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This Nursing theories CLC Assignment – NRS-430V Professional Dynamics is a Collaborative Learning Community (CLC) assignment.

Nursing theories are tested and systematic ways to implement nursing practice. Select a nursing theory and its conceptual model. Prepare a 10-15 slide PowerPoint in which you describe the nursing theory and its conceptual model and demonstrate its application in nursing practice. Include the following:

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Present an overview of the nursing theory. Provide evidence that demonstrates support for the model’s efficacy in nursing practice. Explain how the theory proves the conceptual model.

Explain how the nursing theory incorporates the four metaparadigm concepts.

Provide three evidence-based examples that demonstrate how the nursing theory supports nursing practice. Provide support and rationale for each.

Refer to the resource, “Creating Effective PowerPoint Presentations,” located in the Student Success Center, for additional guidance on completing this assignment in the appropriate style.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center. Since you will not actually be presenting to the class, well written, detailed speakers notes that include in-text citations are expected.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. Nursing theories CLC Assignment – NRS-430V Professional Dynamics

Sample Annotated Bibliography Nursing Essay

Conduct a search for recent (within the last 5 years) research focused on the application of clinical systems. The research should provide evidence to support the use of 
one type of clinical system
 to improve outcomes and/or efficiencies, such as “the use of EMR ( Electronic medical records) to support patients newly diagnosed with hypertension.”

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Develop an annotated bibliography that follows the organization of the Sample Annotated Bibliography resource provided in this Competency.

Complete the annotated bibliography for each of the five peer-reviewed articles you selected for the one type of clinical system you selected. Be sure to include the following:

An introduction of each peer-reviewed article selected.

APA citation of each peer-reviewed article selected.

Summarize the study in each peer-reviewed article selected.

Analyze each peer-reviewed article selected. What are the benefits and limitations of each peer-reviewed article? Sample Annotated Bibliography Nursing Essay

Explain the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system that each peer-reviewed article described. Be specific and provide examples.

 

Sample Annotated Bibliography

Autism research continues to grapple with activities that best serve the purpose of fostering positive interpersonal relationships for children who struggle with autism. Children have benefited from therapy sessions that provide ongoing activities to aid autistic children’s ability to engage in healthy social interactions. However, less is known about how K–12 schools might implement programs for this group of individuals to provide additional opportunities for growth, or even if and how school programs would be of assistance in the end. There is a gap, then, in understanding the possibilities of implementing such programs in schools to foster the social and thus mental health of children with autism. Sample Annotated Bibliography Nursing Essay.

Annotated
Bibliography

Kenny, M. C., Dinehart, L. H., & Winick, C. B. (2016). Child-centered play therapy for children with autism spectrum disorder. In A. A. Drewes & C. E. Schaefer (Eds.),
Play therapy in middle childhood
(pp. 103–147)
.
Washington, DC: American Psychological Association.

In this chapter, Kenny, Dinehart, and Winick provided a case study of the treatment of a 10-year-old boy diagnosed with autism spectrum disorder (ADS). Kenny et al. described the rationale and theory behind the use of child-centered play therapy (CCPT) in the treatment of a child with ASD. Specifically, children with ADS often have sociobehavioral problems that can be improved when they have a safe therapy space for expressing themselves emotionally through play that assists in their interpersonal development. The authors outlined the progress made by the patient in addressing the social and communicative impairments associated with ASD. Additionally, the authors explained the role that parents have in implementing CCPT in the patient’s treatment. Their research on the success of CCPT used qualitative data collected by observing the patient in multiple therapy sessions.

CCPT follows research carried out by other theorists who have identified the role of play in supporting cognition and interpersonal relationships. This case study is relevant to the current conversation surrounding the emerging trend toward CCPT treatment in adolescents with ASD as it illustrates how CCPT can be successfully implemented in a therapeutic setting to improve the patient’s communication and socialization skills. However, Kenny et al. acknowledged that CCPT has limitations—children with ADS, who are not highly functioning and or are more severely emotionally underdeveloped, are likely not suited for this type of therapy.

Kenny et al.’s explanation of this treatments’s implementation is useful for professionals in the psychology field who work with adolescents with ASD. This piece is also useful to parents of adolescents with ASD, as it discusses the role that parents can play in successfully implementing the treatment. However, more information is needed to determine if this program would be suitable as part of a K–12 school program focused on the needs of children with ASD. Sample Annotated Bibliography Nursing Essay

Stagmitti, K. (2016). Play therapy for school-age children with high-functioning autism. In A.A. Drewes and C. E. Schaefer (Eds.),
Play therapy in middle cildhood
(pp. 237–255). Washington, DC: American Psychological Association.

Stagmitti discussed how the Learn to Play program fosters the social and personal development of children who have high functioning autism. The program is designed as a series of play sessions carried out over time, each session aiming to help children with high functioning autism learn to engage in complex play activities with their therapist and on their own. The program is beneficial for children who are 1- to 8-years old if they are already communicating with others both nonverbally and verbally. Through this program, the therapist works with autistic children by initiating play activities, helping children direct their attention to the activity, eventually helping them begin to initiate play on their own by moving past the play narrative created by the therapist and adding new, logical steps in the play scenario themselves. The underlying rationale for the program is that there is a link between the ability of children with autism to create imaginary play scenarios that are increasingly more complex and the development of emotional well-being and social skills in these children. Study results from the program have shown that the program is successful: Children have developed personal and social skills of several increment levels in a short time. While Stagmitti provided evidence that the Learn to Play program was successful, she also acknowledged that more research was needed to fully understand the long-term benefits of the program.

Stagmitti offered an insightful overview of the program; however, her discussion was focused on children identified as having high-functioning autism, and, therefore, it is not clear if and how this program works for those not identified as high-functioning. Additionally, Stagmitti noted that the program is already initiated in some schools but did not provide discussion on whether there were differences or similarities in the success of this program in that setting.

Although Stagmitti’s overview of the Learn to Play program was helpful for understanding the possibility for this program to be a supplementary addition in the K–12 school system, more research is needed to understand exactly how the program might be implemented, the benefits of implementation, and the drawbacks. Without this additional information, it would be difficult for a researcher to use Stigmitti’s research as a basis for changes in other programs. However, it does provide useful context and ideas that researchers can use to develop additional research programs.

Wimpory, D. C., & Nash, S. (1999). Musical interaction therapy–Therapeutic play for children with autism.
Child Language and Teaching Therapy
,
15
(1), 17–28. doi:10.1037/14776-014

Wimpory and Nash provided a case study for implementing music interaction therapy as part of play therapy aimed at cultivating communication skills in infants with ASD. The researchers based their argument on films taken of play-based therapy sessions that introduced music interaction therapy. To assess the success of music play, Wimpory and Nash filmed the follow-up play-based interaction between the parent and the child. The follow-up interactions revealed that 20 months after the introduction of music play, the patient developed prolonged playful interaction with both the psychologist and the parent. The follow-up films also revealed that children initiated spontaneously pretend play during these later sessions. After the introduction of music, the patient began to develop appropriate language skills.

Since the publication date for this case study is 1999, the results are dated. Although this technique is useful, emerging research in the field has undoubtedly changed in the time since the article was published. Wimpory and Nash wrote this article for a specific audience, including psychologists and researchers working with infants diagnosed with ASD. This focus also means that other researchers beyond these fields may not find the researcher’s findings applicable.

This research is useful to those looking for background information on the implementation of music into play-based therapy in infants with ASD. Wimpory and Nash presented a basis for this technique and outlined its initial development. Thus, this case study can be useful in further trials when paired with more recent research.

Sample_Annotated_Bibliography
 Sample Annotated Bibliography Nursing Essay

Pernicious, folate-deficiency, sideroblastic, chronic-inflammation, or post-hemorrhagic anemia pathophysiologies essays

Select one of the following types of anemia: pernicious anemia, folate deficiency anemia, sideroblastic anemia, chronic inflammation anemia, or post-hemorrhagic anemia. Identify the pathophysiological mechanisms of the anemia you selected.

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QUESTION

Discussion: Anemia

In clinical settings, advanced practice nurses often encounter patients with blood disorders such as anemia. Consider the case of a 17-year-old girl who is rushed to the emergency room after suddenly fainting. The girl’s mother reports that her daughter has had difficulty concentrating for the past week, frequently becomes dizzy, and has not been eating normally due to digestion problems. The mother also informs the nurse that their family has a history of anemia. With the family history of anemia, it appears that this is the likely diagnosis. However, in order to properly diagnose and treat the patient, not only must her symptoms and family history be considered, but also factors such as gender, ethnicity, age, and behavior. This poses the question: How do patient factors impact the incidence and prevalence of different types of anemia?

To Prepare

Review Chapter 21 in the Huether and McCance text. Reflect on the pathophysiological mechanisms of iron deficiency anemia.

Select one of the following types of anemia: pernicious anemia, folate deficiency anemia, sideroblastic anemia, chronic inflammation anemia, or post-hemorrhagic anemia. Identify the pathophysiological mechanisms of the anemia you selected.

Consider the similarities and differences between iron deficiency anemia and the type of anemia you selected.

Reflect on how patient factors such as genetics, gender, ethnicity, age, and behavior might impact these anemic disorders.

By Day 3

Post
an explanation of the pathophysiological mechanisms of iron deficiency anemia and the anemia you selected. Compare these two types of anemia, as well as their potential causes. Finally, explain how genetics, gender, ethnicity, age, and behavior might impact the anemic disorders you selected. Pernicious, folate-deficiency, sideroblastic, chronic-inflammation, or post-hemorrhagic anemia pathophysiologies essays.

 

LEARNING RESOURCES

Prochnow, C. (n.d.). Restoring hope: A cancer patient shares her story. Retrieved September 11, 2012, from 
http://www.uwhealth.org/uw-carbone-cancer-center/restoring-hope-a-cancer-patient-shares-her-story/20371
.

Learning Objectives

Students will:

Analyze the pathophysiology of anemia

Compare the pathophysiology of iron deficiency anemia to the pathophysiology of other types of anemia

Evaluate the impact of patient factors on anemic disorders

Understand and apply key terms, concepts, and principles related to alterations of the hematological system

Photo Credit: JPC-PROD/iStock/Getty Images Plus/Getty images

Learning Resources

Required Readings

Huether, S. E., & McCance, K. L. (2012). 
Understanding pathophysiology
 (Laureate custom ed.). St. Louis, MO: Mosby.

 

Chapter 20, “Structure and Function of the Hematologic System”

 

This chapter examines components of the hematologic system, development of blood cells, mechanisms of hemostasis, and hematologic value changes in pediatrics and geriatrics. It also focuses on common blood tests for hematologic disorders.

 

Chapter 21, “Alterations of Hematologic Function”

 

This chapter focuses on common alterations of hematologic function, including alterations of erythrocyte function, leukocyte function, lymphoid function, splenic function, platelets, and coagulation.

 

Chapter 22, “Alterations of Hematologic Function in Children” Pernicious, folate-deficiency, sideroblastic, chronic-inflammation, or post-hemorrhagic anemia pathophysiologies essays

 

This chapter expands on alterations of hematologic function by presenting disorders that affect children, such as disorders of erythrocytes, coagulation, and platelets.

Hammer, G. D., & McPhee, S. J. (2019).
Pathophysiology of disease: An introduction to clinical medicine
(8th ed.). New York, NY: McGraw-Hill Education.

