Race: African American
Facility: REH Crisis Stabilization Program
City: Minneapolis State: MN
WZ was referred to the facility by social worker at Hennepin County Mental Health Center (M. Miller) reports trauma at a local shelter where a “guy got shot in front us” which led to a panic attack and an ER visit at Fairview. Fairview made a referral to Nancy Page, but WZ’s mother is there as resident, and she has past trauma related to her, and WZ does not believe that it would be a healthy environment for her.
WZ denies having any medications for her psychiatric disorder medications, but a referral was made to Hennepin county psychiatry for evaluation.
(309.81) Posttraumatic Stress Disorder
Criteria A: WZ has direct exposure to the death of another person at her shelter.
Criteria B: WZ has Intrusive symptoms of a flashback of witnessing murder.
Criteria C: WZ has Avoidance Trauma-related thoughts or Feelings
Criteria D: WZ has Difficulty in experiencing positive affect.
Criteria E: WZ has Trauma-related arousal and reactivity that began or worsened after the trauma.
Criterion F: WZ Symptoms has lasted for more than one month.
Criterion G: functional significance. Symptoms create distress or functional impairment (e.g., social, occupational
Criteria H: These symptoms are not due to medication, substance use, or other illness.
WZ will benefit from a combination of medication management and psychotherapy.
Stahl (2019), has said that PTSD patients may have “residual symptoms,” and combining selective serotonin reuptake inhibitor (SSRIs and psychotherapy such as cognitive-behavioral therapy (CBT) have shown effective management of the illness.
The goal is always a remission and reduction in symptoms. PTSD is a complicated illness that has many symptoms and multiple pathways to accomplishing a remission for its sufferers. Clinicians need to have a clear communication channel with their clients on the outcomes and the augmentations of their medication, such as the SSRIs that may accompany their choice of therapy (Stahl, 2019).
WZ has many court hearings as a witness to come in and identify the murderer, and she has reported that this is a source of extreme anxiety.
Facility: REH Crisis Stabilization Program
City: Minneapolis State: MN
HH reported that he is continually physically abused, assaulted and robbed. “I am drinking to mask the emotional and physical pain I am feeling.” “I have been up to detox about 12 times. “It does not matter if I am in Minneapolis or St. Paul I manage to get assaulted and have all of my personal identification stolen, and I am exhausted both emotionally and physically.”
“I believe I have suffered from depression and fatigue my whole life and I was finally diagnosed with being Bipolar II, and I remain to be attempting to manage my medications. I am also in need of a new psychiatrist.”
296.89- Bipolar II Disorder
HH met the criteria for at least one hypomanic episode and at least one major depressive episode.
The occurrence of the hypomanic episode(s) and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
HH is moderately depressed and has hypomania 24 hours ago.
HH has seasonal pattern of BPII with major depressive episodes. as well as rapid cycling
Effectiveness of Motivational Interview
Motivational Interview (MI) was initiated to motive individuals that are afflicted with addiction disorders. The therapist coach and guide the patient in amending their thinking and breaking the cycle of addiction (Wheeler, 2014). MI is utilized by mental health practitioners to adjust and modify their addiction lifestyle (Frost, Campbell, Maxwell, O’Carroll, Dombrowski, Williams, Pollock, & et al., 2018).
In using the MI, this patient, HH, was able to identify that he is depressed, has hypomania, drinking more, and that he needs help.
HH has open cases in court regarding child support and assault.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Frost, H., Campbell, P., Maxwell, M., O’Carroll, R. E., Dombrowski, S. U., Williams, B., … & Pollock, A. (2018). Effectiveness of Motivational Interviewing on adult behaviour change in health and social care settings: A systematic review of reviews. PloS one, 13(10), e0204890.
Stahl, S. M. (2019). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (6th ed.). New York, NY: Cambridge University Press.
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how- to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company
Group Therapy Progress
Group Therapy Progress Note
American Psychological Association | Division 12
Client: MT and LT _________________________________________________ Date: _3/20/2020__________Groupname:_Couple Therapy_________________________________________ Minutes:_60_______ Group session # _2_____ Meeting attended is #:_2_____ for this client. Number present in group __2___ of ___2__ scheduled Start time:____2pm____ End time: ____3pm____
Assessment of client 1. Participation level: x Active/eager ❑ Variable ❑ Only responsive ❑ Minimal ❑ Withdrawn 2. Participation quality: ❑ Expected ❑ Supportive xSharing ❑ Attentive ❑ Intrusive ❑ Monopolizing ❑ Resistant ❑ Other: _____________________________________ 3. Mood: ❑ Normal ❑ Anxious xDepressed ❑ Angry ❑ Euphoric ❑ Other: _______________ 4. Affect: ❑ Normal ❑ Intense ❑ Blunted ❑ Inappropriate ❑ Labile xOther:__Flat_____________ 5. Mental status: xNormal ❑ Lack awareness ❑ Memory problems ❑ Disoriented ❑ Confused ❑ Disorganized ❑ Vigilant ❑ Delusions ❑ Hallucinations ❑ Other:__________________ 6. Suicide/violence risk: x Almost none-currently xIdeation-past hx ❑ Threat ❑ Rehearsal ❑ Gesture ❑ Attempt 7. Change in stressors: ❑ Less severe/fewer x Different stressors ❑ More/more severe ❑ Chronic 8. Change in coping ability/skills: ❑ No change ❑ Improved xLess able ❑ Much less able 9. Change in symptoms: x Same ❑ Less severe ❑ Resolved ❑ More severe ❑ Much worse
- Other observations/evaluations:________________________________________________________
__Increase MT and LT awareness to responsibilities
Provide solutions that may help to decrease conflict in the family
Offer financial management/ budgeting skills
_Help family establish a mutual agreement to the problem _____________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ __________ _____________________________________________________________________
1._________Make a list of what triggers mood _______
2._Send each other 3 positive texts of why you love them _________________________________________________________
3 Make a list of positive quotes which are very motivating to each as a person .___________________________________________________________________________________
Other Comments: ______Attend depression group, Depression pamphlet provided, and Suicide risk pamphlet provided__ attend aa meetings_,attend marriage counseling ____________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ ____________________________________________________________________________________
Psychotherapy treatment of mental disorders has received increased attention across the world. It provides an effective way of handling and treating mental disorders. It has been proved to improve emotions and behaviors, which are linked with positive changes in the brain and body. This week, I was privileged to counsel two clients, MT and his wife, LT. This journal provides the diagnosis and legal aspects of counseling these clients.
