Running head: JOURNAL
Journal
Student Name
Institutional Affiliation
JOURNAL
Optionone
Write about the situation that you felt you handled well. What did you do? Provide justification
and reasoning for your actions. This commentary should include a reference to relevant course
content or research.
Agoraphobia
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Write about the situation that you felt you handled well. What did you do? Provide
justification and reasoning for your actions.
During the week, I encountered a middle-aged female patient with Agoraphobia. This is a type of
anxiety disorder in which individual fear and avoids places that could potentially cause panic and
make him or her feel trapped or embarrassed. The middle-aged woman was very agoraphobic to
an extent she could not walk alone or leave bed for several weeks. When interviewed, the patient
expressed her extreme fears that death has been following and ready to "snatch" her away "like
an eagle." The patient revealed that she had survived a fatal motorcycle accident seven years
before in which she lost a very close friend. Further, the patient reveals she always experiences
numerous scary nightmares of her dying of unnatural causes hence the reason she avoids going
out or crowed places.
One of the first things that Ii believe I performed well is diagnosis. Essentially, Agoraphobia
diagnosis is based on signs and symptoms, in-depth interviews with the physician, physical exam
and diagnostic and Statistical Manual of Mental Disorders (DSM-5). Firstly, I interviewed the
patient and her caregivers in order to understand some possible Agoraphobia risk factors that
could be causing her problem. From the interview, I established that in addition to the road
accident, two of the patient's siblings also suffer from the condition. According to Mayo
Clinic(2018), having a blood relative with agoraphobia is a major risk factor for agoraphobia.
For this reason, I believe my diagnosis in this particular case was accurate and backed by
scientific research.
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The second major thing that I believe I performed well is treatment. According to Cleveland
Clinic (2019) "treatment for agoraphobia combines medication with a type of mental health
treatment called cognitive behavior therapy (CBT)." While each treatment approach can be used
separately, modern research has established that a combination of medication and therapy yields
the best, longest-lasting results. Guided by this, I prescribed sertraline (Zoloft) to help improve
her symptoms. Essentially, Zoloft is antidepressant that belongs to a group of medications known
as selective serotonin reuptake inhibitors (SSRIs). The drug affects chemicals in the brain that
may be unbalanced in individuals with mental disorders such as depression, panic, anxiety, and
obsessive-compulsive symptoms. The rationale for prescribing Zoloft for this particular patient
was to ease the symptoms of depression and anxiety in the patient (WebMD,2019). It is also
important to note that Zoloft s relatively cheap and causes fewer side effects compared to some
of the other common antidepressants.
Secondly, I undertook that patient through cognitive behavioral therapy as part of the efforts to
effectively improve the patient's thinking patterns and emotions. CBT is one of the commonly
used types of psychotherapy for treating patients with anxiety symptoms, including agoraphobia
(Aslam, 2016). The primary focus of the CBT sessions will be teaching the patent specific skills
on how to better tolerate and accommodate anxiety as well as strategies to counter her worries.
By helping the patient understand the source of her problem through CBT will help to gradually
return her to normalcy.
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References
Aslam, N. (2016). Management of panic anxiety with agoraphobia by using cognitive behavior
therapy. Indian journal of psychological medicine, 34(1), 79.
Cleveland Clinic (2019). Agoraphobia: Management and Treatment. Retrieved from
https://my.clevelandclinic.org/health/diseases/15769-agoraphobia/management-and-
treatment
Mayo Clinic (2018). Agoraphobia. Retrieved from https://www.mayoclinic.org/diseases-
conditions/agoraphobia/diagnosis-treatment/drc-20355993
WebMD (2019). Zoloft. Retrieved from
https://www.webmd.com/drugs/2/drug-35/zoloft-oral/details
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Optionone
Write about situation that you felt you handled well. What did you do? Provide justification and
reasoning for your actions. This commentary should include reference to relevant course
content or research.
Bipolar disorder
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JOURNAL
Write about situation that you felt you handled well. What did you do? Provide
justification and reasoning for your actions. This commentary should include reference to
relevant course content or research.
