Problems often seem pregnant, with active and intrusive parents who do not seem to leave them alone.
This is an insight that I gained earlier this week during a counseling session at Roseland Christian Ministries where, as a counseling intern with Olive Branch Counseling Assoiates, I provide counseling services to members of the community. That insight was also supported when I reflected on sessions that I have conducted at my internship head office in Tinley Park. I admit that this could seem to the reader as somewhat of an odd metaphor; something that may even be off-putting. I understand. You may ask, where is this going? Let me explain further. In fact, I will call in some help.
According to Zambrano-Vazquez et al (2017:679), “Comorbidity in diagnosis raises critical challenges for psychological assessment and treatment.” In fact, the prevenance of comorbidity and the need to effectively address it in treatment is so important that in 2010, the National Institute of Mental Health (NIMH) identified the need for a paradigm shift and developed the Research Domain Criteria (RDoC) project to the rescue (Insel et. al, 2010, 2010). They indicated, “Throughout medicine, disorders once considered unitary based on clinical presentation have been shown to be heterogeneous by laboratory tests—e.g., destruction of islet cells versus insulin resistance in distinct forms of diabetes mellitus” (Insel et. al, 2010: 748). This is in part the metaphor of pregnancy; a presenting problem that appears to be singular on the outside but may more accurately be as characterized as multiple based on what is on the inside.
Insel et. al (2010: 748) argued further, “[H]istory also shows that syndromes appearing clinically distinct may result from the same etiology, as in the diverse clinical presentations following syphilis or a range of streptococcus related disorders.” This aligns with my metaphor of having intrusive parents.
One may ask, what does this have to do with mental health counseling? Here it is: “NIMH hopes that the scientific and clinical communities will recognize the importance of joining in constructive dialogue on efforts aiming to accelerate the pace of new clinical discoveries and improve clinical outcomes” (Insel et. al, 2010: 748). Other researchers (Coleman et. al 2022: 1) further simplify the intentions of the RDoC as one, “which advocates characterizing psychiatric conditions in terms of underlying biological and psychological processes rather than groups of symptoms.”
The question is, in our own counseling interactions, to what extent do we recognize the RDoC approach to addressing comorbidity in assessment, treatment planning, and evaluating outcomes? For instance, how has the RDoC approach been used to better understand comorbidity in posttraumatic stress disorder (PTSD) and substance use disorder (SUD), or other combinations of interest to you? The idea of the RDoC is to move away from general broad diagnosis categories and search for specific functional mechanisms that link behavioral outcomes to neurological, environmental, cognitive, and other relatively unidimensional constructs that are hierarchically arranged by domains.
In a future blog, I will seek to further unpack what that really means by demonstrating some recent findings in empirical research. For now, I ask you to ponder on the extent to which this metaphor of pregnancy and parenthood of problems makes sense to you. The idea is that when you become aware of a presenting problem, if you examine it further, there will most likely be at least one more little problem on the inside, and one or more bigger problems on the outside. Makes sense?
Now, when realized, what strategies do you employ in response?
Written By: Peter K. B. St. Jean, Intern 2022
Coleman, S. R. M., Oliver, A. C., Klemperer, E. M., DeSarno, M. J., Atwood, G. S., & Higgins, S. T. (2022). Delay Discounting and Narcissism: A Meta-Analysis With Implications for Narcissistic Personality Disorder. Personality Disorders: Theory, Research, and Treatment. Advance online publication. http://dx.doi.org/10.1037/per0000528
Insel, T., Cuthbert, B., Garvey, M., Heinssen, R., Pine, D. S., Quinn, K., . . . Wang, P. (2010). Research Domain Criteria (RDoC): Toward a new classification framework for research on mental disorders. The American Journal of Psychiatry, 167, 748–751. http://dx.doi.org/10.1176/appi.ajp .2010.09091379
Zambrano-Vazquez, L., H. C. Levy, E. L. Belleau, E. R. Dworkin, K M. H. Sharp, S. L. Pittenger, J. A. Schumacher, and S. F. Coffey. (2017). Using the Research Domain Criteria Framework to Track Domains of Change in Comorbid PTSD and SUD. Psychological Trauma: Theory, Research, Practice, and Policy. American Psychological Association. (9) (6) 679–687.