 

Chapter 6, “Blood Disorders”

 

This chapter begins by exploring the anatomy and physiology of blood and the coagulation system. It then examines two types of anemia caused by red cell disorders. White blood cell disorders and platelet disorders are also examined.

Required Media

http://evolve.elsevier.com/huether
.

Home

 

RUBRIC FOR PATHO 7 DISCUSSION.

 

 

 

Outstanding Performance

 

Excellent Performance

 

 

Competent Performance

Room for Improvement

Main Posting:

Response to the discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

44 (44%) – 44 (44%)

Thoroughly responds to the discussion question(s)

is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

supported by at least 3 current, credible sources

40 (40%) – 43 (43%)

Responds to the discussion question(s)

is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.

75% of post has exceptional depth and breadth

supported by at least 3 credible references

35 (35%) – 39 (39%)

Responds to most of the discussion question(s)

is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.

50% of post has exceptional depth and breadth

supported by at least 3 credible references

31 (31%) – 34 (34%)

Responds to some of the discussion question(s)

one to two criteria are not addressed or are superficially addressed

is somewhat lacking reflection and critical analysis and synthesis

somewhat represents knowledge gained from the course readings for the module.

post is cited with fewer than 2 credible references

0 (0%) – 30 (30%)

Does not respond to the discussion question(s)

lacks depth or superficially addresses criteria

lacks reflection and critical analysis and synthesis

does not represent knowledge gained from the course readings for the module.

contains only 1 or no credible references

Main Posting:

Writing
Pernicious, folate-deficiency, sideroblastic, chronic-inflammation, or post-hemorrhagic anemia pathophysiologies essays

6 (6%) – 6 (6%)

Written clearly and concisely

Contains no grammatical or spelling errors

Fully adheres to current APA manual writing rules and style

5.5 (5.5%) – 5.5 (5.5%)

Written clearly and concisely

May contain one or no grammatical or spelling error

Adheres to current APA manual writing rules and style

5 (5%) – 5 (5%)

Written concisely

May contain one to two grammatical or spelling error

Adheres to current APA manual writing rules and style

4.5 (4.5%) – 4.5 (4.5%)

Written somewhat concisely

May contain more than two spelling or grammatical errors

Contains some APA formatting errors

0 (0%) – 4 (4%)

Not written clearly or concisely

Contains more than two spelling or grammatical errors

Does not adhere to current APA manual writing rules and style

Main Posting:

Timely and full participation

10 (10%) – 10 (10%)

Meets requirements for timely and full participation

posts main discussion by due date

0 (0%) – 0 (0%)

NA

0 (0%) – 0 (0%)

NA

0 (0%) – 0 (0%)

NA

0 (0%) – 0 (0%)

Does not meet requirement for full participation

First Response:

Post to colleague’s main post that is reflective and justified with credible sources.

9 (9%) – 9 (9%)

Response exhibits critical thinking and application to practice settings

responds to questions posed by faculty

the use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives

8.5 (8.5%) – 8.5 (8.5%)

Response exhibits critical thinking and application to practice settings

7.5 (7.5%) – 8 (8%)

Response has some depth and may exhibit critical thinking or application to practice setting

Pernicious, folate-deficiency, sideroblastic, chronic-inflammation, or post-hemorrhagic anemia pathophysiologies essays

6.5 (6.5%) – 7 (7%)

Response is on topic, may have some depth

0 (0%) – 6 (6%)

Response may not be on topic, lacks depth

First Response:

Writing

6 (6%) – 6 (6%)

Communication is professional and respectful to colleagues

Response to faculty questions are fully answered if posed

Provides clear, concise opinions and ideas that are supported by two or more credible sources

Response is effectively written in Standard Edited English

5.5 (5.5%) – 5.5 (5.5%)

Communication is professional and respectful to colleagues

Response to faculty questions are answered if posed

Provides clear, concise opinions and ideas that are supported by two or more credible sources

Response is effectively written in Standard Edited English

5 (5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues

Response to faculty questions are mostly answered if posed

Provides opinions and ideas that are supported by few credible sources

Response is written in Standard Edited English

4.5 (4.5%) – 4.5 (4.5%)

Responses posted in the discussion may lack effective professional communication

Response to faculty questions are somewhat answered if posed

Few or no credible sources are cited

0 (0%) – 4 (4%)

Responses posted in the discussion lack effective

Response to faculty questions are missing

No credible sources are cited

First Response:

Timely and full participation

5 (5%) – 5 (5%)

Meets requirements for timely and full participation

posts by due date

0 (0%) – 0 (0%)

NA

0 (0%) – 0 (0%)

NA

0 (0%) – 0 (0%)

NA

0 (0%) – 0 (0%)

Does not meet requirement for full participation

Second Response:

Post to colleague’s main post that is reflective and justified with credible sources.

9 (9%) – 9 (9%)

Response exhibits critical thinking and application to practice settings * responds to questions posed by faculty

the use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives

8.5 (8.5%) – 8.5 (8.5%)

Response exhibits critical thinking and application to practice settings

7.5 (7.5%) – 8 (8%)

Response has some depth and may exhibit critical thinking or application to practice setting

6.5 (6.5%) – 7 (7%)

Response is on topic, may have some depth

0 (0%) – 6 (6%)

Response may not be on topic, lacks depth

Second Response:

Writing

6 (6%) – 6 (6%)

Communication is professional and respectful to colleagues

Response to faculty questions are fully answered if posed

Provides clear, concise opinions and ideas that are supported by two or more credible sources

Response is effectively written in Standard Edited English

5.5 (5.5%) – 5.5 (5.5%)

Communication is professional and respectful to colleagues

Response to faculty questions are answered if posed

Provides clear, concise opinions and ideas that are supported by two or more credible sources

Response is effectively written in Standard Edited English

5 (5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues

Response to faculty questions are mostly answered if posed

Provides opinions and ideas that are supported by few credible sources

Response is written in Standard Edited English

4.5 (4.5%) – 4.5 (4.5%)

Responses posted in the discussion may lack effective professional communication

Response to faculty questions are somewhat answered if posed

Few or no credible sources are cited

0 (0%) – 4 (4%)

Responses posted in the discussion lack effective

Response to faculty questions are missing

No credible sources are cited

Second Response:

Timely and full participation

5 (5%) – 5 (5%)

Meets requirements for timely and full participation

Posts by due date

0 (0%) – 0 (0%)

NA

0 (0%) – 0 (0%)

NA

0 (0%) – 0 (0%)

NA

0 (0%) – 0 (0%)

Does not meet requirement for full participation

Total Points: 100 Pernicious, folate-deficiency, sideroblastic, chronic-inflammation, or post-hemorrhagic anemia pathophysiologies essays

NURS 6650 Group Processes and Stages of Formation Essay

Introduction

Group process involves how people and members work together to attain a common objective. Groups are essential for human experiences and hence it is important for the PMHNP to understand group processes and stage formation (Crane-Okada, 2012). This paper will provide a critique for “Group therapy: A live demonstration” video and provide an analysis for the group processes, stage formation, and curative factors of groups. Finally, the paper will discuss the effect of curative factors on client’s progress and strategies to manage intragroup conflict.

Group’s Processes and Stages of Formation

The study of group processes involves social and cognitive effects and their impact on…

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In a 2- to 3-page paper, address the following:

Explain the group’s processes and stage of formation.

Explain curative factors that occurred in the group. Include how these factors might impact client progress.

Explain intragroup conflict that occurred and recommend strategies for managing the conflict. Support your recommendations with evidence-based literature NURS 6650 Group Processes and Stages of Formation Essay

This is the video

Psychotherapy.net (Producer). (2011a). Group therapy: A live demonstration. [Video file]. Mill Valley, CA: Author

 

Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.). New York, NY: Basic Books.

 

​The Theory and Practice of Group Psychotherapy, 5th Edition by Yalom, Irvin D. ; Leszcz, Molyn. Copyright 2005 by Hachette Books Group. Reprinted by permission of Hachette Books Group via the Copyright Clearance Center.

 

 

Chapter 5, “The Therapist: Basic Tasks” (pp. 117–140)

 

Chapter 8, “The Selection of Clients” (pp. 231–258)

 

Chapter 9, “The Composition of Therapy Groups” (pp. 259–280)

Crane-Okada, R. (2012). The concept of presence in group psychotherapy: An operational definition. Perspectives in Psychiatric Care, 48(3), 156–164. doi:10.1111/j.1744-6163.2011.00320.x

 

Note: Retrieved from Walden Library databases.

 

Lerner, M. D., McLeod, B. D., & Mikami, A. Y. (2013). Preliminary evaluation of an observational measure of group cohesion for group psychotherapy. Journal of Clinical Psychology, 69(3), 191–208. doi:10.1002/jclp.21933 NURS 6650 Group Processes and Stages of Formation Essay

 

Note: Retrieved from Walden Library databases.

 

Nicholson, R. (2002). The dilemma of psychotherapy notes and HIPAA. Journal of AHIMA, 73(2), 38–39. Retrieved from
http://library.ahima.org/doc?oid=58162#.V5J0__krLZ4http://library.ahima.org/doc?oid=58162#.V5J0__krLZ4

 

U.S. Department of Health & Human Services. (n.d.). HIPAA privacy rule and sharing information related to mental health. Retrieved March 18, 2017, from
http://www.hhs.gov/hipaa/for-professionals/special-topics/mental-health/

 

Group Processes and Stages of Formation

Introduction

Group process involves how people and members work together to attain a common objective. Groups are essential for human experiences and hence it is important for the PMHNP to understand group processes and stage formation (Crane-Okada, 2012). This paper will provide a critique for “Group therapy: A live demonstration” video and provide an analysis for the group processes, stage formation, and curative factors of groups. Finally, the paper will discuss the effect of curative factors on client’s progress and strategies to manage intragroup conflict. NURS 6650 Group Processes and Stages of Formation Essay.

Group’s Processes and Stages of Formation

The study of group processes involves social and cognitive effects and their impact on group members. Studies on group process focus on interactions between team members, traits of members, and the effect of such factors on ensuring the efficacy of the group. Group processes consist of essential components like group norms, roles, identity and status of the group, as well as the group social interaction (Crane-Okada, 2012). These components are further influences by qualities such as trust, feedback among group members, and conflict and resolution. Stages of group formation consist of forming, storming, norming, performance stage, as well as adjournment stage (Lerner et al, 2013).

In the “Group Therapy: A live demonstration” video, the group consisted of individuals struggling with social challenges and hence sought treatment to address these challenges. The common goal of the group was identified by the social challenge all members were experiencing and the need to improve their adaptive functionality; this was the forming stage. The storming phase occurs after forming of the group is typified by role assigning and some disagreements NURS 6650 Group Processes and Stages of Formation Essay. The norming stage includes the group members normalizing and getting used to each other (Lerner et al, 2013). This was demonstrated in the group where members could share their experiences freely. The performance group is characterized by trust among group members and this was demonstrated in the group where members were able to solve issues with minimal supervision.  The group in the video is at the performance stage as the members freely share their experiences and interpersonal relationships (Lerner et al, 2013).

Curative Factors in the Group

Curative factors that took place in the group included hope installation; imparting of information; and universality. Hope installation is evident where group members are ready to provide hope to each other (Hauber et al, 2019). The group members also impart information and universality is also evident. An example of hope installation and imparting of information is evident where for example Gill tells about his alcoholism and shares how alcohol addiction has negatively affected his marriage. Phillip shares about his sexual addiction. After sharing these experiences, group members encourage them and thus install hope (Hauber et al, 2019).

