Case Study Reflection On Pathological Gambling

This reflective report is based on a case study. The main character of the case study is a 50 years old woman, Lin, who has married for 15 years with her husband, Geoff. Lin and Geoff have a 14 years old daughter. They both moved from Malaysia to Australia about 10 years ago. An interview has been taken with Lin and Geoff to have an initial assessment in terms of their physical and mental health conditions. This report will first demonstrate the reason for referral, present a brief psychosocial assessment of Lin’s situation. Issues associated with cross-culture in social work practice will be illustrated. It will demonstrate the nature of developing social work relationship. It shows the strength of the relationship that I built, and the skills based on theoretical framework in the therapy session will be outlined. Case Study Reflection On Pathological Gambling. This report will also provide a plan for future intervention.

Reason for referral

Lin was referred by court to participate the gambling counselling group as her life has been heavily affected by gambling issues. Lin has lost her job as a casual shop assistant, because she stole $5, 000 from the shop. Additionally, she lost her inheritance from her mother, which is about $20, 000 due to her gambling issues. Lin’s behaviour has been illustrated by Ellis et al. (2018) who pointed out that people with gambling disorders tend to engage in illegal behaviours and are more likely to be arrested compared with people without gambling disorders. The statistics have shown that 57% of people with gambling disorders have been reported to have illegal behaviours, and 23.9% have a history of arrest. In fact, people may also have high stress level as gambling disorders. They are more likely to suffer suicidality as engaging in illegal behaviours which is caused by distress from gambling disorders. Statistics also showed that gamblers who has arrest history have the tendency to suffer from anti-social behaviours and personality disorder. It is enough evidence to suggest that gambling issues and gambling-related behaviours have an association with the person’s psychosocial status. Therefore, in order to assist with Lin, it would be better to come up with a psychosocial assessment of Lin’s situation.

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Brief psychosocial assessment

Lin is depressed and anxious, which is derived from her unhappy marriage and her daughter who is skipping from school constantly. It appears that Lin and her husband have drifted apart as her husband occupied by his work. It means that her husband has spent a huge chunk of family into his work instead of looking after his family, especially their daughter. In fact, her daughter, Mary, has been reported that she is constantly skipping from school as distress from her household. She has showed a sign of addicting to social media as she does not have many friends and always isolate herself in the room to play computer or phone to attend social media. Lin as her mother has no idea how to improve the relationship with her husband and daughter in order to solve the existing issues. Sooner, she realized that only way for her to relieve from the stress is to play poker machines in order to temporarily escape from issues in her household. It also showed that Lin’s gambling disorders might have an association with her father as a gambler.Case Study Reflection On Pathological Gambling. Her father always took her to horse track to gamble, which might have huge impacts on her later behaviours. Lloyd et al. (2010) pointed out that three primary motives to drive individuals to participate in gambling including mood regulation, to obtain money and pleasure from gambling. It also shows that females are more likely to participate gambling in order to regulate mood instead of driving by other two primary motives in comparison to males. It is also applied to the age factor as well. It means that older people are tended to gamble in order to regulate their mood. It fits into Lin’s needs for enjoyment and escape from reality. It can be conceded as the most important elements to push Lin into gambling.

Cross – culture social work practice

With the development of globalization, there is an increasingly growing culture diversity in modern society. Consequently, it is one of the necessary essential qualities for counsellors to be aware and understand cultural sensitivity in multi-cultural environment. According to Vargas and Wilson (2011), social workers need to understand culture diversity implications to each individual including unique experience, religions, beliefs, norms, values, traditions in order to achieve the goal of expending clientele and foster the strengths of the professional relationships. In this case, Lin’s family moved from Malaysia around ten years ago. She has developed the pattern of pathological gambling in the last two years. It means that Lin’s Malaysian background should be considered as an important factor in the counselling process to provide feasible solution for her gambling problem.Case Study Reflection On Pathological Gambling.  Assessment needs to be completed by counsellor to measure the impacts of Lin’s transformation from well-established Asian cultures from past to current Australian culture. It can estimate the impacts of adapting new cultural environment in her gambling disorders. In addition, it also needs to value the meaning of marriage and gambling in Lin’s case and adjust the cultural difference in compassion to counsellor’s own culture in order to provide solution for Lin’s gambling issue.

