Monday, August 27, 2018

Sleep Aids and Controversy




A controversial topic  I wanted to address deals with psychiatrists prescribing sleep aids where the primary symptom is not insomnia. Preston, O’Neal, and Talaga (2013) noted many kinds of sleep disturbances can be caused by other factors such as anxiety, depression, and other psychiatric disorders. The researchers explained since psychiatric disorders can impact sleep, the soundest approach would be to treat the primary disorder first rather than prescribe a sleep aid. For example, Aho, Pickett, and Hamill (2014) pointed out anxiety disorders are the most widespread mental health problems in the United States and represent more than one third of mental healthcare costs. In addition, anxiety disorders are often co-morbid with insomnia. Further, the researchers noted there is a connection between PTSD, panic disorder, and generalized anxiety disorder. Although this is so, often treatment might not address both conditions. I think this study underscores the importance of exploring co-occurring disorders in relation to insomnia and ensuring that both conditions are treated in order to achieve the best outcome for the client. 
 On the other hand, Waters, Chiu, Janca, Atkinson, and Ree (2015) noted research has demonstrated that interventions that treat symptoms of insomnia can also impact psychotic symptoms and functional outcomes. Study results indicated that individuals with schizophrenia prefer behavioral therapy to other sleep interventions such medication because they find it more empowering. Pharmacological therapies are regarded as beneficial in the management of sleep problems such as insomnia, but only in the short term. For example, the researchers explained among individuals with psychotic disorders, it is a priority clinically to address sleep problems such as insomnia. In their study, psychological and behavioral interventions such as the use of melatonin were viewed as beneficial adjuncts to pharmacotherapy and the study participants were eager to make their own choices about the therapies used. I think this study emphasizes the value of exploring the client’s preferences and taking a sounder approach in which clients are empowered, rather than just prescribing a sleep aid. 


                                                                    References 


Aho, K. M., Pickett, S. M., & Hamill, T. S. (2014). Cognitive behavioural therapy for anxiety disorders and insomnia: A commentary on future directions. The Cognitive Behaviour Therapist, 7doi:10.1017/S1754470X14000117 
Preston, J. D., O’Neal, J. H., & Talaga, M. C. (2013).Handbook of clinical psychopharmacology for therapists(7th ed.). Oakland, CA: New Harbinger Publications. 
Waters, F., Chiu, V. W., Janca, A., Atkinson, A., & Ree, M. (2015). Preferences for different insomnia treatment options in people with schizophrenia and related psychoses: A qualitative study. Frontiers In Psychology, 6 

Treatment methods for ADHD and ODD

Recently, I participated in a forum with my cohort in the PsyD in Clinical Psychology I am active in. The topic of the ineffectiveness of treatment methods for ADHD and ODD in children and adolescents is worth exploring to be sure. Ray (2018) noted ADHD incorporates two dimensions: inattention and hyperactivity as well as impulsivity. Children who exhibit hypersensitivity and impulsivity might also have conduct problems. The researcher explained that a single treatment cannot address other conditions that the individual suffers from. Pharmacological interventions might reduce impulsivity in individuals with ADHD. However, cognitive behavioral therapies might be more effective although it can take a longer amount of time. The researcher noted parent -child interaction therapy can also be helpful for children with both ADHD and other disorders. 


                                                                         References

Ray, W. J.   (2018).   Abnormal psychology/Case Studies in Abnormal Psychology.   (2nd ed.).   Thousand Oaks, 

 CA:   SAGE Publishing.  

Saturday, August 18, 2018

Theorist Karen Horney

This piece  will discuss the work of psychoanalyst, Karen Horney. In addition, the piece will explore Horney’s birth, childhood, education, as well as family issues of importance. Further, the details of her major theory related to her work will be discussed as well as my own understanding of the theory. The psychoanalyst's current status will be discussed and although she is deceased, how she continues to be an influence in psychology and feminism will be discussed.  Finally, a thorough summation of how Horney's  theory applies and can be used in my  work with my own patients. Essentially, the summation will represent   an application of the research and information collected and its application to my practice.

