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Assignment : Practicum – Client Termination Summary Paper

Assignment : Practicum – Client Termination Summary PaperAssignment : Practicum – Client Termination Summary PaperAssignment 1: Practicum – Client Termination SummaryTo prepare:• For guidance on writing a client termination summary, review pages 693–712 of Wheeler (2014) in this week’s Learning Resources.• Identify a client who may be ready to terminate therapy.The Assignment• Identifying information of client (e.g., hypothetical name and age)• Date the client initially contacted therapist, date therapy began, duration of therapy, and date therapy will end• Total number of sessions, including number of missed sessions• Whether termination was planned or unplanned• Presenting problem- Percocet and oxycotin and Xanax addiction, Has anxiety, depression, and pain• Major psychosocial issues/ Wife and mother of 2 children• Types of services rendered (, Cognitive behavioral therapy/group therapy)• Overview of treatment process• Goal status (goals met, partially met, unmet)• Treatment limitations (if any)Assignment : Practicum – Client Termination Summary Paper• Remaining difficulties and/or concerns• Recommendations• Follow-up plan (if indicated)• Instructions for future contact• SignaturesORDER A PLAGIARISM-FREE PAPER HEREAlthough termination is an inevitable part of the therapeutic process, it is often difficult for clients. However, by discussing termination throughout therapy, you can better prepare your clients for life without you. Once a client has achieved his or her therapeutic goals, termination sessions should be held and documented in a client termination summary. For this Assignment, you have the opportunity to practice writing a termination summary for a client with whom you have worked during your practicum experience.Client selected: 63 year-old African American Female. Client was oriented x3 and engaged in the assessment. Client appeared dressed casually and her grooming and hygiene was fair.Diagnosis: F31.4( Bipolar disorder, current episode depressed, severe, without psychotic features) and F51.01 ( Primary Insomnia)Assignment : Practicum – Client Termination Summary PaperAssignmentWith the client you selected in mind, address in a client termination summary (without violating HIPAA regulations) the following:Identifying information of client (e.g., hypothetical name and age)Date the client initially contacted therapist, date therapy began, duration of therapy, and date therapy will endTotal number of sessions, including number of missed sessionsWhether termination was planned or unplannedPresenting problemMajor psychosocial issuesTypes of services rendered (e.g., individual, couple/family therapy, group therapy)Overview of treatment processGoal status (goals met, partially met, unmet)Treatment limitations (if any)Remaining difficulties and/or concernsRecommendationsFollow-up plan (if indicated)Instructions for future contactSignaturesAssignmentWith the client you selected in mind, address in a client termination summary (without violating HIPAA regulations) the following:Assignment : Practicum – Client Termination Summary Paper· Identifying information of client (e.g., hypothetical name and age)· “Autumn,” Female, Age 46, Diagnosis: Generalized Anxiety Disorder (GAD) (F41.1), Seasonal Depression Disorder (SAD) F32.9, Post Traumatic Stress Disorder (PTSD) (F35.10), Obsessive Compulsive Disorder (OCD) (F42).· Depression occurs more often in women than men. In women depression tends to manifest as sadness, worthlessness, and guilt (Anxiety and Depression Association of America, 2020).· Generalized anxiety disorder is characterized by excessive, debilitating worry about life situations for at least six months.  The symptoms of generalized anxiety disorder include being unable to stop worrying, even after the stressor has been resolved. Generalized anxiety disorder is treatable with a combination of lifestyle changes, therapy, and medication. Feeling anxious, worried, or concerned is a normal part of life. However, people with generalized anxiety disorder (GAD) worry so intensely that it interferes with their daily life (American Psychiatric Association, 2020).Assignment : Practicum – Client Termination Summary Paper· Date the client initially contacted therapist, date therapy began, duration of therapy, and date therapy will end· Session 8/10, Contacted office in April to discuss anxiety and depression, First session was April 1st, 60 minutes sessions, plan to terminate in beginning of September after 10th session.· Total number of sessions, including number of missed sessions· 10 Sessions planned, client has been consistent, on time, and is active in each session.· The first step in any case formulation and treatment plan is an accurate diagnosis (Wheeler, K. (Ed.)., 2014).· Whether termination was planned or unplanned· Termination planned at the beginning of treatment sessions in plan.· Presenting problem· Anxiety and depression related to coping with husband going to rehab, client was taking care of 5 children, work, and go to school on her own with no family support. All her family was out of state as she resided in Wyoming and family was in Utah.Assignment : Practicum – Client Termination Summary Paper· Major psychosocial issues· Only having church for support, while intimate family, friends, and spouse were out of state, client was extremely anxious and needed confidential support.· Types of services rendered (e.g., individual, couple/family therapy, group therapy)Individual Cognitive Behavioral Therapy (CBT).· CBT is the most widely researched psychotherapeutic model with demonstrated effectiveness in the treatment of a wide range of emotional and behavioral problems. CBT is a “system of psychotherapy based on a theory which maintains that how an individual structures his or her experiences largely determines how he or she feels and behaves” (Beck & Weishaar, 1986).·· Overview of treatment process· Client adapting and applying coping skills with cognitive behavioral therapy through implementation of grounding techniques, journaling, and finding new hobbies.· Goal status (goals met, partially met, unmet)· Goals have been met by client.· Treatment limitations (if any)· None· Remaining difficulties and/or concerns· Husband was still in rehab, no physical contact allowed, only phone calls and letters allowed, client still is having stress of balancing everyday life with balancing life with 5 children and financial difficulties.