· Develop diagnoses for clients receiving psychotherapy*


Journal 9

 

· Develop diagnoses for clients receiving psychotherapy*

· Analyze legal and ethical implications of counseling clients with psychiatric disorders*

Select a child or adolescent client whom you observed or counseled this week. Then, address the following in your Practicum Journal:

· Describe the client (without violating HIPAA regulations) and identify any pertinent history or medical information, including prescribed medications.

· Using the DSM-5, explain and justify your diagnosis for this client.

· Explain any legal and/or ethical implications related to counseling this client.

· Support your position with evidence-based literature.

 

Patient Data

Pt presents as a 16-year-old male, DOC is heroin. Pt reports using 20 bags of heroin nasal for the last month. Pt denies seizures, DT’s, blackouts, or OD’s. Pt reports that he has been considerably bothered by cravings to use in the last month. Pt reports that one months ago he had 3 weeks clean. Pt has been in treatment in February/March 2019. Pt reports that his mother and uncles struggle with substance use. Pt denies a family history of mental illness. Pt denies SI, HI, and SH. Pt reports dangerous behavior, including driving and working under the influence and buying drugs in dangerous areas. Pt reports that he is employed. Pt reports that he was on Naltrexone in the past but it made his stomach upset. Pt is not interested in Vivitrol due to this experience. Pt plans to return home with dad after treatment. Pt does not have any children. Pt is employed. Pt has a high school diploma. Pt reports that he was attending IOP and would be willing to return. ROI signed for pts dad.

NO LEGAL ISSUES

Diagnoses:

Depressive Disorder, Unspecified

Opioid Use Disorder, Severe

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