NURS-6640:Week 8 Journal Entry-Psychotherapy with Individual Essay.

 

Practicum Week Eight Journal

The client in this weeks journal is identified as Ms. A in other to protect her identifying and pertinent information. Ms. A is a former client of my preceptor; she presents to the clinic today with the complaint of “my anxiety is worse.” This a 52-year-old Asian Immigrant with a diagnosis of anxiety and depression. She is unemployed with her main source of income from disability due to her depression. Ms. A lives with and takes care of her 28-year-old son who has schizophrenia. She has been caring for him all by herself are reports that his condition has gotten worse that she found herself calling the police periodically because her son becomes paranoid and tries to attack her violently. She is afraid that he is “going to hurt me one of these days and there will be nobody to help me.” She reports waking up in the nights feeling anxious and not being able to go back to sleep. She reports often feeling on edge, it is hard to concentrate on house choirs due to my muscles being tensed  “I feel on Client has a history of hypertension and is stable on Norvasc 10 mg by mouth daily.NURS-6640:Week 8 Journal Entry-Psychotherapy with Individual Essay.

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Anxiety Disorder in DSM- 5

According to DSM-5, Anxiety disorders include disorders that share features of excessive fear and anxiety and related behavioral disturbances. There are several types of anxiety and are differentiated from one another by the causative factor. Symptoms of generalized anxiety disorder. Symptoms of generalized anxiety disorder include Persistent worrying, Perceiving situations and events as threatening, feeling restless, poor concentration, poor concentration, irritability and insomnia (DSM-5, 2013).NURS-6640:Week 8 Journal Entry-Psychotherapy with Individual Essay.

Ms. A presents several of these symptoms, and this makes me believe that the diagnosis is right. However, she also has a diagnosis of depression, during the interview, she reports feeling somewhat depressed due to the condition of her son and the burden of caring for him alone. She denies any psychotic features, and she does not remember ever having the manic episode and denies suicidal thoughts.  Ms. A also reports feeling depressed at times due to not having any hope of her son’s condition getting better and feeling helpless because she has no one to talk to and no help caring for her son. These are all symptoms of depression as according to the DSM-5 (2013). Ms. A  does not qualify for major depressive disorder because although she has these symptoms, she is still able to function and carry out her daily responsibility of caring for her son. I believe that the diagnosis given to Ms. A  is correct.

Existential-Humanistic Therapy Approach (EHT)

The existential-humanistic theories propose that each has the freedom and responsibility to overcome the meaninglessness of their existence. Personality change is thought to occur when the individual confronts meaningless in life and has to decide for themselves how to shape their life. If the individual is consumed with feelings of despair and fails to engage with themselves and the world around them to achieve their full potential, this may result in changes in the opposite direction (Osafo, Wood, Boyce, & Dunn, 2015). For my client, I believe that personality change that is achieved with EHT will be helpful for her to begin to have some positive attitude towards life and the existence of her and her son. However, she may benefit more from a therapy approach that teaches problem-solving skills such as Problem Solving Therapy (PST). In PST, people learn how to take more initiative, and utilizing whatever influence they have to make decisions and achieve their goals efficiently. The therapist will have to identify a particular environmental circumstance that is contributing to or causing the problem and then figure out most realistic actionable strategies, (Grumman, & Legg, 2016). For example Ms. A. a plan such as finding a daycare center that will help keep her son during the day so she can have time to herself. She may also want to engage herself with her interests and social therapy like yoga therapy where she will make friends. NURS-6640:Week 8 Journal Entry-Psychotherapy with Individual Essay.

Expected Outcome

A client will learn skills to cope with her anxiety and depression, as well as interactive problem-solving exercises. Therapy will enhance communication skills, and the client will be engaged with motivational homework assignments that will help her with day to day living (Grumman, & Legg, 2016).NURS-6640:Week 8 Journal Entry-Psychotherapy with Individual Essay.

Legal and Ethical Implications of Counselling

There are ethical and moral responsibilities of a PMHNP providing therapy and counseling for mental health clients.These responsibilities reflect that ethical standards of the nursing and counseling profession (Fisher, 2016). Record keeping is an important ethical and legal obligation for the counselor.

Informed Consent: Counselors should obtain client consent before engaging in counseling process (ACA Code of Ethics, 2014). It is essential to get clients consent before initiating therapy for an adult patient, and a minor also should be obtained from the parents or guardian. The PMHNP should seek clients opinion and approval before prescribing treatment and avoiding paternalism. Parents should be informed of treatment and medications plans for their children and be allowed to choose with proper information.The client should be allowed the autonomy refers to the concept of independence and the ability to make one’s own decisions.

