Development of Kleptomania Group Therapy Sessions

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What is Kleptomania?

In DSM-5 Kleptomania is classified in the category of Impulse-Control disorder (behavioral disorder), characterized by recurrent failure to resist the impulse to steal (DSM-5). Often the objects that are stolen are not needed and have no significant monetary value. Kleptomania sufferers do not plan for stealing an item beforehand (Talih, 2011). People with this condition experience relief or pleasure during the theft, and feelings of guilt, self-hate, and remorse following the crime (DSM-5). Often, Kleptomania sufferers are aware of the morality of their actions, and will readily admit that stealing is wrong and immoral (Zhang, Huang,& Liu, 2018). The act of stealing in Kleptomania is a “defense mechanism” to modulate undesirable emotions from being expressed (Saboowala, 2010).

 In the general population, the prevalence of Kleptomania is approximated at 0.6 percent and in those arrested for shoplifting, is 3.8 to 24 percent. (Aboujaoude, Gamel,& Koran, 2004). The female to male ratio in compulsive stealing is estimated at 3:1, the onset occurs in adolescence, and the average age for first treatment seeking is 35 years for women and 50 years for men (Aboujaoude et al., 2004 & Talih, 2011).

Kleptomaniacs rarely seek medical attention voluntarily, and patients are often legally mandated to present for treatment (Talih, 2011). Comparing to women, Men have a higher chance of being sent to prison instead of being referred to treatment” (Sadock, Kaplan,& Sadock, 2007).

Psychoanalytic theories relate compulsive stealing to the experience of traumas such as neglectful or abusive parenting during childhood which resulted in parents and children lack emotional communication, and therefore stealing may symbolize repossessing the losses of childhood (Goldman, 1991).

Kleptomania may also be regarded an addictive behavior which

is frequently accompanied by other co-occurring problems such as substance abuse, obssessive-compulsive disorder, anxiety or depression. (Kohn, 2006 & Bayle, Caci, Millet, Richa,& Olie, 2003). According to Zhang et al. (2018), immediate family members of people with Kleptomania may have a “higher risk of obsessive-compulsive disorder and a higher risk of substance abuse, including the risk of alcohol abuse.”

In most cases of Kleptomania, the sufferer has experienced authoritarian parenting, punishment, and isolation at school and lack of emotional support and communication which resulted in lack of self-esteem (Zhang et al., 2018). Adolescents and adults with Kleptomania often find the locus of their happiness in the certain bad behaviors, and will subconsciously consider those maladaptive behaviors as “kind of psychological compensation for themselves” ( Zhang et al., 2018).

“Self-expansion” and “self-repression” were identified and labeled by Zhang and colleagues (2018) as two personal traits for kleptomania people. People with self-expansion lack empathy and behave arbitrarily and high handedly towards others. Kleptomaniac people with self-repression are described as indifferent to people, aloof or isolated with a lack of self-respect and with  emotional needs that were not satisfied in childhood” (Zhang et al., 2018).

It is currently believed that environment plays a key role in the development of Kleptomania (Grant, 2006). Kleptomania patients develop an “abnormal sense of satisfaction” or achievement, which makes the success in stealing, exciting, and challenging for them (Zhang et al ., 2018).

Kleptomania is curable with a combination of cognitive behavioral therapy, or dialectical behavior therapy and the use of psychopharmacology (Grant, 2006).The purpose, goals, and population for Kleptomania group therapy:

Kleptomania sufferers often live secret lives or feel a heavy load of unspeakable secret and emotional pain on their shoulders (Shulman, 2017). Revealing their unspeakable secret may have a destructive psychological effect on their relationships. Shulman (2017) reports that people with Kleptomania often struggle with letting go of their stealing memories or “come clean” about their history of stealing. Flory (2006) elaborates that in Impulse Control Disorder (ICD) one factor is the urges people have, and the other is the brakes that they may or may not apply. In fact, according to Flory (2006), how and when people utilize the brakes predicts a predisposition towards risky behavior. Thus, for Kleptomania sufferers, group therapy may provide a safe environment to learn strategies on how to keep those brakes on while experiencing empathic interactions, and feeling less ashamed and guilty.

This group will be a legally mandated and closed group therapy for adults who suffer Kleptomania. Members in this group are ten mixed_ gender adults who should participate in ten predetermined, 90 minutes sessions, and are expected to remain in the group until it ends, and new members will not be added. The group is therapeutically oriented and educationally focused. Kleptomania is a sensitive issue, thus to maintain confidentiality and protect the reputation of each member, this is going to be closed group therapy. This group therapy will be carried out in a community-based agency.

