Psychotherapy with Groups and Families Assignment Paper

Part 1.

Select one nursing theory and one counseling theory to best guide practice in psychotherapy and explain why the theories were selected.

The selected theories are Theory of Modeling and Role-Modeling (TMRM) as the nursing theory and Cognitive Behavioral Theory (CBT) as the counseling theory. TMRM is considered relevant since it emphasizes the need for holistic care and how nurses can contribute to address this need by viewing the world through the eyes of the patient/client. The theory enables nurse personnel to provide care and nurture each patient with respect for and awareness of the uniqueness and individuality of each patient/client. This approach to care places the focus on nursing on the needs of the patient. In fact, applying the theory results in nursing care being offered in a manner that recognizes the independence of each patient as well as the awareness that they have the ability and knowledge to comprehend the source/cause of the sickness, and what would get the patient well (Masters, 2014). CBT focuses on helping the client to identify and change the thought patterns that negatively influence emotions and behavior. It focuses on changing the spontaneous/automatic negative thoughts that have a damaging effect on the emotional difficulties such as anxiety and depression. In applying CBT, the psychotherapist guides the client to identify, challenge and replace the negative thoughts with realistic, objective thoughts (Ledley, Marx & Heimberg, 2018). Psychotherapy based on TMRM and CBT would enable the client to recognize and develop strengths to address the health concern, and be empowered to begin the healing process.

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Goals and objectives for practicum experience

The four goals have been identified as:

• To improve counseling and communication skills through the practicum experience.
• To receive feedback from practicing psychotherapists, preceptor and peer observers.
• To provide direct psychotherapy services in a variety of clinical domains that include group, family and individual therapy, and evaluation/assessment.
• To develop and be guided by the professional identity as a psychotherapist with a focus on understanding professionalism and ethics to include behaviors, attitudes and values, and interpersonal and communication skills.  Psychotherapy with Groups and Families Assignment Paper

The three objectives have been identified as:

• Increase knowledge of evidence-based psychotherapy, and basic counseling methods and skills.
• Increase skills in building relationships with clients and empowering them to take charge of their health, developing understanding and empathy of clients’ experiences, integrate psychosocial and biomedical aspects into treatment, assess family and psychosocial context, and respond to clients’ emotions.
• Demonstrate attitude change towards greater self-confidence in psychotherapy skills and the ability to address psychosocial issues in practice, and the importance of behavioral care.

Timeline of practicum activities based on practicum requirements

Part 2.

Client #1 – Mood Swing/Aggression

John, 18 years old, is a father of two children (twins) who reports mild mood swings, frequent irritability and aggression, and trouble sleeping. He has reported these symptoms from childhood. He indicates that his family members are afraid of him because of the mood swings and aggression that are characterized by aggressive verbal outbursts that are out of proportion with the triggers. For instance, he once smashed the television simply because one of his children changed the channel as he was watching a football match. He has a bad relationship with his children, wife and siblings. His aggressive outbursts occur at least three times every week. Also, the mood swings and aggression are affecting his self-image. He reports that he is worried that he could be bipolar, but has checked literature on his symptoms and believes that he is not bipolar. In addition, he has a negative outlook in general. Also, he is pervasively unhappy and irritable. He works in an industrial facility, a noisy environment, has been taking non-prescription medication for migraines. He does not take any recreational drugs and occasionally drinks alcohol in social functions. His brother suffered from depression and committed suicide three years ago. His paternal grandfather similarly suffered from depression. John has not been diagnosed with any mental disorder.

John was diagnosed with disruptive mood dysregulation disorder. Firstly, he is often in an irritable and angry mood that is characterized by aggressive verbal outbursts that are out of proportion with the trigger. The outbursts occur in all settings to include social, home and work settings. He is pervasively unhappy and irritable, with his family, parents and coworkers reporting that he has a problem with his temper. He is facing problems in social situations, at home and at work. He has low tolerance for frustration thus causing him to frequently lose his temper. He has few social relationships and avoids other people after having an outburst. Based on these symptoms as presented by DSM-5, John has been diagnosed with disruptive mood dysregulation disorder (American Psychiatric Association, 2013).

