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Running head: PRACTICUM JOURNAL 1

PRACTICUM JOURNAL 9

Practicum Journal Name Institution

Practicum Experience Journal

This journal reviews and evaluates two clients who are attending a group session. The notes from the group therapy session are attached and a detailed history of each client as well as their diagnoses. In addition, legal and ethical implications analysis of counseling individuals in a family therapy will be discussed.

Demographics of Client #1

The client is a 22-year-old SWF Caucasian female who lives with his father. His father is a meth addict and suffers from Parkinson’s disease. He does not allow the client to leave making her weak and deconditioned. He has paid for her to get treatment but she is concerned about leaving him alone due to his ailment. Her elder brother is also a recovering addict.

Presenting problem of client # 1

The client exhibits symptoms of depression and anxiety. She has trouble with seep, motivation and concentration. She feels hopeless and worries about his father who is sick.

History of Present Illness of Client #1

Client has had a history of abuse of heroin and cocaine. Client is anxious and is depressed. She has trouble with motivation, sleep and concentration. She worries about her dad who has dementia and Parkinson’s disease. Prior to coming for treatment, she was taking care of him since his brother is also recovering from addiction. She is concerned about leaving him alone.

Past Psychiatrist and Substance History of Client # 1

Client has never been seen by a psychiatrist and has not been inpatient. Client has been in treatment in the past and the longest period of sobriety is 5 months. In the past, she has been on Prolozac and Zoloft but was not keen on observing their benefits.

Pertinent Past Psychiatrist History of Client # 1

The client has recurrent problems with psych active substances and has not been in an outpatient facility.

Background And Social History of client # 1

The client grew up with parents who divorced 7 years old. Her father was CEO and her mother is a flight attendant. Her father is now 60 years old suffering from dementia and Parkinson’s disease. Her brother, who has completed through 9th grade, is also a recovering addict who has been sober for the past one month. He has no work history and has a partner of 2years.

Medical/surgical history of client# 1

He client has no past history of medical and surgical experiences.

Seizure and trauma history of client # 1

The client has no history of seizure and trauma

Trauma/abuse history

The client has experienced physical abuse in the past and cites that she was raped.

Psychosocial / Developmental/Family History Overview

The client family has members battling depression, anxiety, PSTD and alcohol abuse. His brother is a heroin addict but is recovering gradually.

Previous history suicidal/homicidal plans

The client denies any of such thoughts and plans /homicidal ideation plan

Current suicidal /homicidal plan

The client denies that she has current thoughts of taking own or other person’s life.

Mental Status Exam

The client is casually dressed, age-appropriate and relaxed. Her speech is normal and she is fluent. She is calms and maintains good eye contact and is cooperative. Her mood is dysphoric and is anxious and she seems depressed. She does not exhibit suicidal, homicidal and other self-destruction behaviors and her thought process is coherent. The vegetative signs include crying spells, Anhedonia, Anergia and decreased concentration.

Cognitive Assessment

The client’s orientation is within normal limit and her intelligence estimate is above average, her memory, both long term and short term and concentration are intact.

Strengths and assets include good communication skills, and cooperation. There are no established barriers to the client’s recovery.

DSM-V Diagnosis of Client #1

F11.20 opioid use disorder, severe F15-20 Amphetamine-type substance use disorder, severe F32.9 unspecified depressive disorder, F41.1 Generalized anxiety disorder (Boscarino, Hoffman & Han, 2015). The medications prescribed include Lexapro 10mg for depression and anxiety, Visatil 50 mg for anxiety, Gebapentin 300mg or tid and Naltrexone 50 mg for qhs cravings (Marin, 2016).

Psychosocial stressors for the client include problems related to the social environment, sexual abuse trauma and primary support group.

Client # 2

The patient was admitted voluntarily for meth abuse. She is a Caucasian white female single girl aged 23 years. She is currently not on medication and there are no known allergies in both food and medications.

