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Don’t work on the progress note below, but remember to add add reference.

Assignment 3 Practicum: Week 8 Journal Entry

University

NURS 6650: Psychotherapy with Groups and Families

Instructor:

January 30, 2021

The Practicum – Week 8 Journal Entry

Pertinent History

Client #1

The family counseled with my preceptor that I will be discussing in this paper is the Stones family of 3. The client is Y, a 14-year-old Caucasian male who lives with his father and mother in a single-family home. According to Y, the parents have frequent arguments about everything, including over money and paying bills, leading to straining their relationship. According to Y, mom is a teacher and is the sole provider (the only financial support) for the family. Dad was recently laid off from his job and always had a challenge in keeping a job due to his alcoholic binging. 

Y reports lots of irritations and annoying behaviors from dad after binging alcohol and is intoxicated. Y reports that mom is angry with subsequent provocative arguments with dad. Y complains that he has no personal space and privacy, and mom walks into his room anytime to search through his personal belongings. Y states that when mom does such, it triggers him into emotional outbursts and defiant behavior. Y feels he is in-between the two couples, and there are no considerations or regards for his feelings. Y reports feelings of depression and isolates himself in his room.

Y resorts to defiant and argumentative behaviors to parents and at school. Y presenting problems include outbursts, aggression, intense anger, and decreased performance at school. Y reports he does not have close friends at school. Mom reports no prior history of hospitalization but has attention deficit hyperactive disorder (ADHD) with associated problems and is currently on Ritalin 10 mg PO.

Diagnosis for Y: Oppositional Defiant Disorder (ODD).

Y meets the criteria for diagnosis with Oppositional Defiant Disorder (ODD). According to American Psychiatric Association (2013), the criteria for ODD diagnosis include exhibiting defiant behavior, challenging authority, displays argumentative tendencies, relentless and persistent irritable mood, attention-seeking behavior, strong emotional reactions, revengefulness, and impulsive behaviors (American Psychiatric Association, 2013). The client must be exhibiting these symptoms for a minimum of six months and has a disruptive impact on the client's development both at home and in school. Y meets these criteria for diagnosis. Additional symptoms Y exhibits include aggressive behavior, always angry with defiant behavior with subsequent poor performance at school.  

Client #2

X is a 16-year-old Hispanic American who lives with her parents and her 13 years old brother. X is having a challenge with her body image because of being morbidly obese. X reports frequent teasing, ridicule, and bullying from other students at school. X reports difficulty in maintaining a close relationship with her brother and friends at school. X reports prior efforts to lose weight, including changing her diets, intensive work out exercises, and one on one personal trainer with no positive impact. X reports she has no friends and is always by herself for fear of being ridiculed or bullied. X reports severe depression, anxiety, and loss of interest in activities, including schoolwork, which has impacted her school performance. X reports feelings of worthlessness, tiredness, lack of motivation, or drive and has no strong physical or emotional supports from parents. X endorse suicidal ideation with an active plan by overdosing on medication. X denies prior history of hospitalization, mental health disorder, substance, and alcohol abuse. 

Diagnosis for X: Major Depressive Disorder (MDD).

X meets the criteria for diagnosis with 296.32 (F33.1) Major Depressive Disorder (MDD). According to DSM-V criteria for MDD, the client must present with these symptoms for a minimum of two weeks or more. The symptoms include loss of interest in last enjoyable activities, constant fatigue, tiredness, feeling of worthlessness, lack of strength to perform tasks, and tendencies to develop suicidal ideation (American Psychiatric Association, 2013). X meets these criteria for diagnosis. X presents these symptoms, which significantly impact her functioning with subsequent poor performance at school.  

Treatment Method Cognitive Behavioral Therapy:

Cognitive-behavioral therapy (CBT) is amazingly effective in treating the oppositional defiant disorder. CBT helps clients modify behaviors by learning a positive approach to problem-solve better by communicating effectively and developing strategies to control emotional temper and impulses. Family therapy reinforces family members to make appropriate and required changes, thereby improving communication skills and family members' interactions. The therapist utilizing CBT among peer group therapy will help Y to develop social and interpersonal skills. Medication may not be necessary for treating ODD but is vital in treating the underlying symptoms or disorders the client displays, like ADHD (John Hopkins Medicine, 2013). According to American Psychiatric Association, loss of interest in last enjoyable activities, constant fatigue, tiredness, feeling of worthlessness, lack of strength to perform a task, and tendencies to develop suicidal ideation meet the criteria for diagnosing major depressive disorder (2013). 

Legal and Ethical Implications

In the case of children and adolescent, the legal and ethical consideration has a profound impact on influencing their psychotherapeutic outcome in a therapy session. The therapist has the responsibility of ensuring the confidentiality of the information client discloses during a therapy session. It is also vital for the therapist to focus on privileged information/communication during counseling sessions (American Nurses Association, 2014). The clients are comfortable discussing their concerns when they establish trust with the therapist. At the beginning of the session, the therapist builds and establishes trust, enabling the clients to always count on the therapist with the privacy of their information. The outcome is that clients will feel free to share their problems and sensitive information, thereby improving the treatment outcome (Newman, 2020).

