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Week 10 Journal B
NURS-6640: Psychotherapy with Individuals
Assignment 4: Practicum – Weeks 9 &10 Journal Entries and Journal Submission
University
2020.
(Week 9) Client information
ZL is a 14-year-old Hispanic-American female client that presents for psychotherapy. ZL reports that she has a step-mom and a step-sister. ZL reports isolating herself in her room and plays her musical instrument ukukele. ZL communicates feeling she has no sense of purpose in life and is detached from life. ZL reports feeling very lonely, disorganized, and stagnant. ZL says she has no future and do not see self-living beyond age 20 years. She states she has only two friends to talk to and wishes she has many more friends and can speak assertively and crack people up with laughter. ZL affirms feelings of sadness, irritability, and anxiety. She endorses anxiety and that someone is out there to break into the house and kill her. She reports continuously watching the door several times in a day to ensure it is locked and many hands-washings over 10 minutes at a time.
The patient reports feeling hopeless, worthlessness, loss of motivation, recent mental breakdown, and suicidal ideation with a plan by cutting self. The patient reports a history of self-mutilation. Patient reports prior suicidal attempt and inpatient admission at age seven years. The patient reports not the best of friends with her mom. The patient says that her mom does not have confidence in her that she will accomplish anything and live a purposeful life because things will not work out for her. The patient lives with dad and step-mom.
ZL is awake, alert, and oriented. ZL appears appropriately dressed, with normal psychomotor activity. Speech is normal. ZL maintains eye contact. The thought process is logical and organized. Mood is depressed. Affect is congruent to mood. ZL denies any active suicidal plan at this time. ZL denies the intent to hurt someone. Denies audio-visual hallucination. Denies current obsessions about being dirty, or unclean, and compulsive desire to wash hands at this time.
Diagnosis
Major Depressive Disorder (MDD): According to the diagnostic and statistical manual of mental health disorders, 5th edition (DSM-5), before arriving at a diagnosis of MMD, the patient has to have five or more symptoms; the patient will also have one of the significant traits which are indicating depressive mood and or loss of interest and pleasure in previously enjoyable activities within two weeks (Tolentino, & Schmidt, 2018). ZL reports feeling low, mental meltdown, lack of interest in activities that give pleasure, prior suicide attempt, says hopelessness and worthlessness, and don’t see self-alive beyond the age of 20 years. Feelings of inadequacy, melancholy, poignancy, lack of interest in significant activities that bring pleasure, feelings of despair, and isolating self from others indicate depression that meets the criteria for the diagnosis of major depressive disorder, according to the American Psychiatric Association (2013).
Obsessive-Compulsive Disorder with fair insight (OCD): According to DSM-5 obsession is frequent, persistent thoughts, drive and urge that won’t go away. Compulsion is repetitive behavior/urges that drives individual to perform same repetitive acts in response to persistent obsessive thought such as repeatedly checking to see if the door is locked (National Institute of Mental Health, 2019). ZL reports frequent checking of the door and handwashing multiple times in a day for more than 10 minutes.
Generalized Anxiety Disorder: The DSM-5 specifies criteria to help diagnose anxiety disorder. According to the American Psychiatric Association (2013), anxiety disorder has symptoms of apprehension, trepidation, uneasiness, inability to sleep, weariness, and discernible physiological changes in behavior that leads to impairment in social, occupational, educational and other essential areas.
Ethical Consideration
The incidence of co-morbidity between OCD and Depression is high. Studies suggesting that about one-third of people with OCD equally have concurrent depression at the time of assessment; in cases of severe depression, anxiety disorder includes obsessive-compulsive symptoms are present (Moore & Howell, 2017). Psych mental health nurse practitioners should do a thorough assessment to ensure accurate diagnosis to successfully and adequately treat these comorbid conditions and interact with patients to educate patients on treatment options available.