Constantine and Ladany (2000) also illustrated that it is necessary to adjust the culture difference as the therapists’ own culture might have an impact on their relationship and work with cross-cultural clients. It implies that therapist’s own culture can cause choosing inappropriate techniques to approach client’s issue, conceptualize client’s behaviours, misunderstand the therapy structure and process with cross-cultural clients. Cultural self-awareness can be defined as a capacity of recognition and inspection of behaviours including cultural values, beliefs and perceptions, which is essential for the development of cultural competence. It is equipped with different lenses, which allows individuals to understand the intentions and motives of their acts. It can also play a role to provide practitioners a clear view of distinguished behaviours from different culture backgrounds or perspectives as an effective tool to adjust practitioner’s perspectives as required in order to improve performance in practise. Thus, there is more than enough evidence to suggest that cultural self-awareness plays an important role on social work practice. In fact, the majority of the practitioners find that cultural self-awareness is difficult to apply in practise as people tend to evaluate other culture in general, but rarely evaluate their own culture. Case Study Reflection On Pathological Gambling.

Nature of developing social work relationship

The nature of developing social work relationship is to create a safe environment where the clients feel safe to disclose their concerns. Particularly, it is significant impacts in which social work practitioners need to build an effective relationship with the involuntary clients. In fact, from social work practitioner’s view, the essence of good practice in complex work is to build up engaging relationships. It is emphasized the relationships, which develops strengths, provides creative solutions between practitioners and clients and has positive impacts of counselling process in practise. The good engaging relationships also provide opportunities to show warmth feeling and non-judgemental concerns between clients and social work practitioners. In this case, Lin felt guilty and embarrassed about what has happened. After Geoff was informed about Lin’s behaviours, he was acting angrily, and perceived that his family was letting him down. This negative reaction from Geoff also affects Lin’s mental status. She feels shamed about what has happened. Case Study Reflection On Pathological Gambling. This shame feeling from Lin can make her bottle up about herself and unwilling to participate in interventions that focus on her gambling issues. In order to overcome this, social workers need to efficiently build a constructive relationship to allow Lin to talk about her concerns, which enables practitioners have a better understanding of her situations and provide therapy to address the underlying issues. This is also the strength of the relationship that I built in the interview. I actively listened to her concerns and manage to understand the underlying issues under the what has happened while interacting with Lin. This patience and non-judgement approach could make Lin be more willing to open herself and provide customised therapy structure and process to fix her underlying issues.

Theoretical framework – Strength approach

The most effective method in the session is to listen actively to client’s story with full attention including the rhythms and patterns of those conservations. The aiming of actively listening is to find themes of hope and courage to reinforce them in therapy process. Strengths approach is to focus on listening actively and finding the signs of capacity and resourcefulness in client’s life instead of exploring issues and shortcomings. It means that social work practitioners should emphasize client’s capacities and existing strengths, which could lead to positive changes in the process of reinforcing and identifying the existing strengths based on strengths-oriented approach.Case Study Reflection On Pathological Gambling.  Strengths perspective approach is not only confined in identifying the strengths of individuals, it also tries to seek out the strengths within their formal and informal social cycles and networks. The strengths approach allows social workers to make use of the existing resources or strengths in individual and group level to address current underlying issues in sessions. Thus, I utilized these skills in the interview were based on strengths-based approach. I listened actively to Lin’s story and used open questions to lead her to find courage and hope to deal with her underlying issues in the session. In this session, I applied the strengths approach to identify and reinforce the existing strengths in Lin’s characters and her marriage, which could help her realized the existing strengths and reinforce the theme of hope and courage to deal with her current gambling issues. It means that it could lead to positive outcomes in the therapy sessions by revisiting and reinforcing her existing strengths.

