Challenging Patient Encounter

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Week 3 clinical 300w. 3 references. Due 1.19.24 NU672 Counseling and Psychotherapy Clinical component.

Course Description

This course examines the guiding principles and ethics of counseling and the therapeutic environment for mental health patients across the lifespan. Techniques of counseling are introduced and correlated with relationships. Students will demonstrate techniques in the clinical setting in therapeutic milieus.

  1. Clinical Highlights
    1. Using the course objective below discuss a difficult or challenging patient encounter and how you handled it?
  2. Looking Ahead
    1. What clinical goal would you like to tackle next week?

Course Learning Objectives

By the end of this course, you will be able to:

  • Demonstrate an understanding of various psychotherapy theoretical concepts, frameworks, and modalities for the treatment and management of individuals, groups, and families across the lifespan with acute, complex, and chronic psychiatric mental health disorders including a focus on vulnerable populations at risk for mental health issues, and considerations of cultural, socio-economic, legal and ethical factors affect those seeking treatment.
  • Exhibit knowledge of acute, complex, and chronic psychiatric mental health disorders related to criteria of the current edition of the Diagnostic and Statistical Manual for Mental Disorders to diagnose and manage individuals, groups, and families across the life span and the formation of a differential diagnosis to establish treatment planning for care with special emphasis on matching specific psychotherapy modalities that correlate to specific psychiatric mental health diagnosis for best outcomes based on evidence- based research data and findings.
  • Analyze evidence-based therapeutic models of interview techniques to obtain a full history and assessment for use in developing a differential diagnosis and to develop a therapeutic relationship with patient-centered care for individuals, groups, and families across the life span with acute, complex, and chronic psychiatric mental health disorders.
  • Evaluate the PMHNP role in screening, assessment, diagnosis, and treatment with psychotherapy modalities in psychiatric mental health care across the lifespan while including health promotion, advocacy, healthcare policy, and placement within the continuum of care.
  • Identify core professional values and ethical/legal standards into the practice of the Psychiatric Mental Health Nurse Practitioner role with relation to patient safety, quality indicators, and outcome improvement in the delivery of quality psychiatric mental health care to patients.

 

Resources

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing, Inc.

Corey, G. (2016). Theory and practice of counseling and psychotherapy (10th ed.). Boston, MA:
Cengage. ISBN: 9781305263727

Carlat, D. (2023) The Psychiatric Interview, 5th Edition.

Recommended

Bickley, L. (2016). Bates’ Guide to Physical Examination and History-Taking [VitalSouce bookshelf version]. https://batesvisualguide.com/. Eleventh, North American Edition; Lippincott Williams & Wilkins: ISBN 1609137620

Heldt, J. P., MD. (2017). Memorable psychopharmacology. Create Space Independent Publishing Platform. ISBN-13: 978-1-535-28034-1

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). Cambridge University Press. ISBN 978-1-107-68646-5

Stahl, S. M. (2020). Prescriber’s guide: Stahl’s essential psychopharmacology (7th ed.). Cambridge University Press. ISBN 978-1108926010

challenging patient encounter

For your Week 3 clinical assignment in NU672 Counseling and Psychotherapy, you will need to discuss a difficult or challenging patient encounter and how you handled it, as well as identify a clinical goal for the next week. Additionally, you should incorporate references from the provided resources. Here’s how you can structure your response:

Difficult or Challenging Patient Encounter

During my clinical experience this week, I encountered a challenging patient who presented with complex psychiatric mental health issues. The patient was a middle-aged individual who had a history of severe trauma and was diagnosed with borderline personality disorder (BPD). The patient displayed intense mood swings, impulsive behaviors, and difficulties in forming stable relationships, which are characteristic features of BPD.

Managing this patient required a combination of therapeutic skills and empathetic understanding. I employed a client-centered approach, drawing upon the principles from Corey’s (2016) “Theory and Practice of Counseling and Psychotherapy.” I actively listened to the patient, validated their emotions, and established a non-judgmental therapeutic alliance. Given the patient’s history of trauma, I also considered trauma-informed care principles to create a safe and supportive environment.

One specific technique that proved helpful was dialectical behavior therapy (DBT), which has been shown to be effective in treating individuals with BPD (American Psychiatric Association, 2013). DBT’s focus on emotion regulation, distress tolerance, and interpersonal effectiveness helped the patient gain more control over their emotions and impulsive behaviors.

Additionally, I consulted with my preceptor and interdisciplinary team to ensure a comprehensive and coordinated approach to the patient’s care. It was crucial to address both the immediate emotional distress and the long-term therapeutic needs of this individual.

Clinical Goal for Next Week

As I reflect on this challenging patient encounter, I realize that there is always room for improvement in my clinical skills. Therefore, for the next week, my clinical goal is to further enhance my understanding and application of evidence-based therapeutic models of interview techniques. I intend to explore the techniques outlined in “The Psychiatric Interview” by Carlat (2023) to obtain a more comprehensive history and assessment of patients.

Specifically, I aim to refine my ability to assess for co-occurring mental health disorders and identify potential comorbidities that may complicate the diagnostic process. By improving my interviewing skills, I hope to develop a more accurate differential diagnosis and provide more effective patient-centered care for individuals with complex psychiatric mental health issues.

In conclusion, the clinical encounter this week challenged me to apply various therapeutic techniques, including DBT, when dealing with a patient diagnosed with borderline personality disorder. Looking ahead, I am committed to enhancing my interviewing skills to better serve the needs of my patients and provide evidence-based care.

References:

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing, Inc.
  2. Corey, G. (2016). Theory and practice of counseling and psychotherapy (10th ed.). Boston, MA: Cengage. ISBN: 9781305263727
  3. Carlat, D. (2023) The Psychiatric Interview, 5th Edition.
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