Intragroup Conflict that Occurred

An example of an intragroup conflict that occurred in the video is where Philip and Sam sharply differed and argued because of their past encounters.  Three strategies that can be used to manage conflicts in a group include collaborating and compromising (Overton & Lowry, 2013). Collaborating includes negotiating between the members having conflict and ensuring members with the conflict learn from each other, compromising strategy include reaching a compromise to ensure all team members find a middle ground (Overton & Lowry, 2013) NURS 6650 Group Processes and Stages of Formation Essay.

References

Crane-Okada, R. (2012). The concept of presence in group psychotherapy: An operational definition.
Perspectives in Psychiatric Care
, 48(3), 156–164.

Hauber K, Boon A & Robert V. (2019). Therapeutic factors that promote recovery in high-risk adolescents intensive group psychotherapeutic MBT programme.
Child Adolesc Psychiatry Ment Health
.  13(2).

Lerner, M. D., McLeod, B. D., & Mikami, A. Y. (2013). Preliminary evaluation of an observational measure of group cohesion for group psychotherapy.
Journal of Clinical Psychology
. 69(3).

Overton A & Lowry A. (2013). Conflict Management: Difficult Conversations with Difficult People.
Clin Colon Rectal Surg
. 26(4),259–264. NURS 6650 Group Processes and Stages of Formation Essay

 

Introduction

Group process refers to when individuals congregate with a common objective that they seek to achieve.  The fundamental elements which any group must have in order to come into existence from the beginning to the end, such as group norms, trust generation, inter member feedback, resistance, conflicts and resolutions are important in any group (Yalom & Leszcz, 2005). In this case, the congregated individuals reach a consensus that they will remain as part of the group until the objective that led to its formation has been met (Allen & Spitzer, 2015). A group is likely to encounter most if not all of the stages of group formations, commonly referred to as forming, storming, norming, performing, and adjourning (Tuckman, & Jensen, 1977). Research has shown group therapy to be as efficient as individual therapy. In group therapy, members are able to effect change as well as make it easier for one another to interact with the guidance of their peers and that of a counselor.  The therapist therefore must understand group process as well as the stages of group formation in order to help them develop the group and determine an individual’s appropriateness for the group (Tuckman, & Jensen, 1977). NURS 6650 Group Processes and Stages of Formation Essay




Explain the group’s processes and stage of formation.

In the present situation, the group has been formed by individuals who are seeking treatment after recognizing that they have a social problem and require help thereby identifying their common goal. Typically, groups with a greater number of objectives will be more cohesive than those with fewer objectives (Psychotherapy.net, 2011).   This group’s current stage of formation is in the storming stage, this is because the group has not yet completed any tasks since it is still unsettled. This was just formed recently and the members are in the process of adjusting. In fact, the members’ uncertainties before forming the group are now being expressed. There are some aspects of forming stage left, as evidenced by Gill’s avoidance of very important self-disclosure, even when pushed by Bonnie, he tried to change the subject by shifting to Julius’s health problem. Avoidance of self-disclosure is typically seen in forming stage (Tuckman, & Jensen, 1977).  Conflicts between members are common occurrences that can make task completion challenging (Tuckman, & Jensen, 1977) This is particularly seen in the case of Philip and Pam who are engaged in a conflict that could degenerate into one of them leaving the group. Conflicts and competitions are characteristics of storming stage of group formation. In resolving the conflicts between members, the group is likely to become more cohesive and develop a culture of mutual support and compromise that avoids conflicts. At this point, the group should have moved to the norming stage to begin the actual process of developing a solution even as the members’ interactions are harmonized (Smith, 2012). NURS 6650 Group Processes and Stages of Formation Essay.

Explain curative factors that occurred in the group. Include how these factors might impact client progress.

The interactions between the group members showed that some curative factors occurred in the group. The members have expressed some hope that they will find a solution for their problems as expressed by their willingness to be a part of the group. The presence of the group offers the members hope that their problems are not unique and that they can share on their experiences to get a better awareness of these problems while supporting each other to develop solutions. Given the presence of hope, each member is motivated to support the group activities. The group brings to attention the fact that each member is not unique in his or her problems. Rather, these problems are universal and the only difference is in the way each individual approaches them. In sharing their experiences, every member can familiarize with the different aspects of the problems and collectively develop a more effective solution while discussing with others. Being in the group allow the members to understand the different aspects of social interaction, what is acceptable, and what is not when engaging with others. It is important to understand that individual problems typically have a social root, and gaining insight into social interaction can help in providing a solution. Finally, the presence of a facilitator (counselor) is important in guiding group interactions and activities as a mediator. Although the facilitator does not develop the solution, he or she guides the group towards a productive direction that allows them to achieve favorable results with minimal negative effects in the shortest time possible (Allen & Spitzer, 2015). The four curative factors occurred in the group and had an impact on the clients’ progress.

Explain intragroup conflict that occurred and recommend strategies for managing the conflict. Support your recommendations with evidence-based literature.

The group experienced an intragroup conflict whereby members expressed dissatisfaction with each other that threatened to break up the group. This was observed in the interaction between Philip and Pam that showed clear evidence of conflict. The two were dissatisfied with each other and Pam threatened to quit from the group if Philip was not expelled. The conflict polarized the group since Pam’s ultimatum implied that the group must choose between retaining Pam and losing Philip or retaining Philip and losing Pam. Although Philip did not mention an intention to quit if Pam was retained, he felt that Pam was appreciated more within the group than him. This was because the group members made ardent pleas to Pam not to quit the group while ignoring his presence and his need for assurance that the group supported him. In essence, he felt that Pam was supported whereas his presence is unnecessary. Philip summarized his feelings by indicating that he felt less valued than Pam according to how the situation was developing (Psychotherapy.net, 2011). In this respect, an intragroup conflict existed between Pam and Philip NURS 6650 Group Processes and Stages of Formation Essay.

Conflict in a group does not have to mean that the group cannot function. In fact, it may actually help the group function if the conflict is handled well. People can grow and learn from conflict, especially if it can be resolved in a way that makes the group a winner, not in a way that makes one individual the loser (Hadad, & Reed,2007). Ignoring conflicts will only make things worse, so conflicts are better delt with as they arise. Treat issues as problems to be solved, and do not engage in blaming. Be open minded and fair when listening to everyone, and brainstorm to find solutions or compromise (Hadad, & Reed, 2007).

The existence of the intragroup conflict between Pam and Philip is one that threatens to break up the group. While the conflict is a threat, it can also act as an incentive that allows the group to understand its purpose. In comprehending that the exit of either Philip or Pam will cause the group to break up, then it will be incumbent upon the group to resolve the existing conflict without breaking up the group. Should the existing conflict be resolved amicably without losing any members, then the group will learn that each problem has a solution and their individual problems similarly have solutions as well (Smith, 2012). In this respect, the group should approach intrapersonal conflict as an opportunity to affirm the efficacy of the group in developing solutions.

 

References

Allen, K. & Spitzer, W. (2015). Social Work Practice in Healthcare: Advanced approaches and emerging trends. Thousand Oaks, CA: SAGE Publications.

Psychotherapy.net (Producer). (2011). Group therapy: A live demonstration. [Video file]. Mill Valley, CA: Author.

Smith, G. (2012). Psychological Interventions in Mental Health Nursing. Berkshire: Open University Press.

Tuckman, B. & Jensen, M. (1977) Stages of Small Group Development. Group and Organizational Studies, 2, 419-427 [Review]. (n.d.). NURS 6650 Group Processes and Stages of Formation Essay

Describe each client (without violating HIPAA regulations)

Students will:

Develop effective documentation skills for group therapy sessions *

Develop diagnoses for clients receiving group psychotherapy *

Evaluate the efficacy of cognitive behavioral therapy for groups *

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

* The Assignment related to this Learning Objective is introduced this week and submitted in Week 10.

Select two clients you observed or counseled this week during a group therapy session. Note: The two clients you select must have attended the same group session.

Then, in your Practicum Journal, address 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 whether cognitive behavioral therapy would be effective with this group. Include expected outcomes based on this therapeutic approach.

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

Support your approach with evidence-based literature Describe each client (without violating HIPAA regulations)

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Psychotherapy with groups and families

Part 1.

The case involved a family that sought psychotherapy for spousal and domestic abuse. The family seeking therapy is comprised of two members. The first member is the mother, Maria, a 24 year old women of Latino descent. She is a housewife with no marketable skills and moved into the country seven years ago upon getting married to her husband. She reports that her husband has been physically and emotionally abusive towards her. He does not allow her to have friends of contact with her family. She further adds that the abuse has escalated to an extent that she feared for her life. Although she is currently separated from her husband after the police intervened after the neighbors made repeated reports to them. She is fearful that she does not have any marketable skills or a social support system in place thus making her vulnerable to manipulation from her husband. She is not on any prescription medication Describe each client (without violating HIPAA regulations).

The second member is the daughter, Angela, a 7 year old child. She is non-communicative and appears fearful in the presence of adult males. She has scars from beatings by her father. She is not on any prescription medication.

Part 2.

Using DSM-5, Maria has been diagnosed as suffering from intimate partner violence. The diagnosis is based on the set criteria that includes being subjected to violence and aggression from an intimate partner who was her husband in this case. She has experienced severe and chronic episodes of spousal violence over the course of her marriage. To be more precise, she meets two out of four conditions for this diagnosis. Besides that, she has been repeatedly subjected to emotional abuse (psychological aggression). These aspects of her relationship support the diagnosis (Sperry, 2016).

Using DSM-5, Angela has been diagnosed as suffering from child physical and psychological abuse. This diagnosis is based on the scars on her body that act as evidence of physical abuse. In addition, her fear of male adults and non-communicative nature are evidence that she has been psychologically abused by her father (Sperry, 2016). Describe each client (without violating HIPAA regulations).

Part 3.

The family therapy should apply cognitive behavioral therapy (CBT) as an appropriate approach. The family are victims of physical and psychological abuse that was targeted at controlling them. This had a negative effect on their behaviors, emotions and thoughts. CBT addresses the negative effects of the abuse through applying a stepwise methodology that identifies the problem, reflects on past abuse, evaluates how the abuse was justified, reflecting on how emotions affected thoughts that ultimately affected behavior, and developing self-talk that changes and challenges the negative emotions to protect the clients (Wheeler, 2014).

Part 4.

Counseling Maria has legal implications over confidentiality and disclosures. The abuse has legal implications and there could be sensational details that the counselor is obligated to report to law enforcement officers. This is particularly the case if the abuse is still ongoing and the police are not aware. This could be challenging since Maria has been assured of confidentiality and that none of the information she discloses will be shared with a third party without her prior informed permission (Cautlin & Lilienfeld, 2015). Describe each client (without violating HIPAA regulations).

Counseling Angela has ethical implications. She is a child and issues of informed consent come into play since she is not consulted on whether or not she wants to attend therapy. In addition, there is an issue of confidentiality since the mother expects to be informed about the case details even if Angela expresses a desire to have all the case details kept confidential and not disclosed to other parties (Cautlin & Lilienfeld, 2015).

References

Cautin, R. & Lilienfeld, S. (2015).
The encyclopedia of clinical psychology, volume II Cli-E
. Hoboken, NJ: John Wiley & Sons.

Sperry, L. (2016).
Handbook of diagnosis and treatment of DSM-5 personality disorders:
assessment, case conceptualization, and treatment
(3
rd
ed.). New York, NY: Routledge.