Additionally, Lin has mentioned that her gambling issues could also have negative impacts on her daughters including skipping school and addicting to social media. Thus, Lin’s future intervention plan will be focused on Lin’s gambling disorder and its impact on her daughter’s rebellious behaviours.Future intervention Plan:In the future intervention plan, assessment will be taken place to measure Mary’s current situation from her biological, social and psychological aspects. After the assessment, she will be referred to other professionals in order to solve her issues, which is associated with issues in her household. Self- exclusion will be utilized to help Lin to tackle her gambling disorders. Self-exclusion involves extreme form of pre-commitment, which is to bar themselves from participate gambling games in one or more gambling venues voluntarily. It means that venue or authorised gaming staff can deny their requests to enter gambling venue. In fact, self-exclusion imposes risks on individuals as breaching this agreement can result in trespassing. Self-exclusion has been approved efficacy as helping participants to regain controls of their financial issues and relationship problems. It is also regarded as the beginning of recovery by many participates. This result is may related to social worker’s counselling skills in the initial interview. Case Study Reflection On Pathological Gambling.

Conclusion

Lin’s pathological gambling might be influenced by her father; however, it is highly associated with the stress from her intimate relationships. As a result, she needs to use gambling to regulate her mood and escape from the reality. It also leads to the gambling-related illegal behaviours such as theft. In order to deal with gambling disorder, it is necessary for social workers to actively listen to the clients and identify their strengths. Additionally, there is a need for social workers to build relationship with the clients to make them feel safe to take about their concerns, which in turn enhances the capacity of the workers to assess the clients. Culture as an important factor should be considered by practitioners while working with cross-cultural clients. Self-exclusion programme is provided as a solution to mitigate Lin’s gambling disorders.

It has been found that between 70 to ninety percent of adults gamble at some point in their life. (Ladoucer, 1991). These figures are from Canada but can be genralised to most developed civilisations. According to the DSM criteria pathological gambling is am impulse control disorder, which is displayed by a persistent and uncontrolled gambling, failure to stop gambling, feeling withdrawal symptoms and uneasiness when not aloud to take part in a gambling activity and finally increased gambling. (ref). The increased availability of gambling opportunities often makes this a hard condition to recover from, as well as increasing the amount of people suffering from pathological gambling(ref). Pathological gambling causes the obvious financial problems (ref), but like any other “addiction” it causes social problems as well (ref). Along with this pathological gambling has been linked in some cases to higher rates of suicide attempts (ref).

Pathological gambling is classified as a behavioural addiction, rather than a chemical addiction. Although seemingly different these both manifest in the same way, that is “the enduring engagement in uncontrolled self-destructive behaviour, despite its negative consequences” (ref).

There are many different theories of behavioural addiction, in particular pathological gambling and how it should be treated, which will be critically reviewed and considered.

It would seem that in the seemingly distant past psychodynamic approaches such as those put forward by Freud and Bergler were prevalent. Since then many approaches and theories to the causes of pathological gambling have been found, these models include; the medical model, some behavioural models, psychological models, cognitive behavioural approaches and of coarse biological, physiological and models of personality. Case Study Reflection On Pathological Gambling. Some of these models are reviewed and considered in greater depth.

