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Psychotherapy With Individual Essay
Download and review the Week 10: Case Study from this week’s Learning Resources.
Review this week’s Learning Resources and reflect on the insights they provide.
By Day 3
Post a treatment plan for the older adult client in the Week 10: Case Study found in this week’s Learning Resources. Be sure to address the following in your post: Psychotherapy With Individual Essay
Which diagnosis should be considered?
What is the DSM-V Coding for the diagnosis you are considering?
What is your rationale for the diagnosis? Be sure and link the client’s signs and symptoms to the DSM-V diagnostic criteria to support your diagnosis.
What tests or tools should be considered to help identify the correct diagnosis?
What differential diagnosis should be considered?
What Treatment Strategy would you recommend?
What treatment would you prescribe and what is the rationale?
Psychopharmacology Psychotherapy With Individual Essay
What standard guidelines would you use to treat or assess this patient?
Clinical Note: Is depression a normal part of aging?
NURS 6640: Psychotherapy with Individuals
Week 10: Case Study
IDENTIFICATION: The patient is a 69-year-old, widowed African American male who is the father of one adult child and grandfather of six grandchildren. The patient is self-referred to a psychiatric outpatient clinic.
CHIEF COMPLAINT: “I need help with depression and anxiety.
HISTORY OF CHIEF COMPLAINT: The patient reports that his father is dying, and he has been experiencing worsening of depression and anxiety symptoms over the past few months. He is seeking a psychiatric evaluation at his son’s advice. The patient does not enjoy being with his family. Psychotherapy With Individual Essay
He has difficulty falling asleep, but then spends the day lying on the couch and reports feeling like he is “moving in slow motion.” He reports feeling tired all the time. He has also stopped going to his volunteer job at the nursing home.
He responded to the practitioner’s question of “why depressed now?” by saying that with the imminent death of his father, he is losing his main support. In addition to his father’s illness, the patient was diagnosed and treated for prostate cancer this year. He received psychotherapy at that time which focused on his anxiety about the diagnosis, his denial of its severity, his wish to “not know what he knew,” and, ultimately, end-of-life issues.
PAST PSYCHIATRIC HISTORY: The patient was never hospitalized for psychiatric reasons. He has no history of suicidal thoughts, gestures, or attempts. The patient described either a partial or negative response from several medications he had been prescribed from his primary care provider (PCP) over the course of a several years, including Effexor, Prozac, Zoloft Lexapro and Duloxetine. Psychotherapy With Individual Essay
He is currently prescribed Lorazeapm 1 mg BID by his PCP which he has been taking for several years.
MEDICAL HISTORY: GERD, HTN and hyperlipidemia. History of prostate cancer.
HISTORY OF DRUG OR ALCOHOL ABUSE: The patient denies history of drug and alcohol abuse.
FAMILY PSYCHIATRIC HISTORY: Patient reports that his mother had depression. He is an only child and does not recall any emotional difficulties in grandparents or other relatives. Psychotherapy With Individual Essay
Perinatal: No known perinatal complications.
TRAUMA/ABUSE HISTORY: Denies
Mental Status Examination
Appearance: Well-groomed, appropriately dressed, older Gentleman who is obese
Behavior and psychomotor activity: Good eye contact, pleasant, cooperative. Slightly unsteady gait uses walker.
Consciousness: Alert and able to answer all questions appropriately.
Orientation: Oriented to person, place, time, and situation.
Memory: Intact. Good recent and remote memory. Psychotherapy With Individual Essay
Concentration and attention: Appears to have good concentration during the interview but reports that he has recently had trouble concentrating while reading.
Visuospatial ability: Not formally assessed.
Abstract thought: Within normal limits, appropriate use of metaphors.
Intellectual functioning: Patient has Masters degree
Speech and language: Normal rate and rhythm.
Perceptions: No abnormalities present.
Thought processes: Goal directed, but evidence of guilt and rumination consistent with depressive symptomatology. Psychotherapy With Individual Essay
Thought content: Patient is highly anxious and expresses thoughts of sadness, frustration. He is preoccupied with thoughts about the anticipated loss of his father.