Wheeler, K. (Ed.). (2014).
Psychotherapy for the advanced practice psychiatric nurse: a how-to-guide for evidence-based practice
(2
nd
ed.). New York, NY: Springer Publishing Company, LLC. Describe each client (without violating HIPAA regulations).

 

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 Describe each client (without violating HIPAA regulations).

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

Describe each client (without violating HIPAA regulations)

 

Group Therapy Sessions with Children and Adolescents

Description of clients, identifying any pertinent history or medical information

Client A, a seven-year-old girl presented to the hospital psychiatric department with a history of feeling anxious when not together with her mother and sleeping away from home.  This happened when the girl slept at a friend’s or relative’s home or while in a school camp. She expressed her nervousness as a worry that something bad would happen to her mother. Whether the detachment had was anticipated or had occurred, the client and her mother stated that she would experience worry, fear, stomach churning, crying, trembling and sweating.  At the period of consultation, the client was not under any medication and medical history revealed that the client did not have any other clinically significant feature.

Client B, a twelve- year old boy was brought to the pediatrician by his mother who was concerned that the boy is no longer rides bikes or play with toys with other children in the neighborhood. Over the last one month, the boy has been isolating himself and has become more irritable with no recognized trigger, has complained of frequent stomachaches and headaches over the last numerous weeks, and worries that all people in the family will die. Teachers have reported inattentiveness and impulsive behaviors in the class. The boy has also been having random durations of uncontrollable screaming and crying with no trigger Describe each client (without violating HIPAA regulations). There doesn’t exist a history of trauma, psychotic medication, changes in everyday life or recent losses.

An explanation and justification diagnosis for each client using the DSM-5

Client A is suffering from separation anxiety disorder (SAD).  The DMS-5 defines SAD as a developmentally unsuitable and excessive nervousness about separation from home or from those to whom the patient is attached.  According to Cooper-Vince et al (2014), diagnostic criteria describe excessive anxiety associated with separation as demonstrated by the existence of at least three of the specified SAD symptoms. These symptoms include  recurrent extreme distress when separation from  key attachment figures or home is anticipated or occurs, excessive and persistent worry  anxiousness  about losing or on probable harm happening to a key attachment figure,  excessive and persistent nervousness that an untoward incident will result in separation from the key attachment figure and persistent refusal or reluctance to go elsewhere for  fear of being separated. Other symptoms include excessively and persistently reluctant or fearful of not being with key attachment figures or at home and frequent reports of physical symptoms like vomiting, nausea, stomachaches, and headaches when a detachment from key attachment figures is anticipated or occurs. Describe each client (without violating HIPAA regulations).

Client B is suffering from major depressive disorder (MDD).  As Fatemi and Clayton (2016) indicate, according to the DSM-5 diagnostic criteria for MDD include the presence of at least five depressive symptoms for two or more weeks. These symptoms include the existence of irritable/depressed mood or anhedonia, reduced along with other depressive symptoms like reduced capability to have fun, sleep disturbance, impaired social relationships or social withdrawal suicidal ideation or thoughts of death, lack of energy, poor concentration. These symptoms should not be as a result of the effects of medication, drug or alcohol use, or a universal medical illness.

Ethical and legal implications related to counseling clients

A key ethical implication related to counselling both clients is competency.  According to Ziomek-Daigle (2017), it is the ethical responsibility of children and adolescent psychotherapist to ensure that they have the proper treating and competency in child and adolescent psychotherapy. There exist diverse systems, such as school, peers, community and family interacting with the child.  Successful and adolescent psychotherapy needs specialized skills and knowledge in counselling these populating along with a thorough knowledge of the bigger systemic context affect the adolescent’s life and behavior Describe each client (without violating HIPAA regulations).

Confidentiality and informed consent are other major ethical issues when counselling children and adolescents.   it is a legal and ethical responsibility for a counselor to get informed consent from clients utilizing a language they are able to understand.  As Sori and Hecker (2015) allege, children and adolescents who have not reached the legal age of giving consent, the counselor is required to obtain consent from the parent, but the child must agree to take part in counselling. Sori and Hecker (2015) claim that confidentiality issues are intricate in treating children and adolescents because their legal guardians or parents are usually involved in the counselling process and can access their medical records. Therefore, the counselor must maintain a balance amid the ethical responsibility of informing the parents on any treatment performed and the progress of the treatment, and the clients’ right to autonomy and privacy. Describe each client (without violating HIPAA regulations).

 

References

Cooper-Vince, C., Emmert-Arponson, B., Pincus, D., & Comer, J. (2014). The diagnostic utility of separation anxiety disorder symptoms: An item response theory analysis.
Journal of Abnormal Child Psychology
, 42(3): 417-248

Fatemi, S., & Clayton, P. (2016).
The Medical Basis of Psychiatry
.  New York:  Springer.

Sori, C., & Hecker, L. (2015). Ethical and Legal Considerations When Counselling Children and Families. 
Australian and New Zealand Journal of Family Therapy
, 36(4): 450-464.

Ziomek-Daigle, J. (2017). Counselling Children and Adolescents:
Working in School and Clinical Mental Health Settings
. Boca Raton, FL:  Taylor & Francis. Describe each client (without violating HIPAA regulations).

Levy Family case study – psychotherapeutic approaches to group therapy for addiction

To prepare:

Review this week’s Learning Resources and reflect on the insights they provide on group therapy for addiction.

View the media, Levy Family: Sessions 1-7, and consider the psychotherapeutic approaches being used.

The Assignment

In a 2- to 3-page paper, address the following:

Identify the psychotherapeutic approach that the group facilitator is using, and explain why she might be using this approach.

Determine whether or not you would use the same psychotherapeutic approach if you were the counselor facilitating this group, and justify your decision.

Identify an alternative approach to group therapy for addiction, and explain why it is an appropriate option.

Support your position with evidence-based literature. I’ll put a link to video Levy Family case study – psychotherapeutic approaches to group therapy for addiction

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Psychotherapeutic Approaches to Group Therapy for Addiction

Introduction

This paper focuses on group therapy for addiction, and specifically on a client named Levy. Levy suffers from alcohol addiction and post-traumatic stress disorder (PTSD). This paper will, therefore, identify the therapeutic approach the facilitator is using, and justify the reason. In addition, the paper will discuss an alternative approach to group therapy.

Approach the Group Facilitator is Using

The psychotherapeutic approach that was used was prolonged exposure therapy. According to Hendriks (2018), prolonged exposure therapy involves exposing the person to trauma reminders and allowing the client to process the imaginal exposure. Prolonged exposure therapy also involves educating the client about the trauma, fears and expected responses, and how to overcome the fears. In addition, clients are educated about different relaxation techniques aimed to reduce stress (McLean & Foa, 2014). In this video, the facilitator is seen using prolonged exposure therapy where Levy, the client is informed to memorize the traumatic event in Iraq, a process known as imaginal exposure. This allows Levy to experience the trauma once again imaginably which in turn gives him the courage to overcome his fears of the traumatic event. The group facilitator also taught Levy regarding relaxation exercises that involved breathing techniques to reduce stress and anxiety Levy Family case study – psychotherapeutic approaches to group therapy for addiction.

The rationale for using prolonged exposure therapy in Levy is to address the root cause of the client’s addiction problem. The root cause of the client’s addiction is the PTSD the client was due to the traumatic event within Iraq. According to Hendriks (2018), alcohol addiction is often a comorbidity of post-traumatic stress disorder.

 

Use of the same Psychotherapeutic Approach

I can use the same approach for a client with addiction and PTSD. This is because prolonged exposure therapy can help the client to overcome the fears, anxiety and other symptoms associated with PTSD. The client is taking alcohol to mask and avoid the symptoms of PTSD and thus exposure therapy can treat the PTSD symptoms and as a result, treat alcohol addiction as well. According to Hendriks (2018), prolonged exposure therapy has been shown to be effective in improving symptoms of PTSD. A study by McLean & Foa (2014) showed that exposure therapy assists the client to reduce avoidance associated with the trauma memories. Therefore, the approach will help Levy to stop taking alcohol in order to avoid the trauma memories because the PTSD will be treated. Levy Family case study – psychotherapeutic approaches to group therapy for addiction.

Alternative Approach to Group Therapy for Addiction

An alternative approach that I would use is motivational interviewing. Motivational interviewing is a short-term counseling intervention and patient-centered style that aims to improve and increase the motivation of the client to change substance or alcohol use (Korcha et al, 2015). Motivational interviewing involves empathic listening to the client and evoking individual reasons to change their behavior. The therapist should approach the client non-judgmentally in order to help the client to move to a higher level of readiness to change.  According to Korcha et al (2015) motivational interviewing assists individuals to become motivated to change behaviors that prevent them from making healthy choices. It also prepares people for more specific therapies. This is supported by Satre et al (2016) who provides that motivational interviewing is effective in reducing alcohol use and can be very effective in addressing adverse effects of substance use in patients with comorbidities such as PTSD and depression. Therefore, motivational interviewing will motivate Levy to change and stop alcohol intake. Evidence shows that motivational interviewing works well with people who begin off without motivation and not being ready to change (Satre et al, 2016).  Accordingly, Levy is unmotivated and unwilling to change the behavior of alcohol use. Therefore, motivational interviewing will help Levy to admit that he has a problem of alcohol intake and be willing to change.

Conclusion

The facilitator of the group used prolonged exposure therapy where Levy was exposed to the traumatic event by being instructed to relieve and describe the traumatic event in Iraq. This technique has been shown to help people with post-traumatic stress disorder to face the traumatic event and stop avoiding it. Levy uses alcohol as a coping mechanism in order to avoid and mask the traumatic memories. Therefore, treatment of PTSD will concurrently treat alcohol use. The alternative therapy I would use to address the client’s alcohol use is motivational interviewing in order to motivate Levy to change the behavior of alcohol use. Levy Family case study – psychotherapeutic approaches to group therapy for addiction.

 

 

References

Hendriks L, Kleine R, Theo B & Minnen A. (2018). Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts.
Eur J Psychotraumatol
. 9(1): 1425574.

Korcha R, Polcin D, Evans K, Bond J & Gantt G. (2015). Intensive Motivational Interviewing for Women with Alcohol Problems.
Counselor (Deerfield Beach)
. 16(3),62–69.

McLean C & Foa E. (2014). The use of prolonged exposure therapy to help patients with post-traumatic stress disorder.
Clin. Pract
.11(2), 233–241.

Satre D, Amy L, Sterling S, Lu Y, Travis A & Weisner C. (2016). A Randomized Clinical Trial of Motivational Interviewing to Reduce Alcohol and Drug Use among Patients with Depression.
J Consult Clin Psychol
. 84(7), 571–579.

 

Psychotherapeutic Approaches to Group Therapy for Addiction

Today substance use disorders are considered a mental health illness. Substance abuse changes an individual’s behaviors and thought processes. Psychiatric mental health nurse practitioners are required to understand addiction and how to treat substance use disorders properly. The purpose of this paper is to explain the psychotherapeutic approach being used in the Levy Family Sessions: 1-7 video, explain whether I would use this approach as a group facilitator, and to identify an alternative approach to group therapy for addiction using reliable resources and evidence-based literature.

