Case B: Dr. Pedestal

Rita James sought psychotherapy with Hy Pedestal, Ph.D., following a breakup with the man she had been dating for 2 months. She described a series of relationships with three different men in the past year. All followed the same pattern: casual social contacts leading to sexual intimacies by the second date and a breakup within a few weeks. Each time, Rita said she “felt like ending my life.” She began her second therapy session with Dr. Pedestal by telling him how helpful the first session had been and what an exceptional therapist he was. She then got out of her chair and sat on the floor by his feet, looking up at him adoringly. When Pedestal asked what she was doing, Rita replied, “I feel more comfortable like this.”

What are some Ethical Dilemmas, and how would you respond as a therapist?

I NEED THIS 01/30/21 BY 5PM

Please no plagiarism and make sure you are able to access all resources on your own before you bid. You need to have scholarly support for any claim of fact or recommendation regarding treatment. Grammar, Writing, and APA Format: I expect you to write professionally, which means APA format, complete sentences, proper paragraphs, and well-organized and well-documented presentation of ideas. Remember to use scholarly research from peer-reviewed articles that is current. Sources such as Wikipedia, Ask.com, PsychCentral, and similar sites are never acceptable. Each classmate’s post is listed so please respond separately.

Read your classmates’ postings. Respond to your classmates’ postings.

• Respond to all colleagues by discussing the      elements of the mini script that you liked, and why. What might you add or      have said differently?

1. Classmate (K. Tri)

Hello, think you for coming in the see us today. I know as a parent this can be hard trying to make the best decision for our children. Based off what you have told me, you want to know what is AHDH and The difference between ADHD? Why do you feel that this maybe the wrong diagnosed for Tonya? Alone with the right treatment plan and medication client should be okay. Medication is a major assets to overcome these type of diagnoses. I want you to know that you are making all the right choices to be proactive with this diagnoses going without having this cared for has short term and long term consequences. Short term it has a big effect on the brain and long term causes struggles with keep relationship. Long term there no cure for ADHD and looking for jump into a state environment. I’m sorry y’all had to come this time and offer gain knowledge. Everyone learn a different ways to discuss what come and stay come go. As you counselor I’m with you every step of the way a strive for my customer satisfaction.

Reference:

Sinacola, R. S., Peters-Strickland, T., & Wyner, J. D. (2020). Basic psychopharmacology for

mental health professionals (3rd ed.). Hoboken, NJ: Pearson.

2. Classmate (L. Mil)

Mini Script

I hear that this diagnosis is new and it may take some time to get used to this. I understand that the idea of your daughter taking medication is new as well. You stated concern with Tonya taking a stimulant medication. There are options for non-stimulant medication. One medication is called Intuniv. It is a common non-stimulant drug. Some side effects include feeling tired or irritable, nausea, and dizziness/drowsiness (Drugs.com, 2021). If you are interested, we can also discuss stimulant medication such as Adderall, Ritalin, or Concerta. It is important to maintain contact with me. As counseling will provide you (mom) with the tools necessary to handle Tonya’s ADHD. Also, Tonya studies show that counseling will help improve your self-esteem and give you a sense of independence (Sinacola, Peters-Strickland & Wyner, 2020).

Lastly, untreated ADHD as a child makes them more at risk for drug abuse (Wolraich, Brown, Brown, Dupaul, Earls & Visser, 2011). In adults, issues with concentration and a decrease in the desire in activities (Sinacola, Peters-Strickland & Wyner, 2020).

Two Questions about diagnoses

Tonya, when you are at school do you find it hard to concentrate or stay focused on your teachers? If so, when this happens what typically occurs?

Tonya, can you tell me your thoughts about your ADHD diagnosis?

Going further with Tonya

Tonya’s diagnosis is new and seems scary to the family. It is important that Tonya’s family make a decision on beginning stimulant or non-stimulant medication. The text does discuss the options for lowering sugar intake along with attending counseling. Tonya’s mother has an important decision to make and bringing Tonya in on the decision making will help as well.

