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week5journaltemplate.docxWEEK 5 JOURNAL ENTRY-PSYCHOTHERAPY WITH TRAUMA 2
WEEK 5 JOURNAL ENTRY-PSYCHOTHERAPY WITH TRAUMA 2
Week 5 Journal Entry-Psychotherapy with Trauma
Psychotherapy with Individuals-NURS 6640-6
September 27, 2019
Running head: WEEK 5 JOURNAL ENTRY-PSYCHOTHERAPY WITH TRAUMA 2
Week 5 Journal Entry-Psychotherapy with Trauma
According to Wheeler (2014), the effects of trauma or adverse life experiences can be cumulative and cause psychiatric disorders, mental health problems, and physical disorders. The severity of the trauma disorder mainly depends on the age of the client, the severity and chronicity of the traumatic event, and the underlying neurophysiology. Post-traumatic stress disorder (PTSD) is one of the trauma-related disorders and will be the focus of discussion for this journal. The purpose of the journal is to describe a client with PTSD. The discussion will include the pertinent history, medical information, current medications, the justification for the diagnosis using the DSM-5 criteria. The journal will also address the therapeutic approaches that will be effective for this client and the legal and ethical implications of counseling the client.
Description of the Client
JS is a 53-year old homeless man admitted to the facility after being discharged from an in-patient psychiatric hospital for an attempted suicide. JS was assured of the privacy of his information prior to the counseling/interviewing session, and permission was obtained to use his information for this journal. JS stated he has been homeless for the past two years and has lived from one shelter to another. JS has been in several psychiatric facilities for either severe depression or attempted suicide in the past. He stated that he has attempted suicide twice before but usually signs himself up in the hospital for suicidal ideations. This time around, he is in the drug rehabilitation center to get off drugs. His drug of choice is heroin and oxycodone.
JS stated that he was diagnosed with depression and PTSD after his father shot his younger brother to death while JS watched. He stated that he tried to resuscitate his brother while waiting for the ambulance. At this time, his father had taken off running but was apprehended and taken to jail a few minutes after police arrived. Their father died a month later while in jail from natural causes. JS stated, “Since my father killed my brother, my life just went downhill, and I will never be the same again.”
Medical Information and Prescribed Medications
JS has no medical history other than his psychiatric history of substance abuse, PTSD, and depression. JS admitted that he had been using drugs even before the incident of his father killing his brother. For his depression, JS takes sertraline (Zoloft) 100mg daily. He also takes propranolol 10mg for the PTSD related anxiety. However, according to Mithoefer et al. (2019), sertraline (Zoloft) and paroxetine (Paxil) are the only approved medications by the FDA for PTSD. The two selective serotonin reuptake inhibitors are antidepressants that also treat anxiety, which also co-occurs with PTSD.
Justification of Diagnosis
According to (Association, 2013), the DSM-5 defines PTSD as a mental health condition experienced after exposure or witnessing a life-threatening event, combat, serious injury, sexual violence, etc. Additionally, Blacker, Frye, Morava, Kozicz, and Veldic, (2019) reiterated that the criteria for the diagnosis of PTSD includes exposure to a traumatic stressor with subsequent intrusion symptoms such as flashbacks, nightmares, physiological reactivity, avoidance behaviors, negative mood/thoughts, and alterations in arousal. Considering JS witnessed his brother being murdered by their father, the diagnosis of PTSD is justified. Additionally, Blacker et al. (2019) indicated that PTSD, depression, and alcohol/drug abuse are comorbid.
Effectiveness of Therapeutic Approaches
JS has been attending both individual and group therapy sessions while in the facility. The cornerstone of psychotherapy with PTSD is cognitive-behavioral therapy (CBT). A literature review by Shubina (2015) found proof that CBT effectively reduces PTSD symptoms and accompanying depression and anxiety. CBT helps as a short-term therapy, and the achieved results are maintained. CBT is, therefore, appropriate for JS because he is only in the rehabilitation center for 28 days as this is the longest anyone can stay at the center. CBT helps patients identify and modify distorted beliefs connected with PTSD.
Legal and Ethical Implications
Treating psychiatric conditions can be a challenge, as these conditions are characterized by disability, suffering, and stigma. The clinician must ensure that the client does not feel stigmatized or judged. Yang, Schneider, Wynn, and Howe (2017) caution the clinician in making sure that the patients are not re-traumatized while in treatment. Therefore, the choice of approach should be suited for each patient. For example, the clinician must assess to make sure a patient is appropriate for exposure therapy. As with any other therapy sessions, the clinician should inform the patient about the course of treatment, alternatives to treatment, and the expected length of treatment.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) Washington, DC: Author:
Blacker, C. J., Frye, M. A., Morava, E., Kozicz, T., & Veldic, M. (2019). A review of epigenetics of PTSD in comorbid psychiatric conditions. Genes, 10(2), 140. https://doi.org/10.3390/genes10020140
Mithoefer, M. C., Feduccia, A. A., Jerome, L., Mithoefer, A., Wagner, M., Walsh, Z., & Hamilton (2019). MDMA-assisted psychotherapy for the treatment of PTSD: Study design and rationale for phase 3 trial based on pooled analysis of six phase 2 randomized controlled trials. Psychopharmacology, 236, 2735-2745. https://doi.org/10.1007/s00213-019-05249-5
Shubina, I. (2015). Cognitive-behavioral therapy for patients with PTSD: Literature review. Social and Behavioral Sciences, 165(2015), 208-206. https://doi.org/10.1016/j.sbspro.2014.12.624
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, LLC
Yang, S., Schneider, B., Wynn, G. H., & Howe, D. (2017). Ethical considerations in the treatment of PTSD in military populations. The American Journal of Psychiatry, 15(4), 435-440. https://doi.org/.org/10.1176/appi.focus.20170035
Week 6 Journal Entry-Psychotherapy for Addictive Disorders
Kaacha Naminda
Walden University
Psychotherapy with Individuals-NURS 6640-6
October 4, 2019
Week 6 Journal Entry-Psychotherapy for Addictive Disorders
JM is a 45-year old male admitted to the drug and rehabilitation center for drug use disorder. This journal will describe the client’s pertinent history, prescribed medications, and justification of his diagnosis using the DSM-5 criteria. Additionally, the discussion will address whether motivation interviewing would be effective for JM, including the legal and ethical implications of counseling JM.