During the week, I encountered a patient with bipolar disorder. This was a 16-year old African
American male who was brought to the facility exhibiting several symptoms of bipolar disorder.
The first major symptom, as narrated by the patent's parents was lack of concentration which had
caused a significant decline in his school performance. The patient also had a short temper,
which, according to his parents, was negatively affecting his relationship with friends and family.
Moreover, the patient exhibited other signs of bipolar disorder, including insomnia, impulsive
and risky behaviours, and some depressive episodes. For these reasons, it was important to put
the patient under the right treatment and medications to alleviate his condition and return him
back to his normal happy life.
Diagnosis is one of the important things that I believe I performed well in this particular case. As
stated by Mayo Clinic (2019), 'it may be more challenging for a doctor to diagnose bipolar
disorder in teens than in adults, and this process may take some time." Given that there aren't
blood tests or brain scans that could be used in confirming bipolar disorder, I began by first
asking the patient ad his parents about the medical history before progressing to asking him to
describe his feelings and moods. From his medical history, it was established that bipolar runs in
the patient's family with two of his siblings and cousins suffering the same. Research has
established that individuals with relatives in the nuclear family with bipolar disorder are usually
at a higher risk of for the same.
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The next step of my diagnoses was mental health evaluation, and it involved asking the patient to
describe his moods, feelings and emotions. This included questions such as: how the bipolar
symptoms had occurred, how they have disrupted his life, his treatment goals, among others.
In order to be exact with my diagnosis, I employed the Diagnostic and Statistical Manual of
Mental Disorders (DSM) to obtain a technical as well as a detailed description of bipolar
disorder. The reason why I believe I performed well in the diagnosis is that I followed all the
established guidelines for diagnosing bipolar disorder, including mental health evaluation and
DSM criteria.
The second thing that I believe I performed well is treatment. While there is no known cure for
bipolar disorder, research has developed new strategies for patients to manage their symptoms
through a combination of medications, therapy as well as lifestyle changes. For this particular
patient, prescribed Aripiprazole (Abilify, Abilify Discmelt) (2 mg once daily can be increased to
5 mg. This is an atypical antipsychotic medication that has been approved for the treatment of a
number of disorders, including bipolar disorder (Medscape 2019). In order to increase the
effectiveness of the treatment, I coupled the medications with cognitive behavioural therapy
(CBT). According to America Psychological Association (2019) "psychotherapy is more
effective than medications, and that adding medications does not significantly improve outcomes
from psychotherapy alone." Also, I prescribed day treatment programs to help provide the
patient with support and counselling as part of the strategies to manage bipolar disorder.
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References
America Psychological Association (2019) How Do I Choose Between Medication and Therapy?
Retrieved from https://www.apa.org/ptsd-guideline/patients-and-families/medication-or-therapy
Medscape (2019). Pediatric Bipolar Affective Disorder Treatment & Management. Retrieved
from https://emedicine.medscape.com/article/913464-treatment
Mayo Clinic (2019). Bipolar disorder. Retrieved from https://www.mayoclinic.org/diseases-
conditions/bipolar-disorder/symptoms-causes/syc-20355955
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Reply Posts
reply to at leastonecounseling therapy.
In your reply post, state whether you agree with your peers. Read and respond in a
scholarly fashion, commenting on how they incorporated theory with evidence-based
practice. At a minimum, your response should be three to four paragraphs of three to
four sentences each.
Please make certain that all counseling therapies have a peer response
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Post for response:
Re: Narrative Therapy
Trauma can be defined as a deeply distressing and or disturbing experience (lexico.com, 2020).
When individuals are exposed to something that causes deep distress or disturbance,
this can alter the way they function in many aspects of their lives, this is especially for
children and adolescence that experience this stressor while growing and developing
into adults. The DSM-V characterizes posttraumatic stress disorder for individuals
greater than 6 years of age as having (a) an exposure to a traumatic event, (b) intrusive
symptoms, (c) avoidance of triggering stimuli, (d) negative alterations in cognitions and
mood associated with the traumatic event, and (e) alterations in arousal and reactivity for
a period greater than 1 month not induced by a substance or other mental health
condition (APA, 2013). Ideally, children and adolescents are a population that is
provided an environment of safety and reassurance by their caregivers, but children and
adolescents are often exposed to forms of stress and adversity, including emotional
neglect, social rejection, and physical or sexual abuse.
