, you should also be open to responding to the questions asked by the patient and educate the patient on the diagnosis, how to cope with the diagnosis, and the available treatment modalities. Lastly, you should also engage the patient while choosing the appropriate treatment plan, schedule him for therapy sessions, and request him to visit the clinic for follow-up sessions.

On an individual level, sharing of diagnosis with the patient directly offers high levels of privacy while offering a personalized approach to the kind of treatment. As a result, a one-on-one therapeutic relationship is created with the therapist where the patient feels safe expressing themselves in an environment where feel all their problems will be addressed (Marmarosh et al., 2022). On the other hand, revealing the news in a family or group setting has some challenges in confidentiality. As a result, it is crucial to first educate the family and group on the importance of maintaining confidentiality and building a trusting relationship with the patient. Lastly, the nurse has to educate all the members on the disorder and how best they can support the patient.

Why the Supporting Sources are Considered Scholarly

Marzilli et al. (2021) is a scholarly source since it has been reviewed by the author’s peers before publication, meaning that it is peer-reviewed. Morken et al. (2022) is also peer-reviewed and has been written by authors with expertise in therapy. Marmarosh et al. (2022) is considered scholarly because it is written in a language that includes specialized terms related to psychotherapy. Lastly, El-Abidi et al. (2024) is scholarly because it is peer-reviewed, has a formal appearance, and written by authors with expertise in mental health.

Conclusion

Personality disorders often begin in late childhood and have detrimental effects later in adulthood. ASPD is a disorder that has a deleterious impact on the patient’s social functioning due to the impact of impulsiveness and lack of empathy. Group CBT has been a very beneficial tool in the management of ASPD. Therapists also have a role in maintaining a safe and trusting environment for their patients to promote a healthy relationship that promotes patient recovery.

References

El-Abidi, K., Moreno-Poyato, A. R., Cañabate-Ros, M., Garcia-Sanchez, J. A., Lluch-Canut, M. T., Muñoz-Ruoco, E., Pérez-Moreno, J. J., Pita-De-La-Vega, J., Puig-Llobet, M., Rubia-Ruiz, G., Santos-Pariente, C., Rodríguez López, A. M., Golmar, L. J., López, C. E., & Roldán-Merino, J. F. (2024). The therapeutic relationship from the perspective of patients and nurses in the first days of admission: A cross-sectional study in acute mental health units. International Journal of Mental Health Nursing, 33(1), 134-142. https://doi.org/10.1111/inm.13227

Marmarosh, C. L., Sandage, S., Wade, N., Captari, L. E., & Crabtree, S. (2022). New horizons in group psychotherapy research and practice from third wave positive psychology: A practice-friendly review. Research in Psychotherapy: Psychopathology, Process, and Outcome, 25(3). https://doi.org/10.4081/ripppo.2022.643

Marzilli, E., Cerniglia, L., & Cimino, S. (2021). Antisocial Personality Problems in Emerging Adulthood: The Role of Family Functioning, Impulsivity, and Empathy. Brain Sciences, 11(6). https://doi.org/10.3390/brainsci11060687

Morken, T. E., Øvrebø, M., Klippenberg, C., Morvik, T., & Gikling, E. L. (2022). Antisocial personality disorder in group therapy, kindling pro-sociality and mentalizing. Research in Psychotherapy : Psychopathology, Process, and Outcome, 25(3). https://doi.org/10.4081/ripppo.2022.649

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Therapy for Clients With Personality Disorders

Individuals with personality disorders often find it difficult to overcome the enduring patterns of thought and behavior that they have thus far experienced and functioned with in daily life. Even when patients are aware that personality-related issues are causing significant distress and functional impairment and are open to counseling, treatment can be challenging for both the patient and the therapist. For this Assignment, you examine specific personality disorders and consider therapeutic approaches you might use with clients.

