Explain why you suggest this alternative and support your suggestion
Respond to the colleagues 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.
CATHERINE.
Initial Post: Psychotherapeutic Approaches to Group Therapy with Children and Adolescents
COLLAPSE
Psychotherapeutic Approaches to Group Therapy with Children and Adolescents
The objective of this discussion post is to evaluate the client in the case study: I am Feeling Like I’m Going Crazy. The most likely DSM-5 diagnosis will be presented, along with the criteria for this diagnosis. Group therapeutic approaches will be discussed, as well as expected outcomes. Legal and ethical implications regarding the counseling of children and adolescent clients with psychiatric disorders will be presented.
DSM-5 Diagnosis and Criteria for Diagnosis
After the review of the case study presented, the DSM-5 diagnosis made by the author is Major Depressive Disorder.
Five or more of the following symptoms must be present during the same two-week period, and is a change from the client’s previous situation. At least one of the symptoms is (1) depressed mood or (2) anhedonia. Symptoms include:
Depressed mood most of the day, almost every day, as exhibited by emotional behavior or observation by others. In adolescents, this may present as an irritable mood.
Anhedonia.
Significant weight loss or weight gain.
Insomnia or hypersomnia.
Psychomotor agitation or retardation.
Fatigue or loss of energy nearly every day.
Feelings of worthlessness or inappropriate guilt.
Diminished ability to think or concentrate.
Recurrent thoughts of death, suicidal ideation or attempt (American Psychiatric Association, 2013).
The client is a 15-year-old pansexual male of Native American descent, who lives at home with his mother and his little brother. He has a history of two suicide attempts, the last one being two months ago, both times overdosing on Tylenol. He began self-injurious behavior 10 months ago, intentionally cutting himself with a razor. He states that he is depressed and has low self-esteem. He states that he is cutting himself because he feels abandoned by his boyfriend. He is having difficulty with onset of sleep, and reports a low energy level. He has lost interest in school and is failing some of his classes. He quit band because he no longer has any interest in it. He has lost his friends due to interpersonal conflict. He exhibits a mild restriction in his emotional behavior. His mother states that he is disrespectful, and exhibits irritability in his behavior towards her. His behaviors and symptoms are not applicable to any substance use or comorbidities.
Group Therapeutic Approaches and Expected Outcomes
There are multiple approaches to therapy designed to create positive changes for the adolescent client and their families. A combination of therapeutic approaches my be used. Positive expected outcomes are anticipated. Sometimes there is a necessity to provide medication intervention. Prior to the client being admitted to the hospital, a panel of lab work is done including a CBC, CMP, PT/INR, TSH, and urine for abuse. If it is determined that there are no comorbidities present, the client may then be admitted to an age appropriate behavioral care unit.
Therapeutic approaches that might be utilized for this adolescent client include:
Acceptance and Commitment Therapy (ACT) – helps the adolescent to understand and accept their inner emotions. Expected outcome is for the client to have a deeper understanding of their emotional struggles, and to move forward in life in a positive manner.
Cognitive Behavioral Therapy (CBT) – helps the adolescents to improve their moods, behavior, and anxiety by addressing confused or distorted patterns of thinking. During CBT, the client learns to identify harmful thought patterns. Expectations are that negative thoughts can be replaced by more appropriate feelings and behaviors. CBT is helpful for depression and anxiety, and has been developed to help clients with traumatic experiences.
Dialectical Behavioral Therapy (DBT) – is used to treat older adolescents that experience suicidal thoughts and behaviors, those who self-harm, or have Borderline Personality Disorder. Expected outcomes include taking responsibility for one’s problems and helps the client pay attention to how conflict and intense negative emotions are dealt with.
Family Therapy – focuses on how the family deals with difficulties. Expectations are better communication between family members, and better individual support and improved education regarding the client’s problems.
Mentalization Based Therapy (MBT) – involves working with adolescents who struggle with who they are. Expectations are that the individual will grow into a healthy adult.
Psychodynamic Psychotherapy – influences the understanding of issues that motivate and influence the client’s behavior, thoughts, and feelings. Expectations are that the client’s behavior and feelings will improve once their inner struggles are addressed.
Supportive Therapy – gives adolescents support in their lives to cope with stress and identify unhelpful behaviors. Expectations are improved self-esteem (American Academy of Child and Adolescent Psychiatry, 2019).
Legal and Ethical Implications
Legal and ethical implications for this patient are complex. The parent gives consent for treatment of the minor and confidential information will only be shared with the parent who has legal custody if there is a mandate to disclose information. This would include a framework for disclosure and is discussed at the onset of treatment. A client’s serious threat to harm themselves or someone else would be disclosed to the parent. The therapist would always include the client in those conversations. The therapist may feel that revealing information to a parent could harm the client or be destructive to the treatment. A decision of refusal to disclose may be legally supported (Behnke & Warner, 2002). Social and cultural diversity for this gay, Native American client, include knowledge of language that has been historically discriminatory to the LGBTQ individual, understanding the diversity of the population and social and cultural underpinnings to mental health issues, and recognition of the acceptance of the Native American community to the “Two Spirit” sexually diverse individual (Harper et al., 2013) (Lumen Learning website, 2014).
References
American Academy of Child and Adolescent Psychiatry. (2019). https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Psychotherapies-For-Children-And-Adolescents-086.aspx
American Psychiatric Association. (2013). Major depressive disorder. In Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Behnke, S. H., & Warner, E. (2002). Confidentiality in the treatment of adolescents. American Psychological Association, 33(March), 44-47. Retrieved from https://www.apa.org/monitor/mar02/confidentiality
Harper, A., Finnerty, P., Martinez, M., Brace, A., Crethar, H. C., & Loos, B. (2013). Association for lesbian gay bisexual and transgender issues in counseling competencies for counseling with lesbian gay bisexual queer questioning intersex and ally individuals. Journal of LGBT Issues in Counseling, 7, 2-43. https://doi.org/DOI: 10.1080/15538605.2013.755444
Lumen Learning website. (2014). courses.lumenlearning.com/culturalanthropology/chapter/two-spirit/
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