Assignment 1: Practicum – Week 8 Journal Entry

Assignment 1: Practicum – Week 8 Journal Entry
This week, you complete a two-part journal entry.

Learning Objectives
Students will:
Develop diagnoses for clients receiving psychotherapy*
Evaluate efficacy of existential-humanistic therapy for clients*
Analyze legal and ethical implications of counseling clients with psychiatric disorders*
Analyze clinical supervision experiences Assignment 1: Practicum – Week 8 Journal Entry*

  • The Assignment related to this Learning Objective is introduced this week and submitted in Week 10.

For Part 1, select a client whom you observed or counseled this week (other than the client used for this week’s Discussion). Then, address the following in your Practicum Journal:

Describe the client and identify any pertinent history or medical information, including prescribed medications.
Using the DSM-5, explain and justify your diagnosis for this client.
Explain whether existential-humanistic therapy would be beneficial with this client. Include expected outcomes based on this therapeutic approach.
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Explain any legal and/or ethical implications related to counseling this client.
Support your approach with evidence-based literature.
For Part 2, reflect on your clinical supervision experiences. Then, address the following in your Practicum Journal:

How often are you receiving clinical supervision from your preceptor?
What are the sessions like?
What is the preceptor bringing to your attention?
How are you translating these sessions to your clinical practice?
Learning Resources
Required Readings
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.

Chapter 10, “Humanistic-Existential and Solution-Focused Approaches to Psychotherapy” (Review pp. 369–406)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author Assignment 1: Practicum – Week 8 Journal Entry.

Note: You will access this text from the Walden Library databases.

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
Note: You will access this text from the Walden Library databases.

Required Media
Sommers-Flanagan, J., & Sommers-Flanagan, R. (2013). Counseling and psychotherapy theories in context and practice [Video file]. Mill Valley, CA: Psychotherapy.net.
Note: For this week, view Existential Therapy, Person-Centered Therapy, and Gestalt Therapy only. You will access this media from the Walden Library databases

Laureate Education (Producer). (2012b). Clinical supervision follow-up [Video file]. Baltimore, MD: Author.
Note: This is a follow-up to the Thompson family media piece in Week 5. The approximate length of this media piece is 9 minutes.
Accessible player
Laureate Education (Producer). (2015d). On a hamster wheel [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 2 minutes.

Accessible player
Bugental, J. (n.d.). Existential-humanistic psychotherapy [Video file]. Mill Valley, CA: Psychotherapy.net.
Note: You will access this media from the Walden Library databases. The approximate length of this media piece is 108 minutes.

Optional Resources
May, R. (n.d.). Rollo May on existential psychotherapy [Video file]. Mill Valley, CA: Psychotherapy.net.

Note: You will access this media from the Walden Library databases. The approximate length of this media piece is 61 minutes.

Steinert , T. (2016, October 3). Ethics of coercive treatment and misuse of psychiatry. Psychiatric Services. doi:10.1176/appi.ps.201600066. Retrieved from http://ps.psychiatryonline.org/doi/10.1176/appi.ps.201600066
Patient Identifying Data

The patient is a 25-year-old single woman of the Caucasian origin who is presently a fulltime student attending college in Chicago, who referred herself to an E.D for evaluation of her low mood and anxiety.

HPI: Mrs. GR is a 25-year-old woman of Caucasian descent who states that she has experienced difficulties with low mood and anxiety for a prolonged period dating back to her 13th period. At 15 years of age, she underwent counseling treatment and was given sertraline 100 mg qd, relevant for ages 16-23. Her present predicament started last year upon ending a romantic relationship with a man she had expected to marry. She laments that her current feeling is her worst and doubts if she will ever recover from the rejection. Her present symptoms include low moods in the majority of the days, decreased interest in her favorite activities, and initial and terminal insomnia, as well as decreased appetite manifested in the fact that she has lost a whopping 15 lbs. over the period since the breakup. She further admits to feeling worthless, having decreased energy, and significant anxiety feelings but denies panic attacks. Whereas concentration is intact, her school performances have been affected by the other feelings. Subsequently, she is considering dropping out of school. She denies suicidal ideation. She also denies symptoms of hallucinations, delusion, pressured speech, and grandiose feelings in addition to excessive irritability. Denies historical trauma. Her psychiatrist attempted to switch her to escitalopram 10 mg for six-week trial, paroxetine that was stopped after a week due to side-effects, and venlafaxine that was started at 75 mg fourteen days ago. However, not noticeable changes were observed in her moods Assignment 1: Practicum – Week 8 Journal Entry.

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Diagnosis: Major Depressive Disorder but initially had social anxiety disorder that degenerated into depression.

