Journal Entry and Journal Submission
Select a client that you observed or counseled this week. Then, address the following in your Practicum Journal:
Describe the client (without violating HIPAA regulations) and identify any pertinent history or medical information, including prescribed medications.
Using the DSM-5, explain and justify your diagnosis for this client.
Explain whether cognitive behavioral therapy would be effective with this client. Include expected outcomes based on this therapeutic approach. Support your approach with evidence-based literature.
Explain any legal and/or ethical implications related to counseling this client.
Note: Be sure to use the Practicum Journal Template, located in the Learning Resources.
Rubric:
Quality of Work Submitted:
The extent of which work meets the assigned criteria and work reflects graduate level critical and analytic thinking.–
Excellent 27 (67.5%) – 30 (75%)Good 24 (60%) – 26 (65%)Fair 21 (52.5%) – 23 (57.5%)Poor 0 (0%) – 20 (50%)
Quality of Work Submitted:
The purpose of the paper is clear.–
Excellent 5 (12.5%) – 5 (12.5%)Good 4 (10%) – 4 (10%)Fair 3.5 (8.75%) – 3.5 (8.75%)Poor 0 (0%) – 3 (7.5%)
Written Expression and Formatting
Paragraph and Sentence Structure: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are clearly structured and carefully focused–neither long and rambling nor short and lacking substance.–
Excellent 5 (12.5%) – 5 (12.5%)Good 4 (10%) – 4 (10%)Fair 3.5 (8.75%) – 3.5 (8.75%)Poor 0 (0%) – 3 (7.5%)
PRACTICUM WEEK 2 JOURNAL ENTRY 2
PRACTICUM WEEK 2 JOURNAL ENTRY 2
Practicum Week 2 Journal Entry
Kaacha Naminda
Walden University
Psychotherapy with Individuals-NURS 6640-6
September 20, 2019
Running head: PRACTICUM WEEK 2 JOURNAL ENTRY 2
Practicum Week 2 Journal Entry
The journal entry for this week will discuss a client who I counseled and whose admission assessment I performed. The journal will include a description of the client, the client’s history and medical information, prescription medications, and the diagnosis, using the DSM-5. The legal and implications of counseling the client will also be discussed.
AW is a 36-year old female client who was admitted to the drug and rehabilitation center from a homeless shelter. YH was admitted voluntarily as she admitted to having being addicted to heroin and methamphetamine. AW was promised confidentiality with her information since the interview was for school purposes only and that her name would not be used for the journal. She, however, was aware that only her initials would be used. AW stated she was on the run from the law from a different state for assault.
AW was open enough to discuss her upbringing and how her environment might have led to her drug addiction. She stated that her father died when AW was five years old from a drug overdose. A year later, her mother went to prison for three years for dealing with controlled substances. At this point, AW stayed in four different residencies, including two foster homes. AW’s mother was released from prison when AW was 9 years old. A month after being released from prison, her mother caused a fatal accident while driving under the influence. AW’s mother died, including two other people in the car. AW was also an occupant of that care and she was the only survivor of that crash. She shows two large scars from the injury that she sustained in that accident.
During the interview, AW indicated that she had been raped as a child when her mother was in prison and that she was recently diagnosed with bipolar disorder, anxiety, and post-traumatic stress disorder in addition to substance abuse disorder. AW denies any medical or surgical history. AW stated that she has never been married but has an 18-year old son who she lost custody of when the son was 13-years old because AW went prison for assaulting her boyfriend with a deadly weapon, and for drug related charges. Her son had to go live with his biological father who raised him in a better home than what AW was capable of providing. AW indicated that she has been in drug rehabilitation program twice in 2004.
Pharmacological Agents
AW stated that she had been taking sertraline 50mg daily but had stopped it after she took many tablets at once a few months ago in an attempt to commit suicide. She has been taking Lamictal 25mg daily for the past three weeks and stated she can feel some relief from her depressive symptoms. During the morning assessment with the Psychiatrist, AW indicated that she was having nightmares and she was hoping to get some relief while she waiting for the Lamictal to start working. The psychiatrist prescribed Prazosin (Minipress) 6mg daily for a start with a chance to increase the dose eventually depending on the patient’s blood pressure since the drug can cause low blood pressure. According to Koola, Varghese, and Fawcett (2014), patients with PTSD frequently remain symptomatic despite being on other medications currently approved by the FDA for PTSD. However, greater utilization of high-dose prazosin for the management of PTSD may lead to better outcomes. Additionally, the Psychiatrist suggested that AW gets back on her Sertraline as a better option for treating PTSD, anxiety, and depression.
