Running Head: THERAPEUTIC PROCESS 2
THERAPEUTIC PROCESS 3
Therapeutic Process
Lori Ann Wright
Grand Canyon University: PCN 610
August 21, 2019
Running head: ASSIGNMENT TITLE HERE
1
Running head: THERAPEUTIC PROCESS 1
Therapeutic Process
Part 1
Stella is a 40-year-old woman who is my client. Her eyes are expressionless as she gives an apology for being late for her appointment. On asking her where she was coming from she states that she had gone to see her nephew whom she had taken a few of her electronics she no longer thought she needed and he was better placed to use them. While she appears and admits to still being sad even after letting go of her electronics, she states that the sadness does not compare as to how she felt when she still had the items in her possession. Stella is recently divorced and had lost custody of her two children after being a stay at home mom for more than ten years.
It has been three months since her divorce and contrary to her wishes, we try avoiding talking about her divorce. We discuss her teenage children’s achievements over the years that she believes she contributed greatly. Mark is an achieving athlete while Ann plays the piano with talented mastery. This however, reminds her that she lost custody and her face is filled with the hopelessness we have been trying to help her see is not necessary. She states that she sees no need to continue living without her children whom she has been forced to stay states away from. Upon her divorce and loss of custody, she has had to move back to her parents’ as being unemployed she could not afford to live on her own. She explains she gave up accounting 12years ago to be a hands-on mom and upon inquiring whether she would like to go back to it she starts sobbing unstoppably.
Since our time was moving fast, there was little we could do amidst her sobs and I chose to let her cry as many tears as she could. After calming down she stated that all she knows how to do is take care of her children’s needs by preparing their meals, attending their games and play sessions, and tend to them when they were sick. At this point, she breaks down into tears stating that there was really no need to keep acting strong as she was feeling very weak and unable to take it all in. it is at this point that I notice the marks on her wrists.
Part 2
I believe that, Stella Matthew could potentially be a suicidal patient whom as much as they have not stated the need to end their life, exhibits symptoms and behaviors of one who has, or is about to start having suicidal thoughts. One of the reasons to believe so are her explicit mood changes and extreme sadness, while she is okay one minute she could be sobbing the next and avoiding eye contact or refusing to talk completely in the other minute (Panagioti et al, 2012). For instance, in this session, she kept sobbing and at some point she refused to continue talking citing that she was tired from having taken the electronics to her nephew and getting rained on.
In addition, she has a general sense of hopelessness that can easily be noted not just from looking at her but also from what she keeps saying. According to her, she dedicated all her life raising and catering to the needs of her children and now that she can no longer do that she does not know what to do and sees no meaning in fighting or even existing. The gravest symptoms in addition to all this is the fact that she has been cutting her wrists whenever the sense of hopelessness overwhelms her and that is one of the things she refuses to talk about.
Part 3
The minute I started being concerned about Stella’s possibility of being suicidal, I asked her the following questions so I could gauge her level of risk at hurting herself or ending her life. The first question was whether she had found herself wishing she didn’t have to wake up in the morning or wishing she were dead to which she replied in the affirmative. This I followed up with whether she ever had any thoughts of ending her life or had a plan in which she would do so, to which she nodded, looking away and avoiding my eyes.
From the questions asked, it is quite clear that Stella is at high risk for suicide, and if action is not taken she may even be tempted to re-attempt taking her life sooner than she states. Considering how hopeless she feels and how frequently she keeps falling into her bouts of hopelessness, action needs to be taken. On a scale of 1 to 10 she is a possible 9.5 and the first thing to do is ensure she is not left alone (Sullivan & Bongar, 2009). Getting her an extensive clinical suicide assessment, brief suicide safety assessment, after which she should be admitted in a mental health facility under strict monitoring. This would then require that her parents who she currently stays with are immediately informed and should also receive some counseling however brief, on how to handle her.
In addition to documenting all she says verbatim in the assessing and reassessing sessions, it is important that anything that could possibly give her a chance to self-harm should be kept away from her, talking to her parents could help with this. Also reconstructing her therapy sessions to help her see the positive things she has going on currently and giving her ideas for life, other than just helping her get over her divorce should be helpful.
References
Panagioti, M., Gooding, P. A., & Tarrier, N. (2012). Hopelessness, defeat, and entrapment in posttraumatic stress disorder: their association with suicidal behavior and severity of depression. The Journal of nervous and mental disease, 200(8), 676-683.