Mood: Depressed and anxious.
Affect: Congruent with mood.
Impulse control: Good.
For Katrina, given her history, the most significant and helpful modality and intervention would be long term individual treatment. Object relations theory and attachment theory inform that choice of treatment because they are theoretical perspectives focused on how early attachment informs the ability to develop healthy relationships later in life. Psychotherapy With Individual Essay
Trauma in early life is usually extremely dangerous in the future of a human being if not dealt with early in life. They are causes to various ill choices that the victims are likely to engage into. Katrina is an example of what most of the trauma victims undergo. Dealing with these cases is usually tough but as recommended above, individual therapy would serve an outstanding purpose in developing a reliable relief. Reliable strategy of dealing with the anxiety, fear, helplessness and confusion that had developed in Katrina must be keenly chosen.
It is usually referred to as psychotherapy or counseling. It is a process where a trained professional meets with a client or clients on one on one basis (Dryden, 2007). The problems, which they seek to solve are psychological without any specific kind or degree. The solution or the process usually depends with the professionalism of the practitioner. Psychotherapy With Individual Essay
The main aim of counseling is to augment individuals’ sense of their wellbeing. This process is not usually easy and requires creativity for the practitioner to understand, which the best strategy is for him or her to use to acquire information from the patient. In this case, individual therapy employs several methods, which include experiential relationship development, communication, dialogue and change of behavior that are formulated to ensure improvement of the mental health of a patient (Dryden, 2007). Psychotherapy With Individual Essay
Experiential relationship development
This is a technique used by psychiatrists that engages them with a patient, using an action, application, reflection or performance support (Palmar, 2008). In this case, an individual suffering from trauma may be exposed to reflection of what occurred in her early life and try to make her understand that the situation was not self-intended. If her situation is difficult enough, the specialist may choose another method, which may be friendlier to her but related to her problem. At the end, the specialist will develop a technique that will expose the patient to adherence of such problems in future. This is one of the techniques that are mainly used in trauma related cases. Psychotherapy With Individual Essay
In the case of Katrina, she has undergone massive mental torture and pain. She has been physically and mentally abused with massive segregation in the new family that her father gets into. To deal with these forms of problems, experience and innovation by the psychiatrist is mandatory. He or she must have handled such a case before with massive success. Looking at the extreme that Katrina has gone, her issue needed to be addressed through intensive measures and precautions (Palmar, 2008).The practitioner may employ past strategies that he has used on other patients who have had similar problems. Psychotherapy With Individual Essay
If there would be no such a case that he or she had handled before, he may opt to gather information that would equip him or her with the necessary measures to develop a cure for Katrina. Necessary concepts need be employed to ensure that the patient will understand that he or she is not the only one who has undergone the problem. A picture must be created in the mind of the patient that what he or she has undergone is normal (Palmar, 2008).If other people have recovered from the problem it is also possible that they will recover. Psychotherapy With Individual Essay
Trauma focused therapy
This is a technique used to make an individual freely adapt to certain feelings that he or she experienced through torture and mistreatments. This process gives room for emotional expression for the individual. The patient may be undertaken through the recovery process by a counselor who has clear understanding of trauma (Cohen, 2006).
The psychiatrist may expose the patient to thoughts of trauma that are not painful and with time push to more painful memories. Developing a narrative out of the trauma will allow the patient reconnect with the problem and bring out a better understanding of what trauma may have meant for the patient (Cohen, 2006).
