Assessing Clients

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This week’s journal will concentrate on two clients engaged in the family sessions. This journal reflects on past medical history and psychiatric diagnosis using the DSM-V criteria for diagnosing and treatment plan. Also, a discussion regarding any legal and ethical implications and the potential impact on therapy and outcomes with the treatment plan will be addressed.

The clients are in therapy for supportive marriage counseling. The couple were married for 12 months, lives in off-post housing along with the wife’s mother. The husband is currently receiving individual therapy for Adjustment Disorder with Depressed Mood for the past 90 days (Kreamer & Morris 2017). Following his counseling, the treatment plan includes marriage counseling with his wife's husband to improve communication, adjusting to the culture, new living situation and mother in law being part of the household, adding tension to the marriage.

The couple has been in counseling for one month, and both are seeking interventions for a successful marriage. Currently, strategic family counseling model is being used to address behaviors and emotions regarding mother in law, who wants her daughter to divorce and leave the husband. This has caused stress and strain on the marriage, particularly on the husband, being accused of “adultery” by the mother in law.

In this couple's counseling, the therapist utilized a developmental model. The Developmental Model of couple’s therapy facilitates both partners to recognize one another feelings or problems within the couple’s dynamic. Also, it teaches methods to convey the current state of stressors within the relationship while working on coping mechanisms and increasing communication skills ((Kreamer & Morris 2017). The counselor encourages more communication, which helps the couple work through barriers in the marriage. This will assist in creating a more reliable, mature and emotional bond to each other (Kreamer & Morris 2017).

Client one- Asian descent, 27-year-old husband Chinese American, English is his primary language; however, speaks fluent Mandarin. He is a specialist E-4, active duty in the US Army. There are no current medical problems. He is "happy" with his new wife and wants to have children soon. He denies any legal issues and has received several awards, including Army Accommodation last year.

Client two- Asian descent, 25-year wife, Chinese immigrant, Mandarin is her primary language, speaks fluent English, she migrated to the US after getting married. She is a nursing student, on a marriage Visa, no legal issues. Her mother moved in the past six months.

Psychiatric history: The husband was diagnosed with Adjustment Disorder with Depressed Mood, 90 days ago. He was reported, having difficulty sleeping, unable to concentrate, feeling “depressed” all the time, since his mother in law moved in. He reports the mother in law is constantly berating him, starting arguments and making accusations of “adultery” against him, which can cost, the marriage and his career. Client one was placed on fluoxetine 10mg daily for symptom relief (Xia et al. 2018). Client reports prior to the mother in law moving in, “everything was great”. Client two is aware of the strife between her mother and her husband. She wants to remain married and trust her husband. Client one admits to “having girlfriends before marriage,” has been faithful since the engagement. Client two ‘feels overwhelmed” all the time (Xia et al 2018).

Diagnosis

Adjustment Disorder with depressed mood 309.0 (F43. 21): Client one, He reports, not wanting to get out of bed and feeling overwhelmed and anxious about coming home and continuously thinking failures in his marriage. He cannot concentrate at work and received a counseling statement for missing deadlines (APA 2013).

Adjustment Disorder With anxiety 309.24 (F43.22) Client two, feeling overawed anxious, nervousness, worried all the time (APA 2013).

Family/Couples Therapy

The student APRN was allowed consent to attend the couple therapy session by both the husband and wife.

Client One (husband) is Alert and Oriented x 4 spheres and willing to participate and engaged in the meeting, as evidenced by the completion of his homework from the previous session. He was task with expressing three positive personal features, and he brought to the marriage. She was anxious during a review of her homework. He feels the stress level is higher over the past 90 days. He had exhibited a few coping skills, such as playing a game to destress. He is using deep breathing techniques and boundaries when his mother in law starts an argument, and this has been beneficial in the past. His mood is consistent with the situation, and he states he implements meditation into his evening routine, before entering the house. His affect is anxious. he denies Suicidal/ Homicidal Intent

Client two (wife) is Alert and oriented x 4 spheres; she completed her assignment on three positive features, she likes to cook, especially for her husband’ looks at the floor when the husband mentions her mother. Client two, she likes attending class and learning new ideas.

Session

.At the initiation of the session, both clients agreed, signed consent, and was notified of HIPPA policy and educated on confidentiality (Roca et al. 2016). The objective and treatment plan were discussed with the couple and both agreed with the plan. The goal is to improve communication for an improved, fulfilling relationship. It is vital to have all involved parties state the purpose of the sessions to ensure all parties agree (Barnett & Jacobson 2019). During the initial first minutes of the therapy session, both clients agreed to respect one another boundaries. The husband was referred to couple’s therapy, per his provider, since the source of his stress is an outside source.

Asking the couple open questions allows the patients to discuss what they deem essential in divulging (Barnett & Jacobson 2019). Using open-ended questions cultivates an environment to address what barriers the clients are facing day to day, allowing the intervention resolution or plans to overcome the obstacles on a unified front.

At the close of the session, each client was asked to describe and rate their mode, asked was there anything they wished to discuss, both denied. Both clients deny suicidal/homicidal intent (Barnett & Jacobson 2019).

References

Association, A. P. (2013). Diagnostic and Statistical Manual of Mental Disorders. doi: 10.1176/appi.books.9780890425596

Barnett, J. E., & Jacobson, C. H. (2019). Ethical and legal issues in family and couple therapy. In B. H. Fiese, M. Celano, K. Deater-Deckard, E. N. Jouriles, & M. A. Whisman (Eds.), APA handbooks in psychology®. APA handbook of contemporary family psychology: Family therapy and training (p. 53–68).American Psychological Association. https://doi.org/10.1037/0000101-004

Kreamer, S., & Morris, E. (2017). What is the efficacy of medication versus CBT or both for the treatment of depression in adolescents?. Evidence-Based Practice, 20(12), E13-E14.

Nichols, M., & Davis, S. D. (2020). The essentials of family therapy (7th ed.). Boston, MA: Pearson.

Roca, R. P., Charen, B., & Boronow, J. (2016). Ensuring staff safety when treating potentially violent patients. Jama, 316(24), 2669-2670

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer.

Xia, W., Zhou, R., Zhao, G., Wang, F., Mao, R., Peng, D., ... & Fang, Y. (2018). Abnormal white matter integrity in Chinese young adults with first-episode medication-free anxious depression: a possible neurological biomarker of subtype major depressive disorder. Neuropsychiatric disease and treatment, 14, 2017.