Therapeutic Relationship in Psychiatry Discussion Essay
Therapeutic Relationship in Psychiatry Discussion Essay
prepare:
- Review this week’s Learning Resources and reflect on the insights they provide about treating clients with personality disorders.
- Select one of the personality disorders from the DSM-5-TR (e.g., paranoid, antisocial, narcissistic). Then, select a therapy modality (individual, family, or group) that you might use to treat a client with the disorder you selected.
The Assignment: Therapeutic Relationship in Psychiatry Discussion Essay
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Succinctly, in 1–2 pages, address the following:
- Briefly describe the personality disorder you selected, including the DSM-5-TR diagnostic criteria.
- Explain a therapeutic approach and a modality you might use to treat a client presenting with this disorder. Explain why you selected the approach and modality, justifying their appropriateness.
- Next, briefly explain what a therapeutic relationship is in psychiatry. Explain how you would share your diagnosis of this disorder with the client in order to avoid damaging the therapeutic relationship. Compare the differences in how you would share your diagnosis with an individual, a family, and in a group session.
Support your response with specific examples from this week’s Learning Resources and at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.
PTSD
- Briefly explain the neurobiological basis for PTSD illness.
- Discuss the DSM-5-TR diagnostic criteria for PTSD and relate these criteria to the symptomology presented in the case study. Does the video case presentation provide sufficient information to derive a PTSD diagnosis? Justify your reasoning. Do you agree with the other diagnoses in the case presentation? Why or why not?
- Discuss one other psychotherapy treatment option for the client in this case study. Explain whether your treatment option is considered a “gold standard treatment” from a clinical practice guideline perspective, and why using gold standard, evidence-based treatments from clinical practice guidelines is important for psychiatric-mental health nurse practitioners. Therapeutic Relationship in Psychiatry Discussion Essay
Neurological Basis for PTSD
The neurobiology of PTSD begins in the hypothalamic-pituitary-adrenal axis (HPA) once the brain is exposed to a traumatic event. The HPA is activated as a stress response, and this reaction begins when the corticotropin-releasing hormone (CRH) is released by the paraventricular neurons (PVN) found within the HPA. The CRH subsequently triggers the release of adrenocorticotropin hormone (ACTH) in the pituitary gland. This reaction further triggers the release of cortisol in the adrenal cortex. Cortisol as a hormone induces negative feedback to the HPA, which when chronic, reduces the noradrenergic stress response. This chronic reaction impairs the neuroplasticity of the brain and its ability to manage stress when triggered (Sherin & Nemeroff, 2022).
To add to this, PTSD develops when there is dysregulation of dopamine, serotonin, and noradrenaline (NA). Upon trauma exposure, NA transmission increases in the hypothalamus. An increase in NA leads to symptoms such as heightened fear and memory coding. These reactions lead to secondary symptoms of PTSD such as hyperarousal and hypervigilance. Decreased dopamine is associated with elevated anxiety. Lastly, an increase in serotonin leads to an increase in sensitivity to stress and suicidal ideation; all hallmarks of PTSD. Therapeutic Relationship in Psychiatry Discussion Essay
DSM-5-TR Diagnostic Criteria for PTSD
Important criteria for diagnosing PTSD using the DSM V manual include direct trauma exposure, re-experiencing the traumatic event through nightmares, intrusive thoughts or flashbacks, and inability to recall details of the traumatic event. From the case study, Dylan appears to meet the DSM V criteria for PTSD given some of his symptoms. First, he experienced direct trauma through the accident at the intersection. Additionally, the other motorist threatened his father and chased after them; meaning he witnessed this event. These are critical stressors that could cause PTSD symptoms in Dylan. Second, Dylan meets the criteria of re-experiencing the event through nightmares. He also has intrusive memories of the motorist chasing after them. He is also unable to completely remember the details of the accident, develop anger bursts at school and hypervigilance.
The case study presents enough information to derive a PTSD diagnosis. First, PTSD is marked by cognitive difficulties with meaning, memories, and their management, according to Goodall et al. (2017). Dylan is unable to remember the details of the accident, he is concerned about his father which means that he infers the trauma some meaning, and is hesitant to talk about the incident, which indicates inability to manage his thoughts and feelings properly.
Based on the case study, I agree with the PTSD diagnosis given that Dylan meets at least four of the DSMV criteria for PTSD diagnosis. I disagree with the other diagnoses that include MDD since it takes longer to diagnose. Dylan’s case acute not, chronic.
Psychotherapy Treatment
A psychotherapeutic treatment option for Dylan would be cognitive processing therapy (CPT). This approach entails helping the client adjust the negative thoughts and evaluations of the traumatic event and memories (Watkins et al., 2018). This outcome is achievable by interrupting maladaptive and negative thought patterns and replacing them with healthier perceptions, especially of the incident. For instance, in this case, the therapist could help Dylan to stop associating the incident with his father’s health by encouraging him to be optimistic and appreciate the fact that no one was harmed and that his father is safe and healthy. Therapeutic Relationship in Psychiatry Discussion Essay
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