Case Report

Austin J Clin Case Rep. 2016; 3(4): 1101.

Case Report on Psychotherapy for Pathological Gambling

Góz G* and Sapiro M

Departnt of Medical Psychology, Clinical Hospital “Dr. Manuel Quintela”, Uruguay

*Corresponding author: Gracy Góz, Departnt of Medical Psychology, Prografor Prevention and Treatnt of Pathological Gambling, Clinical Hospital “Dr. Manuel Quintela”, Avenida Italia 2870, Montevideo, C.P: 11.600, Uruguay

Received: July 10, 2016; Accepted: September 13, 2016; Published: October 10, 2016

Abstract

Conceived as a social or psychological addiction, pathological gambling, is worldwide a health workers concern. Its high prevalence and increang incidence, along with the growing offer of ga posbilities, portrays a not very easy future. In Uruguay, attending to these risk factors was established in 2009, under an agreent between Medicine School (UdelaR) and National Canos Managent, a free prografor the “Prevention and Treatnt of Pathological Gambling”, currently, coordinated by the Departnt of Medical Psychology. The progracarries out its asstance activities at the Univerty Hospital “Dr. Manuel Quintela”. The aiof the prograis that patients with gambling problems achieve continuous abstinence during two years. To achieve this goal, patients should have reached an adequate level of self-control against the harmful behavior exhibited when entered to the progra. It involves the patient solving so issues that go beyond the gambling proble, and linked with history of life. It is based on a psychotherapeutic group approach, on weekly frequency, and with co-therapy, two psychotherapists (Psychologists). Intervention strategies are part of an integrative approach in psychotherapy. It also pursues a didactic purpose. It provides the patients with tools through which they could restructure their lives, in order to find new anings for their lives. The working group is complented by psychiatrist consultation, selfexcluon request (resource that restricts soone to going into a gambling roo) and bi-monthly etings with family or referents.

Keywords: Pathological gambling; Social addiction; Psychotherapy; Cotherapy; Integrative approach

Case Presentation

Susana Martinez is a 71-year-old woman. Divorced, she has two sons aged 48 and 44 and two grandsons aged 16 and 6. She lives alone and she works as an administrative clerk at a Health Center Laboratory. She is a high school graduate. The patient requested the “Prevention and Treatnt of Pathological Gambling” progra(Dr. Manuel Quintela Univerty Hospital, Montevideo, Uruguay), through a 0800 phone number, being registered on the waiting list as a candidate to participate in a group therapy device. In the anwhile a psychiatrist of the prograheld occaonal etings with her.

Psychiatrist First Interview (February 4th, 2013)

The patient exhibits such symptoms as anxiety and depreson.

Biodical History

See Table 1.

Table 1:




  
    15    years old
    Suicide Attempt with Psychotropic Drugs. 
  
  
    26 years old
    Puerperal Depression. 
  
  
    33 years old
    Major Depressive Episode (she has    had multiple episodes / no internment) 
  
  
    From 15 years ago 
    Medicated with antidepressant    and hypnotic.



Table 1:

She expresses:

“’not able to pay my debts”.

“do not have to eat”.

“For several months have been taking out loans, currently have 10”.

“could not leave the roowith any money left. had to lose it all, then, could leave”.

Second Interview with Psychiatrist (February 25th, 2013)

The patient expresses: “got another $ 400 credit. Now have an $800 debt. think they will leave in the “Clearing” (Official list of no-payers, people who are in this list do not receive credit frothe banks).

“asked my youngest son for help. He took away all my credit cards”.

Life History Facts

See Table 2.

Table 2:




  
    12/29/1944
    Birth. Very dysfunctional family. Alcoholic father. Domestic Violence.
  
  
    1953 (9 years)
    Menarche. Left school. From then until 13 years old, she was sexually    abused by her father. 
  
  
    1959
    Suicide attempt with Psychotropic Drugs.
  
  
    1960
    Took school examinations to go to high school.
  
  
    1962
    Met the father of her children.
  
  
    1964
    She got married. 
  
  
    1967 (23 years old)
    Her first son was born.
  
  
    1970 (26 years old)
    Her second son was born. Puerperal Depression.
  
  
    1977(33 years old)
    Major Depressive    Episode. She found out that her husband is    unfaithful and she decides to separate.
  
  
    2010 (66 years old)
    Went gambling for the first time 
  
  
    2011
    Her mom died
  
  
    2012
    Began to attend Anonymous Gamblers.



Table 2:

The psychiatrist kept spaced interviews until the patient is admitted into a psychotherapy group.

Selection Process

The patient attends three interviews. The psychotherapist collects information about the patient’s gambling history, assesses her capacity to benefit froa therapeutic group work and froan educational perspective and observes the kind of bond established between the.

The patient is selected because of:

Her voluntarily attendance.
Her level of commitnt (high level of self-demand).
Her real posbilities to attend the Health Center (she lives nearby).
Her very good capacity for self-reflection.
She reached the “contemplation stage” [1] regarding it’s problematic.

Personal History with Gambling

In 2010, she went gambling for the first ti with two couns who gambled in a controlled manner (social gamblers). She won. The second ti she went alone.

The patient expresses:

“was engaged frothe beginning”.

At that mont of entering into the progra:

She attended the gambling rooalmost daily.
She would engage in gambling for 12 hours non-stop
She had co to lose $400 in a day.
Always returned ho to get more money to continue gambling.
She resorted to money she had reserved to pay bills.
She had requested loans froher family and she had not returned the money.
She had hidden her gambling problefroher family and friends.
She had tried to stop but she could not do it until she had lost everything in spite of feeling very guilty about gambling.