Reconnecting with the problem, would assist the patient in the step by step treatment for the trauma. The patient will easily connect with people since he would have developed clear understanding of what had caused the trauma (Cohen, 2006). With time the patient will accept the problem and be armed with means of fighting the reoccurrence of the problem in their life. Psychotherapy With Individual Essay
This is a phenomenon whereby people unconsciously transfer feelings and attitudes from one individual or situations in the past to current individuals or situations. The transference process is unconscious, and the patient inadvertently projects a needed element of an experienced or wished-for relationship to the psychiatrist. Since it involves the transfer of relationship, the psychiatrist and the patient should take complementary roles. A patient who may be downright afraid that he or she is in a serious condition may employ a helpless child related role and project an invincible parent-like quality on to the practitioner, who in return should provide a solution. This would be hugely beneficial to Katrina since she had no one else to turn to unless the psychiatrist. All the people that she had encountered had turned against her, and she needed to open up to a person who would offer the necessary assistance to her. The psychiatrist should accept to play the role of her parent and embrace her with advice and direction. Through exposure to love and care, Katrina will open up to the psychiatrist (Wiener, 2009). Psychotherapy With Individual Essay
A complex relationship like the one for Katrina with her father and step mother may not be entirely re-enacted. For Katrina, her biological father was the first one to deny her peace of mind. This means that their relationship was played out in transference.
Therefore, transference projection may be viewed as a communication of the needs of the patient to the psychological doctor that may not be expressed verbally but the one that is enacted instead (Wiener, 2009). Psychotherapy With Individual Essay
This is the interference with the transference process. It serves a particularly crucial role as an interpersonal barometer, which is hugely significant in the social interaction field. For example, a psychiatrist who may feel agitated by a patient for no coherent reason may later show up faint and unconscious provocations by the patient that irritate and send off other people. This keeps the patient unsuspectingly lonely and isolated (Wiener, 2009).
For the case of Katrina, counter transference may be acutely vital. By developing positive attitude as a psychiatrist it would be easy to assist Katrina since it will be easy to assist her. It would be truly wise to shed off any facial expression that would make Katrina feel a bother to the psychiatrist. Anything wrong with the attitude of the patient may cost the Katrina dearly as she may opt to take away her life. Therefore, with positive attitude counter transference would be of massive assistance to Katrina (Wiener, 2009). Psychotherapy With Individual Essay
In the application of theories in psychotherapy, it would be easy to dictate which method to use while dealing with a patient suffering from trauma. There are two pure common theories that may be used to explain how the trauma situation engulfing Katrina would be solved. These theories are the attachment theory and object relations theory. Psychotherapy With Individual Essay
Attachment may be defined as the deep and growing emotional bond between people. It aids in connecting individuals across time and space. It is not obvious that attachment would be reciprocal (Fonagy, 2001). There may exist an attachment that is not shared. This means that the attachment is only based on an individual but not in his or her counterparts. Attachment between parents and children is extremely vital. It explains what children expects from their parents and how they may get them (Fonagy, 2001). The appropriate attachment between children and their parents is where parent are able to meet with the needs of their children. Psychotherapy With Individual Essay
This analysis pushed John Bowlby to develop the Attachment theory in 1958. Bowlby had worked as a psychiatrist for a long period of time, where he dealt with children who went through emotional disturbances. This made him develop an analysis on the relationship of the mother with her child in terms of social, emotional and psychological development. The main assumption of the theory was that there is some connection between the infant separations with their mother at an early age and maladjustments that children suffer later in their lives (Fonagy, 2001).
The theory depicts that children suffer excessive distress when they get separated from their mothers. Even if, they are exposed to other caregivers who may seem resemble the mother, some differences still exist (Holmes,1993). This brought forth the definition of attachment from Bowlby as a “lasting psychological connectedness to the mother because she fed the infant” (Holmes,1993). Psychotherapy With Individual Essay
Understanding of this theory by the psychiatrist, who was to cater for Katrina, would be exceedingly vital. It would equip him or her with the necessary skills to deal with the situation that Katrina underwent. Katrina grew up with her father since her mother was dead. Her mother died when she was of a tender age of six years, which marked the beginning of her agony. At this age, she needed her mother most. Bearing that she is a girl, there are several stages that is would undergo that only her mother would understand. It was psychologically difficult for her to grow well being taken care of the father. Having understood Katrina’s past experiences the psychiatrist needs to employ the transference principle to try and act as the mother to the girl and offer assistance from the parent point of view. She would be able to search her mind, listen to her thoughts and offer advice accordingly. Psychotherapy With Individual Essay
Katrina’s father played critical role in defining her fate to trauma. The father was never concerned of her wellbeing. He could not interpret the pain he was putting his daughter in as he molested her. Even after the father remarrying, Katrina remains in pain and segregation from the family. This was very challenging for Katrina as she could not contemplate the painful feelings that she underwent. With proper understanding of the pain that Katrina underwent in the hands of her father, it would be easy for the psychiatrist to deal with the problem.
