Psychotherapy With Individuals
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PRACTICUM-WEEK 1-4 JOURNAL ENTRY
Practicum-Week 1-4 Journal Entry
NURS 6640-Psychotherapy with Individuals
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Running head: PRACTICUM-WEEK 1-4 JOURNAL ENTRY
Running head: PRACTICUM-WEEK 1-4 JOURNAL ENTRY
Practicum-Week 1-4 Journal Entry
Practicum-Week 2 Journal Entry
NURS 6640-Psychotherapy with Individuals
Walden University
Dr. Dickson
June 14, 2018
Practicum-Week 2 Journal Entry
This week I will describe a client I counseled this past week. I will incorporate the finding, medical history, medicinal data, and psychopharmacological prescriptions currently administered. Also, legitimate or potentially suggestions identified in counseling will be examined.
The client, PB is a 28-year-old male diagnosed five years ago with bipolar II disorder. PB also has a diagnosis of insomnia and intervertebral budging disc. PB is currently an entry level engineer at a large firm and is also in a master’s level program. He is an Army veteran who served in Afghanistan who suffered chronic back pain from his time in the military. During the session he displayed euthymic mood with a slightly anxious affect. He has a history of impulsivity and is worried he can’t control the urges when proper decisions need to be made. He mentioned that he has made decisions financially and career wise that have not benefitted his situation. He is also questioning all his decisions and fears did he make the appropriate decision. He mentioned recently he bought a used car and told himself he will not spend more than four thousand dollars on it and stuck to his pronouncement. PB would normally take expensive trips he could not afford, not show up to work because he wanted to see a friend, or make a decision to buy a expensive item instead of paying his rent which resulted in him becoming homeless at one point. PB was very conversational during the session, he did not have any suicidal or homicidal ideations and his speech was not pressured and he sat up in his chair while giving eye contact. He also mentioned that his has things to look forward to such as finishing his master’s degree with honors. He also made a bold statement about one day challenging Elian Musk the owner of Tesla as an entrepreneur, since he really disliked his persona. The client understands when he takes his medications he can make better decisions and decrease his impulsivity.
Psychopharmacological Agents
PB currently takes Divalproex 500 mg 1 tab every 24 hours, Bupropion HCL 300 mg 1 tab every 24hours, and Quetiapine Fumarate 300 mg 1 tab per day. PB also takes Ibuprofen 800 mg as needed for his back pain. The client feels the medications are helping with his manic/depressive symptoms and has not felt any adverse effects. He is healthy young man with all his labs with in normal ranges. He also exercises 6 days a week and mentioned he prioritizes exercise and school on a daily basis.
Diagnosis
The client has a diagnosis of bipolar II disorder, insomnia, and intervertebral budging disc. PB was diagnosed with bipolar disorder II on 8/28/17, insomnia on 9/20/18, and intervertebral disc bulging on 3/15/17. Mental status exam was administered, and result was 26. According to the psychiatrist that administered the exam he considered him pleasant and engaged with good hygiene. The intake form has a 15 min long questionnaire which is also used a diagnostic tool. The two tools and along with the initial meeting with the psychologist and psychiatrist is used to diagnose the patient. Three are tools such as the Young mania rating scale (YMRS) and Hamilton Depression Rating Scale (HAM-D) scores were used to measure the severity of manic episodes and depression, respectively (Vedanarayanan et al., 2019). Nevertheless, according to the lead psychologist in the practicum site, the intake questionnaire and initial session is the criteria used by the Veterans administration in my area.
Ethical and Legal Aspects of Counseling
There are many ethical and legal aspects with in counseling that can affect the rapport and trust between the therapist and client. First, is having the knowledge, skills and judgement to practice appropriately. Having respect for the client’s dignity and freedom. Using the power giving in a responsibly manner. Acting in a professional manner that promotes confidence in the profession. Placing the welfare of the client at is highest priority (Welfe, 2015). Placing priority in the welfare of the client can lead to legal action and loss of autonomy for the individual. An example would be a registered gun owner who mentions to the therapist he has thoughts of hurting himself or someone else. Therefore, the therapist may have the power to remove the license of the gun owner to protect the client or others.
References
Vedanarayanan, L., Munoli, R., Thunga, G., Nair, S., Poojari, P., & Kunhikatta, V. (2019). Identification of factors affecting treatment outcome in bipolar disorder. Indian Journal of Psychiatry, 61(1), 22-26.