References

Drugs.com.(27, January 2021). Guanfacine. Retrieved from https://www.drugs.com/mtm/guanfacine.html#side-effects

Sinacola, R. S., Peters-Strickland, T., & Wyner, J. D. (2020). Basic psychopharmacology for mental health professionals (3rd ed.). Hoboken, NJ: Pearson.

Wolraich, M., Brown, L., Brown, R. T., DuPaul, G., Earls, M. … Visser, S. (2011). ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 128(5), 1007–1022. doi:10.1542/peds.2011-2654 Retrieved from https://pediatrics.aappublications.org/content/pediatrics/128/5/1007.full.pdf

3. Classmate (T. Dav)

Main Post

Tonya is a 10-year-old adolescent whose parents have come to you because of a recent diagnosis of ADHD by Tonya’s pediatrician. Tonya’s parents do not understand how a person is diagnosed with AHDH. They have heard that all ADHD medications are stimulant based and have a high risk for creating substance dependence. Tonya appears motivated to please her parents and teacher but is easily distracted and disengaged. She does not have a history of abusing medications; all medications would be dispensed by Tonya’s mother.    

Write out a mini script showing what you, Tonya’s counselor, would say to her parents.

Provide two potential questions you might ask about Tonya’s diagnosis.

Explain the role of behavioral counseling alongside a diagnosis of ADHD.

Explain the potential short-term and long-term consequences of not treating ADHD.

Include an empathetic reflection to Tonya’s parents.

I can imagine that this is a scary and difficult position for you to be in right now.  There is a lot of misinformation out there regarding ADHD and available treatment options.  Navigating through it all can be daunting, but I’m here to help you get through it.  Together, I believe we can work with Tonya’s doctor to come up with a care plan that works best for her.  Studies have shown that the most effective treatment approach involves a combination of both counseling and medication.  The counseling aspect includes education around things like coping strategies, conflict management, parenting skills, and even meal planning.  The medications address the physiological effects of ADHD, such as the regulation of dopamine and norepinephrine, which are key hormones that affect mood and behavior.  There are a variety of medications used to treat ADHD, and they usually fall into one of two categories.  One category is stimulants, which includes medications like Adderall or Ritalin.  The other category is antidepressants, such as Effexor or Wellbutrin.  The key to all of this though is to remember that for any treatment plan to work well, whether with or without medication, it is important for patients and families to be educated about the condition itself, as well as to set up realistic expectations regarding treatment (Sinacola, Peters-Strickland, & Wyner, 2020).

Given that this education is key, it is important for me to understand what your baseline of understanding is so we can address any concerns and/or misunderstandings you may have before we move further with developing a plan for Tonya.  So first, I’d like to ask you a couple of questions.  1) What do you know about ADHD? Based on what you said initially, it sounds like you’re concerned about the risk of substance abuse connected with ADHD medications.  We will definitely address this further as we take a closer look at treatment options, but for now, let me ask you another question.  2) What is your biggest fear or concern regarding Tonya’s diagnosis?

It’s clear to me that you both love your daughter, and that you want what is best for her.  That’s why I’m glad that you’re here today to learn more about her diagnosis and to take the steps necessary to develop a treatment plan that will allow her to thrive as she lives with this condition.  Although your concerns regarding the risks associated with medications used for treatment are valid, the risks associated with not effectively treating Tonya’s ADHD may be greater.  There are short-term risks, such as poor academic performance, but studies have shown that despite the concerns for addiction associated with medical stimulant use, the long-term risk of poly-drug and nonmedical stimulant use increase without proper ADHD treatment (Sinacola et al., 2020).

Resource:

Sinacola, R. S., Peters-Strickland, T., & Wyner, J. D. (2020). Basic psychopharmacology for mental health professionals (3rd ed.). Hoboken, NJ: Pearson.

Required Resources

Sinacola, R. S., Peters-Strickland, T., & Wyner, J. D. (2020). Basic psychopharmacology for mental health professionals (3rd ed.). Hoboken, NJ: Pearson.

