Assignment 1: Practicum – Week 5 Journal Entry

Introduction

This week’s clients included a 15-year-old male, who presented with complaints regarding depression, drug abuse, and problems with his parents. A family therapy was used to counsel the two involved clients. Accordingly, a diagnosis for the client will be made, and afterward the most effective therapy will be recommended (solution-focused vs. cognitive behavioral therapy). Finally, the legal and ethical implications in providing therapy to the clients will be discussed Assignment 1: Practicum – Week 5 Journal Entry.

Description of Clients

XX, a 15-year-old male, presented to the clinic because of anxiety, depression, drug abuse, as well as conflicts with his parents. XX was probably predisposed to these challenges during his childhood after going through a lot of trauma. His biological parents were drug addicts and his father was always physically abusive to his mother, something he witnessed several times. He would often wander in streets without any adult supervision and barely attended school. When he was 10 years, parental rights were terminated and along with his siblings he moved to a foster home. This was after his father attempted to sexually molest him. He never heard from his parents again, though after two years his mother died. Shortly, XX was adopted by a family and he separated from his siblings. XX started manifesting signs of depression 2 years after his adoption and his depression deteriorated to a point he was always withdrawn and isolated, his academic performance declined, developed difficulties in concentration, experienced sleep disturbance, and attempted suicide two times. He also started acting out behavior-wise, constantly lied to his parents, and abused drugs. XX also reported that he would often dream about the event of his father trying to sexually abuse him and how he would physically abuse his mother. Accordingly, he often kept away from his adoptive parents to try forget his painful memories. He said that he used drugs to do away with distress and forget his problems. XX believed that no one would love him and always feared rejection. During conflicts with his adoptive parents, he would display symptoms of post-traumatic stress and would have problems in remembering the cause of the conflict. He reported that she has never felt as part of his adoptive family.

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The other client in the therapy is Mrs. AB, his adoptive mother. Mr. AB reported that XX appeared to idealize his biological parents and he would frequently compare his adoptive parents to the idealized depiction with negative outcomes. Mrs. AB also said he responded to his adoptive family basing on his past experience with his former family. This was frustrating his adoptive parents.

Clients’ Diagnosis

Client XX’s diagnosis is post-traumatic stress disorder (PTSD) co-occurring with depression. Symptoms manifesting PTSD in the client include the traumatic events (attempted rape and domestic violence) he experienced in the past, dreams and flashing images of these events, as well as the client avoiding aspects that remind him of these events. The client also manifests sleep disturbances, trouble in concentrating, detachment, and reckless behavior as indicated by substance abuse. According to the DSM 5, symptoms of PTSD include: flashbacks and recurrent dreams about traumatic events, effort to avoid things reminding of the events, forgetting vital aspects of the trauma, detaching from others, sleep disturbances, concentration problems, and irritability, among other symptoms (Kolaitis, 2017). XX also manifests depression as shown by symptoms such as sleep disturbances, constant sadness, isolation, declined academic performance, difficulties in concentration, and attempted suicide (Flory & Yehuda, 2015) Assignment 1: Practicum – Week 5 Journal Entry.

Solution-Focused vs. Cognitive Behavioral Therapy

A cognitive behavioral therapy (CBT) would be more effective for the clients than a solution-focused therapy. Even though the focus of both models is on behavior change, in CBT the therapist breaks every problem into distinct part in order to identify the client’s individual patterns of thoughts, emotions, feelings, and behavior. The therapist then assists the client to work out on changing unhelpful emotions, feelings and behaviors (Patterson, 2014). On the other hand, in solution focused therapy, it is believed that clients have what it takes to resolve their problems and hence the therapist makes the client the expert of complaints (Bond et al, 2013).

In this case, client XX responds to his adoptive family basing on his past experience, and hence injects the new family system with the maladaptive, under-functioning style she experienced in the past. Accordingly, the family therapy should focus improving the emotional safety of the family and supplying XX with skills to make appropriate responses to that safe setting. Therefore, a CBT will be the most suitable therapy because it is important for the family to be taught to verbalize their emotions and hence identify the unhelpful emotions, feelings and behaviors and work out a plan to change them (Wheeler, 2014). The CBT will allow open discussion of such thoughts, feelings, and behaviors with the main aim to change the clients’ behaviors (Perry, 2014). Additionally, CBT will allow the two clients to disclose their feelings and fears, and facilitate listening without the fear of being judged.

The expected outcome is that during the initial family therapy sessions, client XX will be feeling sad or fearful. The therapist will identify feelings and behaviors, and coach the clients. Finally, the family will be guided on practicing listening skills and express sympathy, especially towards XX. The next phase will continue emphasizing on communication and empathy, but also move into negotiation and conflict resolution. During this phase, client will be advised to practice the identified and recommended changes. Accordingly, the expected outcome is that client XX will practice more appropriate skills in her adoptive family setting while Mrs. AB will practice listening skills and express empathy towards XX which will make the family blend much better (Wheeler, 2014).

Legal and/or Ethical Implications

The legal and ethical implications for the two clients include maintenance of confidentiality for the information disclosed during therapy sessions. For instance, client XX revealed about a rape attempt that happened a few years ago. It would be important for his adoptive mother to keep this information private and not to disclose even to the other family members. Accordingly, both clients should sign confidentiality agreement before therapy begins. Additionally, therapist should seek informed consent and assent from both clients and inform them regarding what the therapy involves Assignment 1: Practicum – Week 5 Journal Entry Assignment 1: Practicum – Week 5 Journal Entry.

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Conclusion

Clients included a 15 year old boy with his adoptive mother. The client was brought up by alcoholic parents. He often witness his father abuse his mother physically and when he was 10 his father attempted to violate him sexually. He was later adopted and that is when he started manifesting symptoms of depression and PTSD as depicted by symptoms such as sadness, sleep disturbances, lack of concentration, suicide attempt, poor academic performance, substance abuse, flashing images, dreams about traumatic events, and avoiding anything reminding him of these events. The recommended therapy for the clients is CBT because this will identify negative feelings, thoughts and behaviors, and focus on replacing them with the healthy ones, through practicing. Finally, the legal and ethical implications in counseling these clients include confidentiality, privacy and informed consent aspects.

References

Bond, C., Woods, K., Humphrey, N., Symes, W., & Green, L. (2013). Practitioner review: The effectiveness of solution focused brief therapy with children and families: A systematic and critical evaluation of the literature from 1990–2010. Journal of Child Psychology & Psychiatry.54(7), 707–723.

Flory J & Yehuda R. (2015). Comorbidity between post-traumatic stress disorder and major depressive disorder: alternative explanations and treatment considerations. Dialogues Clin Neurosci. 17(2): 141–150.

Kolaitis G. (2017). Trauma and post-traumatic stress disorder in children and adolescents. Eur J Psychotraumatol. 8(4): 1351198.

Patterson, T. (2014). A cognitive behavioral systems approach to family therapy. Journal of Family Psychotherapy. 25(2), 132–144. doi:10.1080/08975353.2014.910023

Perry, A. (2014). Cognitive behavioral therapy with couples and families. Sexual & Relationship Therapy. 29(3), 366–367. doi:10.1080/14681994.2014.909024

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer Assignment 1: Practicum – Week 5 Journal Entry.

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