PRAC 6640: Psychotherapy with Individuals.
PRAC 6640: Psychotherapy with Individuals Practicum – Week 5 and Week 6 Journal Submission Patient #1 Generalized Anxiety Disorder (GAD) Patient #2 Post Traumatic Stress Disorder (PTSD) Week 7 Assignment 2: Practicum – Week 5 and Week 6 Journal Submission 1. Develop diagnoses for clients receiving psychotherapy 2. Evaluate the efficacy of therapeutic approaches for clients 3. Analyze legal and ethical implications of counseling clients with psychiatric disorders Include: • Provide a description of the client • Diagnosis according to DSM-5 • Treatment •
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Expected Outcomes Based on These Therapeutic Approaches • Legal Implications References American Psychiatric Association. (2013). PRAC 6640: Psychotherapy with Individuals. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub. Cohen, I. G., & Mello, M. M. (2018). HIPAA and protecting health information in the 21st century. Jama, 320(3), 231-232. Darby, W. C., & Weinstock, R. (2018). The Limits of Confidentiality: Informed Consent and Psychotherapy. Focus, 16(4), 395-401. doi:10.1176/appi.focus.20180020
Practicum – Week 5 and Week 6 Journal Submission
N is a 40-year-old businessman. He encounters a tough state with his anxiety problem. His friend thought N should consider therapy because some of his symptoms were worsening. While assessing N, he talks of having stress almost all the time and continually worrying about everything. He identifies himself as having once been a pessimist but his distress has increased over the last 1 year after his father became sick, so he no longer believes he can manage such feelings. PRAC 6640: Psychotherapy with Individuals. He even found that he is also becoming bothered than normal over daily out-of-work activities. He has been feeling so tired and depressed lately that he has taken days off his business activities, which is something of a challenge to him. When anxious, N experiences stress in his legs, belly, and shoulders, races in his pulse, and often experiences shortness of breath. He has a poor sleep with trouble trying to sleep because of a stressing and constant wake-up. He has feelings of irritability and fatigue. He refuses to have any kind of substance abuse. The patient has not had any prior therapy regarding mental issues. The client’s physical examination is undistinguished and refuses any experience of other health problems. PRAC 6640: Psychotherapy with Individuals.
Diagnosis According to DSM-5
The DSM-5 lays out common guidelines that help in diagnosing generalized anxiety disorder. Using a standardized list of symptoms while examining clients allows clinicians to identify mental health issues more effectively, and to build a more efficient treatment strategy (Woo, &Keatinge, 2016). The client meets the criteria for generalized anxiety disorder in this case. Such symptoms involve the appearance of intense anxiety and apprehension over some subjects, events, or activities. Worry occurs more frequently or not less than 6 months and is excessive. The second guideline met includes restlessness or edginess, easily exhausted; more tired than normal, impaired focus, or feeling as if the mind is empty irritability, heightened muscle aches or discomfort, trouble sleeping. PRAC 6640: Psychotherapy with Individuals.
The development of support networks, psycho-educational services, and CBT, and demonstrate decreased depression, anxiety, distress, and other mental conditions (Luberto et al. 2017). In this scenario, CBT therapy for this patient will be developed in 15 periods if the improvement is achieved as specified in the plan of care. The length of every period is 1.5 to 2 hours. The CBT therapy will proceed in a manner with completion in 15 periods. For the first 8 periods counseling centers on the intellectual field, and in the final 7 periods, the topic centers on the behavior field. PRAC 6640: Psychotherapy with Individuals.
Motivational interviewing is an important method of coping with N’s condition. By using strategy, N will obtain the requisite incentive to alter habits that would prohibit him from making safe and rational decisions. Motivational interviewing will help N resolve his newly acquired conduct, like the eruption of rage (Miller & Moyers, 2017). Such engagement will be the perfect place to focus on and encourage the individual to declare their awareness back over a brief amount of time.