Confidentiality: while the clients may provide personal information freely, it is essential to sensitize them on their boundaries and protect their privacy.  Before sharing client’s information with friends or family members, it is necessary to discuss the same with the client, failure to which would result in a violation of privacy rights (Laureate Education, 2015a).

Cultural Consideration; the PMHNP should exercise reasonable judgment and take precautions to ensure that their potential biases, their cultural boundaries, and the limitations of their expertise do not lead to unjust practices (Sue, Zane, Hall, & Berger, 2009).NURS-6640:Week 8 Journal Entry-Psychotherapy with Individual Essay.

Part Two

My clinical supervision experience with my preceptor Elaine Cook has been very informative here at Key Point Health System. Elaine is a graduate of University of Maryland School of Nursing for both FNP/PMHNP. My preceptor has a wealth of knowledge and experience as she practiced as a Family Nurse Practitioner (FNP) before she decided to pursue a career in Psychiatric and Mental Health Nurse Practitioner (PMHNP). This exposes her to many kinds of patients, and her assessments as well as clinical judgment skills are phenomenal. Once she signed the documents as my preceptor, Elaine encouraged me to use her for resources and started corresponding before the clinical started. On the first day of clinical, it felt like we have been working together for a while. She introduced me to her co-workers and encouraged them to be supportive in sharing clinical knowledge with me. I meet with my preceptor two times a week from 8 am is to 4 pm. Within this timeframe, we see between 6-8 patients. Privately for counseling, medication management, and psychotherapy mostly. Elaine also monthly holds a group therapy in the Psychiatric Rehab Program (PRP). She allows me to take a role in this group counseling session. Beginning from my second week of clinical, Elaine permits me to complete full patient intake with supervision, complete patient assessment and medication management with guidance.

Clinical Instructor’s Feedback

Improve Assessment Skills; my preceptors encourages me to get more comfortable with utilizing assessment tools for depression and suicidality for all clients during each visit, as well as tardive dyskinesia scales for all patients on antipsychotics and certain antidepressants.

Diagnosis; she also encourages me to not rush into conclusion with making a diagnosis for a patient. Sometimes she allows the client more than one visit before arriving at diagnosis; this allows enough time to observe the client and collect information related to the illness before deciding on the diagnosis. Improve Counselling Skills; Elaine has a practice of allowing the client the first few seconds of silence in her office to settle and survey the surroundings before starting a counseling session. This practice she believes will enable the client to develop thrust and comfort rather than feeling rushed to talk.

 

 

Translating into Clinical Practice

I am comfortable working under the supervision of my preceptor, Elaine. Some of her creative criticism is very helpful for me because I write down the pointers that she give me during my sessions and apply them to my next client contact. I have learned so much in this short period of working under her supervision. I also ask her to evaluate me each type I apply the skills.NURS-6640:Week 8 Journal Entry-Psychotherapy with Individual Essay.

 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental

disorders (5th ed.). Washington, DC: Author.

Grumman, R., & Legg T. J., (2016)Problem-Solving Therapy for Depression

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Laureate Education (Producer). (2012b). Clinical supervision follow-up [Video file]. Baltimore,

MD: Author.

 

Nagy, T. F. (2011). Ethics in psychotherapy. In Essential ethics for psychologists: A primer for

understanding and mastering core issues (pp. 185–198). Washington, DC: American Psychological Association. doi:10.1037/12345-010

 

Osafo Hounkpatin, H., Wood, A. M., Boyce, C. J., & Dunn, G. (2015). An

Existential-Humanistic View of Personality Change: Co-Occurring Changes with Psychological Well-Being in a 10 Year Cohort Study. Social Indicators Research, 121(2), 455–470. NURS-6640:Week 8 Journal Entry-Psychotherapy with Individual Essay.

 

Sommers-Flanagan, J., & Sommers-Flanagan, R. (2013). Counseling and psychotherapy

theories in context and practice [Video file]. Mill Valley, CA: Psychotherapy.net.

 

Sue, S., Zane, N., Nagayama Hall, G. C., & Berger, L. K. (2009). The Case for Cultural

Competency in Psychotherapeutic Interventions. Annual Review of Psychology, 60, 525–548.

NURS-6640:Week 8 Journal Entry-Psychotherapy with Individual Essay.

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