Substance Use Disorders Among Practicum Client Jo

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Substance Use Disorders Among Practicum Client Jo

Students will:
  • Develop effective documentation skills for family therapy sessions *
  • Develop diagnoses for clients receiving family psychotherapy *
  • Evaluate the efficacy of solution-focused therapy and cognitive behavioral therapy for families *
  • Analyze legal and ethical implications of counseling clients with psychiatric disorders *

Select two clients you observed or counseled this week during a family therapy session.

Then, address in your Journal the following:

  • Using the Group Therapy Progress Note in this week’s Learning Resources, document the family session.
  • Describe each client (without violating HIPAA regulations) and
    identify any pertinent history or medical information, including
    prescribed medications.
  • Using the DSM-5, explain and justify your diagnosis for each client.
  • Explain whether solution-focused or cognitive behavioral therapy
    would be more effective with this family. Include expected outcomes
    based on these therapeutic approaches.
  • Explain any legal and/or ethical implications related to counseling each client.
  • Support your approach with evidence-based literature.

These are the client description:

RB is a 45 year old Caucasian woman with a history of bipolar
disorder-manic episode without psychotic features, anxiety and
major depressive disorder. She currently takes Quetiapine 100mg tablets-
2 tablets once a day, and vistaril 50mg – 1 capsule twice a day as
needed. She presents with her sister and daughter for complaints of
increased sadness ans stress and toxic interaction with her family. She presents very fatigue with a flat affect. She has a twenty five-year-old son, and twenty-year-old daughter. She reports that her and her sister have always been known to argue often but the fights increased when their father passed away a few months ago. She claims their disagreements are physically and emotionally draining for her. She reports difficulty sleeping and staying asleep. She denies hearing any
additional voices or seeing things that aren’t there. She also denies
suicidal or homicidal idealization. She was advised to consider individual therapy and trauma focused therapy for the
next session.

JB is the sister of RB and is a 64 year old woman with a history of
major depressive disorder and schizoaffective disorder, and bipolar
disorder. She denies taking any medications at this time. She reports
being tired of the constant arguing and fighting with her sister who
never listen. She presents attentive, easily distracted, and intrusive. She interrupts her sister often and doesn’t believe anything is wrong with her. She has a thirty four-year-old son.
She reports that her and her sister can never get along and her sister is the reason for their father’s death. Their father had an extensive medical history and died of pneumonia. She reports sleeping four hours here and there which is enough for her. She denies hearing any
additional voices or seeing things that aren’t there. She also denies
suicidal or homicidal idealization. She was advised to consider individual therapy and trauma focused therapy for the
next session.

Here is a sample of what the paper should look like:

Client Description

BA is 40-year-old African American female who reports paranoia and anxiety due to recently leaving her abusive ex-husband. She reports previously enduring emotional, physical, and sexual abuse by her former husband before escaping four months ago with her three children. She has a fifteen-year-old daughter, and thirteen-year-old twin boys. She reports getting frequent calls from unknown numbers and no one answering or leaving voicemails since her departure and believes it is her ex-husband. This has caused to be easily frightened, paranoid, avoid certain places, and be hypervigilant. She reports waking up in night sweats from having flashbacks often. She denies hearing any additional voices or seeing things that aren’t there. She also denies suicidal or homicidal ideation. She was informed to follow up with legal authorities to differentiate between scammers calling or her ex-husband as well as to consider EMDR therapy or trauma focused therapy for the next session.

Diagnosis

The Diagnostic Statistic Manual 5th edition (DSM-5) has a myriad of diagnosis for various types of disorders. The three-differential diagnosis for this client includes Abuse and Neglect, Adjustment disorder, and Post Traumatic Stress Disorder (PTSD). The codes are as follows: V61.11 (Z69.11) Encounter for Mental Health Services for Victim for Spouse or Partner Violence, 309.24 F43.22 Adjustment Disorder with Anxiety, and 309.81 (F43.10) for PTSD (APA, 2013). The criteria’s these diagnoses have common include emotional disturbance, exposure distress, anxiety or worry for over a month at least, and avoidance of certain stimulus (Bryant et al., 2013). Like my client, affected individuals are often very fearful of impending doom following separation from their abuser. These effects can be crippling for the survivor as well as their children. Sadly, these symptoms are often chronic with poor prognosis when left untreated.

