DSM Group Therapy Paper

DSM Group Therapy Paper
Client 1
The client for this week is Sam 48 years old. He demonstrated symptoms of sadness, loneliness, hopelessness through consistent observation. Sam lives alone in an apartment having lost his wife, and his only daughter had moved out. He shows reduced pleasure in most activities daily; does not involve himself in any daily activity. Sam has minimal peer relationships and chooses not to socialize with anyone except his daughter. Mood disturbance has shown persistence for more than two years. Sam had a history of ten years of sessions of seeing the psychiatrist. He demonstrates affective feelings of depression that is he increased a sense of grief after the daughter had moved out.

Group Therapy Progress Note

Client:  Sam                                                    Date: 6-26-2019

Group name:____X____________________________________________ Minutes: 45 

Group session # 4           Meeting attended is #: 4 for this client.

Number present in group 4 of 4 scheduled Start time:  10 AM         End time: 10:45 AM

Assessment of client

1. Participation level: ❑ Active/eager ❑ Variable ❑ Only responsive ❑ Minimal ❑ Withdrawn
2. Participation quality: ❑ Expected ❑ Supportive ❑ Sharing ❑ Attentive ❑ Intrusive

❑ Monopolizing ❑ Resistant ❑ Other: _____________________________________

3. Mood: ❑ Normal ❑ Anxious ❑ Depressed ❑ Angry ❑ Euphoric ❑ Other: _______________
4. Affect: ❑ Normal ❑ Intense ❑ Blunted ❑ Inappropriate ❑ Labile ❑ Other: _______________
5. Mental status: ❑ Normal ❑ Lack awareness ❑ Memory problems ❑ Disoriented ❑ Confused

❑ Disorganized ❑ Vigilant ❑ Delusions ❑ Hallucinations ❑ Other: __________________

6. Suicide/violence risk: ❑ Almost none ❑ Ideation ❑ Threat ❑ Rehearsal ❑ Gesture ❑ Attempt
7. Change in stressors: ❑ Less severe/fewer ❑ Different stressors ❑ More/more severe ❑ Chronic
8. Change in coping ability/skills: ❑ No change ❑ Improved ❑ Less able ❑ Much less able
9. Change in symptoms: ❑ Same ❑ Less severe ❑ Resolved ❑ More severe ❑ Much worse
10. Other observations/evaluations: ________________________________________________________

In-session procedures: Self-introduction Expression of feelings and issues experienced Discussion on coping skills

Home Work: Participation in activities Socialization   Other Comments: Demonstrates cooperation

 

Diagnosis

According to DSM-5 criteria, Sam is suffering from dysthymia (persistent depressive disorder). Most of the symptoms he demonstrates conform with the one outlined in the DSM-5 diagnosis criteria. To ascertain the assigned diagnosis for the client consultation with DSM-5 criteria could be very necessary. The specific DSM-5 criteria for dysthymia include the following:

• Depressed mood for the better part of the day observed in at least two years.
• During depression, demonstration of two or more of the following should be evident; insomnia, low self-esteem, poor appetite, fatigue, feeling of hopelessness, and poor concentration.
• During the two years depression period, the individual has always expressed symptoms in criteria 1 and 2 for more than two months at a time.
• The symptoms of major depressive disorder could be persistent for two years.
• Manic episodes, mixed episode, or a hypomania episode has never been witnessed, and Cyclothymic disorder criteria have never been met.
• The depression does not occur exclusively during a chronic psychiatric condition.
• The symptoms are not due to the direct physiological impact of a substance.
• The symptoms result in clinically significant distress or impairment in social, occupational, or functionality (Vandeleur et al., 2017).

Approach

Cognitive behavior family could be the most effective in this family. It offers an opportunity for individuals to express themselves and share their feelings and experiences. It facilitates the change of behavior through dealing with overwhelming concerns in the clients’ context. It alters the negative thoughts and feelings to improve the moods. It is appropriate for the treatment of depression and anxiety (American Psychiatric Association. 2015). The therapy restores the practical ways through which a depressed individual enhances and maintain a state of mind daily.

Client 2

My second client this week is a 32 years old John Franklin, who presented with symptoms of hallucinations and delusions. He has been experiencing trouble concentrating, confused thoughts and disorganized speech, and catatonia. Effective communication is impaired, and responses to questions are unrelated. John expresses an inappropriate behavior that is not goal focused. He has been demonstrating negative symptoms referent to diminished capacity to operate normally that is he has neglected personal hygiene and appear to lack emotions.

Group Therapy Progress Note

Client:  John                                                   Date: 6-12-2020

Group name:____X___________________________________________ Minutes: 45 

Group session # 4           Meeting attended is #: 4 for this client.

