American Psychological Association
Assessment of client
1. Participation level: ❑xActive/eager ❑Variable ❑Only responsive ❑Minimal ❑Withdrawn
2. Participation quality: ❑Expected ❑Supportive ❑XSharing ❑Attentive ❑Intrusive
❑Monopolizing ❑Resistant ❑Other: _____________________________________
3. Mood: ❑Normal ❑X Anxious ❑Depressed ❑Angry ❑Euphoric ❑Other: _______________
4. Affect: ❑XNormal ❑Intense ❑Blunted ❑Inappropriate ❑Labile ❑Other: Tearful at times
5. Mental status: ❑XNormal ❑Lack awareness ❑Memory problems ❑Disoriented ❑Confused
❑Disorganized ❑Vigilant ❑Delusions ❑Hallucinations ❑Other:__________________
6. Suicide/violence risk: ❑XAlmost none ❑Ideation ❑Threat ❑Rehearsal ❑Gesture ❑Attempt
7. Change in stressors: ❑XLess severe/fewer ❑Different stressors ❑More/more severe ❑Chronic
8. Change in coping ability/skills: ❑No change ❑XImproved ❑Less able ❑Much less able
9. Change in symptoms: ❑XSame ❑Less severe ❑Resolved ❑More severe ❑Much worse
Journal Entry
This journal entry aims to provide documentation of two adolescent clients who have been receiving group psychotherapy at my practicum site office. The entry will include a description, diagnosis, and therapeutic approach for each client. Finally, the entry will also analyze the legal and ethical implications when treating adolescent clients.
Client #1
A 15-year-old white female named K.J was brought to the office by her parents for counseling). The parents report a good performance of the client in her junior high school. She reports increased anxiety related to a dysfunctional relationship with her mother as well as increased school work. She reports worry about her relationship with the mother, citing that her mother does not love her. She reports poor concentration, memory loss, and sleep problems. She has no history of childhood trauma or abuse.
Mental Status Examination: The client is A&O *3 with no signs of apparent distress. She is well-groomed, and her speech is within the normal limits. She appears in an anxious mood and has a linear and logical thought process. Her thought content is without obsession, paranoia, or delusion. Her cognition, judgment, and insight are intact.
Diagnostic criteria
The primary diagnosis for this client is a generalized anxiety disorder. According to DSM 5, adolescents diagnosed with GAD must present worry about many things such as past behaviors, future events, family matters, social acceptance, and poor school performance (American Psychiatric Association, 2013). The client reported reduced concentration at school due to constant worry about her relationship with the mother.
Client #2
A 16-year-old white female named G.G was brought to the office by her mother, concerned about her anxiety and mood. The client reports a feeling of being overwhelmed at school and worsening symptoms of depression. In the past several weeks, the client has been experiencing mood fluctuations. During the interview, the client has experienced a depressed mood, lack of interests, fatigue, hypersomnia, irritability, and worthlessness. She reports that she has been experiencing some difficulties understanding the instructions at school, and she experiences some anxiety while preparing to join the college. There is no history of suicidal attempts or psychiatric hospitalization. She denies delusion, paranoia, hallucinations, or emotional abuse.
Diagnostic Criteria
Most adolescents often report mood instability and complaints. Youths have high demands, including their expectations to change their college, ending or standing new friendships, or moving away from their homes (Crocq, 2017). These changes made me not give the client a mood disorder diagnosis due to life changes, demands, and stressors. She reports that she started experiencing mood changes some three weeks ago. Thus, the primary disorder for this client would be Adjustment Disorder with Depressed Mood. This is a behavioral or emotional reaction to a change in a person’s life or a stressful event. Based on DSM-5, the disorder is marked by reduced self-esteem, avoidance, intense feeling of anxiety, and lack of coping skills American (Psychiatric Association, 2013).
Therapy of Choice
Cognitive behavior therapy (CBT) is one of the talk therapies that have proven efficacy in helping children and adolescents to deal with anxiety by altering their thinking patterns. Most children and parents prefer to try CBT rather than medications such as antidepressants. This therapeutic approach addresses distortions and negative patterns in the way perceive the world. The cognitive part of the therapy analyzes how negative cognitions or thoughts contribute to anxiety, while behavior therapy explores how the clients reach and behave in situations that trigger anxiety. CBT’s main assumption is that our thinking affects how we feel and not the situation (Kaczkurkin & Foa, 2015). First, the clients should identify their negative thoughts, challenge the negative thoughts, and replace negative thoughts with real thoughts.
Legal and Ethical Implications
There are numerous legal and ethical dilemmas that psychiatric health professionals encounter when providing psychotherapy to adolescents. First, the parent involvement in the psychotherapy may blur concerns related to confidentiality and therapeutic boundaries. It may be challenging for therapists to determine what they should disclose to the parents, including sexual issues, risky behaviors, and drug use. In essence, the protection of the privacy of an adolescent may be challenging for the professional. Also, the clients must have sufficient trust with the professional to enable them to disclose sensitive information without feeling like with are being judged or there is a violation of their privacy (Zelviene & Kazlauskas, 2018). Therefore, the therapist needs to establish a strong rapport with the child and the family to meet the therapeutic goals.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Washington, DC: Author.
Crocq, M. A. (2017). The history of generalized anxiety disorder as a diagnostic category. Dialogues in clinical neuroscience, 19(2), 107.
Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues in clinical neuroscience, 17(3), 337–346.
Zelviene, P., & Kazlauskas, E. (2018). Adjustment disorder: current perspectives. Neuropsychiatric disease and treatment, 14, 375.