PSYCHOTHERAPY FOR ADDICTIVE DISORDERS

PSYCHOTHERAPY FOR ADDICTIVE DISORDERS

PSYCHOTHERAPY FOR ADDICTIVE DISORDERS

Assignment 2: Practicum – Week 8 Journal Entry

Part 1

Select a client whom you observed or counseled this week (other than the client used for this week’s Discussion). Then, address the following in your Practicum Journal:

Describe the client and identify any pertinent history or medical information, including prescribed medications.

Using the DSM-5, explain and justify your diagnosis for this client.

Explain whether existential-humanistic therapy would be beneficial with this client. Include expected outcomes based on this therapeutic approach.

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

Support your approach with evidence-based literature.

Part 2

Reflect on your clinical supervision experiences. Then, address the following in your Practicum Journal.

How often are you receiving clinical supervision from your preceptor?

What are the sessions like?

What is the preceptor bringing to your attention?

How are you translating these sessions to your clinical practice?

NOTE: PLEASE SEE AND PAY ATTENTION TO THE ATTACHED Practicum Journal Template AND JOURNAL SAMPLE (TIME LOG & JOURNAL ENTRIES) FOR WRITING THIS ASSIGNMENT…..ALSO FOR THE TIME LOG AND JOURNAL ENTRIES, JUST MAKE UP A REASONABLE INFORMATION AND CLIENT INFORMATION IN MENTAL HEALTH NURSING AND INCLUDE REFERENCES

Learning Resources

Required Readings

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.

Chapter 10, “Humanistic-Existential and Solution-Focused Approaches to

Psychotherapy” (Review pp. 369–406)

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

Nagy, T. F. (2011). Ethics in psychotherapy. In Essential ethics for psychologists: A primer for understanding and mastering core issues (pp. 185–198). Washington, DC:

American Psychological Association. doi:10.1037/12345-010

November 4, 2017

PSYCHOTHERAPY FOR ADDICTIVE DISORDERS 2

Time Log

Week

Dates

Times

Total Hours for This Time Frame

Activities/Comments

Learning Objective(s) Addressed

6

10/02/ 2017

8am- 6pm

10 hrs

Admissions, evaluations, follow-ups, medications management

Diagnostic and statistical manual of mental disorders (DSM-5) was utilized, Motivational Enhancement Therapy (MET) was used, Contingency Management (CM) & Cognitive Behavioral Therapy

6

10/05/ 2017

10am- 6am

8 hrs

Follow-ups, evaluations medications management, Discharge instructions.

Diagnostic and statistical manual of mental disorders (DSM-5) was utilized, Motivational Enhancement Therapy (MET) was used, Contingency Management (CM) & Cognitive Behavioral Therapy, discharged

Total Hours Completed: 18

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The Client

The client in this practicum was a 24-year-old female who was in her freshman year in College. The client arrived to the clinic due to her concern about are alcohol use, and how drinking affects her health. He has recently noticed changes in her sleeping patterns, family problems due to her obscure drinking habit, frequent headaches, recent trauma, and motor vehicle accidents that led to the death of her grandparents. During an integral therapy session with the 24-year-old client, at first, the client appeared excited. Per the client’s statement, “So, help me get this out”. My response to her was, since you are exhausted of hassles and demand a life without troubles, but on the other hand, you were advice to come this clinic due to the of the drink-driving charges, and your employer has threatened to terminate you if you are once found to be drunk at job. I am contemplating how continuing in this manner with alcohol will help keep your life problem-free.

Diagnosis

During the diagnosis process, the primary responsibility of the counselor is to respect the dignity and promote the welfare of clients. Using DSM-5 was useful in this mental diagnosis as it provides standards for clinicians able to communicate about psychiatric disorders as a result of substance addiction (Fisher, 2016). Basing on the client’s complaints which is related to DSM-5 Category Substance Related and Addictive Disorders, the client presents with symptoms of Substance Related and Addictive Disorders based on the classifications of the Diagnostic and Statistical Manual of Mental Heal Disorders 5th Ed. (DSM-5) (Wheeler, 2014). The client have had several episodes of slurred speech, poor balance, dizziness, headache and nausea, was recently admitted to the hospital for alcohol intoxication. The most common symptoms of alcohol

PSYCHOTHERAPY FOR ADDICTIVE DISORDERS 4

intoxication are slurred speech, impaired coordination, trouble with balance and walking, involuntary eye movement, impaired attention or memory and loss of consciousness (American Psychiatric Association, 2013). Intoxicated individuals may also experience nausea, vomiting, vertigo, headache and present with bloodshot eyes (Vonghia, et al., 2008). However, it is crucial to know that the DSM-5 also explains that alcohol intoxication can produce problematic psychological or behavioral changes such as impaired judgment, unusual mood changes, inappropriate sexual behavior, and aggression (Wheeler, 2014).

