Psychotherapy with Groups and Families Report

Psychotherapy with Groups and Families Report

Walden University

PRAC 6650: Psychotherapy with Groups and Families

July 19, 2020

Just like group therapy, family therapy is an important psychotherapeutic approach in treating clients with mental health issues especially when working with children. Therefore, as a PMHNP, it is important to understand how to perform a comprehensive family assessment to effectively work with the family. The purpose of this paper is to select two clients observed or counseled during a family therapy session and identify any pertinent history, explain, and justify client’s diagnosis using DSM-5, discuss therapy approach that may be effective with this family and examine the legal or ethical implications related to counseling these client.

Client #1

History of present illness: Client is Ms. ST a 44-year-old Libyan American female who was referred for therapy by her primary care provider following reports by the school social worker of his son’s recent behavior in school. Their family issues started when Ms. ST husband Mr. JT. a 52-year-old psychiatrist born in Libya but raised in Maryland died by suicide a year ago. According to Ms. ST, Mr. JT had suffered from depression for many years that resulted from the death of his brother and he was on treatment on and off and was using prescribed antidepressant prior to his suicide. About a year ago, his son observed him death in the garage of their house from shooting himself in the head. Ms. ST reported that after the suicide she and her son had faced rejection not just by their friends, but also the Muslim community since they believe that, suicide is a crime in Islamic law. She also reported feelings of guilt and shame following her husbands’ death. She admitted that this set her into depression and PTSD as she started having flash back and nightmares about her husband’s death. Other symptoms reported By Ms. ST includes feelings of loneliness, anger, irritability, abandonment, and fear of being alone. Admitted that her efforts to cope was not working and she had to accept to come for therapy as referred by her primary care doctor. Her mood ranges from sad to labile with a guarded affect. Client reported being prescribed Zoloft 25mg twice a day for depression, which she admitted she only used for 6months and she stopped taking it, diphenhydramine 50mg at bedtime for sleep and is helping her. Psychotherapy with Groups and Families Report

Psychiatric History: Client has no prior diagnosis of mental illness. Currently diagnosed with depressive episodes and PTSD

Medical history: Client has history of Hypertension, and asthma.

Social history/Substance abuse: Client denied experimenting or use of any illicit drug, smoking or alcohol use.Reported she graduated from university and she works as a respiratory therapist. Reported she is currently on sick leave to get herself together and plans to start working as soon as she feels mentally fit.

Medical History: Client history of chronic obstructive pulmonary diseases, Hypertension, osteoarthritis, and type 2 diabetes.

Prescribed medications. Zoloft 25mg twice a day for depression, Diphenhydramine 50mg at bedtime for insomnia.

Diagnosis using the DSM-5

The DMV diagnosis for this client is post-traumatic stress disorder (PTSD): PTSD is a mental health disorder that may develop from being exposed to a traumatic event such as natural disasters, assaults, domestic violence, and combat dead (DSM-5),. It is characterized by the following symptoms nightmares and flashbacks about the traumatic event, emotional distress, lack of interest in activities, feeling of helplessness, trouble sleeping and concentrating, irritability, anger, fear, feeling of guilt and shame. According to the Diagnostic and Statistical Manual of Mental Health Disorders, 5th edition (DSM-5), an individual is diagnosed with PTSD when symptoms persist for more than 6months. I think this client meet the diagnosis of PTSD because first she had been exposed to a traumatic event ( the dead of her husband by suicide) and secondly, she present with some of these symptoms such as flash back and nightmares, irritability, feeling of loneliness and she reported she had experienced this symptoms for more than 6 months

Legal and/or ethical implications related to counseling this client.

Counseling this client who had experienced a traumatic event may pose ethical challenges as it may requires additional care especially when it comes to navigating client experience. In this case, counseling this client may present a dilemma as it may increase the risk of re-traumatization of the client. This may thus contradict with the therapist ethical responsibility to uphold to the principle of beneficence (to do good) and non-maleficence (duty to prevent harm) for the client. As a psychiatric mental health nurse practitioner, it is important to always adhere to the legal and ethical standards when counseling this patient to protect client from such psychological harm. Another ethical implication for providing treatment for this client is dealing with the stigma attached to mental illness and suicide especially given his cultural and religious backgrounds.

Group Therapy Progress Note

Client #1: Ms. ST Date: 7/19/20

Group name: Support group.Minutes: 35mins

Group session # N/A Meeting attended #: N/A for this client.