Other legal and ethical responsibilities include protecting client’s privacy and confidentiality to promote trust and foster therapeutic relationships that serve as a firm foundation for the client to disclose sensitive information to help the therapist ensure accurate diagnosis and treatment plan. The patient gave verbal consent allowing students to participate during the therapy session. The therapist protects the client’s autonomy by client participating in her treatment plan. According to Nagy (2011), allowing clients to participate and make decisions in their treatment plan ensures client autonomy and positive treatment outcomes since the client will actively participate and follow through.
Conclusion
OCD, depression, and anxiety tend to personally, socially, and occupationally incapacitate individuals suffering from these disorders and can disable the individual when it is not well controlled or treated. Valid treatments have been developed. Cognitive-behavioral therapy (CBT) is the most widely-used therapy for anxiety, depression, and OCD disorders. The client meets the criteria for diagnoses of MMD, OCD, and GAD disorders according to diagnostic manual 5 of mental health disorders.
References:
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th edition). Washington, DC: Author.
Moore, K. A., & Howell, J. (2017). Yes: The Symptoms of OCD and Depression Are Discrete and Not Exclusively Negative Affectivity. Frontiers in psychology, 8, 753.
Nagy, T. F. (2011). Ethics in psychotherapy. In Essential ethics for psychologists: A primer for understanding and mastering core issues. (pp. 185–198). American Psychological Association. https://doi-org.ezp.waldenulibrary.org/10.1037/12345-010
National Institute of Mental Health (2019). Obsessive-Compulsive Disorder. Retrieved from https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml#part_145345
Tolentino, J. C., and Schmidt, S. L. (2018). DSM-5 Criteria and Depression Severity: Implications for Clinical Practice. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6176119/
NURS-6640: Psychotherapy with Individuals
Assignment 4: Practicum – Week 10 Journal Entry
University
, 2020
Practicum Experiences Utilizing the Roy’s Adaptation model and Cognitive Behavioral Therapy
I used the Roy’s adaptation model (RAM) and cognitive behavioral therapy (CBT) theories at the initial onset of this class. There has been a positive impact on nursing and counseling skills utilizing these two therapeutic theories (frameworks) in psychotherapy. At the beginning of this course, this practitioner presents how a lot of clients with mental health disorders presents in the clinic with active or potential suicidal ideations and these group of clients are high risk, therefore, making this group and the therapist work very challenging.
Utilizing the RAM nursing model facilitates coping strategies to aid in the recovery of these clients. In this practicum experience, a lot of the clients developed positive coping strategies using RAM theories through adaptation. These clients were able to come up with strategies to harmonize with new stressors, triggers, and or challenges they face. Examples of triggers include receiving new diagnoses with an original medical condition; or existing medical/mental conditions getting more complex and unplanned unexpected mental, emotional, and physical strain. My preceptor and I put in the best using the most available substance to help these clients stabilize physically and emotionally. The therapist encourages them to come to terms and positively harmonizing with the environmental stimulus by developing coping strategies in deescalating the triggering situation, normalizing (adapting), and accepting the reality (Petiprin, 2016).
CBT has a positive impact on guiding my practice in psychotherapy at this practicum experience by providing me insight into how clients interact or process their thoughts, feelings, and behaviors. During therapy sessions, my preceptor merges these two approaches, CBT and RAM, in a way, I was able to understand, to help these clients in identifying their maladaptive patterns. With this approach, I can understand that a client’s behavior is an act of what one does; then, cognition is how the client intellectually processes the action and then decode/ascribe meaning to self, others, and the world or to the event. From the meaning ascribed, the client develops beliefs, attitudes, and expectations.
Irrational habitual thinking patterns that are negatively biased and inability to normalize to new triggering situations are made available for alteration or modification through cognitive restructuring. CBT helps the client learn how to identify and dispute irrational, inaccurate, self-defeating, destructive, and maladaptive thoughts and redirect them to definite coping thinking pattern (Birtel, & Crisp, 2015). There has to be a willingness and readiness on the part of the client to change and explore healthier ways to think and readjust when it comes in contact with the environmental stimulus/trigger.