Exposure to trauma when a child and or as an adolescent can be an exceptional
challenge as they may not be able to recall specific details of trauma or may not realize
that trauma has occurred and re-enact what is “normal” to them. Narrative therapy is a
psychotherapeutic technique that utilizes a story or narration to separate an individual
from their trauma and potentially identify aspects of how it affects one’s life and how they
may want to live their life. In narrative therapy with children, clinicians can interact with
clients in a multitude of medias such as storytelling, picture drawing, and explanation of
events via pictures. With pictures, a clinician can have an individual detail a story
between individuals performing neutral actions, such as holding a chair above one’s
head or seeing someone in the bathtub. In telling stories, clinicians can utilize an
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individual or superhero to identify ways that an individual was “attacked,” threatened or
harmed by villains or “bad guys” and help identify ways the hero would deal with the
adversity. Clinicians can also utilize drawings to help individuals identify what they wish
to become and what they want to leave behind (Dyurich & Oliver, 2019). In these
activities, the clinician must be aware that these stories can trigger a client by discussing
certain traumas or relating to the adversity they are describing. The idea behind utilizing
these techniques is to expose clients in a way that removes the client from the situation
to put thoughts into words and to manage or “deal with” the trauma (Schauer, Neuner, &
Elbert, 2017).
In working with adolescents, much of narrative therapy can be utilized in a similar way as
that of children. Clinicians may utilize more of an autobiography story telling style
incorporating an emphasis of asking for details of emotions, cognitions, sensory
information, and physiological reactions. The clinician would record these details and link
them to autobiographic context discussed, highlighting specific time and place. Through
this storytelling, the clinician can also provide directed guidance of the story to prevent
avoidance of specific details associated with trauma to help individuals create meaning
of events and process emotions around events. The clinician would then provide a copy
of text with the recording of the story tied with emotions, cognitions, sensory reactions
and physiological reactions to help adolescents read about issues and have
understanding about self around trauma and issues experienced (Ruf et al., 2010).
Adults and older adults can also benefit from narrative therapy. Narrative therapy allows
the adult to tell their story through their own words with a focus on their values and can
highlight areas that provide meaning while naming their problems and verbalizing their
emotions in the story (Steiner, Pillemer & Thomsen, 2019). Steiner et al. (2019) writes
that life stories reflect an individual’s personal identify and that these stories can be
compartmentalized into what the individual perceives as positive or negative, give the
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therapist and individual an opportunity to address the stories in a non-traumatic way.
Cloitre, Garvert & Weiss (2017) investigated the use of narrative therapy in conjunction
with a coping skill program (STAIR) that focuses on emotional regulation in women
diagnosed with post-traumatic stress disorder who experienced abuse as children.
Results showed that those that received both the STAIR program in combination with
narrative therapy that were experiencing severe depression had a statically significant
improvement in their PTSD severity than those in two other groups (Cloitre et al., 2017).
Older adults will make up over 30% of the population by 2030 and are more likely than
previous generations to utilize therapy in their treatment of mental health disorders with
the most common disorder being depression. Narrative therapy allows older adults to
relive stories through externalization to encourage integrity and quash despair, the final
stage in Erikson’s Development of Identity. Like mentioned previously, naming a
problem in one’s life releases it from the person themselves while addressing it from a
different angle and possibly even prevent their problem from triggering regret leading to
despair. A subjugated story can now be unraveled, one in which the individual becomes
the hero of their story and positive traits emerge. Older adults with memory issues have
also shown to be good candidates for this type of treatment. (Goodcase & Love, 2016)
Nozari, Mo'tamedi, Eskandari & Ahmadivand (2019) studied the use of Narrative
Therapy in a group setting with a focus on the older adult and their perceptions of death
and anxiety around the topic. Researchers found that the use of narrative therapy
deviated the opinion of aging and reduction of anxiety surrounding death in participants
in the study (Nozari et al., 2019).