Silverman, M. M., & Berman, A. L. (2014). Suicide risk assessment and risk formulation part I: A focus on suicide ideation in assessing suicide risk. Suicide and Life‐Threatening Behavior, 44(4), 420-431.
Sullivan, G. R., & Bongar, B. (2009). Assessing suicide risk in the adult patient.
Psychosocial Assessment
____ Part 1 (Topic 2)
Template ____ Part 2 (Topic 3)
Name: ______________________________ Date: _________________ DOB: ________________
Age: ________________________________ Start Time: ____________ End Time: ___________
Identifying Information:
____________________________________________________________________________________ David is a 49 years old man. He is married with two children. He has been working in a steel mill as a metallurgical engineer for 20 years.
Presenting Problem:
David has lost interest in doing the things he used to do such as watching TV, attending family gatherings, and playing golf, and instead spends a lot of time in his bedroom alone. He has lost appetite and also doesn’t sleep well. He doesn’t feel the need for living anymore but believes he will recover from this sour mood.
Life Stressors:
David’s sister’s condition may have contributed to his condition since she has been struggling with depression for 10 years.
Substance Use: FORMCHECKBOX Yes FORMCHECKBOX No
____________________________________________________________________________________ David has had a problem with alcohol abuse. He drinks more at night because he has sleep disturbances.
Addictions (i.e., gambling, pornography, video gaming)
David has a problem with alcohol addiction. However, he has changed his drinking patterns and takes two to three drinks perf night unlike previously when he used to drink frequently.
Medical/Mental Health Hx/Hospitalizations:
David hasn’t sought help previously from any healthcare facility in regard to this condition.
Abuse/Trauma:
David doesn’t have major traumatic events. However, Lisa’s condition may have traumatized him.
Social Relationships:
David has for the last 6 months withdrawn himself from family gatherings and mostly spends time in solitude.
Family Information:
David has not lost any member of his family. However, losing a family member can be traumatic and lead to depression.
Spiritual:
David does not give any information about his spiritual inclinations. However, spirituality can be a cause of mental health problems as well as recovery.
Suicidal:
David admits that he feels that life isn’t worth living. Therefore, it is most likely he is suffering from depression.
Homicidal:
David does not show any signs of violence towards his friends and family, or threatening or attempting to kill them.
Assessment:
Assessment is done to determine whether David is depressed or not. If yes, it should establish the level of depression he is in. Depression can be mild, moderate, severe or the symptoms can be subthreshold depressive (Maj, 2013). First, subthreshold depressive disorder would occur in case David exhibits fewer than five symptoms of depression. This is always the first stage of depression. Second, mild depression requires David to exhibit more than five symptoms of depression. In this case, David would have a minimal functional impairment. Third, moderate depression means David would have significant functional impairment although the symptoms would not be severe. Fourth, severe depression is diagnosed if David has most of the symptoms of depression (Maj, 2013). In this case, the symptoms would be capable of interfering with David’s functioning.
Initial Diagnosis (DSM):
The DSM-5 Diagnostic Criteria of depression outlines that if David has experienced five or more symptoms of depression at the same time in a period of two weeks with at least one of the signs being loss of pleasure or interest, David is likely to be suffering from depression (Maj, 2013). The critical signs highlighted in the DSM-5 model are (1) loss of pleasure or interest in normal activities, increased or decreased in appetite, slowing down of physical movement and thought, loss of energy or fatigue, feelings of worthlessness, indecisiveness, and suicidal thoughts (Maj, 2013). David has been experiencing most of the symptoms highlighted by the DSM-5 model. David’s symptoms are, therefore, sufficient to warrant a depression diagnosis.
Initial Treatment Goals:
The symptoms that David has experienced in the last two months shows that he has been suffering from moderate to severe depression. The following treatments are recommended for the treatment of depression.
1) Antidepressants - These are tablets used to treat depression symptoms. There are various types of antidepressants that are available for use by David.
2) Combination therapy - David can be prescribed to use a combination of antidepressants and therapy. This combination of treatments works better than using only one type of treatment (Davidson, 2010). David may be referred to a mental health support team which may be a psychiatrist, occupational therapist, specialist nurse, or a psychologist for counseling while at the same time taking antidepressants.
Therapists provide the following talking treatments to patients with moderate to severe depression like David.
(a) Cognitive-behavioral therapy (CBT). The aim of CBT is to help a patient to understand their behavior and thoughts that affect them. CBT takes a period of 10 to 12 weeks with 6 to 8 sessions when David would spend time one-on-one with a counselor (Davidson, 2010).