To start with psychodynamic approaches will be looked at. As is commonly known amongst academic community, these approaches are relatively old, mostly carried out in the early 1900’s. Due to the age of these theories and the pace at which theories are changed these psychodynamic approaches may seem quite irrelevant. It is important to gain an understanding of this area as some theories take a basis from psychodynamic approaches. According to the psychodynamic approach, gambling is a way of expressing feelings connected with the pre-genital psychosexual stages (Greenson). In true psychodynamic style pathological gamblers often feel that they have been denied the attention and love they deserved from their parents and as a result need erotic satisfaction, which in tern seems to create a need for excitement and pleasure, as well as a “promise of gain.” According to psychodynamic theories gambling caters for these needs (Simmel 1920). So in a nut shell gambling is a substitute for feelings of subconscious sexual conflicts. Arguably the founder of psychodynamics, Freud (1928), reported that gamblers do not play to win money, quite the opposite. In fact Freud states that gamblers gamble to loose in order to provide a self-inflicted punishment for the guilt carried with an over compulsion to masturbate, which can be related to an Oedipal conflict. This idea put forward by Freud seems quite masochistic, in the way that that the gambler is actually taking part to loose and there for punish themselves. Bergler (1967) agreed with Freud in the respect that a gambler unconsciously desires to lose. Bergler had a different opinion on why compulsive gamblers get addicted. This is that in their unconscious they dislike authority figures, who during childhood, made them consider the “reality pleasure” instead of the “pleasure principle.” These could be parental figures or teachers. This unconscious feeling causes them to try and almost rebel against the people who support the “reality principle” as well as he principle it’s self, this in turn causes a need to punish themselves as a bi-product of having too much built up unconscious aggression.

So far only the very surface of the psychodynamic approach towards pathological gambling has been looked at. In summary according to the psychodynamic approach there seems to be three ideas to explain pathological gambling “an unconscious substitute for pre-genital libidinal and aggressive outlets associated with Oedipal conflicts,” a desire “for punishment in reaction to the guilt,” and a means for recurrent “re-enactments, but not resolutions, of the conflict” (Allcock, 1986, p. 262). So these being the main ideas a treatment plan can be called upon. Case Study Reflection On Pathological Gambling.

Treatments of pathological gamblers offered by the psychodynamic approach are concerned with the narcissistic personality and the related characteristics. Psychoanalysis has been used in an attempt to try and help pathological gamblers, but in most cases have failed. Bergler’s (1957) study is one of the more classic studies and showed a 75% rate of success. This though was only based on 30% of the overall group looking for treatment, meaning that it was in fact a lot lower than 75%. Another issue is the lack of follow up treatment given, with no information given about possible relapses. This is not the only study where this is the case. In a review Greenberg (1980) stated “Effectiveness rates of gamblers treated psychoanalytically have ranked from poor to guarded optimism.” This simply means that results are not very good or are shadowed by other factors, such as selection bias and lack of follow ups. It would seem that a lot of the studies and journals available to view for the psychodynamic approach deal with small sample sizes and do not have important experimental factors, such as control groups. This causes problems with generalisability and also shows why the psychodynamic approach was disregarded as a treatment for behavioural conditions, this coupled with their lack of consideration for social factors.

The next theory that will be looked at is the disease or medical model. This is often seen as a very black and white model (Blume, 1987), meaning that it’s ether on or off, someone either has a condition or they don’t, there is no in-between. Every condition is viewed as a disease. So in terms of pathological gambling, the gambler is pathological or quite simply is not. The disease model, as the name suggests, views pathological gambling as a disease and so the cause is physiological, and pathological gamblers are often predisposed. According to Blume, being a disease, addictive conditions, such as gambling, manifests through stages of development, has signs characteristic to the condition and has symptoms, much like a disease. This is all out of the person’s conscious control, not so different to the psychodynamic ideas.

This concept of a disease suggest that the condition worsens, which will eventually require treatment in order to prevent worsening. It is thought that the physiological underpinning means that there is no out right cure and that it is irreversible. This means that according to the disease model that the most appropriate treatment is abstinence, similar to that of alcohol (ref). This seems like an odd treatment, as it would suggests that there is in fact no real way of recovering, just a treatment.

This model is not used so much now(refbig paper), but is more of a halfway house with other theories, such as the biological explanations of pathological gambling.

The biological approach to pathological gambling is, in relative terms a rather new theory. Case Study Reflection On Pathological Gambling. It is made up of many components to try and explain different aspects of pathological gambling. These all make the same assumption that a physiological cause is behind addiction, much like both the psychodynamic and the disease model.