Resources

 

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

Learning Resources

Required Readings

  • Links to an external site. (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787
    • “Culture and Psychiatric Diagnosis”
  • Paris, J. (2015). Psychotherapies
  • Links to an external site.. In A concise guide to personality disorders (pp. 119–135). American Psychological Association.
  • Wheeler, K. (Ed.). (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). Springer Publishing.
    • Chapter 18, “Dialectical Behavior Therapy for Complex Trauma”

Required Media

 

To prepare:

  • Review this week’s Learning Resources and reflect on the insights they provide about treating clients with personality disorders.
  • Select one of the personality disorders from the DSM-5-TR (e.g., paranoid, antisocial, narcissistic). Then, select a therapy modality (individual, family, or group) that you might use to treat a client with the disorder you selected.

The Assignment:

Succinctly, in 1–2 pages, address the following:

  • Briefly describe the personality disorder you selected, including the DSM-5-TR diagnostic criteria.
  • Explain a therapeutic approach and a modality you might use to treat a client presenting with this disorder. Explain why you selected the approach and modality, justifying their appropriateness.
  • Next, briefly explain what a therapeutic relationship is in psychiatry. Explain how you would share your diagnosis of this disorder with the client in order to avoid damaging the therapeutic relationship. Compare the differences in how you would share your diagnosis with an individual, a family, and in a group session.

Support your response with specific examples from this week’s Learning Resources and at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.

By Day 7

Submit your Assignment. Also attach and submit PDFs of the sources you used.

submission information

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.

  1. To submit your completed assignment, save your Assignment as WK10Assgn_LastName_Firstinitial
  2. Then, click on Start Assignment near the top of the page.
  3. Next, click on Upload File and select Submit Assignment for review.

 

Rubric

NRNP_6645_Week10_Assignment_Rubric

NRNP_6645_Week10_Assignment_Rubric

Criteria Ratings Pts
This criterion is linked to a Learning Outcome Succinctly, in 1–2 pages, address the following: • Briefly describe the personality disorder you selected, including the DSM-5-TR diagnostic criteria.
15 to >13.0 ptsExcellent 90%–100%

The response includes an accurate and concise description of the personality disorder, including the DSM-5-TR diagnostic criteria.

13 to >11.0 ptsGood 80%–89%

The response includes an accurate description of the personality disorder, including the DSM-5-TR diagnostic criteria.

11 to >10.0 ptsFair 70%–79%

The response includes a somewhat vague or inaccurate description of the personality disorder, including the DSM-5-TR diagnostic criteria.

10 to >0 ptsPoor 0%–69%

The response includes a vague or inaccurate description of the personality disorder, including the DSM-5-TR diagnostic criteria.

15 pts
This criterion is linked to a Learning Outcome • Explain a therapeutic approach and a modality you might use to treat a client presenting with this disorder. Explain why you selected the approach and modality, justifying their appropriateness.
25 to >22.0 ptsExcellent 90%–100%

The response includes an accurate and concise explanation of both a therapeutic approach and a modality that could be used to treat a client presenting with this disorder…. The response includes a concise explanation of why the approach and modality were selected, with strong justification for why they are appropriate for the disorder.

22 to >19.0 ptsGood 80%–89%

The response includes an accurate explanation of both a therapeutic approach and a modality that could be used to treat a client presenting with this disorder…. The response includes an explanation of why the approach and modality were selected, with adequate justification for why they are appropriate for the disorder.

19 to >17.0 ptsFair 70%–79%

The response includes a somewhat vague or inaccurate explanation of both a therapeutic approach and a modality that could be used to treat a client presenting with this disorder…. The response includes a vague or inaccurate explanation of why the approach and modality were selected, with a somewhat vague or inaccurate justification for why they are appropriate for the disorder.

17 to >0 ptsPoor 0%–69%

The response includes a vague or inaccurate explanation of a therapeutic approach and a modality that could be used to treat a client presenting with this disorder. Or, response is missing…. The response includes a vague or inaccurate explanation of why the approach and modality were selected, with poor justification for why they are appropriate for the disorder. Or, response is missing.