Don’t work on the progress note below, but remember to add add reference.

Group Therapy Progress Note

Client: Y (Client # 1)

Date: 11/4 /2020

Group name: Family therapy session

Minutes: 45

Group session # 7 Meeting attended is # 3 for this client.

Number present in group 1 of 3 scheduled

Start time: 10:00 a.m. End time: 10:45am

Assessment of client

1. Participation level: ❑ X Active/eager ❑ Variable Only responsive ❑ Minimal ❑ Withdrawn

2. Participation quality: ❑ Expected ❑ Supportive ❑ X Sharing Attentive ❑ Intrusive

❑ Monopolizing Resistant ❑ Other: _____________________________________

3. Mood: ❑ Normal ❑ anxious ❑ Depressed ❑Angry ❑ euphoric ❑ Other: _________

4. Affect: ❑ Normal ❑ Intense Blunted ❑ Inappropriate ❑ Labile ❑ Other: Sad

5. Mental status: ❑X Normal ❑ Lack awareness ❑ Memory problems ❑ Disoriented ❑Confused ❑ Disorganized ❑ Vigilant ❑ Delusions ❑ Hallucinations ❑Other: __________

6. Suicide/violence risk: ❑X Almost none ❑ Ideation ❑ Threat ❑ Rehearsal ❑ Gesture ❑ Attempt

7. Change in stressors: ❑Less severe ❑ Different stressors ❑ More severe ❑ Chronic

8. Change in coping ability/skills: ❑ No change ❑ Improved ❑ Less able ❑ Much less able

9. Change in symptoms: ❑Same ❑ Less severe ❑ Resolved ❑ More severe ❑ Much worse

10. Other observations/evaluations:________________________________________________________

In-session procedures:

 Introductory phase for the therapist and clients

 Clients discussed their week activities since the last session.

 Clients denied any new development or behavioral episodes since the last session

 Clients were encouraged to reflect and participate on the session and ask questions where necessary.

Homework:

1. Clients identified coping skills; exercise, meditation, and deep breathing exercises.

2. Journaling their stressors.

3. Encourage clients to verbalize more about where they picture themselves in the future.

Other Comments: ____________________________________________________________________________

_____________________________________________________________________________________

Signatures: Olu PMHNP-student

Date: 11/4/2020.

Group Therapy Progress Note

Client: X (Client # 2).

Date: 11/4/2020

Group name: Family therapy session

Minutes: 45

Group session # 7 Meeting attended is # 4for this client.

Number present in group 2 of 3 scheduled

Start time: 10:00am. End time: 10:45 a.m.

Assessment of client

1. Participation level: ❑ Active/eager ❑ Variable ❑ Only responsive ❑ Minimal ❑ Withdrawn

2. Participation quality: ❑ Expected ❑ Supportive ❑ Sharing ❑ Attentive ❑ Intrusive

❑ Monopolizing Resistant ❑ Other: _____________________________________

3. Mood: ❑ Normal ❑ Anxious ❑ Depressed ❑Angry ❑ euphoric ❑ Other: _______________

4. Affect: ❑ Normal ❑ Intense Blunted ❑ Inappropriate ❑ Labile ❑ Other: ❑ Sad

5. Mental status: ❑X Normal ❑ Lack awareness ❑ Memory problems ❑ Disoriented ❑ Confused ❑ Disorganized ❑ Vigilant ❑ Delusions ❑ Hallucinations ❑ Other: _______

6. Suicide/violence risk: ❑Almost none ❑ Ideation ❑ Threat ❑ Rehearsal ❑ Gesture ❑ Attempt

7. Change in stressors: Less severe ❑ Different stressors ❑ More Severe ❑ Chronic

8. Change in coping ability/skills: ❑X No change ❑ Improved ❑ Less able ❑ Much less able

9. Change in symptoms: ❑X same ❑ Less severe ❑ Resolved ❑ More severe ❑ Much worse

10. Other

In-session procedures:

 Introduction of preceptor/therapist to the clients.

 Clients discussed their week activities since the last session.

 Clients experienced behavioral issues since the last session

 Clients were encouraged to reflect and participate on the session and ask questions where necessary.

Homework:

1. Client identified coping skills; exercise, meditation, and deep breathing exercises.

2. Journaling their stressors.

3. Encourage clients to verbalize more about where they picture themselves in the future.

Other Comments: ____________________________________________________________________________

_____________________________________________________________________________________

Signatures: Olu PMHNP-student

Date: 11/4/2020.

References:

American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

John Hopkins Medicine (2019) Oppositional Defiant Disorder (ODD) in Children

https://www.hopkinsmedicine.org/health/conditions-and-diseases/oppositional-defiant-disorder.

Newman, R. (2020). Privacy and confidentiality. Psychoanalytic Therapy as Health Care, 119-123.  https://doi.org/10.4324/9781315784182-12