Assignment 1: Practicum – Week 8 Journal Entry

This week, you complete a two-part journal entry.
Learning Objectives
Students will:
• Develop diagnoses for clients receiving psychotherapy*
• Evaluate efficacy of existential-humanistic therapy for clients*
• Analyze legal and ethical implications of counseling clients with psychiatric disorders* Assignment 1: Practicum – Week 8 Journal Entry
• Analyze clinical supervision experiences*

  • The Assignment related to this Learning Objective is introduced this week and submitted in Week 10.
    For Part 1, select a client whom you observed or counseled this week (other than the client used for this week’s Discussion). Then, address the following in your Practicum Journal:
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• Describe the client and identify any pertinent history or medical information, including prescribed medications.
Information about the client as follows: Pt is a 67year old black African American male in a nursing home.
Psychiatric Diagnosis of Bipolar disorder I, anxiety and depression.
Medical diagnosis: CVA with left side weakness, Hypertension, hyperlipidemia.
Psych Medication:
Seroquel 50mg at bedtime- Bipolar disorder
Ativan 1mg PO at bedtime for anxiety
Trazodone 100mg PO at bedtime for depression with insomnia
Chief complaint: Pt with symptoms of depression and thinks his health is not improving in terms of muscle strength weakness. Complain about sleep disturbance. Get angry at times with staff at nursing home when care is done well. C/o somatic pains to legs
Social history: Divorced. Former smoker. Alert and oriented x3. Speech clear. No auditory hallucination. or suicidal ideation . Mood is slightly depressed. Speech is coherent and goal directed.. Energy and appetite is low. Pt feels family ( especially his adopted daughters have abandoned him as they are leaving with the ex-wife and do not come to visit him any longer.

• Using the DSM-5, explain and justify your diagnosis ( Psychiatric Diagnosis of Bipolar disorder I and depression )for this client. Main diagnosis should be Bipolar I with depression
• Explain whether existential-humanistic therapy would be beneficial with this client. Include expected outcomes based on this therapeutic approach.
• Explain any legal and/or ethical implications related to counseling this client.
• Support your approach with evidence-based literature.

For Part 2, reflect on your clinical supervision experiences. Then, address the following in your Practicum Journal:
• How often are you receiving clinical supervision from your preceptor? ( 3 TIMES A WEEK )
• What are the sessions like? ( RECEIVED SESSION (1HR SECTION ) BEFORE PRACTICUM HOURS ON THE TYPE OF PATIENT WITH DIAGNOSIS AND PSYCHOTHERAPY APPROPRIATE TO USE), TEACHINGS IN BETWEEN EACH PATIENT COUNSELING
• What is the preceptor bringing to your attention? – Talk about psychotherapy for clients Assignment 1: Practicum – Week 8 Journal Entry
• How are you translating these sessions to your clinical practice?
The client is a 67-year-old black African American man. The client’s psychiatric diagnosis is Bipolar disorder I, with depression. His medical diagnosis includes; CVA with left side weakness, Hypertension, hyperlipidemia. The client’s psychiatric medications include Seroquel 50mg at bedtime- Bipolar disorder; Ativan 1mg PO at bedtime for anxiety; and Trazodone 100mg PO at bedtime for depression with insomnia.

The current chief complaint includes depression symptoms and the client thinks that his symptoms are not improving, especially muscle strength weakness. The client also complains regarding sleep disturbance, is easily irritable, and complains of somatic pains to legs. His mood is slightly depressed, his energy and appetite low, and he feels abandoned by the family.
Diagnosis Justification (Bipolar Disorder I with Depression)

According to DSM-5, bipolar 1 is characterized by symptoms such as disturbed sleep, grandiosity, racing thoughts, too much talking, distractibility, as well as taking part in risky activities (Parker, 2014). On the other hand, Bipolar 1 disorder with depression is characterized by major depressive episodes. DSM-5 stipulates that the depressive episode should have a noticeable depressed mood or loss of interest for a minimum of two weeks. Specifically, bipolar 1 with depression is typified by: changes in appetite, sleep disturbances, fatigue and irritability, lack of concentration, reduced self-worth or guilt feelings, as well as suicide ideation (Tendon, 2015). Accordingly, the client’s diagnosis of bipolar disorder I with depression is justifiable as demonstrated by sleep disturbance, irritability, depressed moods, low energy, low appetite, as well as feeling of having been abandoned by the family.