Psychotherapeutic Approach  

             
To begin this paper is based on a video I have reviewed, “Levy Family Sessions: 1-7”. Clients with a history of trauma such as combat exposure during military service are at a high risk to develop mental health and substance use disorders. Substance abuse is a significant problem in military veterans and can be rehabilitating to these clients. In the Levy Family video, the group involves men with a history of combat exposure while serving in Iraq and Afghanistan. The group facilitator opened the group by informing the members that they each served in the military and asked how they are adjusting to being back home. Since all members of this group are military veterans, this suggests that the psychotherapeutic approach used is trauma-informed care (Wheeler, 2014). One out of five military veterans from the Afghanistan and Iraq wars has a diagnosis of depression or PTSD; these individuals also have a higher risk of developing a substance use disorder (Capone, Eaton, McGrath, & McGovern, 2014) Levy Family case study – psychotherapeutic approaches to group therapy for addiction.

According to Bodrog and Wittenberg (2014), trauma-focused psychotherapy is the treatment of choice for clients that have PTSD. Many individuals report that they use either drugs or alcohol to cope with their PTSD symptoms such as flashbacks, insomnia, night terrors or hypervigilance. It is critical for mental health professionals to focus on evidence-based treatment approaches to treat the underlying trauma and PTSD while also addressing substance use (Wheeler, 2017).

I believe that the trauma-informed approach is an excellent choice for the clients in this group. Trauma-specific interventions will recognize the following, the clients need to be respected, informed, and hopeful regarding their own recovery, the correlations between trauma and symptoms of trauma such as substance abuse, eating disorders, depression, and anxiety and the need to work collaboratively with the survivor, family and peers (Purkey, Patel & Phillips, 2018).

Additional Psychotherapeutic Approaches   

To continue, another psychotherapeutic approach that could be effective in the treatment of this client is 12 step peers support groups. Military veterans with PTSD are at a higher risk to develop a substance use disorder; many veterans will turn to alcohol to mask their symptoms of PTSD (2015). The consumption of alcohol can prolong PTSD symptoms and intensify them as well (Teeters, Lancaster, Brown, & Back, 2017). Since alcohol is a depressant, it can increase symptoms of depression, insomnia or anxiety. Alcoholics Anonymous is a 12-step peer support program that allows individuals to share their experiences, strength and hopes to assist in the recovery of alcoholism a common problem for each of the members (Wheeler, 2014).

An approach that was developed in the addiction field is motivational interviewing by motivating individuals to commit to living a drug-free and healthy lifestyle (Wheeler, 2014). Motivational interviewing focuses on the opportunity to guide the individual in change talk and increase the client’s motivation to make a difference. The motivation for a client to change is potentiated through the therapeutic alliance between the client, PMHNP and the group members with specific communication strategies that direct the discussion. Change talk with help the client become more confident and develop healthy solutions to everyday problems (Wheeler, 2014). The most successful approaches for clients that suffer from substance abuse are those that encourage self-efficacy. In the past fifteen years, the use of MI in group formats have grown significantly, but more research still needs to take place to determine the efficacy of MI in this setting for clients with SUD (Madson et al., 2016)

           
Couple and family therapy are an essential treatment component in assisting individuals, and their loved ones restore dysfunctional relationships related to substance abuse. Research shows that family and couple therapy is one of the most effective treatment options in adults that suffer from a substance use disorder (Wheeler, 2014). Substance abuse can cause many social complications in an individual’s life such as parenting skills, violence, depression, family conflict and unemployment, these can be addressed during family therapy (Lander, Howsare, & Byrne, 2013). The effectiveness of treatment is limited if only the individual is treated because it ignores the impact that the substance use disorder has on the family unit and it does not recognize the family as a potential system of support for change (Lander, Howsare, & Byrne, 2013). I believe that any time a client is suffering from a SUD the individuals loved ones should be involved in the treatment and recovery process.

Conclusion

In conclusion, there are many different psychotherapeutic treatment approaches to use when working with clients that suffer from a substance use disorder. It is up to the psychiatric mental health nurse practitioner to understand the different treatment approaches and can choose which will work best for each client.

 

References

Bodrog, B., & Wittenberg, E. (2014). Veteran readjustment: What we went through and how to help us. Presentation at HealthPartners, Bloomington, MN.

Capone, C., Eaton, E., McGrath, A. C., & McGovern, M. P. (2014). Integrated Cognitive Behavioral Therapy (ICBT) For PTSD and Substance Use in Iraq and Afghanistan Veterans: A Feasibility Study. 
Journal of Traumatic Stress Disorders & Treatment
, 
3
(4), 1000134.

Kelly, U., Boyd, M. A., Valente, S. M., & Czekanski, E. (2014). Trauma-informed care: Keeping mental health settings safe for veterans. Mental Health Nursing, 35, 413-419. doi: 10.3109/01612840.2014.881941.

Koetting, C. (2016). Trauma-Informed Care HELPING PATIENTS WITH A PAINFUL PAST. 
Journal of Christian Nursing
, 
33
(4), 206–213. https://doi-org.ezp.waldenulibrary.org/10.1097/CNJ.0000000000000315

Lander, L., Howsare, J., & Byrne, M. (2013). The impact of substance use disorders on families and children: from theory to practice. 
Social work in public health
, 
28
(3-4), 194-205.

Madson, M. B., Schumacher, J. A., Baer, J. S., & Martino, S. (2016). Motivational Interviewing for Substance Use: Mapping Out the Next Generation of Research. 
JOURNAL OF SUBSTANCE ABUSE TREATMENT
, 
65
, 1–5. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jsat.2016.02.003

Purkey, E., Patel, R., & Phillips, S. P. (2018). Trauma-informed care: Better care for everyone. 
Canadian family physician Medecin de famille canadien
, 
64
(3), 170-172.

Substance use disorders in the U.S. Armed forces. (2015). 
Military Medicine
, 
180
(3), 243–245. https://doi-org.ezp.waldenulibrary.org/10.7205/MILMED-D-14-00517

Teeters, J. B., Lancaster, C. L., Brown, D. G., & Back, S. E. (2017). Substance use disorders in military veterans: prevalence and treatment challenges. 
Substance abuse and rehabilitation
, 
8
, 69-77. doi:10.2147/SAR.S116720 Levy Family case study – psychotherapeutic approaches to group therapy for addiction

 

Critical evaluations of the patients’ primary characteristics is very essential while dealing with group therapies. The selection of the most appropriate approach while providing psychotherapeutic services to these groups posits a challenge to many facilitators. For the purposes of this paper, I will explore the various psychotherapeutic approaches utilized in group therapy for addition by utilizing levy’s family videos. The case study involves Mr. Levy who uses alcohol to fight his past traumatic experiences gained during the Iraq war. His use of alcohol has negatively impacted on his relationship with his wife whom blames levy for his alcoholic behavior (Laureate Education, 2013). Levy in return seeks aid to stop drinking so as to prevent the possibility of his wife divorcing him.

The therapist initiates the therapeutic session by applying individual therapy. The choice of this approach was informed by the idea that through understanding the clients primary characteristics and beliefs could reinforce the therapeutic approach success. The facilitator was able to identify that the war experiences, deteriorating family relationship and alcohol abuse were the key issues affecting Mr. Levy. The facilitator makes use of various behavioral therapy approaches to deal with Mr. Levy’s case. To begin with, the facilitator applies desensitization approach to help the client in managing his anger as well as his anxiousness (Steenkamp et al., 2015). The facilitator recommends him to be taking breathing techniques as the strategy of controlling his emotions. This technique was aimed at enabling the client to control and manage his anger which might negatively affect his relationship with others as well as to enhance his composure during the therapy Levy Family case study – psychotherapeutic approaches to group therapy for addiction.

Another method was the use cognitive behavioral therapy which helped in dealing with the client’s beliefs, thoughts and helping him deal with his challenges in a positive manner (Levi et al., 2016). This method was chosen as it would help the client have a positive attitude towards life and prompt self-treatment. Moreover, the approach would help Mr. Levy to face his past problems and find the solution of being able to live with the memories without any torture from them (Levi et al., 2016). The third approach is the use of the aversion therapy. This method helps the client to associate the use of alcohol to suicidal ideations among the military men (Neer et al., 2016). The client should be able to relate his traumatic experiences as a result of alcoholism as it is the case when he narrates on how his colleagues committed suicide and being informed that it is good he wasn’t drunk, he agrees proving his ability to generalize suicidal thought to alcoholism. Levy Family case study – psychotherapeutic approaches to group therapy for addiction.

Later, the facilitator adopts a group therapy where she applies the directive approach on Mr. Levy as well as his colleagues whom were in war with him. The application of this approach while dealing with group therapy is fundamental for it utilizes guidance on the topics and areas the group to concentrate in during the therapeutic process thereby achieving success at the initial stages of the group. The strategy enables the facilitator to control the clients’ participation and prevent domination by some group members which may make the session ineffective. Moreover, the facilitator utilized cognitive behavioral group therapy where each group member was help to resolve with the challenge memories and issues which were limiting their group participation (Steenkamp et al., 2015). This enables the member to aid each other and help one another to solve their challenges.

Being in the position of the facilitator, I would utilize the same strategies to help my clients deal with their challenges. Firstly, using the directive approach is essential in enhancing harmonious interactions as the clients are subjected to the same topics and goals which promotes cooperation and collaboration towards the identified goals (Corsini, 2017). Moreover, cognitive behavioral group therapy, will help my clients to come into terms with their past traumatic memories and thus participate fully in the group as well as develop a long lasting solution to their challenges (Steenkamp et al., 2015) Levy Family case study – psychotherapeutic approaches to group therapy for addiction.

However, the use of group psychodynamic approach while dealing with this group would also be essential. This method makes use of the process sensitive approach as well as the directive approach making it more effective in enhancing the participation of individual members as well as enhancing members’ empowerment in dealing with their challenges (Levi et al., 2016). This method goes a step further in facilitating group goal setting, setting expectations as well as appraisals of the members’ contributions (Levi et al., 2016). Consequently, all members in the group can freely participate in the group’s activities and appraise each other on one’s effort towards the achievement of their problems thus promoting change in attitude and behaviors.

In conclusion, primary characteristics plays a major role in assisting the facilitators in the selection of the most appropriate therapeutic approach to utilize. The use of individual therapy is essential in the identification of issues that are disastrous in the clients’ life. The ability to identify these issues informs the facilitator on the how to help their clients overcome these challenges. Group therapies success depends on the use of shared vision and goals thus application of group therapy proved essential in helping Mr. Levy and his colleagues deal with their challenges collaboratively. Levy Family case study – psychotherapeutic approaches to group therapy for addiction.

References

Corsini, R. (2017).
Role playing in psychotherapy
. Routledge.

Laureate Education (Producer). (2013).
Levy family: Sessions 1-7
[Video file]. Baltimore, MD; Author.

Levi, O., Bar‐Haim, Y., Kreiss, Y., & Fruchter, E. (2016). Cognitive–Behavioural Therapy and Psychodynamic Psychotherapy in the Treatment of Combat‐Related Post‐Traumatic Stress Disorder: A Comparative Effectiveness Study.
Clinical psychology & psychotherapy
,
23
(4), 298-307.

Neer, S. M., Trachik, B., Munyan, B. G., & Beidel, D. C. (2016). Comprehensive Treatment: Intensive Exposure Therapy for Combat-Related PTSD and Comorbid Conversion Disorder.
Clinical Case Studies
,
15
(5), 343-359.

Steenkamp, M. M., Litz, B. T., Hoge, C. W., & Marmar, C. R. (2015). Psychotherapy for military-related PTSD: a review of randomized clinical trials.
Jama
,
314
(5), 489-500 Levy Family case study – psychotherapeutic approaches to group therapy for addiction.

