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Change the document to Prevent Matching: Part 1 and Part 2
Part 1 :Assignment 2: Practicum – Week 5 and Week 6 Journal Submission
Developing diagnoses for clients receiving psychotherapy
Department of Hea NURS 6640N: Psychotherapy with Individuals Dr. ———- September, 2020.
MA is a Hispanic American female. MA presents to psychotherapy at my clinical site because she admits to mom, she wants to kill herself. MA appears calm and cooperative at therapy, but mom reports at home MA is obstinate, uncooperative, argues a lot with mom and brothers, always angry and rebellious. Mom reports that at night MA sneaks out of the house to hang out with boys. Mom reports she believes MA is having a sexual relationship with her boyfriend, who has lots of unfavorable influence on MA. MA denies any sexual relationship with her boyfriend. MA reports her boyfriend told her he had replaced her with another girlfriend. MA reports feeling low, traumatized and dejected about that statement. MA reports feeling like killing herself by overdosing on medication after mutilating herself with a knife. MA reports she is always angry and having sibling rivalry with brothers. MA reports her brother claims she has anger issues that require therapeutic intervention. MA reports poor communication between her and her mom. MA reports poor relationship with mom. MA reports she feels mom does not care about her. MA reports that mom and dad are divorced and separated. MA admits anger issues and is willing to go for an anger management class. MA reports a good relationship with the maternal grandmother. MA also reports missing her friends at school due to lockdown.
Diagnoses: Oppositional defiant disorder (ODD) and anxiety disorder.
To treat opposition defiant disorder (ODD), the provider must diagnose accurately. Clients with opposition defiant disorder have some peculiar features like ADHD and Conduct disorder, including struggling with impulse control and behavioral difficulties. To ensure accurate diagnosis, the provider/clinician must use objective standards that meet diagnostic criteria and are evidence-based (American Psychiatric Association, 2013).
According to DMS-5 before diagnosing, the individual must present with four or more of the following symptoms for up to six months or longer: always angry and resentful, a constant argument with authority figures like parents or employers, engage in behaviors that are spiteful or revengeful within six months interval and defies rules or deliberately refuse to conform with a reasonable request from authority (American Psychiatric Association, 2013). MA exhibit characteristic behavior that fits the profile for these diagnoses.
Also, according to the American Psychiatric Association (2013), an individual that meets the criteria/requirement for this diagnosis are belligerent, indignant, unhappy, rebellious, has aggressive behavior, angry, opinionated, are in-submissive to adhere with instruction and rules from higher position/authority figure and revengeful.
On the other hand, anxiety disorder manifest by unsettled/troubled mind, enormous apprehension, nervousness, uncertainty, turmoil, uneasiness, and these symptoms have been going on over six months (American Psychiatric Association, 2013).
Therapeutic Approaches and Expected Outcome
Rebellious behavior has a devastating effect on both at home and at school. Apart from expelling the child from school, it will impact the child’s social relationship and ability to learn. Daring (Defiant) natures and attitudes that are not employed/handled at teenage or grown-up age result in long-standing deep-rooted ramifications and complications that affect the individual communally, emotionally, physically, and psychologically (Good Therapy, 2019).
A child with ODD may later develop conduct disorder. The child frequently hurts and violates the rights of other people and animals. The child may later in adulthood develops antisocial personality disorder.
Psychoanalytic Psychotherapy and Supportive Psychotherapy
Therapy can help children and adults with ODD to control their emotions and behaviors. According to Laezer (2015), utilizing psychoanalytic psychotherapy in children with ODD and ADHD shows that the primary outcome is an effective treatment in symptom reductions and lower scores for Conners Parent and Teacher Rating Scale, Child Behavior Checklist and Teacher Report Form scores.
Also, supportive psychotherapy is a therapeutic regime, method, procedure, and or process the therapist initiates in handling the emotional instability whereby the therapist engages the patient by using their listening skills (to listen attentively) and show sensitivity and understanding; thereby providing an opportunity for the client to express and be themselves (Neuman, 2013). Supportive therapy targets safety measures, awareness, enlightenment, and empowering the development of positive coping skills (Wheeler, 2015). The MA’s positive outcome is holding a healthy dialogue and conversation with her mom with no episode of emotional outbursts.
Legal and Ethical Implications
MA is a minor and cannot make decisions solely on her own. MA may have some personal information she may not want mom to know. The legal and ethical implication is that mom has to consent before providing psychotherapy treatment and because mom is privy to information that she may want to share with only the therapist, MA may not share the whole pertinent information with the therapist, which hinders information/treatment.
There are poor communication skills between mom and client, leading to MA exhibiting defiant, rebellious, and argumentative behavior with mom and is always fighting with siblings. Using the standard for DSM-5, the client has diagnoses of oppositional deficient disorder due to symptoms client exhibits. Treatment modality includes psychoanalytic psychotherapy and supportive psychotherapy intervention. The client has an assignment to find triggers for emotion, treatment goals, and coping skills to establish a sustainable relationship with mom and siblings.
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th Ed.). Wahshington, DC:Author
Good Therapy (2019) Oppositional Defiant Disorder Treatment . Retrieved from https://www.goodtherapy.org/learn-about-therapy/issues/oppositional-and-defiant-disorder/treatment
Laeze, K. L. (2015). Effectiveness of Psychoanalytic Psychotherapy and Behavioral Therapy Treatment in Children with Attention Deficit Hyperactivity Disorder and Oppositional Defiant Disorder
Neuman, F. (2013). Supportive Psychotherapy: Helping those who have emotional problems. Retrieved from https://www.psychologytoday.com/us/blog/fighting-fear/201306/supportive-psychotherapy .