Karen Horney: Life
Henley (2018) explained Horney, nee Danielson was born in Hamburg, Germany in 1885. Rendon (2008) noted Horney passed away in 1952 after founding The American Institute for Psychoanalysis. According to, Sterling (2015),  Horney embraced three childhood wishes that included to become an actress, a doctor, and a wife and mother. Her father was sea captain and a Lutheran pastor who held fundamentalist views that embraced the idea that women were inferior to men as well as being a source of evil. The researcher noted that Horney had ambivalent feelings towards her father. On the one hand, she found his negative statements about her physical appearance and intelligence, abhorrent. However, on the other hand, she appreciated his wanderlust and the exposure to travel he provided by taking her along on seafaring trips to far flung destinations. The researcher explained that Horney’s father developed a reputation for having fits of anger and demonstrated it by throwing the Bible across the room at her mother. As a result, Horney began to experience both religion and authority as anathema. Early on, Horney aspired to become a physician but especially at age 12 when she was treated by one at her village. Horney’s mother supported Karen’s dream of being a physician bit her father opposed it wholeheartedly.  Despite her father’s discouragement, Horney started medical school at age 21 at Freiberg, Germany. A few years later, in 1909, she wed a lawyer, Oskar Horney and had three children. In 1913, she finished her medical training at the University of Berlin. She pursued psychoanalytic training the Berlin Psychoanalytic Institute while also in private practice from 1918 until 1932. In 1932, she was invited by analyst, Franz Alexander to join him in the United States and become an associate director of the Chicago Institute of Psychoanalysis which had been just founded at that time. In 1934, she settled in New York to train analysts at The New York Psychoanalytic Institute and also established a private practice. This moved entailed leaving her husband in Germany, divorcing, and taking her two children with her. Although she trained as a Freudian analyst, she eventually left the institute and founded her own organization, The American Institute for Psychoanalysis to promote her theories which differed to that of Freud’s. Rendon (2008) pointed it that Horney was instrumental in the emergence of radical movement against the psychoanalytic establishment of the time which came to be referred to a Neo-Freudian, or Culturalist.
Theory

