wk2 Assgn2 Due W4

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Practicum Experience Time Log and Journal Template

Week 2 Journal Entries

Dr.

NRNP-6650, Psychotherapy Group and Families

, 2020

Student Name:

E-mail Address:

Practicum Placement Agency’s Name:

Preceptor’s Name:

Preceptor’s Telephone:

Preceptor’s E-mail Address:

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Week 2 Journal Entries

This journal will discuss the clients I counselled in the family therapy, including identifying pertinent history, medical information, and current medications clients are taking. The journal will utilize the diagnostic and statistical manual of mental health disorders to establish each client’s diagnosis. The journal will also discuss the legal and ethical implications of counseling each client. 

Client 1

KL is a 15-year-old Hispanic American female. KL lives with her mom and dad. KL reports that mom is worried because KL does not socialize anymore like before. KL reports since the advent of Covid-19, she lost contact with close friends. KL also reported family newly relocated to her new home, and she has note made friends at her new neighborhood. KL reports spending excessive time on her phone and surfing websites, resulting in her phone privileges taken away from her mom. KL reports unable to text or make calls. KL reports friends live far away from her residential area and are not mobile. KL reports feeling isolated and lack of interest in previously pleasurable activities. KL also reports anxiety, especially when mom tries to force her to escape her isolation mood. KL reports that mom and dad feel worried about her. KL reports her lack of interest in activities makes her procrastinate things she needs to do, including her class assignments and quizzes now that school has started online. KL reports her mind will go blank, causing increased anxiety while testing. KL reports online class does not feel the same as traditional classroom and is affecting her class performance. 

KL reports her parents took her to see her primary care physician (PCP) for her annual physical check-up, and her PCP referred her to group therapy. KL presents with flat affect, feels worthless and withdrawn. KL reports a lack of energy, low sleeping patterns, memory problems, and difficulty focusing. The patient reports she has been feeling this way six months. KL is alert and oriented x4; KL appears neatly groomed, maintains good eye contact, and denies current suicidal ideation. KL denies any history of previous suicidal attempts but reports she has thought about it with no action plan. KL denies use of alcohol, tobacco, and illicit drugs. KL and mom deny any past medical and surgical history. KL is currently on Prozac 20mg daily and Trazadone 50mg at night. The psychiatrist managing KL medications has suggested increasing her Prozac dose, but KL’s mom is resistant to increasing her daily dose to 30mg.

Diagnosis

· Major Depressive Disorder (MDD): KF reports feeling low, lack of energy and interest in fun activities, suicidal thoughts with no active plan, feelings of hopelessness and worthlessness (American Psychiatric Association, 2013). Patient Health Questionnaire-9 (PHQ-9) was used to assess KL for depression. Result demonstrates mild depressive symptoms (Patient Health Questionnaire, 2018).

· Anxiety Disorder: KL reports anxiety and worries when mom tries to isolate herself less and during testing. KL’s mother conveyed that patient is anxious, as evidenced by KL, appears nervous, irritable, and increased tension, especially when KL fails to study adequately before testing. According to DSM-5, anxiety disorders incorporate excessive fear, nervousness, difficulty concentrating, and related behavioral irregularities (Mental Health and Substance Abuse, 2014).

Client 2

AS is a 15 years old Hispanic American female. AS was referred to group therapy after AS broke up with her boyfriend. AS reports she has been dating her boyfriend a little over one year. AS reports being in love and thought the boyfriend was feeling the same for her. AS reports the boyfriend’s last contact was on a Sunday evening family invited boyfriend over for dinner. AS discovered boyfriend has been cheating on her with another girl and was devastated. AS reports this is the second time the same scenario is repeating itself. AS reports her former initial boyfriend also cheated on her with one of her girlfriends. AS reports feelings of anxiety, overwhelmed, worthlessness, inadequacy, unloved, and unappreciated for who she is when she discovered the affair. AS reports experiencing anxiety attacks and feeling like a failure due to her inability to keep a boyfriend, especially since this is the second time. AS reports attempted to commit suicide by overdosing on a bottle of Tylenol in the bathroom cabinet. Mom acknowledged AS reported to her that she (AS) took more Tylenol dosage than she supposed to. AS reports family support though dad appears angry, mom seems to understand what she is going through. 

