Psychotherapy With Individuals

Running head: WEEK 6 JOURNAL ENTRY 1

WEEK 6 JOURNAL ENTRY 2

ss

Week 6 Journal Entry

Week 6 Journal Entry

This paper will describe a client that was seen for psychotherapy in my practicum course. Pertinent medical information and medications will be included to provide a background and understanding of the patient. The DSM-5 will be used to explain and justify his diagnosis. The way in which motivational interviewing will be effective for this patient will be explained along with expected outcomes using a therapeutic approach. Legal and ethical implications related to counseling this patient will be discussed. Evidenced based literature will be used to support the approach used. The purpose of this paper is to choose a client counseled this week that would benefit from motivational counseling and explain why.

Describing the Client and their History

This patient is a 50 year old male who is married and has 2 daughters. He has been married for 25 years. About 3 years ago, the patient was considering divorcing his wife and buying a house with another woman, whom he was having an affair with, and her children. The patient starting seeking therapy at this challenging time in his life and changed his mind deciding to stay with his wife and family. This patient had a rough childhood as he was abused by his mother physically and emotionally neglected. The patient started drinking alcohol when he was approximately 8 years old. Drinking started to become a serious problem in his life when it was interfering with his relationships and work. He had stopped drinking and sobered up about 2 years ago. He had been sober for 2 years until he started drinking again this past summer after an argument with his wife. He now drinks off and on but when he drinks, he gets black out intoxicated. The patient reverts back to drinking when extremely upset and arguing with his wife. With that being said, this patient has an extensive history of alcoholism which runs in his family as his dad was an alcoholic as well. This patient denies any health issues that he knows of and does not take any medications at this time.

The Diagnosis

This patient’s diagnosis is alcohol use disorder. He meets criteria for alcohol use disorder in the DSM-5 by demonstrating a maladaptive pattern of drinking manifested by the fact that his alcohol intake is taken in larger amounts than intended, a persistent desire and unsuccessful effort to control alcohol use, and using alcohol when there is a failure to fulfil role at home (Tyburski, 2014). All of these symptoms have occurred in the same 12 month period meeting criteria. The patient drinks off and on with periods of sobriety. The patient has had periods of sobriety as long as 8 months. Most frequently, he begins binge drinking when things are not going well at home. He is unable to control his intake and will drink large amounts of alcohol for days straight.

Motivational Interviewing

Motivational interviewing is an effective type of psychotherapy for patients who struggle with addiction, therefore, it would be an effective option for this patient. Motivational interviewing focuses on giving the patient autonomy and motivation to want to get better. The patient directs the session and talks about their history and experience. This process helps put things into perspective for the patient. The patient is able to recognize their issue through this process without feeling judged or forced to reach a specific goal set by their therapist. Motivational interviewing is patient-centered, and the only aspect where the therapist speaks up is to help make the patient aware of inconsistencies in their thoughts and actions in a subtle manner without any persuasion (Resnicow & McMaster, 2012). The patient is also encouraged to consider the pros and cons of their goals for change.

Expected Outcomes

One study analyzed the effectiveness of motivational interviewing for patients with alcohol abuse. The effectiveness of motivational interviewing showed that 8 out of 13 cases proved consistent success (Frost, 2018). Factors have been shown to be more effective consistently with short term cases, less than 4 months (Frost, 2018). With that being said, an additional therapeutic approach could improve the outcome long-term for this patient. CBT can help address cognitive distortions, negative emotions, and can be effective after a relapse which would be helpful for this patient (Jhanjee, 2014). Lastly encouraging this patient to seek out a 12-step approach program such as AA and/or family counseling could be beneficial adjuncts to his treatment and improve his outcome (McKay, & Hiller-Sturmhofel, 2011). By including multiple therapeutic approaches, this patient has a high chance of succeeding without relapsing as long as he continues to seek out psychotherapy.

Legal and Ethical Implications

Legal and ethical considerations related to counseling this patient include the fact that alcoholism can cause serious health problems. Counseling this patient who has consistent relapses can be challenging. An interdisciplinary team must be communicated with frequently including a medical physician to ensure that the patient is healthy and compliant with necessary medications related to his physical health. Alcohol use disorder can lead to cancer, diabetes, cardiovascular disease, liver and pancreas disease, infections, and injuries (Rehm, 2011). The patient must be have regular check-ups with his primary care physician to make sure he is in good health. Assessing whether or not the patient has a history of seizures or complicated withdrawals is important when counseling alcoholic patients must be completed. It is unknown whether or not or not the patient will be stable when they come to their session, therefore having an understanding of the patient’s history is essential. There are many medical concerns related to alcohol use disorder which must be taken into consideration.

Conclusion

This patient who struggles with alcohol use disorder generally drinks when there are issues with his wife and family. He has an extensive history of drinking, starting at age 16 which predisposes him to many health risks. Motivational interviewing could be beneficial for this patient along with additional therapies to increase likelihood of success and prevent future relapses as motivational interviewing is generally more effective for short-term case outcomes. Being aware of the patient’s medical history and having contact information for a medical provider and an interdisciplinary team formed for him is an important ethical consideration.

References

Frost, H., Campbell, P., Maxwell, M., O'Carroll, R. E., Dombrowski, S. U., Williams, B., …

Pollock, A. (2018). Effectiveness of Motivational Interviewing on adult behaviour change in health and social care settings: A systematic review of reviews. PloS one, 13(10), e0204890. doi:10.1371/journal.pone.0204890

Jhanjee S. (2014). Evidence based psychosocial interventions in substance use. Indian journal of

psychological medicine, 36(2), 112–118. doi:10.4103/0253-7176.130960

McKay, J. R., & Hiller-Sturmhofel, S. (2011). Treating alcoholism as a chronic disease:

approaches to long-term continuing care. Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism, 33(4), 356–370.

Rehm J. (2011). The risks associated with alcohol use and alcoholism. Alcohol research &

health : the journal of the National Institute on Alcohol Abuse and Alcoholism, 34(2), 135–143.

Resnicow, K., & McMaster, F. (2012). Motivational Interviewing: moving from why to how

with autonomy support. The international journal of behavioral nutrition and physical activity, 9, 19. doi:10.1186/1479-5868-9-19

Tyburski, E. M., Sokolowski, A., Samochowiec, J., & Samochowiec, A. (2014). New diagnostic

criteria for alcohol use disorders and novel treatment approaches - 2014 update. Archives of medical science : AMS, 10(6), 1191–1197. doi:10.5114/aoms.2014.47829