Cohen (2001) noted that Honey was an early student of Freud and she was opposed to his theories about feminine development. Some believe she may have been the woman identified in his papers and labeled a dissident. Erkhardt (2005) noted that Horney questioned why Freud asserted that women felt inferior as a result of lacking a penis. Horney did not argue that penis envy did not exist but questioned whether it might be attributed to cultural and social factors instead. Smith (2007) explained that unlike Freud who viewed individuals as driven by the pleasure principle, Horney believed that the individual pursued a need for  emotional safety. She viewed powerful internal and external forces at the core of driving human behavior. Horney theorized that each individual has a unique universal inner power which is the fountain of the growth process. She termed this power or force, the real self and believed that each individual requires a combination of love, conflict, and frustration in order to develop in a healthy way. Horney asserted that if individuals cannot love the child or acknowledge the child’s uniqueness, the child will become alienated and as a result develop anxiety. In her work, Horney conceptualized the self as having three distinct aspects: real, ideal, and actual.  Smith (2007) noted that Horney asserted the real self cannot develop without a positive environment to nurture it. The ideal self emerges in response to anxiety produced in a chaotic or problematic environment.
Horney pointed out that the child becomes alienated when the caregivers cannot produce positive responses that engender growth. Smith (2007) explained the individual seeks then to handle feelings of isolation through fantasies of an idealized self in which a positive identity is present as well as emotional safety. Horney also theorized that the ideal self contains a counterpart, the despised self which fails to live up to expectations. Much of the loathing of the ideal self is targeted towards the actual self for not encompassing all it should be. Horney referred to this phenomenon as the “tyranny of the shoulds” (p. 59.)  According to Horney, the actual self represents a blend of strength and weakness as well as seeking for  strategies.
Horney also developed schemas for what she termed neurotic trends. Horney believed the neurotic trends are universal and consist of strategies that help the individual cope with life. Smith (2007) noted the first strategy is known as moving toward people and focuses on helplessness and compliance. For example, as Smith (2007) explained the individual seeks to be liked and accepted and thirsts after emotional safety. Quite often, as the researcher pointed out the individual must engage in self-sacrifice to gain approval. The second strategy, moving against people promotes isolation. It is a negative response to handling conflict as it impedes growth. Smith (2007) pointed out that Horney’s theory can be seen as compatible to attachment theory and self-psychology. The third strategy is moving away from people which speaks to the individuals need for independence but also tends to lead toward isolation. Morvey (1999)  noted that Horney’s theory centered around a belief that within the individual’s being there exists an inner essence which represents the source of growth (the real self) which in turn is linked to self-realization. She believed man’s quest and drive was towards self-realization and this movement was based upon evolutionary forces.
Horney’s approach to psychoanalysis was existential and phenomenological in nature. Ingram (2012) explained that Horney’s concept of basic anxiety could be described as unbearable to the extent that the child felt driven to act in order to relieve it and decrease the impending threat. Horney theorized that as the child made the interpersonal move she termed moving toward in which the child demonstrates dependency as the child considers this to be the most emotionally safe strategy. On the other hand, the child may engage in aggressive behavior, contempt, or controlling behavior. The child may also become detached in order to avoid conflict by moving away. Coolidge, Segal, Estegal, and Neuzil (2011) noted that Horney’s argument with Freud derived from his ideas about, “the driving forces in neuroses were largely instinctual in nature and thus the driving forces were confined not just to neurotic people, but all people” (p. 384).
My understanding of Horney’s theory continues to grow as I delve into the literature and i am particularly impressed with her focus on culture as being the aspect that contributes to the appropriate circumstances which in turn help cultivate the real self, as Horney termed it. Rendon (2008) noted that Horney theorized that we all come into the world with, “the quality of being real” (p. 160) and our potential coupled with the favorable circumstances help us to develop towards a real self. This assumes we are born with vulnerability and that favorable circumstances need to be provided by our culture. The researcher noted that Horney theorized that receiving acknowledgement and validation for essentially who we are is a critical component that is instrumental in shaping our character as well as allowing our self- image to be molded further.
Rendon (2008) Horney defined neurosis as having an aspect of fear and described it as assuming a sense of isolation and helplessness.
Further, she theorized that the process of self-realization was natural but that fear interfered with its flowering. I understand this to mean that divesting oneself of fear is an important step to take in embracing self-realization and allowing the real self to be cultivated and emerge. Horney (1958) explained that the concept of neuroses as a psychoanalytic construct was being viewed as the focal point of what she termed “psychic disorders” (p. 450). Horney further theoerized that these were part of character disturbances and asserted that symptoms of psychological distress emerged as a consequence of character traits that stood in conflict. She theorized that basic conflicts contributed to problems with character. She affirmed that rivalry was a powerful source of conflict.
For individuals enduring high psychological distress, the conflict would appear to be blown out of proportion. The behavior that ensued would be demonstrated by comparing self with others, often with those they had nothing in common with or who potentially could not have been their competitor. I understood these ideas to mean that conflict appeared to trigger a feeling of lack of self- worth in which the individual lost touch with reality and exaggerated the actual experience. Horney (1958) referred to, “the content of neurotic ambition” (p. 162) as the drive to not only be a success but to surpass the success of others. Horney asserted that ambitions were present in fantasies buried deep in the unconscious and sometimes  having the potential to come to the surface. The ambitions of the individual never come to assume a central role in their life but they impact the emotional lives of the individual. They begin to exhibit towards criticism and depression. When the ambitions are not realized, in their grandiosity, the individual experiences failure views the success of others as their personal failure as they become oppressed with a sense that they cannot measure up.
Horney analyzed feelings of inferiority deeply and asserted that these feelings constituted,” the most common psychic disorder of our time and culture” (p. 452). She pointed out as the individual cultivates a sense of inferiority, their self-worth diminishes and hostility and anxiety increases. The more demands a culture places on the individual impacts the level of psychological distress an individual experiences in life. Horney’s exploration of the impact of culture and neurosis appears to still be relevant today. I once heard a therapist talk about how she developed an approach called Rapid Transformation Therapy which consisted of using hypnotherapy to help condition clients in emphasizing their self-worth. She shared case studies of successful people including the very wealthy who benefited from working on strengthening their sense of self-worth.
We have only to examine the recent suicides of successful, billionaire designer, Kate Spade and broadcaster Anthony Bourdain to understand how deeply a lack of self-worth and a sense of hopelessness can be present in those who have not addressed their psychological distress.
Endler (1965) noted Horney viewed what she termed neurosis as a disturbance of the psyche driven by fears and defense mechanisms as well as a need to attempt “to find compromise solutions for conflicting tendencies” (p. 189).  Horney in like manner to Fromm and Sullivan, as Endler pointed out in terms of the development of behavior, did not accept biological drives were behind behavior.
Instead, Horney focused on the importance of interpersonal and cultural factors in the development of behavior.  Horney focused on four therapeutic goals in her work with clients. For example, she asserted the therapist should work towards producing change in the attitudes of the client that would help in the realization in the expression of, “ responsibility, inner independence, spontaneity of feeling and wholeheartedness” (Endler, 1965, p. 194).
In terms of the realization of responsibility, Endler (1965) noted the individual views him or herself  as a change agent and assumes self-responsibility and responsibility for others. The goal of realizing spontaneity refers to self-awareness and the expression of vitality. Interpersonal relationships nurtured by spontaneity take on the character of love and friendship. Inner independence implies the individual has the capacity to determine individual values and exhibit respect towards others.  Horney’s ideas are similar to that of Carl Rogers and humanistic in nature.The striving after wholeheartedness refers to being authentic and genuine in one’s life and work. This idea is similar to Carl Roger’s idea about genuineness as an important expression in the therapist toward the client. Endler (1965) pointed out that the four goals seem to be the opposite of externalization.
For example, spontaneity of feeling appears to be the polar opposite of rigidity and wholeheartedness of being conflicted. The researcher noted that eventually, Horney conceptualized self-realization as another key therapeutic goal.  In Horney’s view, the individual finds self-realization through the growth process. Endler (1965) noted Horney’s ideas stood in stark contrast to Freud’s views which were characterized as being pessimistic in nature. Horney embraced an optimisitc view in that she believed the human personality had the capacity towards change. Horney therorized that the reason for analyzing patients was not to gain insight but instead to change the patient’s attitude. This implies that a change in attitude will result in a change in behavior.
Horney focused on two mistaken approaches to psychotherapy that stood out to her. First, trying to understand the patient’s symptoms before focusing on the structure of the patient’s character and attempting to discover a link between the patient’s childhood experiences and their presenting problems. For Horney, focusing on the structure of the patient’s character was most important.
However, she also gathered data about the patient’s childhood experiences as she felt this information provided insight into the patient’s current problems.  In addition, Horney sought to understand the purpose of the patient’s neurotic attitudes and the impact on the patient’s behavior and interpersonal relationships. In her work with patients, Horney used interventions similar to that of Freud in order to bring unconscious material to the conscious level of awareness. For example, she made use of free association, and dream analysis and interpretation (Endler (1965). It appears Horney believed these approaches could help the patient tap into the unconscious so that she and the patient could explore the underlying meaning. This approach also reminds me of phenomenological psychotherapy in which the patient’s experiences and their meaning are the focus of the treatment.

