Discussion: Clinical Supervision

Client Description

Client XX, a 38-year-old female is a successful manager in a multinational company. She was referred for therapy by her immediate boss. XX presented herself as a serious professional and was honest about life events.  Over the past few months, she has become addicted to alcohol. She reports that although she wishes to take on one-two glasses of wine during dinner, she normally takes the whole bottle. About 2 years ago, she started having sleep problems and has been taking a tranquilizer (5 mg Valium) to help her sleep through the whole night. Her sleep disturbances started when she lost her father. She almost became depressed but immersed herself in work to avoid overthinking. XX was also taking Xanax for panic attacks. Lately, she has become more withdrawn and rarely attends business dinners and other social functions. She reports that she is increasingly taking more alcohol such that sometimes she skips work. She also reported she is increasingly taking the Xanax to calm her nerves and Valium to be able to get a full night sleep.

Therapeutic Approach with the Client

Individual cognitive behavioral therapy is the therapeutic approach I would choose for the client. CBT will assist in analyzing the client’s thoughts, feelings, and circumstances to identify thoughts that put the client at high risk of alcohol and benzodiazepines’ abuse (McHugh et al, 2014). The client will also be trained in constructive coping skills that she will use to cope with the life problems without using alcohol or benzodiazepines. Discussion: Clinical Supervision.

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The approach will be effective for the client because the client will be taught about emotion regulation skills and coping skills as well (McHugh et al, 2014). In this manner, the client will be able to use non-substance alternatives to cope with distress and life problems such as social support, physical exercises, engaging in pleasurable e actives etc.

Additional Information about the Client

The client is at risk of accidental overdose from the benzodiazepines. The client also needs to be educated regarding the synergistic effects of benzodiazepines and alcohol (Guina & Merril, 2018). Therefore, the client needs to withdraw from alcohol and benzodiazepines slowly and safely in order to lower the risk of withdrawal symptoms. The client also faces the risk of suicide. This is because she is facing overwhelming life tasks. She is facing several problems such as possible work loss due to her alcohol addiction, embarrassment at work, the stigma of being an addict, as well as unresolved grief due to the loss of her father. The client is also manifesting symptoms of depression and she seems to be taking alcohol to mask her depressive symptoms over the death of her father. For example, XX has started withdrawing from social functions and started experiencing sleep problems after her father’s death. These are issues that need to be considered in her treatment plan. Discussion: Clinical Supervision.

Recommendations

As per Prochaska and DiClemente’s (1983) model, client XX acknowledges that she has an alcohol problem but was not contemplating to change because she was not yet committed to changing. She also sought therapy services after a referral from her senior (Lacey & Street, 2017).  Therefore, there is a need for the client to:

• Recognize that she has a problem, contemplate about a change and commit herself to change
• The therapist should prepare the client to change her alcohol addiction by encouraging her to commit to change; supporting self-efficacy; generating a plan and setting action goals.
• The therapist should conduct a lot of verbal reinforcement and support the client’s belief that she can sustain the change
• Help the client to sustain change and implement strategies to prevent her from relapsing. Accordingly, it will be important to address the client’s grief over the loss of her dad because this is the root cause for her addiction problem in order to prevent any relapse (Lacey & Street, 2017). Discussion: Clinical Supervision.

References

Guina J & Merrill B. (2018). Benzodiazepines I: Upping the Care on Downers: The Evidence of Risks, Benefits, and Alternatives. Journal of Clinical Medicine. 7(2), 17.

McHugh K, Hearon B & Otto M. (2014). Cognitive-Behavioral Therapy for Substance Use Disorders. Psychiatr Clin North Am. 33(3): 511–525.

Lacey S & Street T. (2017). Measuring healthy behaviors using the stages of change model: an investigation into the physical activity and nutrition behaviors of Australian miners. Biopsychosoc Med. 11(30).

Discussion: Clinical Supervision – Kaltura

Substance use disorders are complicated psychiatric and medical conditions that involve physical addiction as well as psychological or emotional dependence. Substance use disorders are some of the most difficult to treat. It takes a great deal of patience on the part of the provider and the client. It may take several attempts before a client is successfully able to “kick the habit.” Your guidance and patience can help the client to persevere through difficult times during the journey to recovery.

Clinical Supervision is an essential component of your development as a psychiatric mental health nurse practitioner. It provides an opportunity for professional collaboration as you share experiences with and gain insights from colleagues. For this Clinical Supervision, consider a client with a substance abuse disorder whom you do not think is adequately progressing according to expected clinical outcomes. Discussion: Clinical Supervision.

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Learning Objectives

Students will:

• Analyze clients presenting for treatment of substance-related and addictive disorders
• Evaluate effectiveness of therapeutic approaches for clients diagnosed with substance-related and addictive disorders
• Recommend treatment plans

To prepare for this Discussion:

• Review this week’s Learning Resources concerning treating patients with substance-related and addictive disorders.
• Reflect on a client you are currently counseling or have previously counseled at your practicum site who has been diagnosed with substance-related and addictive disorders.

By Day 3

Post a 3- to 5-minute Kaltura video in which you do the following:

• Describe the client. Note: Do not use the client’s actual name.
• Explain your therapeutic approach with the client, including the perceived effectiveness of your approach.
• Identify any additional information about this client that may potentially impact expected outcomes.
• Provide specific recommendations for the client to help them in determining why they are not progressing and what your suggested treatment plan consists of. It is useful to consult the Prochaska and DiClement model.

Note: Nurse practitioners must have strong oral communication skills. This Discussion is designed to help you hone these skills. When filming your Kaltura video, be sure to dress and speak in a professional manner.

View a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues by suggesting an alternate therapeutic approach. Support your feedback with evidence-based literature and/or your own experiences with clients. Discussion: Clinical Supervision.