Develop diagnoses for clients receiving psychotherapy
Practicum – Week 5 Journal Entry
Learning Objectives
Students will:
· Develop diagnoses for clients receiving psychotherapy*
· Evaluate the efficacy of therapeutic approaches for clients*
· Analyze legal and ethical implications of counseling clients with psychiatric
disorders*
The Assignment
Select a client whom you observed or counseled that suffers from a disorder related to trauma. Then, address the following in your Practicum Journal:
· Describe the client (without violating HIPAA regulations) 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 any of the therapeutic approaches in this week’s Learning
Resources would be effective with this client. Include expected outcomes based
on these therapeutic approaches. Support your approach with evidence-based
literature.
· Explain any legal and/or ethical implications related to counseling this client.
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 13, “Stabilization for Trauma and Dissociation” (pp. 469–508)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Required Media
Laureate Education (Producer). (2012a). Academic year in residence: Thompson family case study [Multimedia file]. Baltimore, MD: Author.
Ochberg, F. (2012). Psychotherapy for chronic PTSD [Video file]. Mill Valley, CA: Psychotherapy.net.
· NOTE: PLEASE SEE AND PAY ATTENTION TO THE ATTACHED Practicum Journal
Template AND JOURNAL SAMPLE (TIME LOG & JOURNAL ENTRIES) FOR WRITING
THIS ASSIGNMENT…..ALSO FOR THE TIME LOG AND JOURNAL ENTRIES, JUST
MAKE UP A REASONABLE INFORMATION AND CLIENT INFORMATION IN MENTAL
HEALTH NURSING.
Student Name:
E-mail Address:
Practicum Placement Agency’s Name:
Preceptor’s Name:
Preceptor’s Telephone:
Preceptor’s E-mail Address:
(Continued next page)
Time Log
List the objective(s) met and briefly describe the activities you completed during each time period. If you are not on-site for a specific week, enter “Not on site” for that week in the Total Hours for This Time Frame column. Journal entries are due in Weeks 4, 8, and 11; include your Time Log with all hours logged (for current and previous weeks) each time you submit a journal entry.
You are encouraged to complete your practicum hours on a regular schedule, so you will complete the required hours by the END of WEEK 11.
| Time Log | |||||
| Week
|
Dates | Times
|
Total Hours for This Time Frame |
Activities/Comments | Learning Objective(s) Addressed |
| 1 | “not on site” | ||||
| 2 | 6/5/17 | 8am-5pm | 8 | Admissions, evaluations, follow-ups, med management, psychotherapy | Mini-mental state examination, CAGE and Beck depression inventory was used |
| 6/6/17 | 8am-5pm | 8 | Admissions, evaluations, follow-ups, med management, psychotherapy | Intake and initial assessments were performed. Mini-mental state examination was administered. | |
| Total Hours Completed: 16 |
Journal Entries
The Client
24-year-old white male self-admitted as an inpatient due to fear of hurting others. Patient is from out of town, currently attending military drills. Patient found out that his significant other he was planning on proposing to has be actively having relations with his step-brother. Patient has a history of fits of rage at a young age that caused hospitalizations of others so he felt it was best he received help before doing harm to others. Patient has no other psychiatric history, no suicidal ideations, not hearing voices or seeing things that are not present, he does not believe others are out to do harm to him. Patient states that no one in his immediate family has history of psychiatric conditions. Patient does report physical and verbal abuse from step-father as a young child. During his teenage years patient was addicted to illicit drugs and alcohol.
Diagnosis
According to the Diagnostic and Statistical Manual of Mental Health Disorders, 5th edition (DSM-5), the patient presents with characteristics of PTSD. The patient exhibits “irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression, reckless or self-destructive behavior, exaggerated startle response, problems with concentration and sleep disturbance lasting since his early teen years” (American Psychiatric Association, 2013).
Patient states he has difficulty trusting others, assures his back is always to a wall, is easily agitated and tends to frequently relay his anger verbally, was once addicted to illicit drugs to cope with the stress in is life, has difficulty concentrating on simple tasks and must keep himself busy at all time, also states he sleeps very little.
Legal and Ethical Implications
Special concerns with this patient were voiced because of his current non-active role in the military. The patient came from training drills to seek help for his anger. The military has certain requirements for the patient to be able to safely return to drills. Ethically it is important to ensure the patient’s safety first and assess his intent to do harm to others. In the case of this patient, he was kept for observation for three days before being allowed discharge although the patient was addiment that he just needed a safe place for one night and that he did not feel the need to do harm to himself or others. The case can be made that individuals with military training, combat exposure, and ensuing PTSD may find it even more difficult to engage in an accurate appraisal of danger. Training for combat increases reliance on muscle memory or automatic actions in times of perceived threat, training that was provided initially by the military to help soldiers stay alive. But the physiological sensitivity that results from a chronically disordered pattern of arousal as is found in PTSD can set the stage for a quicksilver reactivity that leads to actions in a civilian setting that have criminal justice implications (Tramontin, 2010).
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Washington, DC: Author.
Tramontin, M. (2010). Exit Wounds: Current Issues Pertaining to Combat-Related PTSD
of Relevance to the Legal System. Developments In Mental Health Law, 29(1), 23-47.