            Karen Horney’s theory aligns well as I essentially use a person-centered approach in my work with marginalzed populations such as women with histories of incarceration as well as children who have endured trauma with parents who have been entangled with children services as a result of child neglect. I have found in my work with these clients adhering to Horney’s therapeutic goals particularly that of self-realization that can help my clients embrace change and the growth process as they move forward in their therapy. The population that I work with have been victimized by trauma and also have endured continue to endure the social problems associated with living in poverty. As such, they often experience a  sense of hopelessness and lack of direction.
Horney’s approach has been considered optimistic in nature in that it empowers individuals to to be autonomous once their inner conflcits and their impact have been explored.  Horney believed that life experiences were also therapeutic and that clients have the capacity to change their behavior once they undersand their inner turmoil and how it has impacted them.
Engaging in life and finding fulfillment in healthy experiences, Horney considered a form of therapy.  Horney  explained that individuals can thrive once their fears and anxieties have been alleviated. Applying these ideas to my practice would help engender trust as I work with my clients as encouraging autonomy and self-realization would allow my clients to access the wisdom within. I also believe a person-centred approach encourages the client to become an expert in their lives and destiny.  I also think that Horney valued gathering data about her patient’s childhoods to see if there was a connection with their presenting problems. This strategy is important in  my working with parents and children as often the therapist can discover inter-generational maladaptive patterns that interfere with healthy parenting.  I expect I can apply this exploration to help my client’s develop insight into how to reduce malaptive schemas with my guidance.

