Object relations theory
This is an outcome of psychoanalytic theory, which emphasizes on interpersonal relations, mostly in the family especially between children and their mother. The term object in this theory represents a person. The target person in this theory is the one who is a target to the feelings and intentions of the other individual. This theory aims at explaining how early relationships of a child with their caregiver would determine their perception on the caregivers as well as the rest of the society (Kernberg, 1995). Psychotherapy With Individual Essay
In this case, relations define how people interact with each other and the bond that they develop towards each other. The effect of past bonds to the present situation is the other definition of relations in the theory. Past bonds may build or destroy the future character of an individual as defined in the theory. The theory defines how past experiences may be manifested in the future of an individual (Kernberg, 1995). This is what was happening to Katrina. She underwent massive pain and torture in the hands of her father. This almost claimed her life as she thought the only option available for her was death. As a result of the painful moments that she underwent, Katrina was unable to make informative career choices. This is because; no one was out for her support. The torture she underwent ailed her self esteem making her uncompetitive. She could not seek advice from anyone since she found everyone against her. Psychotherapy With Individual Essay
In the case of Katrina, this theory would be particularly significant. Through the use of the individual therapy, the psychiatrist would try to gather some vivid information from Katrina to assist in providing ample solution to the problem. Her remembrance on the relationship she had with the mother would be a highly critical avenue of advising her on the decisions she is supposed to take in the definition of her problem. The psychiatrist may assist her in evaluating the differences between the relationship with the biological mother and the one with the step mother as well as the rest of the people that she encountered in her life (Kernberg, 1995). This would help her in understanding how she is supposed to relate with people and be able to withstand the pressure that strangers are likely to exert on her. Depression had massively pressed her and she needed relief, which could have only been achieved through psychotherapy. The method to be used needed to be creatively chosen to aid her in getting back into her senses and relieve her from the trauma. Psychotherapy With Individual Essay
Dynamics for Katrina’s case
Katrina is a representation of what many adults who underwent childhood abuse and negligence suffer. At a tender age she is helpless, depressed, fearful, and of low self esteem. As these people grow up, they may also be exposed to shame, guilt and blame (Adult Survivors of Childhood Sexual Abuse, 2009).They may feel shame of guilt since they did not act to solve the problem at an early stage. Following betrayal by the people they would have trusted most, these people may lack trust for any individual. Katrina was betrayed by her father, who pretended to take care of her while he molested her. Revictimization is another problem that may develop in the adults (Adult Survivors of Childhood Sexual Abuse, 2009). Individuals are unlikely to report on a reoccurrence of the abuse that they went through. Psychotherapy With Individual Essay
However, these challenges may be dealt with to relieve an adult who may be experiencing them. Most of the adults remember these activities after they have been triggered by a memory. When these memories come up, it is advisable for the individual to seek intervention by a counselor about the past and the feelings at the moment (Adult Survivors of Child Sexual Assault, 2008). It would be advisable to seek for counselors who have handled similar issues before.
It is also advisable for these people to seek reconnection to the rest of the society. They should develop proper relationships with people who make them feel appreciated. They should spend most time with these people. For example, they may join a group of survivors where they would encourage each other of their past experiences and find their way forward. Psychotherapy With Individual Essay
Although, Katrina’s problem may seem gigantic it can be solved. Getting an individual to a point of taking her life the psychological problem needs be solved accordingly. Katrina’s case is characterized of torture and trauma. This is as a result of inadequate care at her tender age. Isolation, fear, confusion and helplessness were the core factors in her life. To relieve her from these problems, a psychiatrist is needed to take her through counseling or the individual therapy. Past experience by the psychiatrist may be extremely crucial in determining the best solution to the problems that Katrina was undergoing. He or she may opt for the theoretical approach with the attachment and the object relations theories playing an extremely significant. Psychotherapy With Individual Essay