Psychotherapy with Multiple Modalities Essay Example Paper

Posted: December 18th, 2022

Psychotherapy with Multiple Modalities Essay Example Paper

Gender: Both female (mother and daughter)

Age: 40 years old and 23 years old.

Chief complaint — “I am in so much pain, nobody can help me and nothing is helping me manage the pain.

History of present illness (HPI) — The patients are a 40-year-old Iranian-American woman and her 23-year-old daughter, who described the many difficulties she was experiencing in her interaction with her mother and siblings in her interview with the doctor. They have come to be evaluated for trauma-related problems that have arisen as a result of an assault by their father and her spouse. Mom is now dealing with post-traumatic stress disorder (PTSD) as a result of her marriage, as well as difficulties adapting to the customs and values of the United States.

Apparently, one of her children was sexually assaulted and molested by her biological dad, and this has certainly changed the way the household views and interacts with their father. Having problems with each other, challenges with their father, a lack of privacy, problems with the concerns of Iranian Traditional families being “Americanized,” and general mistrust are all issues that they have faced Psychotherapy with Multiple Modalities Essay Example Paper.


Twitching and excitement were two physical indicators that were seen throughout the examination. There are additional indications of hyperactivity, aggressiveness, impatience, a lack of self-control, and a tendency to repeat phrases over and over again. Concentration problems, difficulties paying attention, or a limited attention span are not apparent.

Past psychiatric history — Mother said that she had been having depressive episodes. They denied suicidal ideations or mania. No history of psychiatric hospital admissions.

Substance use history- No alcohol or tobacco use. They deny illicit drug use.

Family psychiatric/substance use– No family psychiatric disorder or substance use.

Psychosocial history/Developmental history — the patients are Iranian immigrants who are presently adapting to a more Americanized way of life while maintaining their traditional values.

Mom is presently unable to work due to disability, while her daughter lives independently. It is worth noting that the daughter is presently enrolled in school, although her social interaction was not addressed during the evaluation.

Medical History– There have been no reported injuries, convulsions, or developmental problems.

Review of Systems (ROS)

General– Mother complains of weariness and exhaustion, but she denies having fevers, chills, or night sweats. The daughter says that she is well, but that she is overburdened by her mother’s expectations and is unsure of how to deal with this problem.

HEENT– There were no apparent head injuries or trauma on any of the patients, and neither patient reported any changes in hearing or hearing. No ear pain, sneezing, runny nose, or sore throat

Skin — patients deny skin problems

Cardiovascular — they deny edema, syncope, heart palpitations, and chest pain

Respiratory — No cough, wheeze, or rales. Occasional dyspnea with exertion was reported.

Gastrointestinal — patients deny constipation, nausea, diarrhea, and abdominal pain.

Genitourinary — No polyuria, dysuria, hematuria, nocturia, or burning sensation when passing urine.

Musculoskeletal — No muscle aches or pain. They deny joint pain.

Hematologic — they deny anemia, easy bleeding, and bruising.

Lymphatics — no swollen lymph nodes reported.

Endocrinology —. They deny polydipsia, polyuria, and polyphagia.

Neurological — they deny seizures, light-headedness, tingling, and dizziness, headache, loss of sensation or coordination, or sense of imbalance Psychotherapy with Multiple Modalities Essay Example Paper.

Physical Exam

Vital signs

Height: M– 5’7, D- 5’11

Weight — 117 pounds.

P– 69

Temp — 98.3 F,

O2: 98%

BP: 106/72,

Head — normocephalic and atraumatic

Eyes — pink conjunctiva, white sclera bilaterally,

Ears — patent, grey pearl TM bilaterally, no discharge

Nose — pink mucosa, intact turbinates, no congestion and

Throat — No exudates noted. Red mucosal membrane.

Neck — full ROM. No swelling or bruits were noted.

Chest/Lungs — Chest is symmetric with respiration, clear to auscultation bilaterally without cough or wheeze. Resonant to percussion throughout.

Cardiovascular — S1, S2 clear, without murmurs, rubs, or gallops. Peripheral pulses 3+ and no peripheral edema.

Abdomen — Bowel sounds are normoactive in all four quadrants. Flat and symmetrical. No guarding or tenderness to palpation. 

Musculoskeletal — Strength 5/5, full ROM. No defect, masses, or swelling. No pain with movement.

