A 38 years old female single Caucasian lady was diagnosed with stage 2 lung cancer about 3 months ago. She was scheduled for chemotherapy but she refused to comply with the treatment because she thinks she will still die. she shared that she smokes a pack of cigarette everyday since she was 17 years old. Presently she’s feeling depressed and not interested in any activity, she also shared that she calls-out at her work 3 times in the last two weeks. She also mentioned that she thinks excessively about her life issues (not married, no children, lung cancer) which interfere with her sleep. She is feeling guilty about her smoking habit and questioning her worth for living.
Using the DSM-5, explain and justify your diagnosis for this client.
Explain whether existential-humanistic therapy would be beneficial with this client. Include expected outcomes based on this therapeutic approach.
Explain any legal and/or ethical implications related to counseling this client. Psychotherapy with Individual Essay
Describe a child or an adolescent patient that you have observed or treated that presents with the symptoms of antisocial personality disorder.
Using the DSM-5, explain and justify your diagnosis for this client.
Analyze therapeutic approaches to treat this client with personality disorders
Explain any legal and/or ethical implications related to counseling this client.
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Diagnosis for the Client
The diagnosis for the client is major depressive disorder (MDD). According to the DSM-5 criteria symptoms of MDD include loss of interest, sad mood, loss of appetite and weight, sleep problems, irritability, loss of energy, concentration problems, feeling guilt or worthlessness, as well as suicidal ideation (Tolentino & Schmidt, 2018). These symptoms impair the ability of a person to function socially, academically, and even occupation-wise. The client in this case study manifests symptoms such as depressed mood, lack of interest, sleep problems, feeling worthless, and guilty feelings for smoking. These symptoms have impaired her occupation as she calls out her work several. This confirms the MDD diagnosis for this client.
Existential-humanistic therapy focuses on ideas of individual responsibility and freedom. During the treatment of this client, existential-humanistic therapy is used to treat depressive disorder holistically by understanding the family context of the manifesting symptoms. According to the existential viewpoint, depression occurs when a person feels they cannot cope or control what happens in their lives (Churchill et al., 2014). As a result, symptoms such as depressed mood occur. For this client, the aspects that may be causing depressive symptoms for this client include the lung cancer diagnosis, loneliness as she is unmarried and no children, and feeling guilty for smoking. The existential-humanistic therapy would thus use a holistic view of the client’s depression and encourage her to examine her life holistically, analyzing how she lives and responds to events in her life. This would help the client to develop a sense of self-determination and take responsibility for her actions by accepting her behavior and the consequences of these actions (Churchill et al., 2014). This will enable the client to control the way she responds and behaves, irrespective of external influences such as the cancer diagnosis. Therefore, existential-humanistic therapy would be effective for this client.
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Legal and/or Ethical Implications
The ethical sanctity of confidentiality binds the patient-therapist relationship in mental health. Therefore, the mental therapist as the duty of maintaining the confidentiality of this patient. Any information shared should not be disclosed to any third party without the client’s consent. Informed consent is also an important ethical issue during the treatment of this client (Bipeta, 2019). Therefore, all information about the diagnosis and treatment options for the client should be provided to the client. Lastly, the autonomy and decision-making ability of the client should be respected. The client should not be forced or convinced to undergo any treatment without her free-will (Bipeta, 2019).
Description of the Adolescent Client
The client presented with the mother. According to the mother, the client was manipulative, disobedient, rude, blamed other people for his mistakes, lacked remorse, would steal mother in the house, and had once gotten in trouble with the law for burglary. The client was very irresponsible and never accepted responsibility for his actions.
Diagnosis for this Client as per DSM-5 Criteria
The diagnosis for this client is antisocial personality disorder. As per the DSM-5 criteria, clinical manifestations of antisocial personality disorder include disregard for other people’s rights, lack of remorse, impulsivity, irresponsibility, lying, irritability, and failure to adhere to the law and this may result to criminal behavior (Black, 2015). The client manifests the majority of these behaviors justifying the diagnosis of antisocial personality disorder.
Therapeutic Approach to Treat the Client
Cognitive-behavioral therapy (CBT) is effective for individuals with personality disorders as it focuses on identification and changing dysfunctional thinking patterns (Oud et al., 2018). Therefore, CBT identifies and challenges the maladaptive automatic interpretations of people with personality disorders. Personality disorders like antisocial personality disorder are maintained by maladaptive beliefs that underpin the problematic behavior and undermine effective coping skills (Oud et al., 2018). In CBT, skills such as cognitive restricting, skills training, behavior modification, and psychoeducation are used in modifying maladaptive beliefs and behaviors. CBT also encourages behavior change and supports clients in making the appropriate changes (Oud et al., 2018). Therefore, CBT would be the appropriate therapeutic approach to treat this client. Psychotherapy with Individual Essay
Legal/Ethical Implications in Counseling the Client
Informed consent should be sought from the parents of this client and assent from the adolescent client before starting the therapy. The information the client reveals during the counseling should be kept private to respect the client’s confidentiality (Warrender, 2017). Moreover, treating clients with personality disorders such as antisocial personality disorders needs the therapist to manage boundaries issues appropriately. Boundary issues may include the client having too many distractions like making many phone calls during the counseling session or making irrational demands involving the availability and accessibility of the therapist. The therapist should thus identify the genuine needs of this client carefully and maintain firm boundaries. This will ensure the provision of ethical and competent treatment for this client (Warrender, 2017).
Bipeta R. (2019). Legal and Ethical Aspects of Mental Health Care. Indian journal of psychological medicine, 41(2), 108–112. https://doi.org/10.4103/IJPSYM.IJPSYM_59_19.
Black D. W. (2015). The Natural History of Antisocial Personality Disorder. Canadian journal of psychiatry. Revue Canadienne de Psychiatrie, 60(7), 309–314. https://doi.org/10.1177/070674371506000703.
Churchill, R., Davies, P., Caldwell, D., Moore, T. H., Jones, H., Lewis, G., & Hunot, V. (2014). Humanistic therapies versus other psychological therapies for depression. The Cochrane database of systematic reviews, 2010(9), CD008700. https://doi.org/10.1002/14651858.CD007800.
Oud, M., Arntz, A., Hermens, M. L., Verhoef, R., & Kendall, T. (2018). Specialized psychotherapies for adults with borderline personality disorder: A systematic review and meta-analysis. The Australian and New Zealand journal of psychiatry, 52(10), 949–961. https://doi.org/10.1177/0004867418791257.
Tolentino, J. C., & Schmidt, S. L. (2018). DSM-5 Criteria and Depression Severity: Implications for Clinical Practice. Frontiers in psychiatry, 9, 450. https://doi.org/10.3389/fpsyt.2018.00450.
Warrender D. (2017). Borderline personality disorder and the ethics of risk management: The action/consequence model. Nursing Ethics, 25(7), 918-927.
Psychotherapy with Individual Essay