Welfe, R. (2015). Ethics in Counseling and psychotherapy: Standards, Rewards, and Emerging Issues (6 ed.). Cleveland Ohio: Cengage Learning.
Practicum-Week 2 Journal Entry
Engelbert Marrero
NURS 6640-Psychotherapy with Individuals
Walden University
Dr. Dickson
June 20, 2019
Practicum-Week 4 Journal Entry
For week four's journal passage, a patient seen during my practicum will be analyzed. The patient’s relevant history, therapeutic data, prescriptions, and diagnosis will be explained. Likewise, legal and/or ethical implications related to counseling this client will be explained.
The Client
The client is a 66-year-old African American female who is suffering from chronic pain on her back and right knee. She mentioned that she had a total knee replacement done on her right knee a few years ago which caused her to have a longer limb and put stress on her right hip and back. The client is an army veteran and a retired clinical social worker. She mentioned in the intake that she is going through the loss of four relatives with in the past 2 years. One being an uncle and another a younger brother she was close to. She also reported she has a history of panic attacks, feelings of anxiety and depression. During the interview she reported loss of sleep and night terrors. She also rated her pain on her knee at 6/10 on the pain scale and 4/10 for her back. The client has worked with a psychotherapist in the past
The client had a GAD-7 and PHQ-9 test administered by her previous psychotherapist and mentioned the results in the intake interview. PHQ9 was specifically designed to assess depression (with all nine items taken directly from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition[DSM-V] depression criteria (Searle, Van Hoof, & McFarlane, 2017). The client scored a 9 in the PHQ-9 which put her depression at the mild range. She also scored a 14 on the GAD-7 which put her on a moderate range for anxiety (Spitzer, 2018). The mentioned she has experienced panic attacks over the past few years. She believes the triggers were with family issues and deaths of close family members. The client is a retired clinical social worker and mentioned helping her patients overcome their issues has helped her with her own thoughts. She also mentioned that her husband has had a total knee replacement and feels that the act of caregiving for him has also giving her the distraction needed from her thoughts and feelings. The patient is adamant about not taking any psychiatric medication because of the side effects she had with them in the past. She is only taking Ibuprofen 800 mg as needed for her pain, while receiving physical therapy sessions for her knee.
Unified Protocol for Transdiagnostic treatment of Emotional Disorders (UP)
UP is designed from the principles of Cognitive Behavioral Therapy (CBT) while focusing on the discrete feelings of panic attacks, anxiety, fears, and depression symptoms. The advantages are that it doesn’t focus on separate treatments for different disorders but instead focuses on handling emotional processes that maintain symptoms across disorders (Harlow, 2017). This takes less pressure off the therapist to have to come up with multiple interventions for specific diagnosis. Since the patient is dealing multiple emotions it helps therapist focus on the emotion that leads to the thoughts and feelings, rather than vice versa.
Ethical/Legal Implications
Confidentiality should be respected in all situations. That is, the APPN should not discuss the patient to the person’s family members or spouse. If a family member calls and is concerned and wishes to tell the APPN something about the patient, the APPN can listen but is obligated to explain that therapy is confidential (Wheeler, 2014). The only reason to break this confidentiality if the client has suicidal or homicidal ideations. The ethics of the profession is to protect and prioritize the welfare of the patient and individuals surrounding the client
References
Harlow, D. (2017). Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide (2 ed.). [ 9780190685973.001.0001]. http://dx.doi.org/DOI: 10.1093/med-psych/ 9780190685973.001.00019780190685973.001.0001
Searle, A. K., Van Hoof, M., & McFarlane, A. C. (2017). Screening for Depression and Psychological Distress in a Currently Serving Military Population: The Diagnostic Accuracy of the K10 and the PHQ9. Assessment. http://dx.doi.org/https://doi-org.ezp.waldenulibrary.org/10.1177/1073191117745124
Spitzer, R. L. (2018). GAD-7 (General Anxiety Disorder-7). Retrieved from https://www.mdcalc.com/gad-7-general-anxiety-disorder-7
The Patient Health Questionnaire (PHQ-9)-Overview. (2015). Retrieved from http://www.agencymeddirectors.wa.gov/files/AssessmentTools/14-PHQ-9%20overview.pdf
Wheeler, K. (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company