AS denies any previous history of suicide attempts or previous PHP in-patient admission or treatment. AS denies any previous attempt to cut or harm herself AS is alert and oriented x4 AS is neatly and appropriately dressed. The thought is organized, and goal directed, affect is consistent with mood. AS denies active suicidal and homicidal ideations. AS is currently not on any medication, stating mom does not want her to on medication yet. As mood has improved and is responding positively to therapy

Diagnosis

· Major Depressive Disorder (MDD): According to the Diagnostic and Statistical Manual of Mental Health Disorders, 5th edition (DSM-5), the client must experience five or more symptoms before diagnosing depression (American Psychiatric Association, 2013). AS attempted suicide by overdosing on Tylenol, felt worthless, hopeless, and insignificant. Patient Health Questionnaire-9 (PHQ-9) was used to assess KL for depression. AS PHQ-9 shows a score of ten, indicating mildly depressed mood (Patient Health Questionnaire, 2018). 

· Anxiety Disorder: AS reports experiencing a panic attack, inadequacy, post-traumatic stress disorder, and apprehension about her inability to maintain a boyfriend (Mental Health and Substance Abuse, 2014). Anxiety disorder typically accompanies unjustifiable uneasiness and behavioral instability. AS has a score/record of six in GAD-7, indicating mild anxiety. According to Beard & Bjorgvinsson (2014), GAD-7 is an evaluation tool for measuring anxiety levels. 

Therapy: 

           Cognitive-behavioral therapy is the choice of therapeutic tool used in supporting family for optimal functioning. Cognitive therapy’s positive outcome is a change in the client’s thinking process, emotion, and behaviors. According to Patterson (2014), family functions more effectively together than individually since each family member affects one another. 

Legal and Ethical Implications

The Psychiatric Mental Health Nurse Practitioners (PMHNP) are under ethical and legal obligations to make legal and ethical decisions when counseling clients and their families. There is a need for the PMHNP to be knowledgeable and versatile with peculiar social, cultural, and legal concerns. Some of the legal implications include:

· The health care provider involving the client in the care plan since the patient can make rational decisions on treatment choice.

· The health care provider will endeavor to show understanding and empathy when relating with the patient, and is imperative before initiating assessment and interview, to obtain consent from the patient (Fivecoat, Cos & Possemato, 2017).

· Due to the nature and sensitivity of the information, the patient may not be willing to fully open to the healthcare provider, necessitating the need for privacy during the assessment. 

· The healthcare provider will reassure the patient of maintaining information shared confidential and for treatment purposes. Because the patient trusts the practitioner, the practitioner must not breach confidentiality for safety purposes (Fivecoat, Cos & Possemato, 2017).

Conclusion

Family/Group therapy is one of the treatment modalities used when there is dysfunctionality in the family pattern to address the interpersonal family conflicts and other differences to restore the family’s health and well-being. The therapist’s function is to examine the whole family as a complete unit, determines the role/function each member plays that deviates from normal; thereby leading to conflicts.  

Group Therapy Progress Note

Client: #1 KL__________________________________ Date: _9/9/20________

Group name: Family Therapy________________________________ Minutes:___60_____ Group session # __2____ Meeting attended is #:___2___ for this client. Number present in group _6____ of __6___ scheduled Start time: __0900______ End time: __1000______

Assessment of client

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

2. Participation quality: ❑ Expected ❑ Supportive ❑ Sharing ❑ Attentive ❑ Intrusive ❑ Monopolizing ❑ Resistant ❑ Other: _____________________________________

