Discussion: Clinical Supervision week 8

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A client that I am currently counseling along with my preceptor, whom we do not think is adequately progressing according to expected clinical outcomes has been a client since February of 2019. This client is a 29-year-old Caucasian female who lives with her husband and 2 year-old daughter. She is a military veteran and has been diagnosed with Attention-Deficit/Hyperactivity Disorder combined type, along with Posttraumatic Stress Disorder. Her symptoms include extreme anxiety, depression, insomnia, and poor attention and focus. She has been in therapy intermittently since her teenage years and has been seeing a therapist weekly for approximately two months. She is primarily focusing on eye movement desensitization and reprocessing therapy, as well as cognitive behavioral therapy. Her medication regimen includes: Vyvanse30mg daily as needed, Adderall 10mg daily as needed, Seroquel 50mg daily, and Lunesta 2mgnightly as needed. Although she reports participating in therapy and taking her medications as prescribed, we do not believe that she is progressing as she should be. Her initial intake appointment was in February of 2019 and had a follow up appointment in March. During the appointment in March she reported that her symptoms seemed “a lot better”, she was getting restful sleep, and she felt as though she was working through a lot in therapy. Her next appointment was set for May as she was stable on her current treatment regimen. During the appointment in May she reported that her marriage was causing a lot of stress at home, and that she was back to only sleeping 2-3 hours a night. Her lack of sleep was again causing low energy, motivation, and poor focus. Per the client’s request, her medication regimen was kept the same as she believed her marital issues were causing her to backpedal in her treatment. We mutually agreed on a follow up appointment of 4 weeks, during the first week of June. Throughout the first three appointments she denied suicidal ideation or thoughts of self-harm, however her husband, whom she had already filled out a release of information, called to notify my preceptor that she was making suicidal statements about jumping in front of a car, and had been declining for the past few weeks. This call came before her appointment that was scheduled for June. My preceptor attempted to reach out to the client through multiple phone calls, and she never answered her calls. Her husband then called back to report that she was not answering his phone calls either. A decision was made to call the local police department for a welfare check. The police conducted a welfare check and stated that the client denied any suicidal statements and was upset that her provider had called the police. Due to this, she did not show up to the June appointment and has yet to try and make contact with her provider or therapist.

As future providers, it is likely that we will run into cases of clients who are not progressing as they should be, so it is important to understand how to combat this challenge. This week’s objective focuses on existential-humanistic therapy, and its utilization in psychotherapeutic practice. According to Wheeler, the humanistic-existential approach has long served as a foundation for psychiatric nursing with its emphasis on holism, self-actualization, facilitative communication, and the therapeutic relationship (2014). Before the client’s reported marital struggles began, my preceptor and myself had established a strong rapport with her that was believed to be effective in her treatment plan. I believe that the client’s stress at home that has led to her suicidal ideation, and the subsequent welfare check have affected the client-provider relationship. Utilizing existential-humanistic therapy can be beneficial in this case, as it highlights the importance of the therapeutic relationship, and the idea that achieving wellness is a process. Reaching out to the client to understand where her feelings are at now can help to mend the client-provider relationship and allow both parties the chance to reestablish rapport that may have been lost. If the client feels as though her provider is not giving up on her treatment, she may feel more inclined to move forward with her treatment regimen, thereby allowing her to adequately progress towards positive clinical outcomes.