Like every other situation, the situation of N is subject to legal and ethical concerns in therapy. The situation addresses two legal and ethical issues: confidentiality and credentialing. Credentialing is for the therapist who is required to have experience in the clinical procedure (Institute of Medicine, 2010). The therapist should be licensed to offer help to N, irrespective of how complex his situation might be. Confidentiality, on the other hand, means maintaining therapist-patient contact. In this situation, even if asked by his family, the therapist will hold contact with N confidential. If the psychologist has to share the details, they must receive informed permission from the client to approve the disclosure of the details. PRAC 6640: Psychotherapy with Individuals.
The client is a 29-year-old woman who has disturbing experiences of trauma hallucinations and is now seeking treatment. She exhibits flashbacks and other recollections of certain incidents that have influenced her interaction and engagement with her family. The client developed these indications because of her uncle’s sexual abuse when she was twelve years of age. The sexual assault made her feel shame and so she has never revealed the incidents to anybody. She has no previous treatment, so this is the very first moment she has tried to talk about the accident. Even so, the recall of experiences growing up has contributed to the formation of tension in her present relationship and has also led to a loss of communication with her family. After further evaluation, her sexual encounters are reduced and any circumstances that could trigger memories to reemerge are avoided. PRAC 6640: Psychotherapy with Individuals.
Diagnosis According to DSM-5
Post-traumatic stress disorder is an appropriate diagnosis for this patient. Criteria A for this diagnosis include trauma experience, as per DSM V (American Psychiatric Association, 2013). The client was subjected to sexual assault at a young age through a direct encounter with the trauma. Criteria B suggests that manifestations of intrusion-related to the trauma should be present (American Psychiatric Association, 2013). The client has intrusive hallucinations and delusions that have led to strain and stress in her interactions. Criteria C involves continuously keeping away from stimuli connected to a traumatic experience (American Psychiatric Association, 2013). PRAC 6640: Psychotherapy with Individuals.For this patient, her family is the stimuli. She stopped communicating with her family as the assaulter was her uncle. She as well resisted discussions about her encounter with individuals who were connected to her. Criteria D necessitate adverse modifications and emotions associated with the abuse. The client is not able to remember certain details about the incident because she downplays the incidents because of 9 (American Psychiatric Association, 2013). Criteria E involve changes in reactivity and stimulation as a result of a traumatic incident, including self-destructive over-the-top behavior. The client mentions having reckless sexual behavior during her adolescent years, which conforms to imprudent and self-destructive factors. The items set out in Rules B, C, D, and E have all continued for more than one month thus meeting the requirements F (American Psychiatric Association, 2013). Therefore, the diagnosis of PSTD can be made based on these DSM V criteria. PRAC 6640: Psychotherapy with Individuals.
The therapeutic approaches entail providing trauma education than by stabilizing the patient’s response and actions. Relaxation approaches were also utilized while enabling the patient to have the power of the approaches. Additionally, the desensitization of violence by narrating the event also helped (American Psychiatric Association, 2013). The practitioner also suggested an improvement in contact with her peers. Such approaches can be identified in the cognitive behavioral therapy management strategy (Zayfert& Becker, 2019). CBT is important as it reflects on trauma in the treatment process (Brown et al., 2019). Exposure therapy is essential because recollections are revealed in a secure setting. Exposure also helps in the progressive experience desensitization. The CBT then tends to take the behavioral modification action through which the client is encouraged to be understandable of the awful memories and work on them (Brown et al., 2019). PRAC 6640: Psychotherapy with Individuals.
Exposure treatment is intended to concentrate on the specifics of the origin of the traumatic event in a supportive atmosphere so the patient can safely handle the experience. The exposure approach took the patient’s path to clarify her understanding of the issue and her encounter. This move allows the patient to talk about the violence in a secure space and thus allow her to deal with it (Brown et al., 2019). The outcome of exposure is also the desensitization of occurrences after they have been openly discussed. This can translate to better interpersonal interactions. PRAC 6640: Psychotherapy with Individuals.
Legal and Ethical Implications
In the treatment of those with PTSD, attention should be given to non-maleficence and beneficence. The client should receive more beneficial effects from treatment and not harmful ones. Confidentiality is another ethical issue since the patient has experienced a personal incident. She, therefore, deserves the freedom to reveal this information to others which will also stay confidential. She is the only one with the freedom of talking about the experience. PRAC 6640: Psychotherapy with Individuals.