3. Mood: ❑ Normal ❑ Anxious ❑ Depressed ❑ Angry ❑ Euphoric ❑ Other: ________

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

5. Mental status: ❑ Normal ❑ Lack awareness ❑ Memory problems ❑ Disoriented ❑ Confused ❑ Disorganized ❑ Vigilant ❑ Delusions ❑ Hallucinations ❑ Other: ______

_

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: Withdrawn ______________________________

In-session procedures:

1. Introduction 3. Family sharing

2. Assessment 4. Treatment plan

Homework:

1. Encourage client and family to spend quality time together.

2. Encourage client to concentrate present and future and let the past be a learning experience to move on from.

Other Comments: Family participated actively during therapy session.

HE ——————, 2020

Signatures Date

Group Therapy Progress Note

Client: #2 AS________________________________________ Date: _9/9/20___ Group name: Family Therapy__________________________________ Minutes:___60_____ Group session # __2____ Meeting attended is #:__2____ for this client. Number present in group __6___ of ___6__ scheduled Start time: __0900______ End time: ____1000____

Assessment of client:

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

2. Participation quality: ❑ Expected ❑ Supportive ❑ Sharing ❑ Attentive ❑ Intrusive ❑ Monopolizing ❑ Resistant ❑ Other: _____________________________________ 3. Mood: ❑ Normal ❑ Anxious ❑ Depressed ❑ Angry ❑ Euphoric ❑ Other: ________

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

5. Mental status: ❑ Normal ❑ Lack awareness ❑ Memory problems ❑ Disoriented ❑ Confused ❑ Disorganized ❑ Vigilant ❑ Delusions ❑ Hallucinations ❑ Other: ______
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: Patient is quiet and withdrawn _____________

In-session procedures:

1. Introduction 3. Family sharing
2. Assessment 4. Treatment plan

Homework:

1. Encourage client and family to spend quality time together.
2. Encourage client to concentrate present and future and let the past be a learning experience to move on from.

Other Comments: Family participated actively during therapy session.

HE ——————–, 2020

Signatures Date

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Washington, DC: Author.

Beard, C., & Björgvinsson, T. (2014). Beyond generalized anxiety disorder: psychometric properties of the GAD-7 in a heterogeneous psychiatric sample. Journal of Anxiety Disorders, 28(6), 547-552.n

Fivecoat, H. C., Cos, T. A., & Possemato, K. (2017). Special ethical considerations for behavioral health consultants in the primary care setting. Professional Psychology: Research and Practice, 48(5), 335.

Mental Health and Substance Abuse (2014). What are the five major types of anxiety disorders? Retrieved from

https://www.hhs.gov/answers/mental-health-and-substance-abuse/what-are-the-five-major-types-of-anxiety-disorders/index.html

Patterson, Terence. 2014. “A Cognitive Behavioral Systems Approach to Family Therapy.” Journal of Family Psychotherapy 25 (2): 132–44. doi:10.1080/08975353.2014.910023.

PHQ-9 (Patient Health Questionnaire-9). 2018. Retrieved from https://www.mdcalc.com/phq-9-patient-health-questionnaire-9

© 2012 Laureate Education Inc.
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© 2014 Laureate Education, Inc.

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· Apply documentation skills to examine family therapy sessions *

· Develop diagnoses for clients receiving family psychotherapy *

· Analyze legal and ethical implications of counseling clients with psychiatric disorders *

*

 The Assignment related to this Learning Objective is introduced this week and submitted in Week 3.

Select two clients you observed or counseled this week during a family therapy session. Note: The two clients you select must have attended the same family session.

Then, address in your Practicum Journal the following:

· Using the Group Therapy Progress Note in this week’s Learning Resources, document the family session.

· Describe (without violating HIPAA regulations) each client, and identify any pertinent history or medical information, including prescribed medications.

· Using the Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition (DSM-5), explain and justify your diagnosis for each client.

· Explain any legal and/or ethical implications related to counseling each client.

· Support your approach with evidence-based literature.