Posted: December 19th, 2022
Practicum – Week 1 Journal Entry and Journal Submission.
Assignment 2: Practicum – Week 1 Journal Entry and Journal Submission Learning Objectives Students will: Analyze nursing and counseling theories to guide practice in psychotherapy Develop goals and objectives for personal practicum experiences Create timelines for practicum activities Develop diagnoses for clients receiving psychotherapy Analyze legal and ethical implications of counseling clients with psychiatric disorders Develop diagnoses for clients receiving psychotherapy Evaluate the efficacy of cognitive behavioral therapy for clients Analyze legal and ethical implications of counseling clients with psychiatric disorders The Learning Objectives are related to the Practicum Journal Assignments presented in Weeks 1, 2, and 4. Week 4 Journal Entry Select a client that you observed or counseled this week. 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 cognitive behavioral therapy would be effective with this client. Include expected outcomes based on this therapeutic approach. Support your approach with evidence-based literature. Explain any legal and/or ethical implications related to counseling this client.Practicum – Week 1 Journal Entry and Journal Submission.
Client Description, Pertinent History, and Prescribed Medications
For this assignment, the preferred patient of choice was FT, a 45year old African American male who was reportedly on a 1013 hold. The client presented at the ER with complaints of suicidal and homicidal ideations, delusions, aggressive behavior and was likely to cause harm to others. It is also worth noting that the patient’s liver function state was widely deranged with significantly high levels of the lipase enzyme. FT agreed to a history use of illicit drug use such as cocaine besides alcohol intake and cigarette smoking. He took up to 5 cans of beer daily and was a smoker of 40+pack years. He was diagnosed with cocaine use disorder, COPD and schizophrenia six months ago. However, the patient denied having a positive family history of mental illness.
The findings of the physical exam were highly consistent with a positive history of using cocaine. He was not only bizarre but also felt agitated, was alert and appeared to be chronically ill. The patient was also dehydrated as evidenced by dry mucous membranes, had auditory and visual hallucinations. Recordings of the vital signs revealed that they were all within the normal range. Although the skin was dry, it was intact. An exam of all other systems revealed no significant findings. The patient was on the following medications: Vistaril 50mg PO to manage anxiety ad agitation, haloperidol 5mg PO bedtime, vitamin b-12 1000mcg PO and Seroquel 400mg PO bedtime (Stahl, 2013).Practicum – Week 1 Journal Entry and Journal Submission.
Client Diagnosis As Supported By DSM-5
According to the DSM for mental health disorders, a client is diagnosed with schizophrenia when he/she presents with the following symptoms: lost interest in routine activities, hallucinations, negative symptoms such as not being able to verbalize individual speech, disorganized speech, being delusional and catatonic behavior (American Psychiatric Association, 2013). In this patient case scenario, the client presented with the symptoms of; being delusional, auditory hallucinations, suicidal and homicidal ideation, and aggressive/bizarre behavior. This warrants the patient to be diagnosed with schizophrenia.
It is wrong to diagnose the patient with Substance Use Disorder (SUD) as well as schizophrenia since in most cases, this usually happens as an approach of self-mediation or to alleviate the symptoms of anxiety or depression that worsens the symptoms and clinical presentation further. In this case scenario, it is inarguable the client’s use of drugs (cigarette, cocaine, and alcohol) were potential triggers of schizophrenic episodes (American Psychiatric Association, 2013).
Effectiveness of CBT With This Client And Expected Outcomes
In the management of this client, CBT would be an effective approach since it will ensure that attention is given to the client’s symptoms that cause psychological impairment. These symptoms include: being delusional, auditory hallucinations and disorganized speech. Through CBT, the client will also be able to conduct a self-assessment of the negative symptoms in cognition, depression and mood and loss of interest. Through this assessment, the client will be able to associate his behavior, emotions, and feelings by identifying individual areas of weaknesses (Nowak et al., 2016). Thereafter, he will be able to develop strategies and objectives on how to regain functional status with the necessary assistance.
In this case, the expected outcome is that the client’s symptoms of being delusional and having auditory hallucinations will gradually subside. The patient will also develop a stable mood and have other abnormal behaviors resolved. This implies that the patient’s thought patterns will be normalized and he will be able to cope with stress while identifying early danger signs of relapse (Nowak et al., 2016). It is also expected that the client will be able to associate the influence of illicit drug use on his behaviors, thoughts, and feelings which would influence a path towards recovery through rehabilitation efforts.Practicum – Week 1 Journal Entry and Journal Submission.
The effectiveness of CBT can be enhanced by other psychosocial interventions for more successful outcomes including training for social skills, family therapy, support for employment and vocational rehabilitation. Most schizophrenic patients require daily living support with aspects such as housing, jobs and during crisis states. These interventions would generally help to improve social interaction and communication and to ensure support (Nowak et al., 2016). Support for employment would ensure that he gets and maintains a job.
Legal/Ethical Implications Related To Counseling This Client
The most essential ethical and legal issue when dealing with this client is that of informed consent and patient privacy and confidentiality. The patient in this case scenario was involuntarily brought to receive care since it is revealed that he was on a 1013 hold. His ability to make informed choices regarding his treatment has been impaired by the mental illness that he is currently suffering from (Treuer, (2013). Therefore, obtaining informed consent from the client and at the same time upholding the patient’s privacy and confidentiality would present numerous challenges.Practicum – Week 1 Journal Entry and Journal Submission.
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