Clinical Supervision Child and Adolescent Group

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Donlashoni Cowley

NURS 6650 WEEK 10 Discussion Clinical Supervision Child and Adolescent Group

The patient I was focusing on was not responding to any of his treatment plan we prepared. The young man was 18-year-old white male who has a history (F31.31) bipolar with depression and (F10.1) alcohol abuse (American Psychiatric Association (APA), 2013).  He lives with his father and stepmother whom his father just married 3 months ago. He had 2 other siblings 3 months old stepsister and a brother who is 25 years old who lives in Ohio with his wife. He dropped out of high school in the 10 grade and moved in with his dad. He was brought to the medical facility due to excessive alcohol abuse and bizarre behavior. The young man refused to participate in group therapy. He would not response to general questions or any activity lessons. He was very disrespectful to the other patient in therapy. He was constantly getting into argument and instigating flights with others. During the session he was invaded other patient space and was redirected several times by medical staff.  He presents as anger, irritated by others and withdrawn. The only thing he would say to express himself is “You’re not like me and you don’t know me”.

Group therapy starts at 1030am and end at 1130 before lunch time.  The age group was between 17 years old to 20 years old both male and female patients present. The group was made up of 10 patients along with1 mental health tech, social worker and me. He stated privately during his intake “he was not happy with living with his stepmother”. He drinks to forget his problems. The young man was escorted out of the group therapy because he continued to be aggressive to others and he was causing the other in the group to become agitated resulting in physical altercation to erupt. The patient denied suicidal ideations or attempts. The patient denied any past medical history and psychiatric history including past hospitalization. The patient also denied any family medical history and described his father as “healthy.” The patient reports that he drinks every day starting when he wakes up. He drinks about of one to two bottle of vodka a day. We administered the PHQ-(2)-(9) assessment where he scored 13 indicating moderate depression. The doctor was notified of the behaviors during therapy and new order placed.

My therapeutic approach with this patient started out to be psychodynamic and group cognitive-behavioral therapy (CBT).  We use “group work to help each patient become aware of there inner feels and needs” (Wheeler, 2014 p.410). CBT was attempted by trying to help the young man view his inner feeling and emotions along with identifying the trigger that influence the behaviors (Wheeler, 2014 p.410). CBT is a short-term psychotherapy which should be seen within 6 to 11 sessions where the patient participates in the therapy. We used psychoeducation to create some structure in the group according to the book of Wheeler (2014) “psychoeducational groups can be directed by nurses, social worker and license professional counselor (LPC).