The Outcome of Behavioral Intervention with a Person Living with Schizophrenia Who Exhibited Medication Noncompliance: A Case Study

By Kanahara, Shunsuke | The International Journal of Behavioral Consultation and Therapy, Fall-Winter 2009 | Go to article overview

The Outcome of Behavioral Intervention with a Person Living with Schizophrenia Who Exhibited Medication Noncompliance: A Case Study


Kanahara, Shunsuke, The International Journal of Behavioral Consultation and Therapy


Introduction

A variety of multicultural issues in clinical settings have been studied and discussed and multicultural competence has become an important research area in the field of counseling psychology (Pope-Davis et al., 2002). One of the beliefs from the research is that if a client and a counselor do not match culturally, the sessions conducted between them can possibly have limitations (Sue, 1977). Besides, as concerned Flaskerud (1991), if a client suffers from a persistent mental illness, the limitations of multicultural counseling can be much greater.

Tim (assumed name) was a middle-aged single male immigrant from a South American country. He first became the client of a mental health agency in the United States during the 1990's for about half a year; his diagnosis was adjustment disorder with depressed mood. He was referred to the same agency again in the beginning of the 21st Century due to social withdrawal; his diagnosis was avoidant personality disorder. Within a year, he dropped out of treatment. Several years later, he became a psychiatric hospital patient with diagnoses of atypical depression and mixed (schizotypal and avoidant) personality disorders. Because of his tendencies to avoid going out in public and not to comply with taking his medications, the treatment did not last long. Tim's symptoms degenerated until his parents appealed to the above hospital for help. The parents claimed that Tim was withdrawn and had become uncontrollable. They could not get enough sleep since Tim was making loud noises every night. When they asked Tim to be quiet, he showed anger and pushed the parents occasionally. Tim refused to come to the hospital with them. The case was accepted and the author, a Japanese counselor, was assigned the case. The author soon made a home-visit and met with Tim. Although he declined the author's proposal that the author would visit him once a week, he agreed to an alternative proposal that the author would visit him once a month. His diagnoses were: (a) Axis I: schizophrenia, paranoid type, and (b) Axis II: deferred.

Client

Tim resided with his parents who were both in their seventies. Tim had sisters who were married and living outside of his home. He was born and raised in a South American country. As a child he was quiet; he tended to prefer reading books or doing homework rather than playing outside. His grades were very good. When he was a teenager, he became a little more outgoing; he played sports and made friends. He and his family left their country and immigrated into the United States. After immigration, he enrolled in college. Due to the onset of the mental illnesses, he dropped out a couple of years later. He periodically did temporary work before and during his college days. He had been unemployed for a long time and was receiving social welfare. He had no friends; the only social interaction he had was with his immediate family. However, as the deterioration of his mental stability progressed, he avoided communication even with them. Since he was depressed, unable to concentrate, and developing some memory problems, he read psychology books and did certain psychotherapeutic exercises without supervision. Then, he had a panic attack and was sent to a psychiatric hospital. The precise year that his mental illness had entered the active phase was unknown. He was able to speak English to some degree, but the English abilities of his parents were limited.

Tim was 6 feet tall and weighed approximately 200 pounds. He had not have a history of major physical diseases. He had not received a medical checkup in the last 20 years, so his health conditions at the time was unknown. He looked healthy. He had an appetite. In his college days, he used alcohol and cigarettes. However, he has never been a substance abuser.

Tim was disheveled. His affect was flat. He did not leave his home at all and usually stayed in his room. He slept in the daytime and was awake at night. …

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