References
A Mind of Her Own (Book Review). (1988). American Journal of Psychotherapy, 42(3), 479.


Cohen, M. (2001). The unknown karen horney: Essays on gender, culture, and psychoanalysis. The American Journal of Psychiatry, 158(11), 1941. Retrieved from http://proxy1.calsouthern.edu/login?url=https://search-proquest-com.proxy1.calsouthern.edu/docview/220470499?accountid=35183


Sterling, Marianne, H. E. (2005). Karen horney: A portrait. American Journal of Psychoanalysis, 65(2), 95-101. doi:http://dx.doi.org.proxy1.calsouthern.edu/10.1007/s11231-005-3620-6


Smith, W. B. (2007). Karen horney and psychotherapy in the 21st century. Clinical Social Work Journal, 35(1), 57-66. doi:http://dx.doi.org.proxy1.calsouthern.edu/10.1007/s10615-006-0060-6


Morvay, Z. (1999). Horney, zen, and the real self: Theoretical and historical connections. American Journal of Psychoanalysis, 59(1), 25-35. Retrieved from http://proxy1.calsouthern.edu/login?url=https://search-proquest-com.proxy1.calsouthern.edu/docview/204611603?accountid=35183


Ingram, D. H., M.D. (2012). Who was karen horney? Psychiatric Times, 29(3), 22-23. Retrieved from http://proxy1.calsouthern.edu/login?url=https://search-proquest-com.proxy1.calsouthern.edu/docview/1009297833?accountid=35183



Coolidge, F. L., Segal, D. L., Estey, A. J., & Neuzil, P. J. (2011). Preliminary psychometric properties of a measure of Karen Horney's Tridimensional theory in children and adolescents. Journal Of Clinical Psychology, 67(4), 383-390.


Rendon, M. (2008). The vicissitudes of affect in Horney's theory. International Forum Of Psychoanalysis, 17(3), 158-168.


Horney, K. (1958). Culture and Neurosis. In C. L. Stacey, M. DeMartino, C. L. Stacey, M. DeMartino (Eds.) , Understanding human motivation(pp. 449-457). Cleveland, OH, US: Howard Allen Publishers. doi:10.1037/11305-044


Endler, N. S. (1965). A behaviouristic interpretation of the psychotherapy system of Karen Horney. Canadian Psychologist/Psychologie Canadienne, 6a(2), 188-200. doi:10.1037/h0083071




- the last page should be a personal summation of how the theory applies and can be used in your personal practice or goal with your degree. This section of your paper must be a personal application of the research and information you gathered.  1
References
A Mind of Her Own (Book Review). (1988). American Journal of Psychotherapy42(3), 479.
Cohen, M. (2001). The unknown karen horney: Essays on gender, culture, and psychoanalysis. The American Journal of Psychiatry, 158(11), 1941. Retrieved from http://proxy1.calsouthern.edu/login?url=https://search-proquest-com.proxy1.calsouthern.edu/docview/220470499?accountid=35183
Sterling, Marianne, H. E. (2005). Karen horney: A portrait. American Journal of Psychoanalysis, 65(2), 95-101. doi:http://dx.doi.org.proxy1.calsouthern.edu/10.1007/s11231-005-3620-6
Smith, W. B. (2007). Karen horney and psychotherapy in the 21st century. Clinical Social Work Journal, 35(1), 57-66. doi:http://dx.doi.org.proxy1.calsouthern.edu/10.1007/s10615-006-0060-6
Morvay, Z. (1999). Horney, zen, and the real self: Theoretical and historical connections. American Journal of Psychoanalysis, 59(1), 25-35. Retrieved from http://proxy1.calsouthern.edu/login?url=https://search-proquest-com.proxy1.calsouthern.edu/docview/204611603?accountid=35183
Ingram, D. H., M.D. (2012). Who was karen horney? Psychiatric Times, 29(3), 22-23. Retrieved from http://proxy1.calsouthern.edu/login?url=https://search-proquest-com.proxy1.calsouthern.edu/docview/1009297833?accountid=35183
Coolidge, F. L., Segal, D. L., Estey, A. J., & Neuzil, P. J. (2011). Preliminary psychometric properties of a measure of Karen Horney's Tridimensional theory in children and adolescents. Journal Of Clinical Psychology67(4), 383-390.
Rendon, M. (2008). The vicissitudes of affect in Horney's theory. International Forum Of Psychoanalysis17(3), 158-168.
Horney, K. (1958). Culture and Neurosis. In C. L. Stacey, M. DeMartino, C. L. Stacey, M. DeMartino (Eds.) , Understanding human motivation(pp. 449-457). Cleveland, OH, US: Howard Allen Publishers. doi:10.1037/11305-044
Endler, N. S. (1965). A behaviouristic interpretation of the psychotherapy system of Karen Horney. Canadian Psychologist/Psychologie Canadienne6a(2), 188-200. doi:10.1037/h0083071