The benefits of narrative therapy is well-established in the literature and can be used
successfully throughout the lifespan. Addressing trauma and anxiety disorders can be
challenging and recognition of non-pharmacological treatments that improve the lives of
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our patients demonstrates commitment and accountability to their care.
References
Cloitre, M., Garvert, D. W., & Weiss, B. J. (2017). Depression as a moderator of STAIR
Narrative Therapy for women with post-traumatic stress disorder related to childhood
abuse. European Journal of Psychotraumatology, 8(1),
1377028.https://doi.org/10.1080/20008198.2017.1377028
Dyurich, A., & Oliver, M. (2019). Using narrative therapy’s Tree of Life to promote
exploration and insight for unaccompanied refugee children. CEDER Yearbook, 39–55.
Goodcase, E. T., & Love, H. A. (2016). From despair to integrity: Using Narrative
Therapy for older individuals in Erikson’s last stage of identity development. Clinical
Social Work Journal, 45(4), 354-363.https://doi.org/10.1007/s10615-016-0601-6
Lexico.com (2020). Trauma. Oxford University Press. Retrieved
fromhttps://www.lexico.com/en/definition/trauma
Peltonen, K. & Kangaslampi, S. (2019). Treating children and adolescents with multiple
traumas: a randomized clinical trial of narrative exposure therapy. European Journal of
Psychotraumatology, 1.https://doi.org/10.1080/20008198.2018.1558708
Nozari, Z., Mo'tamedi, A., Eskandari, H., & Ahmadivand, Z. (2019). Narrative Group
Therapy to improve aging perceptions and reduce thanatophobia (death anxiety) in older
adults. Elderly Health Journal.https://doi.org/10.18502/ehj.v5i2.2158
Ruf, M., Schauer, M., Neuner, F., Catani, C., Schauer, E., & Elbert, T. (2010). Narrative
exposure therapy for 7- to 16-year-olds: A randomized controlled trial with traumatized
refugee children. Journal of Traumatic Stress, 23(4), 437–
445.https://doi.org/10.1002/jts.20548
Schauer, M., Neuner, F., & Elbert, T. (2017). Narrative exposure therapy for children and
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Response:
As stated in the post, adults and older adults can also benefit from narrative therapy. Narrative
therapy allows the adult to tell their story through their own words with a focus on their values
and can highlight areas that provide meaning while naming their problems and verbalizing their
emotions in the story. It is important to note that narrative therapy aims to separate the
individual from the problem. In so doing, narrative therapy encourages the person to rely on his
or her skills to minimize problems affecting their lives. In addition to what has been highlighted
in the post, it is important to note that storytelling is an integral component of narrative therapy.
The practitioner believes that telling one's own story drives change in a person. The therapist
may help the patient objectify their health problem or frame the problem in such a larger and
objective sociocultural context (Hannen & Woods, 2012). Narrative. During the process, the
therapy may also teach the individual how to accommodate other stories as part of the strategy to
overcome a mental problem.
The other notable point made in the post is that narrative therapy allows older adults to relive
stories through externalization to encourage integrity and quash despair. According to
Depression Alliance (2018), "narrative therapy was created to be an empowering, collaborative
and non-blaming approach to psychotherapy. Practitioners of narrative therapy see people in
treatment as capable individuals who can bring about change in their own lives." It is founded on
the assumption that there is not truth but rather a variety of perceptions of reality. Payne (2006)
says the meanings people tend to attach to different things are founded on socio-cultural and
political contexts. It should also be noted that each individual is an expert in his or her own life.
References
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Depression Alliance (2018). How Narrative Therapy Works. Retrieved from
https://www.depressionalliance.org/narrative-therapy/
Payne, M. (2006). Narrative therapy. Sage.
Hannen, E., & Woods, K. (2012). Narrative therapy with an adolescent who self-cuts: A case
example. Educational Psychology in Practice, 28(
