Question

Select a client whom you observed or counseled that suffers from a disorder related to trauma. Then, address the following in your Practicum Journal:

• Describe the client (without violating HIPAA regulations) and identify any pertinent history or medical information, including prescribed medications.
• Using the DSM-5, explain and justify your diagnosis for this client.
• Explain whether any of the therapeutic approaches in this week’s Learning Resources would be effective with this client. Include expected outcomes based on these therapeutic approaches. Support your approach with evidence-based literature.
• Explain any legal and/or ethical implications related to counseling this client.

Answer 1

Description of the client:

Ms. xy 22 years old, was admitted to the hospital for not taking food for two days and neither maintaining personal hygiene nor doing Activities of daily living. While reviewing clinical history, her father revealed that before 6 months she witnessed the murdering of her boyfriend, while both are out for a dating . After the incident, she stopped her Masters degree   and came back to home from hostel. Now nealy 5 months, she is gradually withdrawing from all social / family interactions, neglecting food and personal hygiene, sittting in the room alone for a whole day and screaming some times.

A SPECT scan revealed a very high activity in thalamus, basal ganglia and Cingulate gyrus. This pattern mainly seen in patient's with PTSD.

Prescibed Medication :

* Sertraline( Zoloft ): Antidepressants, Selective serotonin Reuptake inhibitors.

* Prazosin: to reduce nightmares.

* : Anti anxiety medications

2. Diagnosis for the client:

Post traumatic Stress Disorder ( PTSD)

It is a Mental health disorder, characterised by the anxiety, nightmares, flash backs and mental images of any negative incident that triggered the disorder.

According to Diagnostic and Statistical Manual ( DSM), one can be diagnosed as PTSD, if she or he experience a traumatic event:

* witnessed in person the traumatic event

* directly experienced traumatic event

* knowing that someone closed to you is experienced the trauma.

* experiencing the mental images or flashbacks of the traumatic events.

If the problems and after effects are experiencing more than one month and the person's functioning in social, occupational and family setting is impaired significantly, then it can be PTSD.

Ms. XY , directly experienced the traumatic event, she is having anxiety, depression, and repeated flash backs of terrific events. Her family , scial and occupational functioning got impaired.

3. Therapeutic approaches:

Other than Medical management ( described in the first Answer,above), Psychotherapies are greatly helpful for treating PTSD.

* Cognitive therapy: To get rid of Negative cognitions.

* Stress Management training along with relaxation therapy like progressive muscle relaxation,meditation, yoga etc.

* Exposure therapy: to reduce the occurance of flash backs and nightmares. It also includes virtual reality programmes to re- enter the place , where trauma occurred.

Expected outcome:

* Patient will learn to utilise positive copying strategies.

* patient nt will demonstrate relaxation techniques and control of emotions.

* Patient will be able to identify triggers .

* Patient will learn to maintain personal hygiene and Activities of Daily Living

Legal and ethical implications:

* Counsellor should have the required qualifications and practical experience.

* Clinical, legal,ethical issues should be considered.

Mandatory reporting, is essential in case of child abuse, harm to self or harm to others.  

In this case all ready interrogation is going on. So no additional reporting is needed.

no suicidal or homicidal tendency.

* Privacy and confidentiality should be maintained.