The purpose of this paper is to examine a client with addictive disorder and analyze the therapeutic approach for treating the client.

Episode 1

Mr. Levy’s perception of the problem is that he just is sick. He becomes confrontational and aggressive when his perception is questioned by his wife. Mr. Levy also wants other to share his perception, because when his wife asked him to go up stairs so the children don’t see him hungover he replies that he is only sick. Mr. Levy also perceives that the problem started when he went to war in Iraq.

Mrs. Levy’s perception of the problem is that her husband is depressed, angry, and drinks excessively. Her perception of her husband is that he is am alcoholic and he is tearing their family apart.

Mr. Levy’s alcoholism, anger, and depression can have a devastating impact for his whole family. Each member in the family will be affected uniquely in their own way, for the children there is a higher risk of developing issues with substance abuse or being abused themselves (Lander, Howsare, & Byrne, 2013). The family could face financial, psychological, and developmental strain and the potential for domestic violence (Lander, Howsare, & Byrne, 2013). Levy Family case study – psychotherapeutic approaches to group therapy for addiction.

Episode 2

Mr. Levy’s social suggested the use of art therapy, meditation, and yoga, these therapies can relieve stress, but this should not be at the forefront of the therapeutic plan. The Veterans Affairs (VA) has set a policy for the treatment of alcohol abuse for veterans. The policy requires the client to participate in two therapies, CBT for relapse prevention, 12-step facilitation, community reinforcement approach, substance use disorder focused behavioral couples/family therapy, and motivational enhancement therapy (Allen, Crawford, & Kudler, 2016). Mr. Levy’s social worker should focus on the VA’s suggested therapies first and then add in the holistic therapies.

The supervisor’s questions were appropriate for this situation. He wanted Mr. Levy’s social worker to think about the suggested therapies and are they evidence based. The supervisor did not want the social worker to use a therapy because she finds it interesting, but one that is backed by evidence to be effective. The supervisor was correct by telling her that she needs to meet the client before making his treatment plan so that it can be customized to his needs. Levy Family case study – psychotherapeutic approaches to group therapy for addiction.

Episode 3

Mr. Levy’s therapist allowed him to speak freely about his encounters in Iraq and analyzed his emotional state. She responded appropriately by interjecting when Mr. Levy showed extreme emotional distress re-enforcing that he is in a safe place. The therapy session at this point has gone well. The therapist allowed the client to talk freely, identified his emotional distress, explained her treatment plan, and taught the client deep breathing to reduce stress.

Deep breathing exercise starts with the contraction of the diaphragm, the expansion of the abdomen, and deep expansive inhalation and exhalation (Ma et al., 2017). Deep breathing reduces the frequency of needed respirations and maximizes the amount of gas dissolved in the blood (Ma et al., 2017). Deep breathing can improve cardiorespiratory fitness, enhance pulmonary function, reduce sympathetic nervous system activity (Ma et al., 2017).

Exposure therapy helps people confront their stressors in a safe environment by exposing them to the stressor physically or through imagery (American Psychological Association, 2018).

Exposure therapy is endorsed by the VA as one of the best treatments for PTSD and consider it to be the best supported treatment (VA.gov, 2016). The research done by the VA and Department of Defense in the efficacy of exposure therapy for the treatment of PTSD leads me to believe that this would be my choice in treatment.

Episode 4

I would have responded in a sympathetic tone enforcing that the client is in a safe place. I would also express that even though the memory was stressful to relive it was therapeutic to do so. The exposure therapy should focus on the situation Mr. Levy described, this was the major traumatic event that caused him to spiral out of control.

Episode 5

I would respond by sympathizing with the therapist do to the difficult story the client told her. The therapist should be told that she needs to maintain emotional boundaries to avoid countertransference that could negatively affect the therapeutic relationship (Colli & Ferri, 2015). I would suggest that the therapist involve the client’s family in therapy. Support for the client and his family can reduce the likelihood of more damaging consequences in the future (VA.gov, 2016). Levy Family case study – psychotherapeutic approaches to group therapy for addiction.

 

References

Allen, J. P., Crawford, E. F., & Kudler, H. (2016). Nature and Treatment of Comorbid Alcohol Problems and Post-Traumatic Stress Disorder Among American Military Personnel and Veterans.
Alcohol Research: Current reviews
,
38
(1), 133-140. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4872608/

Colli, A., & Ferri, M. (2015). Patient personality and therapist countertransference.
Current Opinion in Psychiatry
,
28
(1), 46-56. doi:10.1097/yco.0000000000000119

Lander, L., Howsare, J., & Byrne, M. (2013). The Impact of Substance Use Disorders on Families and Children: From Theory to Practice.
Social Work in Public Health
,
28
(3-4), 194-205. doi:10.1080/19371918.2013.759005 Levy Family case study – psychotherapeutic approaches to group therapy for addiction

Ma, X., Yue, Z., Gong, Z., Zhang, H., Duan, N., Shi, Y., … Li, Y. (2017). The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults.
Frontiers in Psychology
,
8
. doi:10.3389/fpsyg.2017.00874

Treatment of the Returning Iraq War Veteran – PTSD: National Center for PTSD. (2016, February 23). Retrieved from https://www.ptsd.va.gov/professional/treatment/vets/treatment-iraq-vets.asp

What Is Exposure Therapy? (2018). Retrieved from http://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy.aspx Levy Family case study – psychotherapeutic approaches to group therapy for addiction

Hernandez Family Assessment Essay

Assessment begins informally when the therapist first meets the client. According to Nichols, (2013), assessment aims to help the therapist decode the challenges and defenses that occur during the ongoing course of trying to help the family members open up to one another. Nichols & Tafuri (2013) noted that the goal of assessment is not just to gather information but rather, it should be an active and dynamic process in which the therapist explores the presenting complaint, does not accept it at face value but examine the possibility that the family interactions might influence the presenting complaint. The subsequent paragraphs will present a family assessment of the Hernandez family.

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Demographic information

Juan Hernandez is a Hispanic male who is married to Elena Hernandez a Latina female. They both have two children named Juan Jr. who is 6 years-old and Alberto who is 8 years old. Low socioeconomic status and a working-class family Hernandez Family Assessment Essay.

Presenting problem

The social worker requested parenting classes and therapy for Juan and Elena because she believes their style of discipline is too harsh.

History or present illness

The clients present with concerns of their two children being taken away because the social worker thinks their discipline style is harsh. They portray themselves as excellent parents, and they verbalize the fact that disciplining a child is very necessary. They stated they were brought up that way and it is part of their culture. The client reports that he was punished severely by his mother and father while he was growing up and that did not break him. Hernandez Family Assessment Essay.

Past psychiatric history

The client denies any past psychiatric history. He states his father has been of sound mental health. Both Juan and Elena were punished severely as kids.

Medical history

Juan Hernandez denies any medical history. Need to be added.

Substance use history

No history of substance abuse reported. Need to be added.

Developmental history

Juan and Elena Hernandez reported normal development. She reported both of her sons met their developmental milestones. Need to be added.

Family psychiatric history

No psychiatric history reported. Need to be added. Hernandez Family Assessment Essay.

Psychosocial History

A heterosexual couple, married. Juan Hernandez works full-time and overtime to be able to provide for his family. Need to be added.

History of abuse and/or trauma

Both clients reported receiving similar harsh disciplinary treatment from their parents. Juan Hernandez stated that when his dad was mad at him, he will send him to get books from the encyclopedia and hold them on his hands until he will tell him to stop. He also stated those caused so much pain on his arms, and he felt like his hands will break off. He also indicated his mother did the same thing. To him, books only meant one thing “misery.” He ended by saying “I guess I inherited it from then.” Elena also described her childhood with one word “misery.” Both clients deny any physical abuse. Hernandez Family Assessment Essay.

Review of systems

Gen
:  Denies any fever, chills or sweats

Head
: normocephalic. Denies any head injury

ENT
: Denies any tinnitus or ear tubes.

Denies any nosebleeds, epistaxis, nasal discharge

Neck
: Denies any stiffness or swelling

Cardiopulmonary:
 Denies dyspnea, tachycardia, chest pain, palpitations or orthopnea

GI
: denies any decrease in appetite

GU
: denies urgency or frequency

MS
: Denies joint pain

Heme/Skin
: Denies any bleeding or bruising, pruritis and rash

Neuro
: Denies muscle weakness and paresthesia

Psych
: denies any SI/HI ideation

Mental status exam

Appearance:
both clients look appropriate for their age, well-groomed and in no acute distress.

Mental status exam

Both clients are alert and oriented to time, person, place, and situation. Well groomed, good eye contact. Juan Hernandez appears agitated about attending parenting classes because he would instead work overtime to care for his family. Elena, on the other hand, is more accepting and willing to compromise if her privacy is guaranteed and if the classes will prevent her from losing her children.

Differential diagnosis

Stress and aggressive disorder

Post-traumatic stress disorder

A client is diagnosed with PTSD when they have been exposed to an intense or prolonged psychological distress (American Psychiatric Association, 2013). In the case scenario above, both clients described their childhood as “miserable.” The goal of therapy is to assist the clients to change the behavior which as Juan stated: “I think I inherited it from my parents.” Hence the question “is the discipline meted on their children justified or do the parents have stress or anger issues that play a role in their method of discipline? According to Coleman (2018) in the process of disciplining a child, parents who are fraught with stress and anger could cross the line from discipline to abuse. Hernandez Family Assessment Essay.

Case Formulation

The clients were referred for parenting classes because the social worker believed their discipline method was too harsh.  During the therapy sessions, both clients verbalized the fact that they were punished severely by their parent’s during childhood. The goal of the therapist is to explore their parenting styles and create awareness about other discipline techniques.

Treatment Plan

Family therapy and group therapy once a week

Cognitive behavioral therapy

Behavioral and learning theory

Family-Directed Structural Therapy (FDST) is an approach to family therapy that is concretely organized, easily administered and family progress is easily measurable. According to Mclendon, Mclendon, & Petr (2005), FDST approach to therapy aims to accentuate families strength and decrease family conflict. Some of the critical issues that are explored during family therapy are commitment, empowerment, and consistency. CBT can be incorporated into family therapy to address caregivers behavior and consequences such as behavior and emotional adjustment that might occur as a result of these behaviors.

References

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

Coleman, P. (2018). What is the Difference Between Discipline and Abuse? It’s all about what transpires in the moment. Retrieved from https://www.fatherly.com/parenting/what-is-the-difference-between-discipline-and-abuse/

Mclendon, D., Mclendon, T., & Petr, C. G. (2005). Family-Directed Structural Therapy. 
Journal of Marital and Family Therapy,
 
31
(4), 327-339. doi:10.1111/j.1752-0606.2005.tb01574.x

Nichols, M., & Tafuri, S. (2013). Techniques of structural family assessment: A qualitative analysis of how experts promote a systemic perspective.
Family Process, 52
(2), 207–215. doi:10.1111/famp.12025

Nichols, M. (2014).
The essentials of family therapy
(6th ed.). Boston, MA: Pearson.

Wheeler, K. (Ed.). (2014).
Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice.
New York, NY: Springer Hernandez Family Assessment Essay.

 

Introduction

Hernandez family has health patterns which are  essential in evaluating the models of provision of health care for the in-depth look and overall examination of health situation of the family.

Demographic Information

The Hernandez is a typical family that consists of three children, father, and mother. Like any form of belief, the family has its values and beliefs. After carrying out an intensive examination of the family, members of the family care for each other deeply (American College of Sports Medicine Ed, 2013).

