Paranoid Personality Disorder and Treatment :A Case Study Report
Category : Case Studies Samples, Health Psychology
The workplace, more often than not, tends to be the place most adults spend a bulk of their time. With the presence of deadlines, tough workloads, and stress, the workplace may well be the source of psychological disorders. This took place in the case of Brian. The depression and anger that he experienced after he was bypassed for promotion triggered his paranoid personality disorder. The following discussion shall analyse the case of Brian and provide a mode of treatment.
II. Assessment process
To begin with, the personality of Brian has been questioned by the company. He has questionable interpersonal skills. That is the very reason that he was bypassed. Consequently, this triggered the full blown paranoia on the part of Brian which similarly the reason that he assaulted one of his co-workers. The diagnosis on Brian fits the bill perfectly. The poor interpersonal skills are symptoms of paranoia along with the stubborn and belligerent nature of the client. Moreover, after some observation, the client appears to be rather overly attentive. He possesses some degree of delusions that he is being persecuted. In the same sense, these delusions are compounded by the fact that he holds grudges straightforwardly with animosity towards others.
The assault on the colleague is based on the delusions of Brian. It appears that he thought that the co-worker is a potential threat to himself. He may have thought that the co-worker is bound to exploit him or take advantage of him if he gives him a chance. The problem in this regard is that the accusations of Brian are apparently baseless. Despite this fact, the reaction of Brian should essentially trigger an immediate response from the management as the safety of the co-workers is at stake. Apparently, Brian is unstable because of the depression, anger, and paranoia.
III. Counselling theory
The appropriate counselling theory is cognitive-behavioural therapy. It focuses on the thinking patterns of the client. The maladaptive cognitive processes are espoused to recognise beliefs and their implications and to participate in tests to analyse their viewpoints. The said therapy centres on thought patterns that bring about misery and similarly on creating more adaptive and practical construal of events. These illusions are cared for by creating an appreciation of the type of evidence the individual employs to sustain the viewpoint and encouraging the client to realise the substantiation that may have been ignored that does not sustain the said point of view.
IV. Action planned
The cognitive behavioural therapy to be implemented in the case of Brian involves three major stages: cognitive restructuring and behavioural activation.
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 realise that individuals suffering from paranoia displays misrepresented thoughts with themselves, their immediate environment and possibly what lies ahead in the future. What Brian 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 Brian, depression came in first and consequent paranoia.
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 Brian, 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.
V. Legal and ethical issues
In this case, the therapist is bound by the standards of law and ethics. He must guarantee that all the activities in the treatment are authorised. It is also imperative that the client is disclosed of the information regarding the treatment. Like any relationship involving medical care, the therapist should inform the patient whether or not the treatment would be risky. The duty of care should always be espoused and should be the basis of the actual treatment. He should not take advantage of his position to unjustly enrich himself in the expense of the client. Confidentiality should also be taken into utmost consideration as the therapy will involve actual divulging of information that could be detrimental or unfavourable to the reputation of the client.
VI. Affective, cognitive and behavioural responses
One must recognise that in the case of Brian, the main trigger that made the paranoid disorder to materialise is the depression caused by the bypass of promotion. One of the affective responses of this paranoia due to depression is to protect the individual from the aggression of others. This is the cause of anger on the part of the client. In the same time, he increases his guard against others because of this paranoia.
Another effect of the paranoia is the social anxiety which Brian have experienced. This is the very reason why he was bypassed for promotion because he displays social retardation. The effect would be underachievement and the manifestation of idiosyncratic intentions of self-preservation. In addition to this response, the client also displayed significant difficulty in managing stress. This triggered the conflict with co-workers which culminated to the assault against a colleague.
Upon observation, other characteristics that have materialised on the part of the client are the reluctance to strike a settlement. He is belligerent and argumentative which is also compounded by deceit and frequent disloyalty. In any case, the level of maliciousness has aggravated on the part of the client. This is because he treats other individuals as possible adversaries.
VII. Wider systems of support and referral
As presented in the previous parts of this paper, the treatment for paranoia is behaviour therapy. Specifically, this therapy is aimed towards the lessening of the sensitivity of the client on minor criticisms and developing some level of social skills. To this end, it is anticipated that the progress would be rather slow as implied by the characteristics of the client indicated above. Those stated characteristics are basically not collaborative in nature. It is the intention of the therapy to sever any more possibility of such doubt and seclusion though certain activities like recreation and management of the individual’s anxiety. In doing so, the end is to change the behaviour of the client.
However, this would increase in effectiveness if the immediate relatives or the friends of the client chip in the process. The family members of the client must always be sympathetic and accommodating. The treatment of paranoia is rather protracted and requires loads of patience. Having the loved ones of the clients cooperate would do the trick. However, it is imperative that the relatives and loved ones should be informed of certain checkpoints in the process. They should refrain from feeding the paranoia of the client by carefully measuring their actions and spoken words.
The minor injustice that Brian experienced created a ripple effect that constituted essentially to paranoia. The discussions above have manifested the causes of paranoia and its effect in the individual. It is a breakdown of the important mental and emotional functions. These consequently affect the reasoning of the individual as well as the assigned meanings to his immediate environment. As a whole, the reasons for the manifestation of paranoia in an individual are diverse and shrouded with doubt. In any case the effects of such an illness are damaging. It causes delusions which may be harmful to the client and to the people in the immediate environment. This is what happened to Brian. The assault to the co-worker is the culmination of the pent up depression and anger compounded by the delusions of antagonism against the client. Thus, treating paranoia is not merely a means to help the individual but to make the environment and the persons interacting with the client free from harms way.
Davidson, R., Pizzagalli, D., Nitschke, J., Putnam, K. (2002) "Depression: Perspectives from Affective Neuroscience." Annual Review of Psychology. Page Number 545.
Dia, D. (2001) "Cognitive-Behavioral Therapy with a Six-Year-Old Boy with Separation Anxiety Disorder: A Case Study." Health and Social Work. 26(2), 125.
Kantor, M. (2004) Understanding Paranoia: A Guide for Professionals, Families, and Sufferers. Westport, CT: Praeger.
Marcote, D. (1997) "Treating Depression in Adolescence: A Review of the Effectiveness of Cognitive-Behavioral Treatments." Journal of Youth and Adolescence. 26(3), 237.
Margolese, S., Markiewicz, D., and Doyle, A. (2005) "Attachment to Parents, Best Friend, and Romantic Partner: Predicting Different Pathways to Depression in Adolescence." Journal of Youth and Adolescence. 34(6), 637.
McCarthy, J., Downes, E., and Sherman, C. (2008) "Looking Back at Adolescent Depression: A Qualitative Study." Journal of Mental Health Counseling. 30(1), 49.
Patten, C., Martin, J., Myers, M., Calfas, K., Williams, C. (1998) "Effectiveness of Cognitive-Behavioral Therapy for Smokers with Histories of Alcohol Dependence and Depression." Journal of Studies on Alcohol. 59(3), 327.
Whalen, J., and McKinney, R. (2007) "Panic Disorder: Characteristics, Etiology, Psychosocial Factors, and Treatment Considerations." Annals of the American Psychotherapy Association. 10(1), 12.