Practicum – Week 10 Journal Entry

Assignment 2: Practicum – Week 10 Journal Entry

Learning Objectives

Students will:

Develop effective documentation skills to examine group therapy sessions with children and adolescents *

Develop diagnoses for child and adolescent clients receiving group psychotherapy *

Analyze legal and ethical implications of counseling child and adolescent clients with psychiatric disorders *

Select two clients you observed or counseled this week during a group therapy session for children and adolescents. Note: The two clients you select must have attended the same group session. If you select the same group you selected for the Week 8 or Week 9 Journal Entries, you must select different clients. Practicum – Week 10 Journal Entry

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Then, address in your Practicum Journal the following:

Using the Group Therapy Progress Note in this week’s Learning Resources, document the group session.

Describe each 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 each client.

Explain any legal and/or ethical implications related to counseling each client.

Support your approach with evidence-based literature.

Adolescent Group Psychotherapy for Anxiety Disorders: The Case of Selective Mutism and Generalised Anxiety Disorder

Group therapy is one of the psychotherapeutic modalities that are normally employed to treat various psychological disorders. This is true for both adults and children, including adolescents. This paper looks at two adolescent clients’ with anxiety disorders and who are engaged in group therapy.

Client Number One

This is a twelve year-old Caucasian female who presented with social withdrawal, bouts of temper tantrums, social isolation, and excessive shyness in public social spaces. She has a history of not being able to speak in social situations openly, even though she doesn’t face the same problem when speaking at home. This includes school where she has had problems wiyh teachers who at times think that she is rude and doesn’t want to speak. This is something that has gone on for several years without anyone realising that it was a psychological ptoblem that needed therapy. The girl has no history of a communication disorder to ehich this problem can be attributed. Furthermore, she has no intellectual deficiencies and is quite knowledgeable on academic matters. Practicum – Week 10 Journal Entry

According to the symptom spectrum that this client displays (failure to speak in public places for several years that interferes with her education, and handicap not attributable to lack of knowledge or a communication disorder), this girl is suffering from selective mutism: 313.23(F94.0) (APA, 2013). This diagnosis is reinforced by the fact that she also has excessive shyness, social isolation and withdrawal, and displays temper tantrums (APA, 2013). This client started of with sessions of cognitive behavioral therapy or CBT, but had recently been started on the drug Prozac (fluoxetine) (Stahl, 2017). Her symptoms appear to be recalcitrant hence the multipronged approach to management. In group psychotherapy, she is slowly responding to therapeutic factors, especially altruism, universality, and instillation of hope (Hauber et al., 2019).

Client Number Two

This is an African American fourteen year-old male adolescent. He presented with symptoms of excessive anxiety, worry, and fear that he found very difficult to control. He had a history of irritability, sleep disturbance, and restlessness. All these symptoms had lasted for over a year. On assessment and further questioning of the parents, it was discovered that these symptoms have been incapacitating the client and rendering him socially dysfunctional, including at school. Furthermore, he had no other mental disorder to which the symptoms could be attributed, or a history of substance abuse. All this fit near perfectly with a diagnosis of generalised anxiety disorder: 300.02(F41.1), according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (APA, 2013). Practicum – Week 10 Journal Entry

This young man has also been indergoing cognitive behavioral therapy as the first line of therapy. He has been doing well on this cognitive behavioral group therapy (CBGT) as shown by his response to the k own group therapeutic factors. Specifically, he has responded well to interpersonal learning, cohesion, instillation of hope, carthasis, and existential factors (Hauber et al., 2019). However, this response has not been satisfactory; a factor which prompted the Psychiatric-Mental Health Nurse Practitioner or PMHNP to put him also on the selective serotonin reuptake inhibitor (SSRI) escitalopram (Cipralex) (Stahl, 2017). It is the hope that this multifaceted approach to management will enable him to be free from the symptoms (remission).

The understanding of the different therapeutic factors as expertly presented by Dr. Yalom is crucial in understanding the response of different clients to group psychotherapy. By understanding these factors, the therapist can maximise on those that are working and producing noticeable results (Hauber et al., 2019). In the case of these two clients, altruism (helping one another), universality (knowi g that one is not alone in the situation), instillation of hope, interpersonal learning, cohesion (a sense of belonging), carthasis (venting verbally one’s frustrations to the group), and existential factors (the taking of responsibility for one’s life) seem to have shown promising results. By this very fact, the CBGT sessions need to continue, even as the two combine this therapeutic measure with the psychoactive agents fluoxetine and escitalopram. Practicum – Week 10 Journal Entry

Legal and/ or Ethical Implications Related to Counseling

It has to be remembered that the twelve year-old and the fourteen year-old analysed here are still minors. This means that tbey cannot give free consent for treatment themselves. This was done by their parents who are the ones that brought them for therapy. For the same reasons, their treatment and psychiatric medical records cannot be kept confidential from their parents. This is an ethical dilemma in that the client may want their treatment information to remain confidential, whereas the law allows their parents to still access it. This calls for so much tact and the consideration of the best interest of the minor (Koocher, 2003). Only if the reason for treatment was of public interest as in substance abuse would the law in most states prevent the parents of these adolescents from accessing their medical records.

References

American Psychiatric Association [APA] (2013). Diagnostic and statistical manual of mental disorders, 5th ed. (DSM-5). Washington, DC: Author

Hauber, K., Boon, A.E., & Vermeiren, R. (2019). Therapeutic factors that promote recovery in high-risk adolescents intensive group psychotherapeutic MBT programme. Child and Adolescent Psychiatry and Mental Health, 13(2). Doi: 10.1186/s13034-019-0263-6

Koocher, G.P. (2003). Ethical issues in psychotherapy with adolescents. JCLP/In Session, 59(11), 1247–1256. Doi: 10.1002/jclp.10215

Stahl, S.M. (2017). Stahl’s essential Psychopharmacology: Prescriber’s guide, 6th ed. New York, NY: Cambridge University Press.    Practicum – Week 10 Journal Entry