Practicum – Assessing Client Family Progress
Practicum – Assessing Client Family Progress
Part 1: Progress Note
The client admits that both psycho-educational and interpersonal therapies have been efficient considering his ability to manage his anger and depressive episodes. He reports that the family therapy has enabled him to change the perception of his diagnosis and drug regimen despite his inability to resume work. However, the client is concerned about the performance of his son who he thinks has been affected by his reckless behavior in the past. At 14 years and attending school, he believes that the boy may not benefit from the therapy. He also feels the same for his wife who is always busy at school or performing house chores in the evening. All members of his family are supposed to attend all therapy sessions for optimal outcomes. Consequently, he feels that he is presently not benefiting from the family therapy sessions since he can only benefit from supportive therapy considering the extent of his illness.
Mr. J.K maintained calmness throughout the sessions. He made sound remarks to approve the strategies aimed at improving his condition. Despite the few challenges during the meeting, the client demonstrated satisfaction and a willingness to continue with the therapy at the end. He claimed that he was prepared enough to overcome attempts to withdraw from the interventions. Of the three members of the family, he was the only one that attended all the sessions. His wife missed three, while the son missed five.
In as much as the client presented a few episodes of weariness and sadness during the family therapy, the review of the system, physical evaluation, and the mental status exam did not reveal any abnormalities. The same can be said of the other members of his family who had been dressed appropriately for the day and session. They were all oriented to time, place and person. The patient presents to the session with alcohol use disorder and admits he uses tobacco and marijuana. He resorted to abusing alcohol after being diagnosed with stage two lung cancer. At the time the diagnosis was made, Mr. J.K felt that only alcohol consumption would enable him to overcome the grief and anxiety of having to live with the deadly disease. The support from his family has been insignificant, primarily due to the busy schedule of his wife as well as by the fact that she has suffered depression in recent months. She attributes the depression to her husband’s illness, alcohol consumption the burden of having to support the family single-handedly.
There is a need for the therapist to consider making changes to his schedule to ensure that all members of this family benefit from the sessions. Becvar & Becvar, (2017), share the same assertions in their article. The client’s wife who has reportedly suffered from depression will require to attend all the family therapy sessions so that she may find better ways of supporting her son and husband who has been reduced to supportive and palliative care by his illness. The therapy sessions also need to take into consideration the school timetable to enable the 14-year old boy to attend them. He has been affected adversely by the current illnesses that both his parents are suffering from in the last few years. The therapist should prescribe antipsychotics for the client’s wife to make sure that she can put her moods under control. However, there is a need for the family to make sure that they progress with the interpersonal and psychoeducation therapy for at least three weeks for better outcomes (Weitz et al., 2015). There is an immense need for each one of them to change their thoughts and general perception about life and resume the activities of daily living.
Part 2: Privileged Note
Mr. J.K provides a perfect example of a person that is frustrated in life due to his reckless behavior. His excessive intake of alcohol has not only resulted in being sacked by four different employers but has also been arraigned in court for dangerous driving. Besides diagnosis of stage 3 lung cancer and spouse depression episodes complicates the family. The mental status examination does not reveal any incidences of him being suicidal or homicidal, but the actions make a justification. The failure to put in place therapeutic interventions for this patient may result in the loss of his life through reckless actions. Had the therapist visited the family a bit earlier, the family would not be experiencing the challenges they are in at present. The client would not have resorted to consuming alcohol in excess amounts as a strategy to overcome the grief and sorrow that comes with a lung cancer diagnosis.
The information presented in the privilege note could not be displayed in the progress note because of the HIPAA regulations concerning privacy and confidentiality Weitz et al., 2015). This information is intended for use by a therapist alone and no other party. It is not uncommon for my preceptor to use the privilege notes to preserve the information on the experiences of those with psychiatric conditions. This information guides the development of strategies that guide the treatment of these disorders (American Psychiatric Association, 2013).
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Arlington: American Psychiatric Publishing.
Becvar, R. J., & Becvar, D. S. (2017). Systems theory and family therapy: A primer. Rowman & Littlefield.
Weitz, E. S., Hollon, S. D., Twisk, J., Van Straten, A., Huibers, M. J., David, D., … & Faramarzi, M. (2015). Baseline depression severity as moderator of depression outcomes between cognitive behavioral therapy vs. pharmacotherapy: an individual patient data meta-analysis. JAMA Psychiatry, 72(11), 1102-1109.