The initial goals of this group are to provide support and coping strategies as well as raising awareness and enhancing clients’ self-esteem against compulsive stealing. Besides, this group therapy is to help the client identify the triggers and early warning signs and how to get past them without resorting to stealing. Through this group therapy, clients will receive guidance on how to cope with distress, managing anger issues as well as constructive ways to re-channel their

unacceptable impulses into socially approved activities.

Leader’s role in the group and leadership style:

The leader develops the group into a therapeutic social system and facilitates the building of therapeutic norms. The leader will observe the process of interactions in the group and assist members in openly expressing their fears and expectations. The leader will create a climate of safety and trust and will offer acceptance, support, and empathy to encourage engagement in productive interchanges. When necessary, group leaders utilize therapeutic interventions and psychoeducation to facilitate therapeutic progress. Group leaders will promote member-to-member interaction by encouraging feedback and sharing (Corey, Corey,& Corey, 2018).

Group ground rules and the methods for establishing the rules in the group:

Preconceived ideas about what takes place in a group may mislead members towards wrong assumptions which should be predicted, corrected, or warned about by group leaders. Members may assume, for example, honesty and openness in group means; they should reveal everything about themselves or other people, with no regards for ethical or privacy norms. Another example of a wrong assumption is pressure to become as emotional as other members about every story to engage in self-exploration (Corey et al., 2018). Group leaders and co-leaders will address false assumptions.

Group ground rules will be stated clearly by group leaders or co-leaders. The group members and the leaders can jointly determine part of group norms. Punctuality, respecting other group members’ culture and religious belief, providing support for group members instead of distraction or confrontation, sharing meaningful aspects of themselves, sharing their perception instead of holding them, and focusing on here-and-now interactions and feelings, are amongst those norms that are required for this group (Corey et al., 2018).

Introduction:

During the initial session of the group, I will discuss group norms and expectation, and I will bring up the topic of “socialization outside of the group.” Outside of the group socialization may create parallel subgroups (Corey et al., 2018); however, I will not adhere to this norm as a fixed norm as I have learned that outside of the group socialization can assuage social isolation for some members and provide a profound empathetic exchange. After establishing group norms each participant will be given an equal opportunity to share their concerns, hopes, pains, stories or needs and while I am actively listening, I try to identify common themes in group members’ narratives in an effort to “link common experiences” and let the members know that they are not alone in their journey (Corey et al., 2018). By encouraging feedback, I will indirectly propel members to talk to one another, and not to me, as it allows members to become more comfortable with one another (Corey et al., 2018)

Discussing stigmas and dispelling misconceptions associated with Kleptomania, as well as installation of hope, appreciation of transformation and “nurturing oneself” (Corey et al., 2018) will be my next step in the introduction session.

Members in Kleptomania group therapy often have distorted cognition and lack of confidence about the world and themselves, and I will intend to gain access to my clients’ world and their unmet needs. For that purpose, for the last part of the session, I will invite members to participate in an activity. In this activity, members will identify the first three issues that they consider them as perpetual predicament in their lives. Then, they will share at least one or two personality traits that they like about themselves as well as a wish that they hope will be true one day in the future and on that note I will end the first session.

References:

 

  • Aboujaoude E, Gamel N, Koran L. Overview of kleptomania and phenomenological description of 40 patients. J Clin Psychiatry. 2004;6:224–247.
  • Bayle FJ, Caci H, Millet B, Richa S, Olie J. Psychopathology and comorbidity of psychiatric disorders in patients with kleptomania. Am J Psychiatry. 2003;160:1509–1513
  • Corey, M. S., Corey, G., Corey, C., & Brooks/Cole Publishing Company. (2010). Groups: Process and practice. Belmont, Calif: Brooks/Cole.
  • Goldman MJ. Kleptomania: making sense of the nonsensical. Am J Psychiatry. 1991;148:986 996References:
  • Grant, J. E. (2006). Understanding and treating kleptomania: New models and new treatments.The Israel Journal of Psychiatry and Related Sciences, 43(2), 81-7.
  • Living on impulse ( April, 2006). NewYork Times. Retrieved from:
  • https://www.nytimes.com/2006/04/04/health/psychology/living-on-impulse.html
  • Saboowala., Dr.Hakim. “Understanding Neurobiology of Kleptomania (repetitive stealing)-An impulse control disorder : New Models and New Treatments.” .[ Kindle Edition.]
  • Sadock BJ, Kaplan HI, Sadock VA. Synopsis of Psychiatry, Tenth Edition. Philadelphia, PA: Lippincott Williams & Wilkins; 2007
  • The Shulman Center, (October, 2017). Monthly e-Newsletter, Retrieved from:  https://www.theshulmancenter.com/newsletters/oct17.pdf
  • Zhang, Z., Huang, F. & Liu, D. CURR MED SCI (2018) 38: 937. https://doi-org.paloaltou.idm.oclc.org/10.1007/s11596-018-1966-2
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