Assignment: Practicum-Week 8 Journal Entry
Assignment: Practicum-Week 8 Journal Entry
Schizophrenia refers to a severe and chronic mental disorder that changes the behaviors, feelings, and thoughts of a person (Kendler, 2017). The disease makes a patient lose touch with reality. The disorder was seen in a patient managed during week 8 practicum. The purpose of this paper is to, therefore, describe the pertinent history of the patient, justify the diagnosis done using DSM-5 criteria, explain whether existential-humanistic therapy can be used to manage the patient and the expected outcomes and offer the legal and ethical considerations when managing schizophrenic patients. The paper will also outline the clinical supervision experience.
Assignment Part A: Practicum – Week 8 Journal Entry
Client’s Pertinent History
The client is a 33 years old female who was brought in by the police due to aggression and agitation. She was taken from NPC after receiving Haldol, Ativan and Benadryl injection. It was reported that she is not compliant with her medication. The police reported that she claimed to be followed by several men who were trying to attack prompting her aggressiveness to herself and others. The patient reported she was very tired but refused to answer any other question and left. From her medical record, she has a history of violence. The record indicated that she had no history of drug abuse but she was homeless. The patient was withdrawn, irritable and with a depressed mood. She was paranoid and did not answer about suicidal ideation. The patient currently is on olanzapine, fluphenazine and benztropine oral.
The patient is suffering from paranoid schizophrenia DSM-5 295.90 (F20.9). According to DSM-5 criteria, one is diagnosed with schizophrenia if they show symptoms like delusions, hallucinations, disorganized speech, catatonic behavior and negative symptoms like affective flattening, alogia or avolition (Kendler, 2017). The patient also has to show social or occupational dysfunction, continuous signs of disturbance that persist for at least 6 months. The disease is also confirmed when one rules out schizoaffective disorder, major depression, and bipolar disorder. The use of the substances has also to be ruled out for the disorder to be confirmed. The current patient has hallucination, catatonic behavior and affective flattening. She has social dysfunction and lacks a drug abuse history.
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Existential-humanistic therapy refers to a therapy that focuses on ideas of personal responsibility and individual freedom (Eneman et
al., 2019). The sessions helps one realize their reason for existence as well as the free will to make personal decisions about life. It is applicable when managing schizophrenia. It offers a therapist a chance to acknowledge the patient’s problem and show a deep understanding of their issue by gathering data on what has caused the mental challenge. The obtained data acts as a guide which the therapist follow to help the patient regain their self-esteem, achieve personal growth and change into a new untroubled being (Eneman et al., 2019).
The therapy also enables one to offer sympathetic and constructive feedback in a friendly manner. It also helps in establishing a similar interest that enhances the client/ therapist therapeutic relationship and makes it easier to converse (Hoffman, Vallejos, Cleare-Hoffman & Rubin, 2015). It also helps in creating activity schedules that keep the patient organized. The therapy also outlines some behavioral assignments and stress management skills that helps the patient to be self-sufficient, gradually cut down medications and eventually independent of drug intake. The therapy then trains the patient to deal with surroundings, people and social life as well as gaining self-esteem and overcoming the fear of relapse. Lastly, the patient is tested for stress and coping abilities and daily plan constructed in line with the patient needs and requirements.
For the patient in question, the therapy will help in understanding the cause of the problem. Once the problem is determined, the best plan will be set to help her regain self-esteem, achieve personal growth and change into a new untroubled being. The patient has medication compliance issues and thus behavioral assignments and stress management skills will be taught to help her cut down medication and be independent of drug intake. She will then be helped to get home care and then trained on how to handle fear of relapse.
Legal and Ethical Consideration
When treating patients with schizophrenia ethics are important. First one has to understand that they can strengthen the therapeutic relationship with the client if one withholds information that may make the patient worse (Kong, Dunn & Parker, 2017). Autonomy should be respected by adopting the patient values, beliefs and perception into the plan of care and any decision made should reduce harm and maximize the benefits. For instance, the current patient is to undergo existential-humanistic therapy to help her deal with drug compliance, enhance self-esteem and help her cope with her condition.
In terms of practicum supervision, it began in February 2019. My supervisor has been instrumental because he has enhanced my professional functioning and monitors the quality of professional services I offer to clients. Every week I have to clear 16 hours of practicum thus I have been having 1.6 hours per week of face-to-face supervision. The session occurs twice per week and during the sessions, I have managed to learn various psychotherapy approaches as well as the need to create a therapeutic relationship with a patient to enhance treatment. My preceptor also has been a supportive pillar during the practicum. He has answered any questions I have on diagnosing patients, corrected where I have missed a point. He has also taught the need to guide the client during therapy sessions as a way of building self-esteem, reducing anxiety and strengthening coping mechanisms. My role during the session is to document client information which has enhanced the knowledge in recording the pertinent history of the patient and developing differential diagnosis from the same. All the accrued information will be instrumental in my future career and I am better at handling patients in my normal placement duties.