DSM-5 Justification

        According to the DMS-5 tool, major depressive symptoms can be diagnosed pursuant to certain symptoms. The client meets the diagnosis of criterion A of the tool as most of the symptoms therein including depressed mood and loss of pleasure/interest in favorite activities are discernable (American Psychiatric Association, 2013).  The client also shows loss of appetite hence weight loss yet she is not dieting. Further, she feels worthless and fatigued. Further, the symptoms also meet the criterion B of the tool as the client has shown  impaired functioning in education matters hence why she is considering quitting school altogether. Indeed, according to criterion C of the DMS-5 tool, major depressive disorder symptoms exist when a patient’s condition is not attributable to substance abuse or another medical condition. In this case, the patient is depressed because of a post-breakup hurt. Thus, all the symptoms that the client demonstrated in the HPI are consistent with the major depressive disorder symptoms as presented by the DSM-5 criteria tool.

Application of Existential Humanistic Therapy

The usage of existential-humanistic therapy in the present scenario would be effective. The client’s source of major depressive disorder is the break-up that she had with her boyfriend some nine months ago. Evidently, the client has refused to accept the fact that the happenstance may be beyond her control. Wheeler (2014) observes that the basic tenet of existential-humanistic approach involves making a client extricate themselves of self-imposed limitation, and embrace a comprehensive understanding of their authentic goals in life. In its sessions, the patient will experience their problems via a procedure of examining their affective as well as bodily sensations (Bugental, n.d.). Thus, by emphasizing on the concepts of responsibility, freedom, and experiential reflection, the therapy enables a patient to completely see their problem in a different light. To this end, the existential-humanistic approach’s effectivity is non-questionable in the present scenario.

Legal/Ethical Implications to Counseling the Client

The psychotherapeutic intervention for the present client will feature the most intimate and hidden world of her life. Accordingly, it becomes imperative that one observes certain ethical values whilst managing the client. Since the issue at heart involves intimacy, the therapist will need to demonstrate and observe ethical values that are related to respect, confidentiality, and responsibility as well as integrity during the course of the treatment sessions. Further, the therapist will be required to consider the questions that they will be asking as going too far may prove counterproductive inasmuch as it may be the right thing to do (Steinert, 2016). Thus, there is an ethical angle for the therapist to seriously consider before starting a session Assignment 1: Practicum – Week 8 Journal Entry.

Part 2

Clinical Supervision Experience

So far, my clinical supervision experiences have been positive from both the preceptor’s and the hospital’s end. The frequencies of preceptor supervision have been welcome as they have not given the impression that I am doing things the wrong way. I do receive the preceptor 2-3 times supervision fortnightly. The supervisory sessions normally occur after the preceptor has consulted me on the suitability of a session.

Importantly, the sessions are quite informative and interesting at the same time. The preceptor has great man management skills and does not make me feel like I am flopping. In fact, he takes it upon himself to ensure that I have confidence in whatever I am undertaking. As a general rule, the preceptor makes it clear that the purpose of the practicum is to give one experience and not to judge them on their failings. For these reasons, I always look forward to the next supervisory session.

Further, the preceptor always outlines the goals of supervision before every session. According to him, the most fundamental goal of supervision entails enhancing my developmental growth via teaching. To this end, he always points out the things that I need to undertake so as to enhance my applied skills. Additionally, the supervisor does not tire in reminding me of the value of privacy in this profession. Thus, he constantly identifies the instances that I might have breached the goal. After making the necessary identification, he goes ahead and teaches me regarding how I was supposed to approach that particular circumstance.

As mentioned above, the central goal of practicum supervision is to facilitate the growth of the supervisee. Therefore, after very supervision, I strive not to repeat the mistakes that the preceptor pointed out in the previous session. I focus on putting his pieces of advice regarding various issues into practice. For instance, I tend to focus on identifying the mistakes that he pointed out and use his own advice to approach the matter. As a consequence, I have demonstrated remarkable growth in the few weeks that the preceptor has guided me during the practicum. Therefore, my clinical practice has consequently becomes easier and enjoyable due to the translation of my preceptor’s knowledge into practice.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Arlington, VA : American Psychiatric Publishing.

Bugental, J. (n.d.). Existential-humanistic psychotherapy [Video file]. Mill Valley, CA: Psychotherapy.net.

Steinert , T. (2016, October 3). Ethics of coercive treatment and misuse of psychiatry. Psychiatric Services. doi:10.1176/appi.ps.201600066. Retrieved from http://ps.psychiatryonline.org/doi/10.1176/appi.ps.201600066

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company Assignment 1: Practicum – Week 8 Journal Entry.

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