MT is a 45-year old while his wife, LT is 40 years old. The family has been visiting various mental crisis centers with no help. Both clients appear knowledgeable and calm. However, they have been involved in constant family feuds, which sometimes result in physical abuse.
Therapy Progress Note
Last year, MT, a computer network architect, was fired from his job due to absenteeism and drinking cases. The dismissal greatly affected his mental health as he was admitted to the psychiatric crisis center for suicidal ideations and acute depression. This situation was exuberated by his wife’s miscarriage, which cost the family a lot of money. The family was advised to go for couple therapy to speed up his recovery and maintain sobriety.
In this session, MT reported increased depressive moods, which are exuberated by his drinking behavior. He admits that excessive alcohol drinking has ruined his family and career. Turner is ready to use any means possible to save his health, career, and family. On the other hand, the wife LT appears gloomy and frustrated. She blamed MT for the family woes and difficulties they have been experiencing for the past year. LT looked much worried about the future of the family as the husband is jobless, and they cannot cater for the bills.
After the hospitalization, MT was given tricyclic antidepressants and selective serotonin reuptake inhibitors to control depression and suicidal thoughts. However, he stopped taking the drugs after experiencing low sexual drive and erectile dysfunction. MT resolved to alcohol as a way to manage his depression. He reported having been using bhang to control his situation. LT reported a history of anxiety and depression, especially after the miscarriage. These effects were exuberated by his husband, who turned abusive and chaotic when drunk. Both reported no history with mental disorders.
Substance Use Disorder
MT reported a struggle with substance addiction after the dismissal from work. Substance use is usually measured on the continuum from mild to severe (Hasin et al., 2013). Most substance use disorder involves problems emanating from a drug overdose and continued use despite its consequences on an individual’s health and life. MT reported continued use of alcohol despite losing the job and messing up his family. He also uses bhang to control his situation. Instead of looking for another job, he resorted to drug abuse to manage his depression. MT agrees that it has been challenging to stop excessive alcohol intake despite warning from therapists
Major Depressive Disorder
Major depression disorder affects how an individual feels, thinks, and behaves, leading to persistent feelings of sadness and loss of interest in enjoyed activities. MT reports struggling with depressive mood since his dismissal from work. He was admitted for suicidal ideation as he battled depression. Ideally, depressive moods bring about waves of painful feelings, mixed negative attitudes, and suicidal thoughts (American Psychiatric Association, 2013). The victims usually suffer corrosive feelings of worthlessness and self-hate. This hammer self-esteem which can lead to social isolation and aggressive behaviors. To meet the diagnostic criteria of this disorder, the patient has to show signs of mental impairment or distress. MT reported that depression drove him to become abusive and overly chaotic. He would often engage in a chaotic brawl with his wife resulting in physical abuse.
The posttraumatic disorder can develop when an individual is exposed to the death of their loved ones. To be diagnosed with this disorder, the event should cause clinically significant distress or impairment to the individual’s capacity to function (American Psychiatric Association, 2013). The intrusive upsetting memories of traumatic memories can lead to fear, hopelessness, and horror. The negative cognition and moods may bring a distorted sense of self-blame and worthlessness. LT reports undergoing intense stress after the miscarriage. She appeared extremely irritable and anxious, which indicated posttraumatic disorder brought by her miscarriage. MT persistent abusive also played a significant role in reminding her of the death of their unborn child.
Legal and Ethical Implications of Counselling the Couple
The main legal and ethical themes in counseling include confidentiality, informed consent, and duty to warn. The counselors must balance what is right for them with what is right for the clients based on their beliefs (Shaw, 2015). This helps them to avoid misjudgments ad provide effective therapy. Family therapy requires high impartiality and equality as each party blames the other for the woes. It is most likely that MT and his wife will blame each other during the recovery period. This may lead to increased mistrust between the couple brought by the possibility of MT return to alcoholism. It may be unethical to side with the wife or tell her that the blame may impede her husband’s recovery. The couple should be advised that the past may affect their recovery, so they need to forget about it and move towards a new world.
In conclusion, the couple was willing to accept their roles in the situation and demonstrated great openness. MT took the blame for the family woes and promised to work with the therapists in changing his behavior. The wife also accepted her role in the persistent brawls and was willing to steer the change.
Major Depressive Disorder. (2013). American Psychiatric Association. Retrieved from https://images.pearsonclinical.com/images/assets/basc-3/basc3resources/DSM5_DiagnosticCriteria_MajorDepressiveDisorder.pdf
Hasin, D., O’Brien, C., Auriacombe, M., Borges, G., (…), Grant, B. (2013). DSM-5 Criteria for Substance Use Disorders: Recommendations and Rationale. The American Journal of Psychiatry, 170(8): 834-851 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767415/
Shaw, E. (2015). Special Issue: Ethics in Couple and Family Therapy. Australian and New Zealand Journal of Family Therapy, 36(1): 403-408. https://doi:10.1002/anzf.1132.
Nursing Assessing Client Family Progress