· Chapter 9, “Treatment of ADHD and Disorders of Attention”

Optional Resources

Sinacola, R. S., Peters-Strickland, T., & Wyner, J. D. (2020). Basic psychopharmacology for mental health professionals (3rd ed.). Hoboken, NJ: Pearson.

· Chapter 15, “Case Vignettes: Children”

· Chapter 16, “Case Vignettes: Adolescents”

ADDitidue. (n.d.). ADDitude for Professionals. Retrieved June 11, 2019 from https://www.additudemag.com/category/adhd-professionals/

Brain and Behavior Research Foundation (n.d.). Attention-deficit hyperactivity disorder (ADHD) FAQs. Retrieved from https://www.bbrfoundation.org/research/faq/frequently-asked-questions-about-attention-deficit-hyperactivity-disorder-adhd

Wolraich, M., Brown, L., Brown, R. T., DuPaul, G., Earls, M. … Visser, S. (2011). ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 128(5), 1007–1022. doi:10.1542/peds.2011-2654 Retrieved from https://pediatrics.aappublications.org/content/pediatrics/128/5/1007.full.pdf   

(Rate mother in caregiver domain)

Alex is a 15-year-old male, recently discharged after a thirty-day stay in an in-patient psychiatric hospital. He was hospitalized because he heard voices telling him “terrible things about himself” and telling him to kill himself. He reported this to the school social worker who notified his parents. He was taken from school to the hospital. Alex presents as depressed and withdrawn, but will engage in one-on-one interaction with an adult. Alex has been telling people that he has been hearing voices since he was 5 years old. The parents have expressed their gratitude to the school personnel for believing Alex and responding quickly because when he has said similar things at home, they didn’t know what to do. Now they are worried that they might not be able to keep him safe at home.

Alex lives with his mother, father, and two older sisters. It is a loving family with close emotional ties. All of the children are kind, obedient, and care about other people. Alex’s mother has severe mental illness and is often overwhelmed by Alex’s needs which causes a lot of stress in their family. She says she feels a special connection to Alex because she can relate to his feelings of being unable to escape the ‘voices in his head’. Alex’s older sisters have also struggled with mental health issues in the past. Alex has no relatives in the area and the family has no child care resources.

Although his family has moved many times over the past few years, Alex has remained enrolled in the same school district. He exhibits no behavioral problems at school but he often responds verbally to his auditory hallucinations. In addition, these hallucinations make it difficult for him to concentrate which has impacted his grades. While he has educational goals appropriate for a tenth-grader, he is currently struggling to complete his requirements. He also often comes to school in the same clothes, which appear unwashed, several days a week. The teacher has expressed concern because he is regularly teased by other children. The teacher and the school social worker have met with Alex’s parents who have a hard time understanding the immediate risk that Alex’s hallucinations pose for him. Alex has no friends at school but is interacts well with all staff. He attends school regularly.

Alex and his family have been seen at the same clinic for the past four years. His mother was recently referred to a treatment program that she attends Monday through Friday during the day and is doing well. In an effort to get good housing in a safe neighborhood, the family has moved six times in the past 18 months. The family receives financial assistance through programs such as Section 8 benefits, SSI, and food stamps and is able to provide for the basic needs of their family.

When Alex was six years old, he witnessed the shooting of his uncle in front of their house. His uncle died on the sidewalk. The police questioned Alex a number of times about the incident. He experienced sleeplessness consistently for months after the incident and still does periodically. He will randomly ask his parents if they remember “when Uncle Sammy got killed.” He sometimes refers to the ‘voices in his head’ as Uncle Sammy’s killers who tell him he is to blame for Sammy being killed.

Place ratings in the section that are marked red

Put rating (number) next to each.

0. No evidence of need

1. History or   Suspicion

2. Action Needed, Need   interferes with Functioning

3. Immediate Action   Needed, Need is dangerous or disabling