Number present in group 4 of 4 scheduled Start time:  10 AM         End time: 10:45 AM

Assessment of client

1. Participation level: ❑ Active/eager ❑ Variable ❑ Only responsive ❑ Minimal ❑ Withdrawn
2. Participation quality: ❑ Expected ❑ Supportive ❑ Sharing ❑ Attentive ❑ Intrusive

❑ Monopolizing ❑ Resistant ❑ Other: _____________________________________

3. Mood: ❑ Normal ❑ Anxious ❑ Depressed ❑ Angry ❑ Euphoric ❑ Other: _______________
4. Affect: ❑ Normal ❑ Intense ❑ Blunted ❑ Inappropriate ❑ Labile ❑ Other: _______________
5. Mental status: ❑ Normal ❑ Lack awareness ❑ Memory problems ❑ Disoriented ❑ Confused

❑ Disorganized ❑ Vigilant ❑ Delusions ❑ Hallucinations ❑ Other: __________________

6. Suicide/violence risk: ❑ Almost none ❑ Ideation ❑ Threat ❑ Rehearsal ❑ Gesture ❑ Attempt
7. Change in stressors: ❑ Less severe/fewer ❑ Different stressors ❑ More/more severe ❑ Chronic
8. Change in coping ability/skills: ❑ No change ❑ Improved ❑ Less able ❑ Much less able
9. Change in symptoms: ❑ Same ❑ Less severe ❑ Resolved ❑ More severe ❑ Much worse
10. Other observations/evaluations: ________________________________________________________

In-session procedures: Self-introduction Expression of feelings and issues experienced Discussion on coping skills

Home Work:   Participation in activities Socialization     Other Comments: Demonstrates cooperation

 

Diagnosis

In reference to DSM-5 criteria, the diagnosis for John id Schizophrenia. His observed symptoms directly related to the hallmarks of schizophrenia. To confirm the diagnosis, the DSM-5 criteria for the diagnosis of schizophrenia include the following:

• The presence of 2 or more of the following symptoms; delusions, hallucinations, disorganized speech, catatonic behavior, and negative symptoms each present for a significant portion of time during one month.
• The level of functioning in one or more significant areas is markedly below the level achieved before the onset for a substantial portion of the time since the start of the condition.
• Recurrent symptoms of the disorder are experienced for at least six months, attributed by moderate forms of delusions and hallucinations.
• The disorder is not related to the physiologic impacts of a substance or any other medical condition.
• Rule out of Schizoaffective and bipolar disorders with psychiatric characteristics due to lack of adequate features within an appropriate period. (Biedermann, & Fleischhacker, 2016).

 

Approach

Cognitive behavior therapy would be the perfect psycho-social intervention for schizophrenia. The therapy is purposed to improve cognitive behaviors through the transformation of inappropriate cognitive distortions and emotional regulation. The approach ensures psychological balance in the context of thoughts, beliefs, attitude, and practice (Morrison, 2017). The outcome of this therapy could involve the restoration of appropriate behavior and enhancement of coping strategies.

Legal and ethical implications of counselling families

The Health Insurance Portability and Accountability Act (HIPAA), strives to ensure the protection of clients’ information and their privacy. However, during group therapy sessions privacy and confidentiality of the information provided cannot be guaranteed. Thus, trust issue could be the primary challenge in conduction of them, which means that the expected outcomes might not be attained as required (Parker, & Malhi, 2019). Some clients may sue the therapist in a legal process for breaching their rights for privacy in case their information leaked to unauthorized hands.

 

 

 

 

 

 

 

 

 

 

 

 

 

References

American Psychiatric Association. (2015). Depressive Disorders: DSM-5® Selections. American Psychiatric Pub.

Biedermann, F., & Fleischhacker, W. W. (2016). Psychotic disorders in DSM-5 and ICD-11. CNS spectrums, 21(4), 349-354.

Chen, Y. L., Shen, L. J., & Gau, S. S. F. (2017). The Mandarin version of the kiddie-schedule for affective disorders and schizophrenia-epidemiological version for DSM–5–a psychometric study. Journal of the Formosan Medical Association, 116(9), 671-678.

Morrison, J. (2017). DSM-5 made easy: The clinician’s guide to diagnosis. Guilford Publications.

Parker, G., & Malhi, G. S. (2019). Persistent Depression: Should Such a DSM-5 Diagnostic Category Persist?. The Canadian Journal of Psychiatry, 64(3), 177-179.

Vandeleur, C. L., Fassassi, S., Castelao, E., Glaus, J., Strippoli, M. P. F., Lasserre, A. M., … & Angst, J. (2017). Prevalence and correlates of DSM-5 major depressive and related disorders in the community. Psychiatry research, 250, 50-58.