Evaluation of Goals and Objectives for Personal Practicum Experiences
The RAM and CBT therapeutic approaches ensure the successful accomplishment of my set-up goals at the beginning of this course. One of the achievements is providing therapeutic psychotherapy that helps the client resolve internal struggles that attribute to their immediate dysfunction and malfunction (Thompson, 1986). Another accomplishment is treating each client with great respect during the therapy session (Thompson, 1986). Another achievement is learning various theoretical methods available in administering individual psychotherapy, particularly the ability to help the client identify and elicit wrong patterns in cognitive distortive thinking. The use of the RAM and CBT therapeutic approaches also serves as a foundation for developing and implementing the treatment plan (Thompson, 1986).
Impact of Psychotherapy on Social Change
There are many societal stigmas attached to mental health illnesses that serve as a barrier. Some people do not disclose the disorders resulting in underreporting of some of these psychiatric disorders, thus less treated. According to Hoge et al. (2016), studies show enhancing access to care due to stigmas and barriers to those seeking care for mental disorders. Practitioners must show compassion and care when clients present with concerns about mental health disorders. Practitioners should provide an adequate treatment plan to manage the needs of these patients. The practitioner needs to perform a thorough assessment that leads to accurate diagnosis to provide quality treatment plans that will meet the needs of these populations. According to Begley, (2010), practitioners must have fortitudes, endurance, benevolence, empathy, commitment, and responsibility in caring and advocating for clients for successful treatment and recovery.
The nurse must provide safe, compassionate care to all patients under her care, including patients who are vulnerable and defenseless, including patients who are both physically and intellectually debilitated, impaired, and disabled to make competent decisions on their own. Health care professionals, by the value they place on sound knowledge, excellence, and quality of care, and their reliability and trustworthiness are at an advantage in providing leadership in debates on health policies (International Council of Nurses, 2008).
It is equally imperative the practitioners educate the clients that the goal of therapy is not solely on pharmacotherapy. Still, they should also seek appropriate evidence-based approaches and treatments to meet and manage their needs. These approaches are psychotherapies that include or involve group meetings /interactions that facilitate curative and remedial collaborations and interrelations that encourage positive mental health recovery.
References:
Begley, A. (2010). On being a good nurse: Reflections on the Past and Preparing for the Future.
International Journal of Nursing Practice, 16(6), 525–532. Retrieved January 17, 2017
fromhttp://web.b.ebscohost.com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?sid=
e5d00d85-583d-49a6-b7c4-fa9320ccf26e%40sessionmgr113&vid=5&hid=107
Birtel, M. D., & Crisp, R. J. (2015). Psychotherapy and social change: Utilizing principles of
cognitive-behavioral therapy to help develop new prejudice-reduction interventions. Frontiers in Psychology, 6, 1771. http://doi.org/10.3389/fpsyg.2015.01771
Hoge, C. W., Ivany, C. G., Brusher, E. A., Brown, M. D., Shero, J. C., Adler, A. B., & … Orman,
D. T. (2016). Transformation of Mental Health Care for U.S. Soldiers and Families During the Iraq and Afghanistan Wars: Where Science and Politics Intersect. American Journal of Psychiatry, 173(4), 334-343. doi:10.1176/appi.ajp.2015.15040553
International Council of Nurses. (2008). Promoting health: Advocacy guide for health
professionals. Retrieved from http://www.whpa.org/PPE_Advocacy_Guide.pdf
Petiprin, A. (2016). Psychiatric and mental health nursing. Nursing Theory. Retrieved from
http://www.nursing-theory.org/theories-and-models/psychiatric-and-mental-health-nursing.php
Thompson, L. (1986). Peplau’s theory: An application to short-term individual therapy. Journal
of psychosocial nursing and mental health services, 24(8), 26-31.
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