History of Present Illness for Client# 2

The client is a 23-year-old white female who has extensive substance history which started at age 10. She is in her second treatment program but the first one since she was released from jail. The client denies suffering from anxiety and depression but she struggles with focus/attention as she fidgets often and cannot sit still. She admits she passed High School by doing all the work in school and then getting high at night.

Past Psychiatrist and Substance Treatment History for Client #2

The client has never seen a psychiatrist and has never been admitted in hospital .She has done one program and was sober for 4 months. In the three years she was in prison, she stayed sober but relapsed there months after she was released.

Pertinent Past Psychiatric History for Client #2

The client has recurrent problems with psycho –active substances and also with the legal system.

Background and Social History for Client #2

The client grew up with her parents who divorced when she was four years old and split her time between dad’s and mom’s house equally. Her mother is a dentist and the father a sales man. Her sister is bipolar who has been charged recently with being under influence while driving and causing death when she was involved in an accident. She worries that her mother is being hurt by their behavior .She has a boyfriend who is eleven years older than her and is in recovery. She has graduated high school and has college credit she acquired in prison. Her work history includes working at a call center in and after prison. She possesses certificates to do hair which did not impress her after doing it for a while.

Medical/surgery history for client #2

The client does not have the surgical /medical history; neither does she have seizure history neither does she have no history of trauma

Mental Status Exam

The client appears to be disheveled, age appropriate, her speech is normal and fluent, she maintains good eye contact though tearful, she is restless and is fidgeting, but cooperative. Her memory is intact.

DSM V Diagnoses for Client #2

F11.20 Opioid use disorder, Severe, F15.20 Amphetamine-type substance use disorder, Severe, F32.9 Unspecified depressive disorder, F41.1 Generalized anxiety disorder. The prescribed medication was Strattera 40mg daily for focus/attention. Treatment recommendations, were medications management, individual and group psychotherapy, psychoeducational groups, PHP day –night and after care plan (Bandelow & Michaelis, 2015).

Legal and Ethical Implications of Counseling Families

During the provision of psychotherapy in families the practitioner often faces more ethical challenges compared to individually oriented therapists (Pope & Vasquez, 2016). Therefore they ought to be aware of the existing codes of conduct among other ethical guidelines that should be adhered to. The competency to practice is a major ethical consideration as without the required training to attend to issues surrounding relationships, a breach in in duty care may occur (Pope & Vasquez, 2016). Additionally, the issue of informed consent is imperative in family counseling given that there are many different power levels in families. In addition, there are other complexities that surround the informed consent with people across ages and circumstances and how one is supposed to communicate therapeutic messages to them.

Additionally, when it comes to the arrangement of individual consultations within people who are related presents a plethora of difficulties which the therapist ought to overcome to achieve optimal results. Issues of privacy and confidentiality in such counseling may be at times confused, and at times therapist may find themselves being held in breach of confidentiality through work they executed in good faith (Pope & Vasquez, 2016). 

Moreover, dealing with families at times may lead to compromising neutrality when a therapist may opt for individual sessions, thus it is essential to have the ability to manage multiple alliances even though challenging to avoid the possibility of taking sides with one party (Pope & Vasquez, 2016). 

References

Bandelow, B., & Michaelis, S. (2015). Epidemiology of anxiety disorders in the 21st century. Dialogues in clinical neuroscience, 17(3), 327.

Boscarino, J. A., Hoffman, S. N., & Han, J. J. (2015). Opioid-use disorder among patients on long-term opioid therapy: impact of final DSM-5 diagnostic criteria on prevalence and correlates. Substance abuse and rehabilitation, 6, 83.

Marin, O. (2016). Developmental timing and critical windows for the treatment of psychiatric disorders. Nature medicine, 22(11), 1229.

Pope, K. S., & Vasquez, M. J. (2016). Ethics in psychotherapy and counseling: A practical guide. John Wiley & Sons.