Physical Assessment

Seeking of physical help has been established as a norm where people such as Elena are the primary providers of health care. The members do not have a regimen of carrying out physical activities. The mother is left behind because of hypertension, high cholesterol level, and borderline hypertension Hernandez Family Assessment Essay.

Psychosocial History

The family is highly sociable, and it ensures that the family members communicate well thus creating good relationships with everyone. The members of the family have strong interaction bonds where they talk and respect each other’s opinions. There are annual check-ups where everybody has an examination on hearing, eye and sight (Heyward & Gibson, 2014). The use of Acne is highly discouraged from the family because of its impacts on children’s self-esteem. It is clear that children who have Acne are required to on constant medical check-up that ensure any negative effects are controlled.

 

Medical History

The medical history of the family suffers because of the stretched schedule of the father and mother. It has become difficult for the family to seek medical check-ups on a daily basis. Children are taken for medical check-ups when they face any disorder because of the increased nutrition risks. The family has lived a healthy life for a long time and monitoring of sons life (Weber & Kelley, 2013). Elena shows that their sons will be given good life when she is near her parents. Hernandez Family Assessment Essay.

Substance Use History

The family advocates against substance abuse and there have been no issues surrounding substance abuse within the family members. The mother and father have shown their children on how to live responsibly thus avoiding any form of family conflicts. Any child who is found to use any substance abuse will lead to the denting the family’s reputation.

Developmental History

The Hernandez family has an irregular and profoundly disturbed form of development. Mother and father have a demanding schedule that mostly causes them to work for an extended period until nighttime. Due to lack of adequate sleep, the mother always feels sleepy and always overwhelmed with many responsibilities (Gurland et al., 2013). So that they can realize their development agenda, the father helps in conducting household activities. The children of the family have the belief of education as the only form where they can get the required development.

History of Abuse and Trauma

The father suffers from depression because of the increased work schedule. Juan Hernandez states that she punishes her son so that they would understand what should be done. She perceives such form of action as the right thing to be done by parents. Children were raised the way they were initially brought up (American College of Sports Medicine Ed, 2013).

Mental Status Exam

Hernandez family has a lot of health risks which are acknowledged mainly by the mother. Health issues relating to psychological status have received attention from both the mother and father because they are the man providers of the family. They have been able to give solutions to problems facing the family (Hoge et al., 2014). Carrying out an appropriate diagnosis of Hernandez family will be critical for maintaining the stable mental status of Hernandez family.

Review of Systems

The family of Hernandez has worked to ensure that homemade meals are prepared where they can form health choices. The father and mother have managed to establish a well-documented plan where every member of the family is allocated a certain task making them have a required and specialized self-care Hernandez Family Assessment Essay.

Differential Diagnosis

The family members have devised a mechanism of having medical checkups after every one month. There have never been issues of health problems because of the physical schedule where solutions to members of the family are provided with the required patterns of metabolic provisions. The diagnosis has helped in preventing any form of the disease that may affect any member of the family (Hoge et al., 2014).

Case Formulation

The Hernandez family advocates for the protection of the children by advocating for abstinence. The mother has the responsibility of handling any stressful event that may be caused forward and copies them by use of prayers. The children are made to have more books for maintenance of their education level, and some of the work was inherited their grandparents.

Treatment Plan

The family has had a smooth schedule of planning for their future medication. Hernandez family is encouraged to use an appropriate form of treatment scheme where each is given the priority of consuming enough water that is concerned with elucidating all the time. Children enjoy drinking juice that has become a standard form treatment when faced with any form of human problem (Gurland et al., 2013) Hernandez Family Assessment Essay.

Family Psychiatric History

There has been no psychiatric problem before in the family of Hernandez. The family is committed to ensuring that enough support is given to the child during family members hospitalization. The family has displayed a strong familial bond that will be critical when they will be treating their children lead by the father and mother (Heyward & Gibson, 2014).

References

American College of Sports Medicine (Ed.). (2013). 
ACSM’s health-related health assessment manual
. Lippincott Williams & Wilkins..

Gurland, B., Kuriansky, J., Sharpe, L., Simon, R., Stiller, P., & Birkett, P. (2013). The Comprehensive Assessment and Referral Evaluation (CARE)—rationale, development and reliability. 
The International Journal of Aging and Human Development
, 
8
(1), 9-42.

Heyward, V. H., & Gibson, A. (2014). 
Advanced health assessment and prescription 7th edition
.

Hoge, C. W., Lesikar, S. E., Guevara, R., Lange, J., Brundage, J. F., Engel Jr, C. C., … & Orman, D. T. (2014). Mental disorders among US military personnel in the 1990s: association with high levels of health care utilization and early military attrition. 
American Journal of Psychiatry
, 
159
(9), 1576-1583.

Weber, J. R., & Kelley, J. H. (2013). 
Health assessment in nursing
. Lippincott Williams & Wilkins Hernandez Family Assessment Essay.

 

Assignment 1: Hernandez Family Assessment

Assessment is as essential to family therapy as it is to individual therapy. Although families often present with one person identified as the “problem,” the assessment process will help you better understand family roles and determine whether the identified problem client is in fact the root of the family’s issues. As you examine the Hernandez Family: Sessions 1-6 videos in this week’s Learning Resources, consider how you might assess and treat the client family.

Learning Objectives

Students will:

Assess client families presenting for psychotherapy

To prepare:

Review this week’s Learning Resources and reflect on the insights they provide on family assessment.

View the Hernandez Family: Sessions 1-6 videos, and consider how you might assess the family in the case study.

Note: For guidance on writing a comprehensive client assessment, refer to pages 137–142 of Wheeler (2014) in this week’s Learning Resources.

The Assignment

Address in a comprehensive client assessment of the Hernandez family the following:

Demographic information

Presenting problem

History or present illness

Past psychiatric history

Medical history

Substance use history

Developmental history

Family psychiatric history

Psychosocial history

History of abuse and/or trauma

Review of systems

Physical assessment

Mental status exam

Differential diagnosis

Case formulation

Treatment plan

Note: Any item you are unable to address from the video should be marked “needs to be added to” as you would in an actual comprehensive client assessment Hernandez Family Assessment Essay

Child and Adolescent Group Psychotherapy Essay

Review this week’s media and consider the insights provided on group therapy with children and adolescents.

Reflect on a child and adolescent group that you are currently counseling at your practicum site

Describe a child and adolescent group you are counseling.

Describe a client from the group who you do not think is adequately progressing according to expected clinical outcomes. Note: Do not use the client’s actual name.

Explain your therapeutic approach with the group, including your perceived effectiveness of your approach with the client you identified. Child and Adolescent Group Psychotherapy Essay.

Identify any additional information about this group and/or client that may potentially impact expected outcomes

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Child and Adolescent Group Psychotherapy

Adolescent Group being Counselled

The group consisted of 5 adolescents who presented with similar mental health problems. The group members attended the group one therapy session every week and each session lasted for two hours. Group members varied from the age of 13 years to 17 years. Some of the group members were receiving treatment somewhere else. At the start of the therapy, the main goal was to activate group members and later attention was given to how feelings of sadness, and hopelessness affected their lives and how to overcome these feelings. Child and Adolescent Group Psychotherapy Essay.

Description of the Client

Client XX, a 15-year-old male presented for therapy after he attempted suicide through medication overdose. The client reported that he was having suicidal thoughts for a long time and attempted suicide twice at the age of 12 and 14 years. The client reported that he started having suicidal thoughts 5 years ago after he lost his father when he was only 10 year. According to the client, after losing his father he began having sleeping problems, being sad throughout, feeling hopeless and worthless, always fatigued, lack of appetite, irritable, loss of interest in activities that were formerly pleasurable, loss of weight, suicidal thoughts, and his academic performance had dropped significantly. His affect also appeared apathetic and flat. XX further reported that football and hanging out with his estate friends were among his favorite activities, but lately, he has completely lost interest.  From the observation, the client looked gloomy, sad, and could not make eye contact.  However, in spite of the therapy sessions, the client has not achieved any significant symptom remission. Child and Adolescent Group Psychotherapy Essay.

 

Therapeutic Approach with the Group

Cognitive-behavioral group therapy was the approach used for this group. Cognitive-behavioral group (CBT) is a structured psychotherapy where the client is made aware of their maladaptive and negative thinking patterns so that they are able to adopt a more positive thinking pattern and view challenging situations more clearly and respond to the situations more effectively (Arias-Pujol & Anguera, 2017). During the therapy, various strategies were used to understand and manage the physiological and cognitive aspects of different mental health issues the group members were facing. A comprehensive and systematic assessment of each group member was done at the start of the therapy to ensure the formulation of personalized treatment plans and setting person-centered goals (Keles & Idsoe, 2018).  Afterward, the group members were then provided with information on how to handle their mental health issues using psychoeducation. This is because when individuals understand their mental health issues better, they are able to learn new skills in order to better manage their symptoms. In addition, various techniques such as cognitive restructuring and relaxation were used for the group members (McGillivray & Evert, 2014).

CBT is likely to be effective for this client. This is because evidence demonstrates the efficacy of CBT in the treatment of depression. CBT will be used to identify the troubling situations in the client’s life, ensure the client becomes aware of his feelings, thoughts, and beliefs regarding the challenging situations in his life, identify the client’s maladaptive thinking, and finally, modify and reshape the client’s maladaptive thinking pattern (Wolgensinger, 2015). Child and Adolescent Group Psychotherapy Essay.

Additional Information about the Group

At times, the attention of the psychotherapist and the entire group was divided among all the group members. Sometimes during the therapy sessions, it appeared that some group members did not get a chance to express themselves and work on their issues effectively within the timeframe of the session.

 

 

References

Arias-Pujol E & Anguera M. (2017). Observation of Interactions in Adolescent Group Therapy: A Mixed Methods Study.
Front Psychol
. 8(1188).

Keles S & Idsoe T. (2018). A meta-analysis of group Cognitive Behavioral Therapy (CBT) interventions for adolescents with depression.
J Adolesc.
9(67),129-139.

McGillivray, J. A., & Evert, H. T. (2014). Group cognitive behavioural therapy program shows potential in reducing symptoms of depression and stress among young people with ASD.
Journal of Autism and Developmental Disorders
. 44(8), 2041–2051. doi:10.1007/s10803-014-2087-9.

Wolgensinger L. (2015). Cognitive behavioral group therapy for anxiety: recent developments.
Dialogues Clin Neurosci
. 17(3), 347–351. Child and Adolescent Group Psychotherapy Essay.

Comprehensive Integrated Psychiatric Assessment of a child or adolescent

Evaluate comprehensive integrated psychiatric assessment techniques

Recommend assessment questions

Review the Learning Resources concerning the comprehensive integrated psychiatric assessment.

Watch the Mental Status Examination video.