Contradicting What Your Body Tells You

Environmental and cultural influences make a strong impact. Recently, I was reading the work of Dr. Bessel Van der Kolk who specializes in trauma. One of the ideas that stood out to me related to how critical it is for individuals impacted by trauma, even childhood trauma, to engage in experiences that contradict what their bodies are telling them.
For example,if  I have a client who says he or she feels powerless and that powerlessness shows up as anxiety, if the client begins some sort of activity such as martial arts, this experience will strengthen their self efficacy, and will help build their confidence as well as empower them in that they will feel better about themselves. Now as I work with my clients, I try to explore their fears or what disempowering  messages they internalized in childhood so that I can help the client find experiences that can contradict all that.
One of my clients is feeling better as she embraces change. She endured childhood abuse and abandonment and as such developed some cognitive distortions. She will tell me when night comes, she experiences a feeling of paralysis as she believed once darkness falls, she must retire for the night and “disappear.” I encouraged her to plan activity when the sun sets such as taking a walk, or whatever she pleases to do.
Later,she reported she had been doing more rather than giving in and felt better. I do believe that embracing experiences  that help contradict what the body has internalized which usually results in maladaptive behavior, can be healing and transformative. 
 

Reflection on Personality Development


Reflection on Personality Development


I found the reading interesting in that Cervone and Pervin (2016)  observed that Freud’s theory of the mind encompasses the idea related to the body and mind being interrelated in the sense that the mind as an energy system, as Freud termed it, draws upon the body  to sustain its energies and vice versa. Both Freud and Erickson proposed  several stages of development.
For example, as the researchers noted, psychoanalytic theory  focused  on the impact of early events  in life as playing a significant role in the unfolding of personality development later in one’s life. On the other hand, Erickson placed emphasis on psychosocial aspects in addition to an instinctual focus towards personality development.
A great number of researchers have suggested the potential towards the growth process and development as encompassing the whole lifespan of an individual. As the researchers noted, development can follow varied trajectories. The case study  the researchers presented concerning the infant, Jenny who had endured abuse at the hand of her father and also had a weak attachment to her mother, serves to illustrate as the researchers asserted, that isolated  traumatic events appear to have less significance  than continual experiences that are more adaptive and consistent in nature.
For example, Jenny was eventually placed in a warm, loving environment. Hence, she became more responsive where previously she appeared to be sad and lethargic. While she still experienced difficulty in relating to her mother, her life had markedly improved and she began to demonstrate more adaptive behavior.
It is interesting to note that  Berk (2010) pointed out   since the 1960’s researchers  focused exclusively  on child development,  but eventually began exploring the process of development that explored  the whole life span. In their investigations, the researchers noticed social, physical, and mental changes.  






References 
Cervone, D. & Pervin, L.A. (2016). Personality theory and research. (13th ed.). New York , N.Y.: Wiley, John & Sons, Inc. 


Sleep Aids and Controversy

A controversial topic  I wanted to address deals with psychiatrists prescribing sleep aids where the primary symptom is not insomnia...