Diagnosis
The client already has standing diagnosis for the disorders mentioned above. Regarding substance used disorder, the DSM-5 (2013) classifies the disorder as based on pathological pattern of behaviors, such as craving, taking larger amounts over a longer period of time than previously intended, risky behaviors, etc. Regarding bipolar II disorder, the DSM-5 (2013) indicated that clients will present with hypomania and major depression which are symptoms that are exhibited by the client. As for PTSD, Bisson, Cosgrove, Lewis, and Roberts (2015) stated that the DSM-5 criteria for the diagnosis of PTSD includes someone whose ability to function normally has been noticeably impaired for one month. Some patients may present with symptoms of PTSD years after exposure to a traumatic event, such as childhood sexual abuse, etc. Fight of flight is a normal reaction of a person with PTSD and patient might also present with nightmares.
Legal and Ethical Implication of Counseling
In the case of AW, she is an adult who signed a consent for treatment upon admission to the facility. The consent spells out what most of the treatment involves, including counseling. However, the AW was also promised confidentiality of her information especially considering the is on the run from the law. The clinician must promote the client’s autonomy and remind the clients of their rights before the counseling session. Lambert (2011) indicated that counselor must pay attention to informed consent, compensation, confidentiality, and collection, and protection of data. Additionally, coercion must be avoided, and clients should be provided with alternative treatment options.
Summary
AW was reminded of her rights and that the purpose of the interview was for school and that any patient identifiers would be kept confidential. AW interview included her family/social history, medical and psychiatric history, including her current and past medication management. Legal and ethical implications of counseling clients were reviewed even though AW was only interviewed and not counseled.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) Washington, DC: Author:
Bisson, J. I., Cosgrove, S., Lewis, C., & Roberts, N. P. (2015). Post-traumatic stress disorder. BMJ (Clinical Research Edition), 351-161. https://doi.org/10.1136/bmj.h6161
Koola, M. M., Varghese, S. P., & Fawcett, J. A. (2014). High-dose Prazosin for the treatment of post-traumatic stress disorder. Therapeutic Advances in Psychopharmacology, 4(1), 43-47. https://doi.org/10.1177/2045125313500982
Lambert, S. F. (2011). Ethical and legal issues in addictions outcome research. Counseling Outcome Research and Evaluation, 2(1), 25-36. https://doi.org/10.1177/2150137811400594
Practicum-Week 4 Journal Entry
Kaacha Naminda
Walden University
Psychotherapy with Individuals-NURS 6640-6
September 20, 2019
Running head: PRACTICUM-WEEK 4 JOURNAL ENTRY 2
Practicum-Week 4 Journal Entry
The client that was seen in week four is a 60-year old man who is in an in-patient drug rehabilitation center. The journal will describe the client, pertinent history, medical and psychiatric information, and the client’s medications. Additionally, the client’s diagnosis will be justified using the DSM-5 criteria. An explanation of whether cognitive behavioral therapy would be effective for this client and the legal and ethical implications related to counseling for the client will be addressed.
Client Description
The client is a 60-year old male who was admitted to the drug rehabilitation center about 14 days ago. The client stated he has been in drug rehabilitation three times before over the years but kept relapsing. He indicated that the last time was last year, and this time around, it took longer than previously to relapse. The client is currently homeless because he was kicked out of the home that he has shared with his wife for 25 years.
While already at the rehabilitation center, the client was transferred to an acute care hospital for a cough and shortness of breath. He was found to have pneumonia and was treated with intravenous antibiotics before he was discharged back to the drug rehabilitation center on oral antibiotics. He also has a history of diabetes mellitus, hypertension, and major depressive disorder. The client has no health insurance and stated it has been a challenge to manage his medications even though sometimes he goes through the county hospital to obtain free medications. The client stated that due to the lack of health insurance, he does not see a psychiatrist. The medical doctor manages all his medications including his antidepressant….