25 pts
This criterion is linked to a Learning Outcome • Briefly explain what a therapeutic relationship is in psychiatry. Explain how you would share your diagnosis of this disorder with the client in order to avoid damaging the therapeutic relationship. Compare the differences in how you would share your diagnosis with an individual, a family, and in a group session.
30 to >26.0 ptsExcellent 90%–100%

The response includes an accurate and concise explanation of the therapeutic relationship in psychiatry…. The response clearly and concisely explains an approach for sharing the disorder diagnosis to avoid damaging the therapeutic relationship, and how this approach would be similar or different in individual, family, and group sessions.

26 to >23.0 ptsGood 80%–89%

The response includes an accurate explanation of the therapeutic relationship in psychiatry…. The response adequately explains an approach for sharing the disorder diagnosis to avoid damaging the therapeutic relationship, and how this approach would be similar or different in individual, family, and group sessions.

23 to >20.0 ptsFair 70%–79%

The response includes a somewhat vague or incomplete explanation of the therapeutic relationship in psychiatry…. The response provides a somewhat vague or incomplete explanation of an approach for sharing the disorder diagnosis to avoid damaging the therapeutic relationship, and how this approach would be similar or different in individual, family, and group sessions.

20 to >0 ptsPoor 0%–69%

The response includes a vague and inaccurate explanation of the therapeutic relationship in psychiatry. Or, response is missing…. The response provides a vague or incomplete explanation of an approach for sharing the disorder diagnosis to avoid damaging the therapeutic relationship, and how this approach would be similar or different in individual, family, and group sessions. Or, response is missing.

30 pts
This criterion is linked to a Learning Outcome ·   Support your approach with specific examples from this week’s media and at least three peer-reviewed, evidence-based sources. PDFs are attached.
15 to >13.0 ptsExcellent 90%–100%

The response is supported by specific examples from this week’s media and at least three peer-reviewed, evidence-based sources from the literature that provide strong support for the rationale provided. PDFs are attached.

13 to >11.0 ptsGood 80%–89%

The response is supported by examples from this week’s media and three peer-reviewed, evidence-based sources from the literature that provide appropriate support for the rationale provided. PDFs are attached.

11 to >10.0 ptsFair 70%–79%

The response is supported by examples from this week’s media and two or three peer-reviewed, evidence-based sources from the literature. Examples and resources selected may provide only weak support for the rationale provided. PDFs may not be attached.

10 to >0 ptsPoor 0%–69%

The response is supported by vague or inaccurate examples from the week’s media and/or evidence from the literature, or is missing.

15 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.
5 to >4.0 ptsExcellent 90%–100%

Paragraphs and sentences follow writing standards for flow, continuity, and clarity…. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineates all required criteria.

4 to >3.5 ptsGood 80%–89%

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time…. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.

3.5 to >3.0 ptsFair 70%–79%

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time…. Purpose, introduction, and conclusion of the assignment are vague or off topic.

3 to >0 ptsPoor 0%–69%

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time…. No purpose statement, introduction, or conclusion were provided.

5 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation
5 to >4.0 ptsExcellent 90%–100%

Uses correct grammar, spelling, and punctuation with no errors.

4 to >3.5 ptsGood 80%–89%

Contains 1 or 2 grammar, spelling, and punctuation errors.

3.5 to >3.0 ptsFair 70%–79%

Contains 3 or 4 grammar, spelling, and punctuation errors.

3 to >0 ptsPoor 0%–69%

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

5 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.
5 to >4.0 ptsExcellent 90%–100%

Uses correct APA format with no errors.

4 to >3.5 ptsGood 80%–89%

Contains 1 or 2 APA format errors.

3.5 to >3.0 ptsFair 70%–79%

Contains 3 or 4 APA format errors.

3 to >0 ptsPoor 0%–69%

Contains many (≥ 5) APA format errors.

5 pts
Total Points: 100

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