Neurological — intact from CN I up to XII

Mental Status Examination

Maybe because of distress from getting married young and harsh marriage, the mother appears older than her age indicated. Her daughter, who is here today, seems to be her claimed age without any problems. She cooperates with the doctor throughout the process. They are well-groomed and neat, and they are dressed properly for the occasion. There is no indication of aberrant motor activity in these patients, b But they’re both exhibiting considerable stress, unrest, and irritability. They have no auditory or visual hallucinations, or delusions. They have clear speech, which is emphasized, and loud, but they are also logical and average in terms of intensity and tonal quality. The thought process is goal-oriented and rational.

Irritability, restlessness, aggressiveness, arousal, and annoyance are all clearly exhibited. There is also continuous repeating of certain phrases in a forceful and angry tone, as well as a lack of self-control. There was no problem concentrating while they were being talked to; there was no loss of recollection, and there were no difficulties staying attentive. They have a flat affect and a gloomy mood. They state that they have no present suicidal or homicidal thoughts.

When it comes to cognitive functioning, they are alert and oriented to themselves, the context and current and distant recollections are all sound. Concentration is good, comprehension is normal, and recall of memories is not problematic. They also have intact judgment and abstraction Psychotherapy with Multiple Modalities Essay Example Paper.

Eye contact– Good

Judgment: Intact

Insight: Fair

Memory: No problems with recollection

Cognition: Alert, and oriented to person, place, and time.

Attention: Concentration and attention maintained.

Perception: External stimuli elicit the lowest response.

Thought Content:  No suicidal or homicidal thoughts. No delusions.

Thought Process: rational, goal-oriented, and systematic 

Affect — Flat.

Mood — gloomy

Psychomotor — No spontaneous motions.

Speech — Clear and coherent.

Differential Diagnoses

Post-Traumatic Stress Disorder

Following a traumatic experience like conventional war, a brutal physical attack, or a catastrophic event, PTSD may develop. While tension is normal after a traumatic event, individuals with PTSD frequently replay terrible situations in their thoughts (Iribarren et al., 2015). They might also become estranged from their family members and friends. They might even begin to feel a spectrum of feelings, including rage, which may persist or worsen with time.

Constant unpleasant emotional thoughts, severe dread, anxiety, fright, rage, shame, or humiliation are among the symptoms of PTSD. Significantly reduced desire or involvement in crucial tasks. The mother and daughter have persistent PTSD symptoms as a result of being married to a violent guy and having a sibling who was raped by their dad. Another important component in PTSD is verbal aggressiveness, as well as an unhealthy family and a financially devastating livelihood. These characteristics are prevalent in the conduct of the mother. A major part of her alienation from her children has also been attributed to her verbal hostility Psychotherapy with Multiple Modalities Essay Example Paper.

Adjustment Disorder

An unanticipated significant emotional or behavioral response that happens due to a recognizable stressful event or that happened within the last 3 months is referred to as adjustment disorder. It may manifest itself in a variety of ways and habits, such as a sense of despair, sorrow, or emotional upset. Physical symptoms that arise after a stressful incident in one’s life may also be included (Patra & Sarkar, 2018) Psychotherapy with Multiple Modalities Essay Example Paper. Nervousness, sadness, aggressiveness, emotional highs and lows, trouble concentrating, a desire to be isolated, and other psychological symptoms are only a few examples.


The diagnostic criteria for adjustment disorder are not fulfilled in this instance since the duration for diagnosis is between 0 and 3 months, which falls outside of the normal range. Sadness, despair, and a loss of pleasure are some of the symptoms of adjustment disorder, as depicted by the mother and daughter. The following symptoms are common: weeping on a regular basis; fretting or feeling worried; being tense; restless or agitated; problems sleeping; decreased appetite; difficulties focusing; feeling overpowered; and trouble functioning in general Psychotherapy with Multiple Modalities Essay Example Paper.

Acute Stress Disorder

Acute Stress Disorder (ASD) is a mental illness that develops during the first month after a person experiences or observes an incident that includes a danger or actual tragedy of any kind. In general, these individuals’ reactions to these occurrences are characterized by overwhelming emotions of despair, fear, and terror (Bisson, 2020). In order to aid in the identification of individuals who might eventually acquire post-traumatic stress disorder, ASD was developed as a diagnostic technique.