Watch the two YMH Bostonvideos

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Child and Adolescent Diagnostic Assessment Worksheet

IDENTIFYING INFORMATION: (age, gender, and ethnicity of client; parents)

COLLATORAL INFORMANTS
:

CHIEF COMPLAINT: (in the client’s own words
)

Other informants:

HISTORY OF PRESENT ILLNESS
:
(this should create the timeline and details of the child/adolescent symptoms so that it leads to the clinical assessment and formulation)
­­­­­­­­­­­­

 

PAST PSYCHIATRIC HISTORY/PREVIOUS PSYCHIATRIC VISITS/HOSPITALIZATIONS:­­­­­­­­­­

 

PAST MEDICAL HISTORY
:

 

PAST SURGICAL HISTORY
:

 

CURRENT MEDICATIONS (INCLUDING COMPLIANCE):

 

ALLERGIES
:

 

PSYCHOSOCIAL

HISTORY: (who the child lives with, relevant cultural information, school, grade, teacher, friends)

 

Sexual Orientation/Gender Identity (if unknown, evidence of gender dysphoria):

 

­­­­­­­­­­­­­­­­­­(NOTE: If LGBT, elicit “out” status, family dynamics): _________________________________

History of physical/emotional/sexual abuse: __________ History of bullying: _________Religion: ________

FAMILY HISTORY OF PSYCHIATRIC ILLNESS:

 

History of Family Suicide Attempts/Completed Suicides:

SUBSTANCE ABUSE HISTORY:

Smoker: _____History of alcohol, marijuana, meth use/abuse:  ____________________________________

 

REVIEW OF SYMPTOMS:

 

 

 

GENERAL WELL BEING:

(Example:

-Child/parent reports that (she/he) is sleeping (well, poorly, fair). States that (she/he) has trouble (falling asleep, staying asleep, or waking up feeling as if she/he had not slept at all).

 

-Further, reports (low, fair, good) energy throughout the day. Comprehensive Integrated Psychiatric Assessment of a child or adolescent.

 

-Child/parent acknowledges (poor, fair, good) appetite (if fair/poor, indicate how long this has persisted for). Any significant weight loss/gain.

 

 

MENTAL STATUS EXAMINATION
:
(see
Kaplan & Sadock’s Synopsis of Psychiatry: Behavior Sciences/Clinical Psychiatry
for Child MSE)

 

=============================================================================

 

CLINICAL FORMULATION: (Discuss diagnostic reasoning here.) ­­­­­­­­­­­­­­­­­­­­­­

 

 

 

DIAGNOSIS USING DSM-5:

 

(Begin with psychiatric diagnosis that the patient is being treated for; then, in order of relevance/importance/significance to the overall clinical picture, list the diagnoses.
DSM-5 combines the first three DSM-IV-TR axes into one list that contains all mental disorders, including personality disorders and intellectual disability, as well as other medical diagnoses. Other conditions that are a focus of the current visit or help to explain the need for a treatment or test may also be coded.)

 

DIAGNOSIS:

 

 

PLAN OF TREATMENT:

 

Comprehensive Integrated Psychiatric Assessment

Introduction

The Vignette 4 video describes a 16-year-old teenage client who presented for a mental health assessment. The client was referred by the mother and he claimed that he was not aware why he was referred for a mental health assessment. The video indicates that the client is not interested in the assessment and the therapist utilizes various techniques, where some are helpful while other techniques are not helpful. This will be discussed in this post. Comprehensive Integrated Psychiatric Assessment of a child or adolescent.

What the Practitioner did Well

Before the session starts, the practitioner informs the client regarding confidentiality. According to Sadock et al (2014), confidentiality is the foundation of effective therapeutic relationships and effective treatment (Wheeler, 2014).  Secondly, the practitioner actively engaged the client and asked him regarding his opinion which indicates that the practitioner believes about independency of the client’s feelings and thoughts. The client responds positively and both his eye contact and verbal interactions improve. As per Sadock et al (2014), engaging adolescents leads to a better rapport because they feel they are being given a chance to have their side of the story heard.  In addition, the practitioner asked regarding other individuals in the life of the client which informs him that the client ha better relationships with his coach and girlfriend.  The client is very comfortable talking about these relationships which can inform the practitioner.

Areas the Practitioner need to Improve

The practitioner can improve in a few areas. For example, the provider tries to air his own opinion regarding what he thinks of the client’s mother. This is evident where the client reports that the mother feels he has an “anger management” issue and the practitioner tells him that the mother has his won reasons for stating so. At this point, the practitioner uses facial expression and a voice tone that indicates that he completely disagrees with the client’s perspective. Such an approach can make the client feel alienated. This is clear, where the client withdraws and looks down. According to Sukhodolsky et al (2016) the ability of a practitioner to read the body language of clients is an important skill. Comprehensive Integrated Psychiatric Assessment of a child or adolescent.

Compelling Concerns

Some of the concerns include that the practitioner fails to come up with strategies that the client and the mother can adopt for effective communication. The client claims that the mother is nagging. This can be perceived as a family issue or a developmental issue since teenage boys are not likely to disclose their personal feelings to their mothers (Bista et al, 2016). It is also important for the practitioner to acknowledge the client’s feelings about the whole issue. At this point, the practitioner reflects and normalizes the aversion of the client talking to his mother through humor. This resonates with the client and assists in improving the connection between the client and the therapist.

The Next Question and the Reason

The therapist did not address the client’s possible risky behavior. Therefore, I would assess if the client has any issues to do with substance or alcohol abuse. The first question would be “have you ever been in a CAR driven by a person (including yourself) who was intoxicated or had been using drugs or alcohol?” This question is derived from the CRAFFT screening tool. According to Sadock et al (2014), substance abuse or alcohol abuse can significantly affect psychiatric symptoms as well as the treatment. Comprehensive Integrated Psychiatric Assessment of a child or adolescent.

 

 

References

Bista B, Thapa P, Sapkota D, Suman S & Paras P. (2016). Psychosocial Problems among Adolescent Students: An Exploratory Study in the Central Region of Nepal.
Front Public Health
. 4(158).

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014).
 Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.)
. Philadelphia, PA: Wolters Kluwer.

Sukhodolsky D, Smith S, Spencer M, Karim I & Piasecka J. (2016). Behavioral Interventions for Anger, Irritability, and Aggression in Children and Adolescents.
J Child Adolesc Psychopharmacol.
26(1), 58–64.

Wheeler, K. (Eds.). (2014).
 Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.)
. New York, NY: Springer Publishing Company Comprehensive Integrated Psychiatric Assessment of a child or adolescent.

Psychiatric Mental Health Practices Ethics and Dilemmas

Review literature for moral/ethical issues encountered by a PMHNP.

Select one of the articles you found that was published within the last 5 years to use as a focus for this assignment

Summarize the moral/ethical issue in the article (no more than 1 paragraph).

Describe the moral and ethical dilemmas surrounding the issue.

Analyze the ethical issue and compare them to the state health laws and regulations in your state.

Outline the process of ethical decision making you would use to address this ethical dilemma.

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Psychiatric Mental Health Practices Ethics and Dilemmas

A summary of an ethical issue in the article

“Hem, M., Molewijk, B., Gjerberg, E., Lillemoen, L., & Pedersen, R. (2018). The significance of ethics reflection groups in mental health care: a focus group study among health care professionals.
BMC Medical Ethics
, 19 (1):54”.

Coercive treatment is a prominent ethical issue that professions in psychiatric mental health practices face. Over the past years, the utilization of coercion in psychiatric services has gained increasing attention and raised some of the utmost hard ethical issues. The usage of coercion threatens the autonomy of the patient. It can cause both physical and psychological harm and it as well threatens the perception of healthcare professionals of what entails good treatment and care. Generally, coercion is used to assist the patient. Nevertheless, it might also be utilized to safeguard others or be misapplied by healthcare professionals. Thus, the usage of coercion is an intricate ethical enterprise Psychiatric Mental Health Practices Ethics and Dilemmas.

Ethical and moral issues surrounding the use of coercion

There are several different ethical challenges connected to the usage of coercion.  As Norvoll et al (2018) indicate, coercion entails professionals overriding apparent autonomy of patients, with resultant ethical implications. The serious impacts of coercion on a patient’s liberty and autonomy make coercion an innately value-laden action.  The most significant justification for coercion is that it is aimed at promoting the well-being and best interest of the patient. As Hem et al (2018) allege, the usual argument is that coercive care and treatment might improve the health of the patient or that failure of not doing what is viewed as safe or good can cause impairment. Psychiatric Mental Health Practices Ethics and Dilemmas. This line of thinking presumes that a patient’s best inters is thoroughly evaluated and carefully considered when applying coercion.

How to balance between nonmaleficence and beneficence when using coercion is a major ethical dilemma because it entails balancing between inflicting harm(nonmaleficence) and promoting good. For instance, restraints lessen the risk of physical harm to the patient but they have an adverse effect resulting in humiliation, fear, anger, embarrassment, and powerlessness. Practitioners are also faced with the ethical dilemma of balancing between the patient’s best interest and the safety of hospital staff and other patients (Hem et al, 2018). According to Steinert (2017), if practices that restrict liberty, like involuntary detention and inpatient treatment or seclusion becomes essential due to dangerous behavior, there is a likelihood of severe deterioration of psychosocial health. Averting such an outcome may be regarded as acting in the best interest of the patient’s well-being. Therefore, treating a patient against her or his will is justifiable as being beneficent to the patient if the aim is to avert long-term constraint of his freedom and if this restriction isn’t merely a hypothetical possibility Psychiatric Mental Health Practices Ethics and Dilemmas.

An analysis of the ethical issue and its comparison to Indiana state laws and regulations

Legislation exists in the majority of states to allow for coercion and involuntary treatment of individuals who are considered to be ill and at danger. The civil commitment laws are a mechanism to coerce a person to undergo outpatient treatment of psychiatric hospitalization. AS Cautin and Lilienfeld (2015) assert, civil commitment might transpire only after a court determines that a person is suffering from a statutorily needed level of mental condition and probably associated conditions.  Typically, a court orders civil commitment when the involved person is unable to voluntarily consent to treatment. Psychiatric Mental Health Practices Ethics and Dilemmas. Like other states, Indiana has civil commitment laws that determine the criterion establishing when involuntary care or treatment is suitable severely mentally ill patients who cannot voluntarily seek care. Indiana state laws permit for inpatient treatment and assisted outpatient treatment.

Ethical decision process

As a PMHNP, I might address the ethical dilemma of the use of coercion by evaluating the patient’s decisional capacity and the best interest of the patient. If the capacity of the patient to make rational choices is hindered, I may respect the autonomy of the patient by involving his relatives to make decisions on behalf of the patient or offer any pertinent information that they possess about the possible preferences of the patient. As Baruth and Lapid (2017) allege, discussions with healthcare team and family are key in making a determination of patient values that apprise medical decision making. Information from other healthcare professionals and family are useful in supporting conclusions when establishing capacity, and can also be valuable to a proxy or surrogate decisionmaker when the patient is considered to not to have decisional capacity. Psychiatric Mental Health Practices Ethics and Dilemmas.

 

References

Baruth, J., & Lapid, N. (2017) Influence of Psychiatric Symptoms on Decisional Capacity in Treatment Refusal.
AMA Journal of Ethics,
19(5): 416-425.

Cautin, R., & Lilienfeld, S.  (2015). The Encyclopedia of Clinical Psychology, 5Volume Set. New York:  John Wiley &  Sons

Hem, M., Gjerberg, E., Husum, T., & Pedersen, R. (2018). Ethical Challenges when using coercion in mental healthcare: a systematic literature review.
Nursing Ethics
, 25(1): 92-110.

Norvoll, R., & Hem, M., Pedersen, R. (2016). The Role of Ethics in Reducing and Improving the Quality of Coercion in Mental Health Care.
HEC Forum
, 29(1): 59-74.

Steinert, T.  (2017). Ethics of Coercive Treatment and Misuse of Psychiatry.
Psychiatric Services,
68(3): 291-294. Psychiatric Mental Health Practices Ethics and Dilemmas.