6394 Revision Order Within 6 Hrs

E-mail Address:

Practicum Placement Agency's Name: A Better Tomorrow Counseling Service

Preceptor’s Name: Dr. Anthony Redmond, Ed.D, LMSW, LLP

Preceptor’s Telephone:

Preceptor’s E-mail Address:

Journal Entries

The purpose of this journal entry is to review and evaluate two clients that are attending a family group session at A Better Tomorrow Counseling during my week 2 practicum experience. Group therapy session notes are attached and a detailed history of each client are included along a differential diagnosis. Additionally, an analyses of legal and ethical implications of counseling individuals in family therapy will be discussed.

Demographics of Client #1

Client BM is a 17-year old, African American male. BM lives with his mom and grand-mother in a single-family home and attends high-school. Client, BM does not have a relationship with his father and was close to his grand-father who passed away 4 years ago. Client is currently enrolled in 12th grade and struggles with regular attendance and most recently attended summer school to make up for sessions missed due to his “skipping” school. Family support is limited and client does not report support other than his mother and grandmother.

Presenting Problem of Client #1

CC: Increased anger, aggression, and anxiety. The client is quiet and tense, answering most questions with a “yes or no”. Client states, “I have been angry since my grandfather died, and I have trouble focusing. My mind is always racing.”

History of Present Illness of Client #1

Client was referred to group therapy by the hospital psychiatrist after a recent discharge from Kingswood Hospital for a “crying spell”, and aggression during a road trip with his mother and grandmother. Client is very anxious, fidgets often, and presents with a depressed mood. Symptoms present are moderate to high in presentation. Client is primarily non-verbal and tense with occasional nodding to questions asked during interaction. Client was taken to the ER while on a road trip due to a “crying spell”, extreme anger, and aggression after his driving privileges were banned for “skipping” school. Client’s mom reports that she would not allow BM to drive after he was reported to be consistently “skipping” school, and BM was reported to have outbursts followed by screaming obscenities and intense crying. Client, BM reports has had wanted to harm others over the past month. Client is challenged when asked to follow directions, and presents malodorous, and has slovenly appearance. Client, BM reports that he is verbally aggressive to his mother, grandmother and often disrespectful to authorities at school. Client, BM reports he has been unable to sleep most nights, which makes focusing more difficult. BM has not received psychotherapy in the past and was provided with medication post hospital discharge.

Past Psychiatric History of Client #1

Client, BM has never seen a therapist outpatient. Client has been hospitalized most recently for aggression, anxiety, and anger for 1 week. Client had not been prescribed medication until recently but would take a friends Adderall because it helped him excel at video games. Client’s mom has believed her son to have ADHD but was not formerly diagnosed in the past. Client’s mom reports a worsening of symptoms since the death of his grandfather.

Medical History of Client #1

The client has an unremarkable medical history, and has not been hospitalized in the past since birth. No known allergies (food, medications). All immunizations are up to date and client received the flu vaccine in September of 2018. Client has no surgical history. Physical assessment not completed during this visit.

Substance Abuse of Client #1

BM denies the use of any illicit drugs past and present. Alcohol and tobacco usage is also denied.

DSM-V Diagnosis of Client #1

314.0X (F90.X) Attention-Deficit/Hyperactivity Disorder (ADHD), can be defined as a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning and development. ADHD is characterized by specific symptoms that must be present for a minimum of 6 months (APA, 2013). BM’s current symptoms are congruent with the diagnosis of ADHD. The diagnosis of (F43.1) PTSD can be considered related to the feelings of loss since the death of his grandfather. BM symptoms correlate to ADHD criteria in that he is failing in most school work subjects, fails to follow directions, fidgety, inattentive, and aggressive in tone and behavior.

Demographics of Client #2

Client TB is a 35-year old, African American female, who is employed as a Certified Nurse Assistant at a nursing home in Detroit. TB lives with her son BM who is 17 years of age and her mother who is 62 years of age in a private residence. The home of TB is located in a lower socioeconomic, heavy crime neighborhood. Client, TB has a strained relationship with her son’s father, and has not spoken with him since BM’s birth. Client reports that she works 12 hour day shifts but often picks up additional overtime on midnights to pay bills. Client does not have siblings and has not had a car since it was stolen 3 months ago. TB relies on public transportation to get back and forth to work. Client reports that she depends on her mother for emotional support and has struggled with her emotions since the death of her father.

Presenting Problem Client #2

CC: Increased anxiety, and depression. Client states, “I’ve been very sad and depressed since my dad passed, I have so much anxiety that my mom will die next. This anxiety forces me to stay up and not sleep for fear of something bad happening.”

History of Present Illness of Client #2

Client TB presents to A Better Tomorrow Counseling with the compliant of depression and continued feelings of sadness since the death of her father. This sadness has led to the client not being able to sleep for fear of something bad happening to her mother. Client reports, “I often feel paranoid, like something bad is going to happen to my family.” Client is alert and oriented to person, place, time, event, and withdrawn. Client is dressed appropriately for the time of year and occasion. Client does not currently take medications but feels that she could benefit from something to help with her mood. Client, TB is cooperative and reports feelings of sadness, anxiety, difficulty sleeping, and concern related to her son’s recent behavior.

Past Psychiatric History of Client #2

Client, TB reports that she went to the ER with her son for his “melt down”, aggressive behavior, and became tearful and in a “sad fit” after feeling overwhelmed with the loss of her father and her son’s out of control behavior. Client has not seen a therapist in the past and does not report previous psychiatric hospitalizations. Client reports that her father suffered with depression.

Medical History of Client #2

Client TB reports that she has not been hospitalized since the birth of her son, and reports a non-complicated natural birth. Medical history is unremarkable. Immunizations are up to date and client has received the flu shot 2 weeks ago at her place of employment. Client has no known allergies (food, medications). Physical assessment was not completed during this visit.

Substance Abuse of Client #2

Client denies the use of illicit drugs. Client does not take any prescription medications. Client use to drink wine socially, but no longer feels engaged with friends. Client denies smoking cigarettes or vaping.

DSM-V Diagnosis of Client #2

296.32 (F33.1) Major Depressive Disorder, is defined by the following criteria: depression that is recurrent in nature with moderate to high severity, and accompanied by a peripartum onset. Additional criteria includes five out of nine symptoms that must be present over a two week span. Proper diagnosis includes the presentation of symptoms, one for a depressed mood, and one related to loss of enjoyment and/or interest (APA, 2013). TB is moderately depressed on a daily basis and no longer finds enjoyment with friends, hobbies, or life. TB reports poor sleep and extreme fatigue. Zoloft 50 mg PO daily is prescribed for depression and Trazadone 100mg PO HS is prescribed for sleep deprivation (Carlat, 2018).

Legal and Ethical Implications of Counseling Families

When providing psychotherapy to families the PMHNP must be aware of several ethical and legal considerations. Defining the client and protection of the client welfare is the primary obligation of the mental health counselor. This area can be quite challenging in family therapy where the welfare of one client may not be in the best interest of another (APS, 2011). Informed consent is another area of importance to consider as it requires each family member to consent to the process of treatment (Wheeler, 2014). Lastly, confidentiality must be maintained within family therapy. Individual and family “secrets” that are not related to criminal behavior should not be shared with outsiders.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Washington, DC: Author.