According to the generally recognized time period for identifying this illness, it is extremely unlikely that these individuals are dealing with acute stress disorder. As of right now, this is just a hypothesis, not a definitive diagnosis. At this point, post-traumatic stress disorder (PTSD) as an outcome of a terrible marriage and assault is the most likely diagnosis.

Case Formulation and Treatment Plan

Everybody is unique, and PTSD manifests itself in various ways in different individuals. As a result, a therapy that is helpful for one individual may be useless for something else. It is critical that individuals with post-traumatic stress disorder (PTSD) be treated by a certified mental health professional who has extensive expertise and understanding of this disease. Some individuals suffering from post-traumatic stress disorder (PTSD) may require a number of different therapies before finding one that is effective for them. This is when the expertise of a seasoned professional comes into play Psychotherapy with Multiple Modalities Essay Example Paper.

The presence of co-occurring mental disorders is a significant complicating issue in mental health (Kelley et al., 2016). It is critical to treat diseases at their source rather than just masking the symptoms. Example: If my patient is suffering from post-traumatic stress disorder (PTSD) as a consequence of an abusive and physical relationship, it is critical to eliminate the trigger, which generally entails terminating the relationship and charting a new path of recovery (Brüne, 2015). Just as previously mentioned, in the event that depression is linked to the underlying cause of a client’s PTSD manifestation, that depression must be managed with first-class SSRIs and psychotherapy, or in some cases, group counseling, based on the cause and exacerbating factors. Anxiety attacks, depression, drug addiction, and suicidal thoughts are some of the other persistent issues that may co-occur.


The mother in this situation is displaying clinical manifestations of poor interpersonal skills, and she has observed a rise in the severity of her depression symptoms. Providers may help in connecting clients to resources in the community, assisting them with medical visits, providing psychiatric treatment, and problem-solving with concerns pertaining to daily responsibilities (Rajan, 2017) Psychotherapy with Multiple Modalities Essay Example Paper.

The treatment plan for these patients would include:

  • Seroquel 50mg PO QHS
  • Buspar 15mg twice daily
  • Prozac 20mg daily
  • Cognitive Behavioral Therapy.
  • Follow-up in 4 weeks.
  • Education of approaches for dealing with stress
  • Referral to Nutritionist
  • Educating patients about the adverse effects of medicine and what to anticipate in general Psychotherapy with Multiple Modalities Essay Example Paper


American Psychiatric Association. (2013). In Diagnostic and statistical manual of mental disorders (5th ed.).

Bisson, J. I. (2020). Acute stress disorder, adjustment disorders, and post-traumatic stress disorder. Oxford Textbook of Medicine, 6506-6509.

Brüne, M. (2015) Textbook of Evolutionary Psychiatry and Psychosomatic Medicine: The Origins of Psychopathology. OUP Oxford.

Iribarren, J., Prolo, P., Neagos, N., & Chiappelli, F. (2015). Post-traumatic stress disorder: evidence-based research for the third millennium. Evidence-based complementary and alternative medicine: eCAM, 2(4), 503–512.

Kelley, T., Docherty, S., & Brandon, D. (2016). Information needed to support knowing the patient. ANS. Advances in nursing science, 36(4), 351–363.

“Mother and Daughter: A Cultural Tale.” , directed by Anonymous., Masterswork Productions, 2003. Alexander Street. daughter-a-cultural-tale

Patra, B. N., & Sarkar, S. (2018). Adjustment disorder: current diagnostic status. Indian journal of psychological medicine, 35(1), 4–9.

Rajan P. (2017). Community physiotherapy or community-based physiotherapy. Health promotion perspectives, 7(2), 50–51.

Document the following for the family in the video, using the Comprehensive Evaluation Note Template: Chief complaint History of present illness Past psychiatric history Substance use history Family psychiatric/substance use history Psychosocial history/Developmental history Medical history Review of systems (ROS) Physical assessment (if applicable) Mental status exam Differential diagnosis—Include a minimum of three differential diagnoses and include how you derived each diagnosis in accordance with DSM-5 diagnostic criteria Case formulation and treatment plan Include a psychotherapy genogram for the family Note: For any item you are unable to address from the video, explain how you would gather this information and why it is important for diagnosis and treatment planning Psychotherapy with Multiple Modalities Essay Example Paper

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