Joining the Group (October 23^th, 2013)

months later, the patient went back gambling (January 1^th, 2014)
The following stressful tuation is identified: his youngest son did not invite her to his birthday party.

The following stressful tuation is identified: his youngest son did not invite her to his birthday party.

Conflict in the relationship with her children. She feels rejected and guilty because her eldest son cannot “move on in life” (he is not working, he has a child but he is unable to take care of hi). The other son has problems with alcohol and he has been distant lately.

Therapists worked with the patient against the different tuations that ca up, favoring a more assertive behavior [2-4] (setting limits to the others, confront hypotheses, expresng what she thinks and feels, developing self-confidence). It shows up difficulties in their marriage (alcoholis, infidelity of her ex - husband) and the issue of sexual abuse by her father, fact that she had never told anyone.

Currently, her oldest son lives with her; he is working and has recovered healthy habits. Her youngest son was hiding her that his partner (mother of his child) had been unfaithful. He is separating.

5 months later, the patient went back to gambling (July 20th, 2014)

The following stressful tuation is identified: a very dear friend of the patient dies.

Fears about death and about her own death appear.

14 months later, the patient went back to gambling (November, 20^th, 2015)

The following stressful tuation is identified: she found out that a friend who had abandoned her after knowing she had problems with gambling (fact that had hurt her a lot), was dying of cancer.

In therapy, the patient’s feelings and thoughts related to her friends illness where explored. They could identify the presence of this thought “You rejected when had problems with gambling and now look what’s happening to you.” The patient felt imnse guilt, what made her gamble.

The therapist works with the “A, B, C of Human Behavior” [5] and negative emotion managent, helping the patient to forgive her friend and forgive herself.

Discuson/Concluon

The patient “uses” gambling, as a way to handle stressful life tuations, unable to connect with negative emotions and escaping froloneliness [6-8]. We understand compulve gambling as a sympto, the “tip of the iceberg” of a life story that is often gned by abuse, dostic violence, unresolved grief, relationship problems, and financial problems. We work froan integrative [9] and trans-academic approach in psychotherapy, ung theoretical concepts and techniques frodifferent disciplines as cognitivis, psychoanalys, psychodrama, communication sciences, psycho-immuno-endocrinology. As well as a “toolbox” [10], that includes [11-24].

Control techniques and response prevention.
Relaxation and ditation techniques to connect with emotions and regulate anxiety and stress.
Restructuring irrational beliefs and distortions of information procesng (statistical probability of winning)
Social and communication skills training.
Techniques of artistic expreson
Psychodrama techniques

In this case, therapists worked on the several relapses the patient had, based on the principle of “A.B, C of Human Behavior” [5] and the History of Patient Life [25].

This principle allowed theanalyzing the behavior of gambling again (recurrences). Therapists sought to identify with the patient, the different elents involved:

The trigger event: what happened? (Recapitulation of the circumstances in which the act of gambling is presented).
The emotional response to the event: what did you feel in that mont? (Identification of emotions).
The interpretation of the event/adjustnt to reality: what did you think? (Irrational ideas/distortions in information procesng).
The link with the patient life history: what does this tuation have to do with your personal story? (Traumatic tuations).

The work done, let the patient “see and think by herself “. The developnt of self-observation and self-reflection [26] allowed the patient to:

Work stressful and traumatic life tuations.
Improve personal, relational and economic aspects of her life.
Strengthen the motivation to change stereotypic (harmful) behavior [27,28].
Show new, creative (healthy) behavior [29].

Evaluation of the process by the own patient:

Therapist: What does having co to the group an to you?

Patient: A big change.

T: What changed?

P: All.

T: Can you tell us what changed?

P. “Before ca to the group, when thought about , thought was a bad person”, “learned to connect with what feel”, “changed my appearance. My closet was full of clothes and did not use the. Now, care, go to the hairdresser and enjoy it”

“The mood. feel good. ’happy”.

“When asked where had heard the word “relience” [30] and we talked about what it was, realized everything had done alone. knew the aning of that word, but was unable to see it in myself. “learnt a lot here”.

“acharging more than my salary. When ca here, did not have money to eat”

As a final concluon, today, nine months after the last recurrence, the patient has not gambled again. She is also very committed to achieve two years of abstinence. Therapists are confident that she can achieve her goal.

References

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Citation: Góz G and Sapiro M. Case Report on Psychotherapy for Pathological Gambling. Austin J Clin Case Rep. 2016; 3(4): 1101. ISSN:2381-912X

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15 years old	Suicide Attempt with Psychotropic Drugs.
26 years old	Puerperal Depression.
33 years old	Major Depressive Episode (she has had multiple episodes / no internment)
From 15 years ago	Medicated with antidepressant and hypnotic.

12/29/1944	Birth. Very dysfunctional family. Alcoholic father. Domestic Violence.
1953 (9 years)	Menarche. Left school. From then until 13 years old, she was sexually abused by her father.
1959	Suicide attempt with Psychotropic Drugs.
1960	Took school examinations to go to high school.
1962	Met the father of her children.
1964	She got married.
1967 (23 years old)	Her first son was born.
1970 (26 years old)	Her second son was born. Puerperal Depression.
1977(33 years old)	Major Depressive Episode. She found out that her husband is unfaithful and she decides to separate.
2010 (66 years old)	Went gambling for the first time
2011	Her mom died
2012	Began to attend Anonymous Gamblers.