Effectiveness of Motivational interviewing to the client

As a nurse practitioner student, I was at lookout for motivational statements the client may make. These may recognize the problem in a cognitive way, however during the therapy, she expressed some optimistic stance when she said, “I’m pretty sure that I can do it if I try.” Recent research has proven that psychoanalytically qualified general practitioner operating in rehabilitation programs for addictive patients has hypothesized that integrating psychoanalysis practices to dependence management would improve the results (American Psychiatric Association, 2013). Clinical studies have shown a consistent improvement when psychotherapy programs are efficiently applied. It has been helpful to patients with addictive disorders, with an effect size ranging from mild to moderate. The baseline of starting this programs for addictive patients is to review their background information on psychotherapy and drug counseling presentation.

Moreover, Motivational Enhancement Therapy (MET) strives to induce from clients their own enthusiasm for change and to combine an individual decision and strategy to adjustment

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(Wheeler, 2014). This therapy program is used by experts entirely centered onto patients with planned directions. It is based on principles of cognitive and social psychology. Work of the counselor is to elicit and consolidate the client’s intrinsic motivations for change. Most of the substance dependence according to many research has identified a range of behavioral therapies that have been recorded to be most effective. This review highlights the roles played by behavioral treatments discussed below as compared to pharmacotherapies. Behavioral therapies that will be considered are the family and interpersonal approaches, clinical management, coping skills management, as well as motivational interviews.

Behavioral approaches such as contingency management (CM) are based on the formed standards of behavioral pharmacology and operant training and therefore have a founding principle that behaviors that are strengthened are more expected to be repetitive (Albrecht et al., 2017). Behavioral approaches help people engage in drug abuse therapies, provide incentives for the patients to remain abstinent, modify their attitudes and behavior related to addiction.

Contingency Management (CM) as a therapy functions under the conviction that substance use is significantly influenced by societal, environmental, and biological causes. Clinicians who are using psychotherapy treatment method make the patient move away from substance use so as to enter into a recovery process (Wheeler, 2014). The recovering process must face a much-stressed relation, poor financial conditions, and ill mental and physical health consequential from the drug misuse.

Another form of therapy is the cognitive behavioral therapy which works under the principle of non-twelve phase recovery plan which focuses on the notion that overcoming dependence and maintaining long-term sobriety is based on abandoning the unhealthy behaviors

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and moving on without considering the illicit substances to initiate positive changes (American Psychiatric Association, 2013).

Legal and Ethical Implications

The legal and ethical considerations a counselor has to maintain is to ensure there are proper and safe records keeping and documentation (Fisher, 2016). A counselor must have an informed consent in the counseling relationship to safeguard the welfare of the clients. A counselor must avoid imposing harm and values to the clients especially beliefs and behaviors. In essence maintaining and managing boundaries and professional relationships is the primary goal of ensuring there is the protection of client’s rights and exploitation from the counselors. Following the APA ethics of measures will help the counselor maintain the confidentiality of the client which promotes the therapeutic association and reveals the professional’s respect for the privacy and self-respect of clients.

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References

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

Albrecht, U., Kirschner, N. E., & Grusser, S. M. (2007). Diagnostic instruments for behavioral addiction: An overview. German Medical Science Psycho-Social-Medicine, 4, 1–11. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2736529/

Fisher, M. A. (2016). The ethical ABCs of conditional confidentiality. In Confidentiality limits in psychotherapy: Ethics checklists for mental health professionals (pp. 13–25). Washington, DC: American Psychological Association. Doi: 10.1037/14860-002

Vonghia, L., Leggio, L., Ferrulli, A., Bertini, M., Gasbarrini, G. & Addolorato, G. (2008). Acute alcohol intoxication. European Journal of Internal Medicine. 19(8): 561-567

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.