In this adjustment case study, I will review two storycorps recordings. The first recordings is that of a mother and daughter. The mother is facing the end of her life and discusses these issues with her daughter. In the second recording, a military veteran deals with the symptom of guilt associated with Post Traumatic Stress Disorder due to a military experience wherin many soldiers were killed. The veteran meets on storycorps with the wife of one of the men killed during the incident. Following a summary of these two cases, I discuss three evidence based strategies that may be used for treatment of these two individuals. I suggest Acceptance and Commitment Therapy and Prolonged Exposure therapy strategies for the veteran, and Dignity Therapy for the dying mother.
Two Cases
In Nearing Life’s End, A Mother Reflects On ‘The Most Important Thing I Did’ [Audio file]. 2016, May 6. Retrieved from http://www.npr.org/2016/05/06/476872164/nearing-lifes-end-a-mother-reflects-on-the-most-important-thing-i-did, Patricia Mishler was diagnosed with the terminal disease of ALS. Mishler now faces the end of her life. She says that she mourns the things that she can no longer do. She claims it is frustrating, but the situation has given her a different perspective on life. Things that used to be essential to her, she claims, are no longer important. Having children was the most important thing in life to her. She met with her daughter on storycorps and discussed her disease. She is not afraid to die, but is saddened to leave her two daughters behind. She would like to be remembered as a proud mother. Mishler faces the end of life which is her major adjustment issue. She appears to be addressing the situation appropriately, but it is likely that some difficult issues will arise before her actual death.
In For Decades, He Carried Guilt For Another Soldier’s Death [Audio file]. 2016, April 9. Retrieved from http://www.npr.org/2016/04/09/473536609/for-decades-he-carried-guilt-for-another-soldiers-death, Army Colonel David Taylor suffers from a major adjustment issue relating to an experience he had while serving in the Gulf War in 1991. Taylor had been plagued with guilt since the day in which thirty-five Americans were killed by friendly fire during a maneuver in which he was leading. Taylor felt as though he could have prevented the incident from occurring. He carried the guilt of this around for twenty-five years. On storycorps, he met with the wife of one of the soldiers killed that day. The woman told him that he did not need to carry the guilt around. Taylor said that he felt better after meeting with her. Taylor’s adjustment issue seems to be associated with Post Traumatic Stress Disorder. Carrying guilt inhibits an individual’s quality of life.
Evidence Based Strategies
Acceptance and Commitment Therapy (ACT) is one strategy that could be used to treat David Taylor. This form of therapy is evidence based and relies upon the theory of mindfulness. ACT is a mixture of cognitive and behavioral therapy. Values and consistent action if the focus. The patient is taught nonjudgmental acceptance of the experience and the present moment, commitment to change and mindfulness. The patient learns to stay present through the recognition of mind, body and emotional sensations. This therapy could assist Taylor in overcoming his guilt by teaching him to accept the past and move forward in life. As he noted in the meeting with the woman, this process has began for him, so a continuance with ACT will ultimately lead him into a satisfying life.
Prolonged Exposure Therapy (PE) is another strategy that could be utilized for Taylor. Studies have shown that carrying guilt for failing to prevent the death of a fellow soldier is linked to Post Traumatic Stress Disorder. This appears to be the adjustment issue Taylor has been experiencing. PE is a method of psychotherapy wherein the goal is to extinguish the fear and guilt and any related symptoms that the patient acquired during war. The therapy and treatment would include imaginal, situational and repeated exposure. The patient would recount the memory repeatedly, and partake in activities that he or she has avoided due to the traumatic experience. This would be repeated so as to show the patient that there is no longer any threat by the experiences. Cognitive and spiritual interventions are also implemented also to significantly reduce the patient’s guilt and shame.
For Mishler, Dignity Therapy is recommended. Dignity Therapy is a rather new evidence based treatment strategy used for individuals who are aware of their impending death. This therapy provides the patient with a more enhanced experience at the end of his or her life. I chose this method because it seems that storycorps is similar and was a benefit to Mishler. For her to continue to share her experience with dying, her positive nature will remain. Dignity Therapy consists of therapy in which the patient speaks about the things that matter most to them in life, just as Mishler did in the story. The conversations are recorded and transcribed so that the patient can give the recorded document to her loved ones when she passes. The therapist presents questions to the patient concerning recollections, hopes, wishes, life lessons and things she wants to be remembered for. The discussions target areas that will enhance the patients “sense of meaning, purpose, continued sense of self, and overall sense of dignity” .
References
Coyne, J. (2014, July 29). Is dying a mental health issue? Retrieved from Tell them your story: http://blogs.plos.org/mindthebrain/2014/07/29/dying-mental-health-issue/
Dewane, C. (2012). Acceptance and Commitment Therapy for Veterans with PTSD. Social Work Today, 12(3), 14. Retrieved from http://www.socialworktoday.com/archive/051412p14.shtml
Paul, L. A., Gros, D. F., Strachan, M., Worsham, G., Foa, E. B., & Aciemo, R. (2014). Prolonged Exposure for Guilt and Shame in a Veteran of Operation Iraqi Freedom. American Journal of Psychotherapy, 68(3), 277-286. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4260526/
Storycorps (2016). For Decades, He Carried Guilt For Another Soldier's Death [Recorded by D. Taylor]. [Audio file]. Retrieved from http://www.npr.org/2016/04/09/473536609/for-decades-he-carried-guilt-for-another-soldiers-death
Storycorps (2016). Nearing Life's End, A Mother On 'The Most Important Thing I Did' [Recorded by P. Mishler]. [Audio file]. Retrieved from http://www.npr.org/2016/05/06/476872164/nearing-lifes-end-a-mother-reflects-on-the-most-important-thing-i-did