The first aspect with in the biological approach to be considered is that of hemispheric dysregulation (Goldstein et al, 1985). By comparing EEG patterns of recovered pathological gamblers, Goldstein observe that pathological gambler’s EEG readings where similar to those of patients suffering with ADHD (Carlton and Goldstein, 1987). This means that they had a shorter attention span, frontal lobe lesions. This is also very similar to findings of alcoholism which have also led to more reported symptoms of ADHD symptoms with in the population of problem gamblers (Rugle and Melamed, 1993). This all seems very convincing, but the original 1985 study by Goldstein was only carried out on eight participants, such a small study provides problems with generalisability.

Other suggestions are that it is connected to faults in the neurotransmitter systems (Blanco et al, 2000). This includes the Serotoneric system, which as the name suggests holds the function of serotonin release. If this is not functioning, to a healthy level, then psychiatric syndromes, such as impaired impulse control, can become present. This has been linked with pathological gambling (Blanco et al, 1996). Later research by Berg et al (1997) failed to support these findings, stating in the following wel used quote, “risk-taking does not have a unitary neurochemical correlate. If risk-taking is a form of loss of control over impulse, it follows that impulse control is not merely a simple function of the neural serotonin systems.” (p.475).

Links have also be found in DNA, supporting the biological idea Perez de Castro (1999). According to Brunner et al (1993) these is a link between genetic deficit coding and impulsivity, possibly providing a good explanation.

The increased release of Dopamine has also been linked to pathological gambling (Berg et al 2007), this is much like a positive reinforcement. It can though also be linked to a negative inforcment, with more gambling causing a withdrawal, which creates the release of more dopamine, not unlike that of an opiate withdrawal (Berg, 1997). Case Study Reflection On Pathological Gambling.

The evidence for the biological approach seems quite strong. There is a few outstanding issues that need to be looked at. For example almost all of the above studies use male participants. This creates an issue as whether they can be used with women. The samples are also very small in most cases. The main problem that can be observed in all the studies in this area is whether the biological processes cause the addiction of the addiction it’s self, causes these biological processes.

So as can be seen the medical/disease model and the biological model are both very similar but can be separated in the way that the biological model believes that pathological gambling can be treated with certain drugs.

So far all models, with the exception of psychodynamic, have been based on biological internal processes. The cognitive social learning and behavioural theories are based on external and behavioural processes. The learning theories suggest that gambling is a learned behaviour that has resulted from both operant and classical conditioning. According to the behavioural view point there are a mixture of different positive reinforcement these are, the amount of money that is won (Moran, 1979), excitement gained (Brown, 1986). Obviously there are also negative reinforcement, namely the escapism that gambling can produce (Diskin, 1997). Some how though theses models don’t seem complete. They can not explain punishments, like the cost of gambling, as discouraging to the gambler, which using a classic behavioural model it would be.

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Despite this, studies into using behavioural theories of addiction as treatment have been very successful. Case Study Reflection On Pathological Gambling.

Behavioral treatment studies have, however, provided some of the most comprehensive treatment literature on PG. Treatments based on learning principles (i.e., behavior modification) have involved aversion therapy using physical or imaginal stimuli (Barker; Barker and Goorney), controlled gambling/behavioral counseling (Dickerson & Weeks, 1979), positive reinforcement of gambling abstinence, paradoxical intention (Victor & Krug, 1967), covert sensitization (Bannister and Cotler), and imaginal desensitization (McConaghy, Armstrong, Blaszczynski, & Allcock, 1983). These have been administered singularly or in combination. However, due to methodological shortcomings in such studies, it is difficult to assess how effective these treatments are. Most of these treatment studies have small sample sizes and limited follow-up periods. They have unspecified or poorly operationalized dependent variables/criteria for successful outcome or treatment objectives (Allcock, 1986). Also, there is usually a lack of controlled comparisons of one treatment with another or with a placebo procedure, or combinations of several techniques are used concurrently so that identification of the active component is impossible (Blaszczynski & Silove, 1995). Case Study Reflection On Pathological Gambling.