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The aim of this paper is to plan, experience, and reflect on the therapeutic pro

by | Nov 25, 2021 | Sociology | 0 comments

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The aim of this paper is to plan, experience, and reflect on the therapeutic process, including engagement, assessment, intervention, evaluation and termination with a client in your field placement. You will integrate your understanding your emotional reactions and use of self as well as design and implement an evidence-based individual treatment plan. Grading is based upon your ability address all required elements, integrate the scholarly literature and write professionally using 6th APA format. The paper should be 15-18 pages (which does not include title or reference pages). This paper must include a minimum of eight references with at least 50% being research articles. This assignment requires you to have direct clinical contact with a client long enough to experience the stages of engagement, assessment, intervention, evaluation, and termination, even if this occurs over a brief period of time. It is your responsibility to share this assignment with your Field Instructor at the beginning of the semester and make a plan for this to happen. If there will be an extended period before you will work independently with clients, plan on completing the assignment on a client as you shadow or do co-therapy. If for any reason you are unable to meet the requirements for this assignment at your placement, talk to your instructor as soon as possible. Select a current client, either an individual adult, adolescent, or child, and address the following required elements: Client Description and Agency Context Introduce the paper by briefly describing the demographics of the client (age, gender, ethnicity, etc.) you will focus on for the purpose of the paper. In order to protect confidentiality, please create a pseudonym and exclude any specific information that could identify the client. Briefly describe the agency or setting in which you are seeing the client. What is the mission of the agency? What is the theoretical orientation of the agency? (e.g., CBT, solution-focused, etc.). Does the theoretical base of the organization match your own? Why or why not? Engagement and Use of Self Describe the nature of your interactions with the client thus far (type of contact, number of sessions, etc.). Describe specific skills you used to engage the client and build a working therapeutic alliance. What worked and what did not? How do you rate the quality of the working alliance and why? How well was the client able to engage? Discuss at least two relevant therapeutic principles outlined in the Teyber and McClure text (e.g., client resistance, ambivalence, motivation, etc.) that may be affecting engagement. Identify your most salient or striking emotional reactions to the client. How do you think this has, or could, affect engagement, assessment, or intervention? Discuss both transference and counter-transference issues. If this is not showing up yet, hypothesize about ways it could potentially arise in the future. Identify three similarities and three differences between you and the client. How do you think these similarities and differences are affecting, or could affect, the treatment process (positively and/or negatively)? What have you done to gain more knowledge of the diversity reflected in the client system and how have you applied that to engagement? Did you self-disclose? If not, why? If yes, what did you self-disclose and what was the therapeutic reason for your self-disclosure? Did it seem to be helpful or not? Assessment What means were used to obtain the information for the assessment (e.g., interview, standardized assessment form at agency, case review, formal clinical measures, collateral contacts, etc)? Based on all the data collected, complete a dynamic formulation. A dynamic formulation is a brief narrative (no more than two paragraphs or one double-spaced page) that demonstrates your ability to critically evaluate and condense the clinical information received. It should include strengths of the client in addition to challenges, prominent stressors, risk factors or vulnerabilities in the client system; the intervention is guided by this formulation. The following is an example: Mary is a 16-year-old Caucasian female with a history of complex trauma: severe childhood abuse including sexual abuse and neglect, removal from her home to foster care, termination of parental rights, failed adoption, residential treatment, alcohol and cannabis use/abuse, unreported rape one year previous, and 6 weeks ago discovered her boyfriend’s body after his gruesome suicide by gunshot. She presented with Posttraumatic Stress Disorder as evidenced by more than 30 days of symptoms, which include: reliving the event through flashbacks and nightmares; avoidance by feeling detached, avoiding reminders of the event and lack of interest in normal activities; arousal by startling easily, feeling irritable and difficulty sleeping in addition to physiological symptoms of racing heart, shaking and dizziness. There are significant complicating factors for Mary. She was an only child with no known relatives with whom she could have been placed or adopted. At 15, she ran away from the residential treatment facility where she had been living, stayed on the streets, met her boyfriend, moved to another state to live with his father and is currently living with the boyfriend’s father who brought her in for treatment. Mary lacks access to health care, an extended support system, education, job opportunities, driving license, and temporary motivation. Mary has housing, one person of support, religious affiliation, strength of character, empathy, perseverance, and treatment opportunity. What is the primary (and secondary if applicable) diagnosis of the client? Provide a diagnosis using DSM 5 or ICD-10-CM. State the specific evidence that warrants this diagnosis. If there is more than one diagnoses, prioritize which one you will focus on for the intervention and why. Treatment Plan Formulate a treatment plan with the client. Write a specific treatment plan in outline form, that includes both objectives and specific interventions. Goals should be written following the SMART format. An example is presented below: Presenting Problem or Diagnosis: PTSD Specific Evidence: physiological reactivity, insomnia, and activity avoidance Objective 1: Reduce physiological reactivity by at least 30% within 60 days. Intervention 1: Teach deep muscle relaxation Intervention 2: Teach breathing skills Intervention 3: Teach guided imagery Intervention 4: Develop and encourage routine of physical exercise Intervention 5: Purchase journal and encourage journaling Objective 2: Restful sleep as evidenced by receiving 8 or more hours of uninterrupted sleep per night for at least 3 out of 7 nights. Intervention 1: Psychoeducation for client regarding sleep disturbance and trauma Intervention 2: Psychoeducation for healthy sleep habits Intervention 2: Practice relaxation, breathing and/or imagery before sleep Intervention 4: Monitor sleep patterns nightly Intervention 5: Investigate activities that promote sleep Objective 3: Engage in pre-trauma activities at least once a week for a period 30 days. Intervention 1: List former activities in which client participated Intervention 2: Brainstorm a list of potential new activities Intervention 3: Brainstorm a list of potential positive self-reinforcers Intervention This section is where you demonstrate the logical flow and alignment from the dynamic assessment, to the diagnosis, to the treatment plan, to the chosen interventions. Describe your current intervention with the client and the proposed plan for the rest of treatment. Describe the course of treatment, not session by session, but outlining key treatment choices using evidence-based research. What is your rationale for using a certain theory or intervention? Use the scholarly literature to support your decisions. For example, if a recommended intervention is to have the client journal, you must find research about the effectiveness of therapeutic journaling. If you are using CBT techniques to address anxiety symptoms, you must reference literature that shows the effectiveness of this choice. For many, completing all of this intervention will be unrealistic within the timeframe you have seen the client, the agency mission, or other circumstances beyond your control (e.g., they stop coming). Approach the intervention “as if” you could do the most effective intervention possible. The intervention section is worth 1/3 of your grade and should be least 1/3 of the paper. Most of your references will be in the intervention section. Evaluation Comment on the client’s progress to date relevant to the treatment plan. What are the short-term and long-term prognoses (expectable response to treatment: poor, fair, good, excellent, etc.) for the client? How will you evaluate progress or symptom relief? What standardized measures are available to evaluate progress (e.g., the BDI to measure depression)? Termination How does evaluation determine when the intervention is done? How and when will you introduce termination to the client? What are key elements to an effective termination? Will you follow-up with the client? If so, how? Even if you cannot follow through with everything you would like because of circumstances beyond your control, what would you do in the best of all possible worlds?

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