Client #2 – Bipolar/Depression

Mary, 38 years old, is a mother of two children who reports extreme mood swings. She reports that occasionally she feels low in spirits and tired, and this has been occurring for the past three years. In such occasions, she feels like staying in bed for days on end at a time without going to work, taking care of her family or attending to the many social responsibilities. On other occasions, she feels very excited, full of energy and capable of tackling just about anything. However, on this occasions when she is full of energy, Mary finds that she cannot focus on any single task, and finds it difficult to rest and sleep without taking much more alcohol than she would like to. In addition, she reports that her moods change abruptly. Most of the time she is in control of her emotions, but in some occasions she does not have control over her emotions. Mary reports that there is no known history of mental illness in her family although paternal grandmother was diagnosed with Alzheimer disease while her maternal grandfather was diagnosed with arthritis. Mary is not on any prescription medication and reports that she is reluctant to take medication but could agree to take small doses.

Mary was diagnosed as having bipolar disorder, specifically cyclothymic disorder, a cyclic disorder characterized by brief episodes of depression and hypomania. DMS-5 sets the six conditions for diagnosing cyclothymic disorder and requires that a client meets the six conditions for a positive diagnosis. Firstly, Mary reports multiple incidences of hypomanic symptoms and depressive symptoms. Secondly, she has been reporting the hypomania and depression symptoms for more than two years. Thirdly, she has not been diagnosed with other mental disorders. Fourthly, she does not meet the criteria for hypomanic episode, manic episode or major depressive episode. Fifthly, the depressive and hypomanic are not linked to substance abuse, medication or other medical conditions. Finally, the depressive and hypomanic symptoms significantly disrupt her functional, occupational and social activities. Additionally, she is restless, has concentration problems, lacks motivation, has impaired judgement, is pessimistic, and socially withdrawn. Based on these symptoms as presented by DSM-5, Mary has been diagnosed with cyclothymic disorder (American Psychiatric Association, 2013).

Legal and ethical implications

In providing counseling to the two clients (Mary and John), the psychotherapist has a responsibility to uphold public trust in the ethical and legal application of counseling practices. Based on this awareness, three ethical and counseling implications have been identified. Firstly, observing the five moral principles: fidelity, nonmaleficence, beneficence, justice and autonomy. Fidelity concerns concepts of honoring commitments, faithfulness and loyalty. Nonemaleficence concerns doing no harm to the client. Beneficence concerns doing good and acting in the client’s best interest. Justice concerns treating the client fairly, and not necessarily treating all the clients in the same way. Autonomy concerns the concept of independence and ability to make decisions (Cottone & Tarvydas, 2016).

Secondly, having an appropriate counseling relationship with the client. There is a legal and professional requirement for a therapist to wait at least five years after the end of the counselor-client relationship has ended before having a sexual or romantic relationship with the client, the client’s romantic partner, or the client’s family member. In addition, there may be a need to have a personal relationship for treatment purposes (such as observing the client in a social setting), although this must be conducted with caution (American Psychological Association, 2017). Thirdly, obtaining the client’s informed consent for the therapy techniques, goals, procedures, potential risks and benefits, continuation of services, fees and billing arrangements, intended use of tests and reports, right to refuse treatment, ongoing treatment planning, and right to confidentiality and limitations (Cottone & Tarvydas, 2016).

References

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders. Author.

American Psychological Association (2017). Ethical Principles of Psychologists and Code of Conduct. http://www.apa.org/ethics/code/ethics-code-2017.pdf

Cottone, R., & Tarvydas, V. (2016). Ethics and Decision Making in Counseling and Psychotherapy (4^th ed.). Springer Publishing Company.

Ledley, D., Marx, B., & Heimberg, R. (2018). Making Cognitive Behavioral Therapy Work: Clinical Process for New Practitioners (3^rd ed.). The Guilford Press.

Masters, K. (2015). Nursing Theories: A Framework for Professional Practice (2^nd ed.). Jones & Bartlett Learning, LLC.  Psychotherapy with Groups and Families Assignment Paper