(b) Psychodynamic psychotherapy. David can be assigned a psychodynamic therapist to encourage him to give more information about his thoughts to find out whether there are hidden patterns that are influencing his behavior (Davidson, 2010).
(c) Counseling. Counseling can help David solutions of how to deal with the problems he is facing. The counselor would give David practical advice within 6 to 12 sessions of counseling.
Plan:
Due to the severity of David’s symptoms, he will be required to start taking paroxetine antidepressants immediately. Paroxetine is a type of Selective serotonin reuptake inhibitors (SSRIs) that are recommended for they help improve the mood of a patient through a natural chemical known as serotonin. David will also be required to attend therapeutic sessions. He will be seeing the doctor once a week to assess his progress. If David responds well to the medication, he will continue with the same dose of paroxetine. If there are no changes in the symptoms of David, the doctor will change the medication and prescribe a different antidepressant such as Vortioxetine. During the period of medication, David may have some side effects such as dry mouth, headaches, and nausea. However, the side effects should improve with time.
Name: _____________________________________________ Date: __________________
References
Davidson, J. R. (2010). Major depressive disorder treatment guidelines in America and Europe. The Journal of clinical psychiatry, 71, e04-e04. DOI: 10.4088/JCP.9058se1c.04gry
Gore, W. L., & Widiger, T. A. (2013). The DSM-5 dimensional trait model and five-factor models of general personality. Journal of abnormal psychology, 122(3), 816. Doi: org/10.1037/a0032822
Maj, M. (2013). “Clinical judgment” and the DSM‐5 diagnosis of major depression. World Psychiatry, 12(2), 89-91. doi: org/10.1002/wps.20049
Schwitzer, A. M., & Rubin, L. C. (2014). Diagnosis and treatment planning skills: A popular culture approach (2nd ed.). Los Angeles, CA: Sage Publications. ISBN-13: 9781483349763
Psychosocial Assessment
____ Part 1 (Topic 2)
Template ____ Part 2 (Topic 3)
Name: ______________________________ Date: _________________ DOB: ________________
Age: ________________________________ Start Time: ____________ End Time: ___________
Identifying Information:
____________________________________________________________________________________ David is a 49 years old man. He is married with two children. He has been working in a steel mill as a metallurgical engineer for 20 years.
Presenting Problem:
David has lost interest in doing the things he used to do such as watching TV, attending family gatherings, and playing golf, and instead spends a lot of time in his bedroom alone. He has lost appetite and also doesn’t sleep well. He doesn’t feel the need for living anymore but believes he will recover from this sour mood.
Life Stressors:
David’s sister’s condition may have contributed to his condition since she has been struggling with depression for 10 years.
Substance Use: FORMCHECKBOX Yes FORMCHECKBOX No
____________________________________________________________________________________ David has had a problem with alcohol abuse. He drinks more at night because he has sleep disturbances.
Addictions (i.e., gambling, pornography, video gaming)
David has a problem with alcohol addiction. However, he has changed his drinking patterns and takes two to three drinks perf night unlike previously when he used to drink frequently.
Medical/Mental Health Hx/Hospitalizations:
David hasn’t sought help previously from any healthcare facility in regard to this condition.
Abuse/Trauma:
David doesn’t have major traumatic events. However, Lisa’s condition may have traumatized him.
Social Relationships:
David has for the last 6 months withdrawn himself from family gatherings and mostly spends time in solitude.
Family Information:
David has not lost any member of his family. However, losing a family member can be traumatic and lead to depression.
Spiritual:
David does not give any information about his spiritual inclinations. However, spirituality can be a cause of mental health problems as well as recovery.
Suicidal:
David admits that he feels that life isn’t worth living. Therefore, it is most likely he is suffering from depression.
Homicidal:
David does not show any signs of violence towards his friends and family, or threatening or attempting to kill them.
Name: _____________________________________________ Date: __________________
References
Gore, W. L., & Widiger, T. A. (2013). The DSM-5 dimensional trait model and five-factor models of general personality. Journal of abnormal psychology, 122(3), 816. Doi: org/10.1037/a0032822
Schwitzer, A. M., & Rubin, L. C. (2014). Diagnosis and treatment planning skills: A popular culture approach (2nd ed.). Los Angeles, CA: Sage Publications. ISBN-13: 9781483349763
Treatment Plan
Based on the information collected in Week 4, complete the following treatment plan for your client Eliza. Be sure to include a description of the problem, goals, objectives, and interventions. Remember to incorporate the client's strengths and support system in the treatment plan.