Client Description

VI is a 57-year-old African American male and the brother of BA with a history of alcohol and substance abuse. He recently got his driver’s license revoked due to a DUI in which he crashed into a stop sign pole and resulted in his friend in the passenger seat becoming a paraplegic. He reports using these substances to numb the pain and change his thoughts. He denies any SI/HI but reports passive SI with statements like the world would be a better place without me and I have nothing to offer. He shares that he’s been told he has mood swings often.

Diagnosis

The most befitting diagnosis for this client is bipolar disorder. He shared people always told him he has mood swings but never knew what that meant. Despite his labile mood, his more specific diagnosis is Bipolar disorder, current episode depressed, moderate (F31.32). Some of the symptoms he poses are irritability, physical and mental sluggishness, easily fatigue, and feelings of hopelessness with passive suicide ideation (APA, 2013).According to a metanalysis study by Mays et al (2018), black men with mental disorder are often chronic and untreated. This is higher among Caribbean black men. Some factors for this are perceived race-based discrimination and stigmatization.

Cognitive Behavioral Therapy

I believe Cognitive Behavioral Therapy (CBT) is best for this family. They have to unlearn some of the behaviors and beliefs they are accustomed to in the past. This is a family that is rooted in dysfunction and chaos. They were conditioned to believe that seeking a therapist or medical support is a form of weakness and signifies madness. This is a common myth, often seen in African American population. CBT is a form of cognitive approach that helps people make positive changes in their lives by teaching new ways to think and behave. CBT is based on the belief that thoughts, feelings, and actions are inter-related with each other (Jagbdheri et al., 2019). Our thought and emotions influence the decisions we make and our overall actions. This approach will be able to motivate both individuals to seize control of their lives and take more responsibility of their behaviors.

Legal and Ethical Considerations

Practitioners must approach both clients with sensitivity while forming a therapeutic alliance. It essential to promote these individuals to see the consequences of every decision that led them up to their current situation. Despite how much they believe their unfortunate events suddenly occurred, they had a conscious contribution. Mental health practitioners must be careful to not attack or blame these clients but allow them to reason through their past and suggest ways in which it could have been different or better.

Summary

Furthermore, Mr. VI has more impulsive and reckless behaviors and needs to practice more self-control strategies. This will help him consider the positive and negative effect of every circumstance before making a decision. The goal is to teach both individuals how to better manage their anxiety by challenging thinking errors related to catastrophic cognitions that could lead to avoidance behavior and interpersonal dependence.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). Washington, D.C.: American Psychiatric Association. ISBN 0890425558. Read more: http://traumadissociation.com/adjustment.html

Bryant, R. A., Mastrodomenico, J., Hopwood, S., Kenny, L., Cahill, C., Kandris, E., & Taylor, K. (2013). Augmenting cognitive behaviour therapy for post-traumatic stress disorder with emotion tolerance training: a randomized controlled trial. FOCUS: The Journal of Lifelong Learning in Psychiatry, 11(3), 379-386.

Jaberghaderi, N., Rezaei, M., Kolivand, M., & Shokoohi, A. (2019). Effectiveness of Cognitive Behavioral Therapy and Eye Movement Desensitization and Reprocessing in Child Victims of Domestic Violence. Iranian journal of psychiatry, 14(1), 67–75.

Mays, V. M., Jones, A. L., Cochran, S. D., Taylor, R. J., Rafferty, J., & Jackson, J. S. (2018). Chronicity and Mental Health Service Utilization for Anxiety, Mood, and Substance Use Disorders among Black Men in the United States; Ethnicity and Nativity Differences. Healthcare (2227-9032), 6(2), 53.