/
The Truculent Client The Truculent Client

The Truculent Client - PowerPoint Presentation

phoebe-click
phoebe-click . @phoebe-click
Follow
396 views
Uploaded On 2016-07-31

The Truculent Client - PPT Presentation

Dr Michael J Scott michaeljscott1virginmediacom Fight or Flight In the new DSM 5 Criteria for PTSD Fight can b e a s i mportant a s Flight Whilst avoidance continues to be part of the symptom profile Fight is given increased recognition ID: 427078

cbt coping client anger coping cbt anger client skills ptsd trauma tfcbt truculent treatment therapist evidence stressor statements avoidance

Share:

Link:

Embed:

Download Presentation from below link

Download Presentation The PPT/PDF document "The Truculent Client" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.


Presentation Transcript

Slide1

The Truculent Client

Dr Michael J Scott

michaeljscott1@virginmedia.com

Slide2

‘Fight’ or ‘Flight’

Slide3

In the new DSM 5 Criteria for PTSD ‘Fight’ can b

e

a

s

important as ‘Flight’

Whilst avoidance continues to be part of the symptom profile, ‘Fight’ is given increased recognition.

Cluster E in DSM 5 refers, amongst other symptoms, to:

Irritable or aggressive behaviour

and

R

eckless or self-destructive behaviourSlide4

The Incongruence of Client and Therapist Agendas in Trauma Focussed CBT (TFCBT)Slide5

The Powder Keg of Cognitive Avoidance and Increased IrritabilitySlide6

A Vignette Of The Truculent Client

Therapist:

I’ve noticed that you keep looking at the door

Client:

I just want to go

Therapist:

Why is that?

Client:

You’ve got it all there in the notes, and you are asking me about it, haven’t you even bothered to read the records!Slide7

Preventing Derailment

Anger leads to therapist non-compliance with evidence based treatment protocols.

Barlow et al. 2013

Derailment can be prevented by:

Fidelity to a cognitive model of the disorder and

Flexibility in the use of evidence based treatment protocolsSlide8

A DSM 5 Based CBT Model of PTSD

CBT for Common Trauma Responses . London: Sage Publications.

Scott et al.

2012 Slide9

Intrusions in PTSD clients a

re

e

xperienced as unwanted

surprisesTreatment should focus on the management of surprises by the distillation of coping self-statements in 4 stages:

1. Preparing for the stressor

e.g

flashback

2. Encountering the stressor

3. Coping with feeling overwhelmed by the stressor

4. Review of coping effortsSlide10

Anger can be viewed as ineffective

c

oping with a state of terrified

s

urpriseIneffective Coping

A Preventative Function

A Restorative Function

Control Freak’

Disproportionate anger when startled

Avoidance of talking about the trauma

Slide11

Anger and avoidance can

a

lso be addressed using

coping self-statements1. Preparing

for

anger/ avoided situation

2. Encountering

the

anger / avoided situation

3. Coping

with feeling overwhelmed

4. Reflection

on copingSlide12

Psycho-education to prepare for stressors

Useful metaphors

The ‘dodgy alarm’, ’bubble’, ‘lemonade bottle without the top on’

Distress as inappropriately going back in the ‘

Tardis’ to the memory of the trauma and constructing a model of current threat from elements retrieved in this time machine. Focussing on using a different ‘construction kit’. Slide13

The use of coping Self-Statementsconstitutes a Non-Trauma Focussed CBT intervention that

i

s particularly

a

pt for‘The Truculent Client’Slide14

Coping Skills and the Truculent Client

A ‘coping skills’ approach:

Makes it easier to market ‘better ways of handling the flashbacks’ than TFCBT

Is an alternative for those who refuse TFCBTMay be a first step in facilitating TFCBTSlide15

The effectiveness of a Coping Skills approach to PTSD

Increasing evidence

that a coping skills approach to PTSD is effective

The Cochrane Collaboration. Chichester: John Wiley & Son Ltd.

Bisson

et al. 2009

A comparison of Coping Skills/CBT with Support/CBT found:

1. Lower dropout rate in the Coping Skills/CBT group (17%

cf

38%)

2. No difference in recovery between groups at end of treatment

3

. At follow up a significantly higher proportion of clients had recovered from PTSD in the Skills/CBT group (72%

cf

50%)

Psychological Medicine.

Epub

ahead of print. Bryant et al. 2013Slide16

Presentation available at:

michaeljscottptsd.com

Thank You