Use of Existential-humanistic Therapy for the Client

Existential-humanistic therapy is a therapy whose focus is on the ideas of individual responsibility and personal freedom where during therapy the focus is on discussing the client’s reasons for existence and life purpose, as well as client’s free will to make decisions regarding their life (Varvatsoulias, 2015).

Accordingly, existential-humanistic therapy would be appropriate for the client because with this approach the client would be able to face the life realities that need to be changed and be able to search for meaning and purpose in life and at the same time acquire an awareness of himself. Through this therapy, the client would be able to experience life freely at all levels and make an authentic decision and find a way on how to deal with his inner self and the world (Varvatsoulias, 2015). Patients with bipolar disorder and depression normally have problems when it comes to understanding isolation because their belief is that their loneliness is synthetic and idiosyncratic (Wolfe, 2016). This is evident in this client where he feels that his family has abandoned him and this might be significantly contributing to his depressive moods. Accordingly, existential-humanistic therapy would help the client to learn that loneliness is part and parcel of life and that one can handle this by investing in other individuals, and learning to accept indifference and cope with loneliness. In addition, existential-humanistic therapy would help the client find purpose in life. Assignment 1: Practicum – Week 8 Journal Entry

Legal and/or Ethical Implications

The key legal and ethical aspects for this patient include his ability to make decisions regarding his treatment regimen. This is because patients with mental health conditions sometimes lack the capacity to make decisions (Gopalakrishnan, 2016). Another issue regards his autonomy. This is because the client may refuse to accept treatment and yet the therapist is obligated to act in the patient’s best interests and for the client’s good (Jain et al, 2017). Another important issue is to respect the client’s confidentiality regarding all issues discussed with him, including his family issues.

Part 2

My clinical supervision experiences were outstanding. My clinical supervision was frequent since my preceptor would come three times a week. This was so helpful to me because I gained more confidence and competency in clinical practice because of my preceptor’s support and hence I was able to achieve the appropriate learning outcomes.

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During the clinical supervision, the sessions would take one hour prior to practicum hours. The sessions would focus on the patient, the diagnosis, and the appropriate psychotherapy to use for each specific diagnosis. The preceptor would take the opportunity during patient counseling to conduct teaching and therefore I was able to gain first-hand clinical instruction. More importantly, the teachings were comprehensive and the practical aspect of it equipped me with clinical skills regarding counseling and on how to handle different patients.

The preceptor mostly focused on the importance of psychotherapy for clients with different mental health conditions. Using psychotherapy clients’ thoughts, feelings and behaviors would be explored in order to improve the client’s wellbeing. It was remarkable to see the preceptor successfully use psychotherapy to assist clients in eliminating and controlling troubling symptoms and most clients ended up functioning better after attending the recommended therapy sessions.

I intend to translate the sessions into clinical practice by applying the skills and knowledge I acquired during clinical supervision in clinical practice. For instance, I intend to use different forms of psychotherapy used by my preceptor during my clinical practice. More importantly, I learnt that even if the client opens up regarding their private life during counseling sessions, I should always maintain confidentiality. Assignment 1: Practicum – Week 8 Journal Entry

References

Gopalakrishnan G. (2016). Mental Health and Law – Contemporary issues. Indian J Psychiatry. 58(2): S166–S167.

Jain S, Kuppili P, Deep P & Sagar R. (2017). Ethics in Psychiatric Research: Issues and Recommendations. Indian J Psychol Med. 39(5): 558–565.

Parker G. (2014). The DSM-5 classification of mood disorders: Some fallacies and fault lines. Acta Psychiatr Scand. 1(;129), pp:404–9

Tendon R. (2015). Bipolar and Depressive Disorders in Diagnostic and Statistical Manual of Mental Disorders-5: Clinical Implications of Revisions from Diagnostic and Statistical Manual of Mental Disorders-IV. Indian J Psychol Med. 37(1): 1–4.

Varvatsoulias G. (2015). Depression as a Maladaptive Process: Discussion of the Condition According To The Humanistic And Existential Approach. GESJ: Education Science and Psychology. 2(34).

Wolfe B. (2016). Existential-humanistic therapy and psychotherapy integration: A commentary. Journal of Psychotherapy Integration. 26(1):56-60. Assignment 1: Practicum – Week 8 Journal Entry

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