Number present in group 2 of 2 scheduled Start time: 11:30am End time: 11:35am

Assessment of client

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

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

❑ Monopolizing ❑ Resistant ☒ Other: None

3. Mood: ❑ Normal ❑ Anxious ❑ Depressed ❑ Angry ❑ Euphoric ☒ Other: Sad

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

5. Mental status: ☒ Normal ❑ Lack awareness ❑ Memory problems ❑ Disoriented ❑ Confused

❑ Disorganized ❑ Vigilant ❑ Delusions ❑ Hallucinations ❑ Other: N/A

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

7. Change in stressors: ❑ Less severe/fewer ☒ Different stressors ❑ More/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: N/A

In-session procedures:

The counseling session started with mother and son. Treatment approach, that is used is cognitive behavioral therapy for family. The benefits and techniques of cognitive behavioral therapy for family were discussed with both clients. Also explained to both clients was therapy goals and rules. It was focused on targeting specific thoughts and behaviors especially their feeling of guilt and shame that may be maladaptive in the family. We explored their family believes, attributions and expectancies to identify factors that triggers her memories and cause dysfunctional emotional and cognitive patterns. Ms. ST. was more focus with active participation and response to the therapist during the therapy session. However, she was able to share her personal experience, feelings, and coping skills. The family was helped with using realistic thinking and provided suggestions on positive coping skills including use of relaxation techniques. Ms. ST was receptive to therapy and had shown some improvement. Psychotherapy with Groups and Families Report

Homework:

1. Client triggers of her bad memories and how she reacted.

2. Client to write how she feels when among other members of her religion and relatives.

3. Client to prepare on discussing the impact of her symptoms on her activities and social relations.

Other Comments: Continue group counseling and support therapy

Rufina Ewane RN, BSN, PMHNP Intern

Signatures Date: 7/19/20

Client # 2

Client is a 16-year-old Mr. QT the son of Ms. ST who was referred by their family doctor following his father’s dead by suicide. His father the 52-year-old psychiatrist born in Libya but raised in Maryland. QT was raised by both parents in Maryland and he felt the impact of a father figure in his life. He reported strong bond with his father and always looked up to his father a role model. Admitted that his father’s mental health had been very challenging to him but his death by suicide made everything worst and turned his life around. He reported he started experiencing symptoms of depression right after his father passed away as he was dealing with not just the feeling of guilt that he could do more to help his father but also with a sense of rejection from members of his community and religious group. Some of the symptoms reported by QT includes, difficulty concentrating at work, sadness, forgetfulness, feelings of emptiness, and loneliness. His mother reported that QT had been experiencing irritable and depressed mood, withdrawn and lack of interest in activities he used to like, which had affected his schoolwork and the way he interacts with his peers. Admitted he is not want any prescribed medication. Reported using over the counter Benadryl to help with sleep. Denied suicide or homicide ideation.

Psychiatric History: Client has no prior diagnosis of mental illness. And is currently on no prescribed medications but uses over the counter Benadryl for sleep

Medical history: None

Social history/Substance abuse: No current use of illicit drugs, smoking cigarettes. Reported he occasionally uses alcohol especially when with his friends.

Medical History: None.

Prescribed medications: None.

Family history of psychiatric illness: Father had depression, mother PTSD and anxiety

Diagnosis using the DSM-5

The DSM-5 diagnosis for this client is Major depression disorder. This is a mood disorder that may affect an individual feelings, thoughts, and behavior. It is characterized by feeling of sadness, loneliness, difficulty concentrating, emptiness or hopelessness, irritable mood, anger outburst, sleep disturbance and lack of interest. According to the DSM 5 criteria, for an individual to be diagnosed with major depression, five or more of these symptoms must be present for 2-week period (American Psychiatric Association. (2013). Some of the symptoms evidenced in this client that may align with major depressive disorder includes feelings of emptiness, loneliness difficulty concentrating, irritability, depressed mood, and lack of interest for more than 6 months. Psychotherapy with Groups and Families Report

Group Therapy Progress Note

Client #2: Mr. QT Date: 7/19/20

Group name: Group counseling and support therapy.Minutes: 35mins

Group session #: N/A Meeting attended #: N/A for this client.

Number present in group 2 of 2 scheduled Start time: 11:30am End time: 11:35am

Assessment of client

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

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

❑ Monopolizing ❑ Resistant ☒ Other: None

3. Mood: ❑ Normal ❑ Anxious ❑ Depressed ❑ Angry ❑ Euphoric ☒ Other: Sad

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

5. Mental status: ☒ Normal ❑ Lack awareness ❑ Memory problems ❑ Disoriented ❑ Confused

❑ Disorganized ❑ Vigilant ❑ Delusions ❑ Hallucinations ☒ Other: N/A

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

7. Change in stressors: ❑ Less severe/fewer ☒ Different stressors ❑ More/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: N/A

Psychotherapy with Groups and Families Report