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NURS 6650 WEEK 10 Discussion Clinical Supervision Child and Adolescent Group
The patient I was focusing on was not responding to any of his treatment plan we prepared. The young man was 18-year-old white male who has a history (F31.31) bipolar with depression and (F10.1) alcohol abuse (American Psychiatric Association (APA), 2013). He lives with his father and stepmother whom his father just married 3 months ago. He had 2 other siblings 3 months old stepsister and a brother who is 25 years old who lives in Ohio with his wife. He dropped out of high school in the 10 grade and moved in with his dad. He was brought to the medical facility due to excessive alcohol abuse and bizarre behavior. The young man refused to participate in group therapy. He would not response to general questions or any activity lessons. He was very disrespectful to the other patient in therapy. He was constantly getting into argument and instigating flights with others. During the session he was invaded other patient space and was redirected several times by medical staff. He presents as anger, irritated by others and withdrawn. The only thing he would say to express himself is “You’re not like me and you don’t know me”.
Group therapy starts at 1030am and end at 1130 before lunch time. The age group was between 17 years old to 20 years old both male and female patients present. The group was made up of 10 patients along with1 mental health tech, social worker and me. He stated privately during his intake “he was not happy with living with his stepmother”. He drinks to forget his problems. The young man was escorted out of the group therapy because he continued to be aggressive to others and he was causing the other in the group to become agitated resulting in physical altercation to erupt. The patient denied suicidal ideations or attempts. The patient denied any past medical history and psychiatric history including past hospitalization. The patient also denied any family medical history and described his father as “healthy.” The patient reports that he drinks every day starting when he wakes up. He drinks about of one to two bottle of vodka a day. We administered the PHQ-(2)-(9) assessment where he scored 13 indicating moderate depression. The doctor was notified of the behaviors during therapy and new order placed.
My therapeutic approach with this patient started out to be psychodynamic and group cognitive-behavioral therapy (CBT). We use “group work to help each patient become aware of there inner feels and needs” (Wheeler, 2014 p.410). CBT was attempted by trying to help the young man view his inner feeling and emotions along with identifying the trigger that influence the behaviors (Wheeler, 2014 p.410). CBT is a short-term psychotherapy which should be seen within 6 to 11 sessions where the patient participates in the therapy. We used psychoeducation to create some structure in the group according to the book of Wheeler (2014) “psychoeducational groups can be directed by nurses, social worker and license professional counselor (LPC).
The reason I think that group CBT was not helpful to the patient is mainly because he would not participate in group but would open up to one on one counseling at times. My treatment plan was to increase more one on one therapy and slowly implement group therapy with the same participates within the same age group. According to the video with Microtraining Associates (2009) this patient follows the typical “conflict of interpersonal relationship, this mean we had find another approach by using group therapy in a way to get more of the patient peers involved with the discussion”. This helped the patient to relate to the others in the group which allowed the patient to feel better with the acceptance to modify his behavior and value what is being expressed from his peers. This therapeutic approach would not look like the adult in the room, is tell him anything but rather he understands it from a selected similar position of his peers.
We used the CBT approach to help this patient to recognize and understand his negative thoughts and feelings in order to ultimately substitute them with positive ones but to help this young adolescent man, we must implement other approaches to help achieve a positive out for the patient. The journey for this client can be achieved but would require a long time with individual, group therapy along with substance abuse counseling to confront the under lying issues with this patient. Since this patient doesn’t interact with the group it is hindering his progress though group sessions. We notified the doctors and followed up on this patient with referrals for more frequent visits by the psychologist and psychiatric included medication changes to help with improving behaviors.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Washington, DC: Author.
Microtraining Associates (Producer). (2009). Leading groups with adolescents [Video file]. Alexandria,
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