Client Description
JM smokes marijuana occasionally, but his drug of choice is cocaine. JM stated he was prescribed Percocet five years ago when he was run over by a car and sustained a fracture to his right knee. He was supposed to have surgery to his knee, but he declined and opted to go home instead. He has since been having severe pain to the knee. However, since he does not have insurance, he was unable to fill his prescription but instead resorted to using heroin.
JM has never been married and has no children. After being homeless for a while, JC recently moved in with his brother, who gave him a condition to either quit using drugs or be homeless. JM has a history of hypertension, depression, and anxiety. JM has never been in a drug rehabilitation center or psychiatric hospital before. He has however, been seeing a psychiatrist who was managing his medications. He has not been able to fill his prescriptions for the past six months.
Justification of the Diagnosis using DSM-5 Criteria
JM was admitted to the facility for drug rehabilitation. He, however, has comorbid major depressive disorder 296.32 (F33.1), social anxiety disorder 300.23 (F40.10), and drug use disorder of moderate to severe cocaine use 292.89 (F14.229) as classified by the DSM-5. Even though the client does not take his medications, the following is the list of his ordered medications:
1. Effexor 75mg daily for depression.
1. Amlodipine 10mg daily for hypertension
Effectiveness of Motivational Interviewing
According to Wheeler (2014), motivational interviewing (MI) is a collaborative, client-centered communication process designed to help individuals resolve ambivalence and plan for change. Additionally, Madson, Schumacher, Baer, and Martino (2016) discussed the components of motivational interviewing as relational and technical. The relational component includes person-centered counseling traditions, such as being empathic, non-judgmental, autonomy-supporting, and affirming with clients. The technical component occurs when clinicians intentionally elicit client arguments for or against change. Madson et al. (2016) also stated that the technical component of MI involves a directional approach in which clinicians selectively attend to and purposively elicit and elaborate discussions about healthy changes. These authors also stated that research supports the efficacy of MI for reducing alcohol and drug use behaviors, including cigarette smoking.
Additionally, Moyers (2014) differentiated MI from other kinds of treatment in that other treatments focus on assisting the client make a change while MI helps clients make decisions to change. MI addresses the question of why change should occur now, helps resolve ambivalence, and helps clients move forward to make positive change. For this reason, MI is sometimes the only intervention needed for a drug addict to change. For the reasons above, MI might be effective for JM for his substance use disorder.
The expected outcome after MI would be that that client would be able to maintain sobriety after he is discharged from the drug rehabilitation center. According to Frost et al. (2018), MI was initially introduced to help people with alcohol problems change their drinking behavior. MI does this by guiding and maintaining goal-related behaviors. MI helps strengthen a person’s motivation and commitment to change. As indicated by Frost et al. (2018), MI helps people engage in a working relationship, focus on a problem to change, and plan the change. Therefore, MI can help drug-addicted individuals in changing their behaviors.
Legal and Ethical Implications
According to Roemer (2015), competency is one of the prominent ethical issues in the treatment of clients with substance use disorder. Therapists and counselors have an ethical responsibility to ensure that they are adequately trained and competent in their specific area of practice. Roemer (2015) reiterated the importance of informed consent and confidentiality. Residents at the drug rehabilitation center share their most private information during individual therapy. The therapist, therefore, has to keep this information confidential to avoid the violation of the client’s private information.
References
Frost, H., Campbell, P., Maxwell, M., O’Carroll, R. E., Dombrowski, S. U., Williams, B., ... Pollock, E. A. (2018). Effectiveness of motivational interviewing on adult behavior change in health and social care settings: A systemic review of reviews. PLOS ONE, 13(10), . https://doi.org/org.ezp.waldenulibrary.org/10.1371/journal.pone.0204890
Madson, M. B., Schumacher, J. A., Baer, J. S., & Martino, S. (2016). Motivational interviewing for substance use: Mapping out the next generation of research. Journal of Substance Abuse Treatment, 65(2016), 1-5. https://doi.org/org/10.1016/j.jsat.2016.02.003
Moyers, T. (2014). The relationship in motivational interviewing. American Psychological Association, 51(3), 358-363. https://doi.org/org/10.1037/a0036910
Roemer, A. (2015). Ethical issues surrounding in-patient treatment for adolescents with substance use disorders. International Archives of Addition Research and Medicine, 1(2). https://doi.org/10.23937/2474-3631/1510007
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, LLC