Client: Eliza Doolittle Date: 8/13/2019
Age: 18 DOB: 8/1/2001
|
DSM Diagnosis |
ICD Diagnosis |
|
|
300.02 |
|
Goals / Objectives: |
Interventions: |
Frequency: |
|
□ Mood Stabilization |
□ Psychotropic Medication Referral & Consultation □ Journaling □ Cognitive Behavior Therapy □ Skill Training □ Emotion Recognition – Regulation Techniques |
□ Weekly □ Bi Weekly □ Monthly □ other: ____________________ □ Group □ Individual □ Family |
|
□X Anxiety Reduction |
□ Psychotropic Medication Referral & Consultation □ Journaling □ Cognitive Behavior Therapy □ Skill Training X□ Relaxation Techniques |
□ Weekly □ Bi Weekly □ Monthly □X other: 1 x per day □ Group □X Individual □ Family |
|
□ Reduce Obsessive Compulsive Behaviors |
□ Psychotropic Medication Referral & Consultation □ Journaling □ Cognitive Behavior Therapy □ Skill Training |
□ Weekly □ Bi Weekly □ Monthly □ other: ____________________ □ Group □ Individual □ Family |
|
□ Decrease Sensitivity to Trauma Experiences |
□ Verbalize Memories Triggers & Emotion □ Desensitize Trauma Triggers and Memories □ Utilize Healing Model/Support (Mending the Soul) |
□ Weekly □ Bi Weekly □ Monthly □ other: ____________________ □ Group □ Individual □ Family |
|
□ Establish and Maintain Eating Disorder Recovery |
□ Overcome Denial □ Identify Negative Consequences □ Menu Planning □ Nutrition Counseling □ Body Image Work □ Healthy Exercise □ Trigger Mngmt Recovery Plan □ CBT |
□ Weekly □ Bi Weekly □ Monthly □ other: ____________________ □ Group □ Individual □ Family |
|
□X Maintain Abstinence from substances (Alcohol/Drugs) |
□X Substance Use Assessment □ Stepwork □ Overcome Denial X□ Identify Negative Consequences □ Commitment to Recovery Program □ Attend Meetings □ Obtain Sponsor |
□ Weekly □ Bi Weekly □ Monthly X□ other: 1 X □ Group □X Individual □ Family |
|
□X Increase Coping Skills |
□ DBT Skills Training □X Problem Solving Techniques □ Emotion Recognition & Regulation X□ Communication Skills |
□ Weekly □ Bi Weekly □ Monthly X□ other: DAILY □ Group □X Individual □ Family |
|
X□ Stabilize, Adjustment to New Life Circumstances |
□X Alleviate Distress □X Cognitive Behavior Therapy □ Stress Management □ Skills Training X□ Improve Daily Functioning X□ Develop Healthy Support |
□ Weekly □ Bi Weekly □ Monthly □X other: 1 X DAILY □ Group □X Individual X□ Family |
|
□ Decrease/Eliminate Self Harmful Behaviors |
□ Cognitive Behavior Therapy □ Skills Training □ Develop and Utilize Support System |
□ Weekly □ Bi Weekly □ Monthly □ other: ____________________ □ Group □ Individual □ Family |
|
□X Improve Relationships |
□X Communication Skills □ Active Listening □X Family Therapy X□ Assertiveness □X Setting Healthy Boundaries |
□ Weekly □ Bi Weekly □ Monthly □ other: ____________________ □ Group X□ Individual □X Family |
|
□X Improve Self Worth |
X□ Affirmation Work □X Positive Self Talk X□ Skills Training □X Confidence Building Tasks |
□ Weekly □ Bi Weekly □ Monthly □X other: 1 X DAY □ Group □X Individual □ Family |
|
□ Grief Reduction and Healing from Loss |
□ Psychoeducation on Grief Process/ Stages □ Process Feeling □ Emotion Regulation Techniques □ Reading/Writing Assignments □ Develop/Utilize Support |
□ Weekly □ Bi Weekly □ Monthly □ other: ____________________ □ Group □ Individual □ Family |
|
□ Develop Anger Management Skills |
□ Decrease Anger Outbursts □ Emotion Regulation Techniques □ Cognitive Behavior Therapy □ Increase Awareness/Self Control |
□ Weekly □ Bi Weekly □ Monthly □ other: ____________________ □ Group □ Individual □ Family |
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