Practicum – Week 2 Journal Entry.

Posted: January 10th, 2023

Practicum – Week 2 Journal Entry.

Assignment 2: Practicum – Week 2 Journal Entry
Learning Objectives
Students will:
• 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. Practicum – Week 2 Journal Entry.
Then, address in your Practicum Journal the following:

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• 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. Practicum – Week 2 Journal Entry.

Patient Description

The first patient was RH, a 36-year-old African American male who was diagnosed with PTSD one year ago. The client reportedly had flashbacks and violent behaviors. During his examination, he expressed his dislike against his mother, whom she accused of having failed to protect him from sodomy by a close uncle between the ages of 5 and 15. The patient reported several instances when he saw people who wanted to harm him. The patient’s physical examinations recorded no significant findings with all his vital signs lying within the normal range. RH was on medications: Prozac 20md PO daily for mood regulation and Ativan 0.5mg PO for anxiety management. Practicum – Week 2 Journal Entry.

The second client was a 28-year-old White-American male FG with a history of Major Depressive Disorder (MDD) and sleep disorder. The patient was socially withdrawn had suicidal ideation and was delusional but reported no audio-visual hallucinations. The client had attempted to commit suicide twice. Before losing his job, the client used to work in North Carolina but initially worked in Georgia, but later moved to Texas where he is not only homeless but also jobless. His depressive state negatively impacts his ability to efficiently perform activities of daily life. He could hardly verbalize his own words and seemed to be confused and alert. The patient was on Seroquel 100 mg PO daily and Prozac 20 mg PO daily and was reportedly compliant with medications. Practicum – Week 2 Journal Entry.

DSM-5 Diagnosis

            A diagnosis of Post-Traumatic Stress Disorder is made based on a specific criterion categorized as A-H where a patient is deemed to be positive if they exhibit at least one symptom in each of the eight categories(American Psychiatric Association, 2013). In criterion A, a patient should have the history of direct or indirect exposure to a stressor. In criterion B, a patient should have intrusion symptoms such as: upsetting memories, nightmares, flashbacks and distress, and. In criterion C, a patient should exhibit signs of avoidance as evidenced by traumatic thoughts and feelings. In criterion D, a patient should reportedly have negative changes in cognition and mood which can be evidenced through self-blame, isolation, antisocial behavior.          Criterion F, a patient should report the recurrence of symptoms for at least one month, in criterion G- the patient’s symptoms should be the major contributing factors to distress and functional impairment. And lastly criterion H, a patient’s symptoms should not be as a result of medications, an underlying illness, or substance use (American Psychiatric Association, 2013). In the case of RH, he was exposed to sodomy (a stressor), had intrusion symptoms (flashbacks and violent behaviors), negative changes in mood and cognition (dislike for his mother). Therefore, PTSD is the most relevant diagnosis.

On the other hand, FG reportedly had symptoms of suicidal ideation, antisocial behavior, and was delusional. These symptoms stemmed from being jobless and homelessness which have made him highly vulnerable. The DSM-5 framework is clear that, for a patient to be diagnosed with major depressive disorder, he/she should exhibit the symptoms of weight loss, constant fatigue, continuous depression, indecisiveness and lack of concentration, persistent suicidal ideations, and irregular sleep patterns (Maj, 2013). Hence, FG meets the diagnostic criterion for major depressive disorder.

Legal and Ethical Impacts on Guide Counselling Each Client

The ethical principle of patient privacy and confidentiality is critical for both patient scenarios. The patients have specific symptoms that largely contribute to individual health Practicum – Week 2 Journal Entry. concerns. Considering this state, input from close friends and family members may be required to achieve optimal health outcomes. Therefore, there’s a high likelihood that this may result in the disclosure of patient medical information and a violation of the patient’s right to confidentiality (Treuer, 2013). However, the counselor can still withhold sensitive patient health information to safeguard patient confidentiality and privacy and still achieve the desired therapeutic goals.