Part 2:Efficacy of Motivational Interviewing Techniques
O Department of Health Sciences, Walden University NURS 6640N: Psychotherapy with Individuals Dr. J
Psychotherapy shows to be an effective intervention in the treatment of mental health disorders. The practitioner can decide to use only Psychotherapy in treating a mental disorder, or it can serve in combination with psychotropic medications. The practitioner will elaborate on a client that presents at PHP with generalized anxiety disorder, a review of diagnostic criteria for diagnosing mental diseases, and the application of psychotherapy intervention.
SH is a 15-year-old Hispanic American that presents for psychotherapy. SH reports anxiety flares up at the slightest provocation. SH reports a lack of motivation, drive, no goal, no purpose, and has nothing to look forward to in the future. SH reports a feeling of fatigue, muscle pain, or soreness, and unedges always. SH endorse difficulty in coping with life stress, school stress, and family challenges. SH reports frequent communication conflicts with mom. SH reports feelings of hopelessness, helplessness, unedge, and anxious always, especially since mom decided to give her up to foster care. SH reports being judged both at school and at home. SH reports mood swings that significantly impact her sleeping pattern, ability to concentrate, increase in her appetite, and self-concept. Reports loss of commitment to self, behind in getting caught up with schoolwork, has lost interest in school and has intense anxiety thinking about going to live in a foster home, and returning to school when school reopens. SH reports a feeling of uncertainty with no defined plans about the future and did not see self in the future. SH expressed a feeling of frustration with life and did not plan life will take her in this direction. SH denies a current plan or intension to hurt herself. Current medications are Quetiapine 25mg 1 tab orally at nighttime, and citalopram 10mg one tablet orally twice daily. Reports that she is compliant with her medications.
Diagnosis: Generalized anxiety disorder (GAD), and adjustment disorder.
According to the American Psychiatric Association (2013), defines GAD as a state of constant apprehension that is ongoing for at least six months. Characteristics features of GAD include difficulty in controlling worry and anxiety. The resultant consequences include impairment and malfunction in social, educational, vocational, and other vital aspects of life. The anxiety and worry have three or more accompanying symptoms/features to include but not limited to disturbances in the sleeping pattern (which can be an inability to fall or stay asleep or restless unsatisfying sleep), tensions in the muscles causing aches and soreness, irritability and constant fatigue (Substance Abuse and Mental Health Services Administration, 2016).
The client’s report of not being able to cope with a life situation, especially since mom decided to give her up to foster care; with client’s feeling of uncertainty with no defined plans about the future, school and not seeing herself in the future qualify for a diagnosis of adjustment disorder. According to the American Psychiatric Association (2013), the diagnostic criteria for adjustment disorder include expression or demonstration of physical, emotional, and intellectual clues that manifest in response to a distinct or detectable stressor that has been ongoing within three months onset of the stressor. There is a significant impact in both emotional and behavioral manifestations, as evidenced by impairment in social, academic, and professional functions (Substance Abuse and Mental Health Services Administration, 2016). Children that exhibit adjustment disorder with anxiety manifest fear of separation and uncertainty from parents and loved ones.
Motivational interview (MI) is a tool the therapist used in assisting the client to go through a change process and shows the therapist acceptance of the client. According to Wheeler (2014), MI thrives on the principle of acceptance, the ability of the individual to be who they are (autonomy) and acknowledging individual strength and confidence. Evidence-based MI helps the therapist make informed, focused, and goal-directed counseling (Lundahl & and Burke, 2009). Motivation is not mandatory on the client; instead, it elicits naturally from the inside. MI is a vital tool that helps in behavioral change and a significant step in client empowerment (Keith, 2020).
The client utilizing MI intervention will benefit from it because it will help the client in self-discovery, self-identification, and rediscovery of her coping strategies. The client expresses a feeling of frustration with the direction things are going in her life. The therapist can use the MI skills by asking client open-ended questions that will allow the client to explore her inner mind to gain insight into the situation and come up with strategies in handling the situation. The expected outcome for MI intervention is to help the client and the family recognize the need for behavior change and develop their plan or solution to prepare them to be ready and confident to carry out their portion of the plan. The therapist engages the client with the critical component of helping the client verbalize the pros and cons of behavior change and self-discovery her motivations and concerns with counseling techniques (Keith, 2020). The therapist can guide the client to identify her strengths and coping skills and possibly improves communication skills with mom without engaging in an emotional outburst.
The therapist will endeavor to ensure that patient’s autonomy is maintained by not imposing his/her opinions/beliefs to the client on what is good or bad (Conlin and Boness, 2019). The therapist serves as a support to the patient in finding her voice, drive, and strength. The therapist’s role is not to find solutions on ways the client will overcome barriers; instead, the goal is to provide evidence-based information and support the client need to voice concerns and make appropriate decisions according to goals (Keith, 2020).
MI is psychotherapy that provides willpower, courage, and boldness to sort through their mixed and uncertain emotions and insecurities. Thereby developing inner strength and motivation to alter their behaviors in a positive direction. Clients who verbalized resentment and dissatisfaction in coping with challenges need MI to develop inner strengths by identifying and voicing strategies, establishing coping stabilities (example on how to maintain a good relationship with mom), that will help in achieving goals.
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