Explain why you suggest this alternative and support your suggestion

Respond to the discussion below by providing one alternative therapeutic approach. Explain why you suggest this alternative and support your suggestion with evidence-based literature and/or your own experiences with clients.

Stephanie

COLLAPSE

DSM-5 diagnosis

The 15-year old male meets the criteria for adjustment disorder (AD). According to the DSM-5, AD requires the development of emotional or behavioral symptoms in response to an identifiable psychosocial stressor, either chronic or acute, within three months of the stressor (Bauman, & Belous, 2016). The symptoms must be clinically significant and represent distress out of proportion to the severity or intensity of the stressor causing substantial impairment in social, occupational, or other functioning (Bauman, & Belous, 2016). The symptoms must also not meet the criteria for any other disorder or do not represent normal bereavement (American Psychiatric Association, 2013). The 15-year old’s current stressor is feeling abandoned by his boyfriend and is not emotionally supported; therefore, he cannot cope and resorts to self-harm. His thoughts are consumed with distress about peer relationships where he recently lost close friends due to conflict; thus, he has lost interest in things he used to like, and his grades have been slipping in school. These stressors make it hard for him to adjust to the situation; therefore, he feels like he is going crazy and uses self-harm to deal with the stress. People with AD are associated with an increased risk of suicide attempts and complete suicide (American Psychiatric Association, 2013). This patient has a history of two prior suicide attempts. AD symptoms overlap with depression and anxiety symptoms; therefore, AD is often misdiagnosed (Bauman, & Belous, 2016).

Group therapeutic approaches

Cognitive-behavioral therapy group has been recommended as first-line treatment for depression (Ruesch, Helmes, & Bengel, 2015). Cognitive-behavioral therapy can help the patient in a group with AD to combat the depression, which is contributing to the low mood, low self-esteem, which is causing the individual to be unable to adapt to a stressful situation. A study showed that cognitive-behavioral therapy effectively reduced depression and anxiety symptoms in patients with somatic diseases and adjustment disorder (Ruesch, et al., 2015). Another therapeutic group approach to AD could be mindfulness, mediation, and relaxation group. Mindfulness-based therapies decrease depressive symptoms, anxiety, and reduce psychological distress, which can be accessible to a larger group of patients (Sundquist, et al., 2015). Also, mindfulness is associated with less physical illnesses, improving well-being, increasing self-control, decreasing negative affect, improve concentration, and working memory (Sundquist, et al., 2015). Therefore, working on mindfulness with AD can help the patient to be able to deal with their emotions and stress in an appropriate way rather than self-harm.

Expected outcomes for the client

Using cognitive-behavioral group therapy or mindfulness-based group therapy, the excepted outcome for this patient would be for him to reduce his stress; therefore, he can deal with his emotional state and reduce self-harm. Both therapies would improve the patient’s psychological symptoms, quality of life and use the skills to reduce symptoms of depression, anxiety, or stress (Sundquist, et al., 2015). As a result of adjusting to stress, the expected outcome would be the patient would be able to start to repair his relationship with his mother and not be stressed out about peer relationships, improving his quality of life all around.

Legal and ethical implications

Legal and ethical issues can arise in any type of psychotherapy; it is vital to know your state’s laws in your practice to avoid ethical dilemmas. Parents’ involvement in psychotherapy often blurs therapeutic boundaries and issues related to confidentiality (de Sousa, 2010). As professionals, we are to obey the ethical code that supports quality care to properly treat the child and adolescent’s psychiatric problem (de Sousa, 2010). Therefore, the patient needs to know when confidentiality needs to be broken and what information can be released to their parents or guardian. It is crucial to be our best to do no to harm, promote autonomy, and respect their confidentiality the best we can.

Summary

AD is a maladaptive emotional or behavioral response to an identifiable psychosocial stressor (O’Donnell, et al., 2019). It is often overlooked due to the fact it has overlapping symptoms from depression and general anxiety disorder. Cognitive-behavioral therapy and mindfulness-based group therapies can reduce the symptoms of AD, which can improve the patient’s quality of life. When dealing with children and adolescents in psychotherapy, it is essential to provide them with the best care possible.

References

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

Bauman, M. L., & Belous, C. K. (2016). Using Symbolic-Experiential Family Therapy to Treat Adjustment Disorder: A Case Study. American Journal of Family Therapy, 44(5), 285–300. https://doi-org.ezp.waldenulibrary.org/10.1080/01926187.2016.1231599

de Sousa, A. (2010). Ethical issues in child and adolescent psychotherapy: a clinical review. Indian Journal of Medical Ethics, 7(3), 157–161.

O’Donnell, M. L., Agathos, J. A., Metcalf, O., Gibson, K., & Lau, W. (2019). Adjustment Disorder: Current Developments and Future Directions. International Journal of Environmental Research and Public Health, 16(14). https://doi-org.ezp.waldenulibrary.org/10.3390/ijerph16142537

Ruesch, M., Helmes, A. W., & Bengel, J. (2015). Immediate help through group therapy for patients with somatic diseases and depressive or adjustment disorders in outpatient care: study protocol for a randomized controlled trial. Trials, 16, 287. https://doi-org.ezp.waldenulibrary.org/10.1186/s13063-015-0801-3

Sundquist, J., Lilja, Å., Palmér, K., Memon, A. A., Wang, X., Johansson, L. M., & Sundquist, K. (2015). Mindfulness group therapy in primary care patients with depression, anxiety and stress and adjustment disorders: Randomised controlled trial. The British Journal of Psychiatry, 206(2), 128–135. https://doi-org.ezp.waldenulibrary.org/10.1192/bjp.bp.114.150243