· Recommendations· Finding support outside of therapeutic sessions such as support groups, contacting church for financial and emotional support, and self-care time.Assignment : Practicum – Client Termination Summary Paper· Follow-up plan (if indicated)· Continue with therapy to conclusion of scheduled therapy sessions.· Instructions for future contact· Call for follow up appointments as needed. Client will be assessed by case managers 30 days post conclusion of therapy sessions.· Signatures· Client signed therapy contract agreement with this therapist and is aware of all recommendations. She has been given homework throughout her sessions.ReferencesAmerican Psychiatric Association (2020). Help with Anxiety Disorders. Retrieved from: and Depression Association of America (2020). Depression. Retrieved from:, A. T., & Weishaar, M. E. (1986). Cognitive therapy (p. 43). Philadelphia, PA: Center forCognitive Therapy.Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-toguide for evidence-based practice. New York, NY: Springer.Termination of ServicesRachel RuskampWalden UniversityNURS 6650: Psychotherapy Adolescents and GroupsJanuary 22,Assignment : Practicum – Client Termination Summary Paper Termination by the PsychotherapistThere are many reasons a therapist may terminate services for a client. A psychotherapist who works in may leave the current organization at the cease of an internship, and treatment with all of his or her consumers thus terminating services with the consumers, once in a while prematurely (“Termination of Psychotherapy: Reasons, Manner, and Legal Issues,” 2019). Other times a psychotherapist will have countertransference issues that can intervene with the treatment. The psychotherapist may also have to consult with a peer professional to talk about the case, and it can also be decided that instances ethically require the termination of treatment to protect the Client’s quality interests (“Termination of Psychotherapy: Reasons, Manner, and Legal Issues,” 2019). The termination of the psychotherapy relationship is a difficult phase of therapy at times for the Client, so ensuring resources are available to facilitate healthy coping is imperative, and ensuring the resources are available to provide support are necessary at this transition of care.The termination note must contain the following (“Termination of Psychotherapy: Reasons, Manner, and Legal Issues,” 2019).Assignment : Practicum – Client Termination Summary PaperDemographic-JA is a 27-year-old Divorced Caucasian male. He is being treated for PTSD and anxiety related to flashbacks from a deployment in 2008 to Iraq for approximately 15 months.Chief Complaint- The Client is receiving Group interpersonal- CBT to facilitate relief of PTSD symptoms associated with a deployment to Iraq in 2007. The Client was deployed for 15 months and witnessed countless acts of violence and death.Treatment Goals-MET. The Client desired to obtain anxiety relief related to flashbacks and voiced interest in discontinuing benzodiazepines, which he reported made him tired and unable to function throughout the da.Diagnosis: PTSDTreatment Modality and Interventions– The Client received 12 weeks of intensive at 60 minutes in duration, Group CBT therapy. At week 6, the Client reported a decrease in medication use to manage symptoms of anxiety. Therapy session length throughout the protocol was 60 minutes of face to face intervention weekly with 15 minutes of journaling and reflection nightly. At the end of therapy client has decreased medication use for anxiety and reports that he is sleeping well. He reports uninterrupted sleep nightly lasting 6-8 hour nightly. This sleep that he reports has improved substantially as he is no longer awakened in the night without being able to fall back to sleep, due to flashbacks of his time in Iraq. CBT methods used for flashbacks were EMDR and reflection of past events that the Client described he continued to have vivid memories of certain times he felt he was vulnerable and sad during the deployments. Deep breathing exercises in a session facilitated relief of physical symptoms related to the flashbacks.Treatment Goals and OutcomeTreatment goals discussed at the beginning of therapy indicated the Client wanted to improve sleep and anxiety related to the events that he experienced during his time deployed. The Client voiced interest in discontinuing the frequency of the prescribed benzodiazepine to facilitate anxiety relief.Assignment : Practicum – Client Termination Summary PaperPrognosis.The Client has been engaged in treatment as evidenced by missing zero scheduled therapy appts and completing all necessary homework to obtain symptom management. Healthy coping mechanisms were voiced by the Client in the form of deep breathing and continuing to support groups with peers as he recognizes that the PTSD symptoms, while manageable, he recognizes the importance of peer support.The probability of completing the treatment and symptom relief is dependent on mutually agreed to treatment objectives and the individual committed to CBT. Thus they receive the greatest benefit of treatment (Institute for Quality Health, 2016).Supports in place: The Client plans to attend a weekly PTSD Veteran group that meets Friday evening at the VFW in Eagle River, AK, to continue to heal and gain new coping strategies from peers. The Client has attended the group therapy for two months and states that it is a huge support network that provides him hope and friendship.Follow-up- The Client agreed to this plan and was given the number to the crisis line in the event of a Psychiatric Emergency.Assignment : Practicum – Client Termination Summary PaperThe Client denies SI/HI and has voiced an understanding of the plan in place. The Client is scheduled with his Psychiatrist in two weeks to discuss discontinuing the medication regimen he once used to manage his anxiety related to the PTSD. .Medications were discussed and no questions or concerns were voiced by the client related to medication and use of the medications. There are no upcoming appts for group psychotherapy.The Client voiced an understanding of this plan. Rachel Ruskamp RN-BC/CCM  ReferencesCognitive Behavioral Therapy.” PubMed Health. 8 Sep. 2016. Institute for Quality andEfficiency in Health Care. 19 Dec. 2017. Retrieved July 30, 2019, from Termination of Psychotherapy: Reasons, Manner, and Legal Issues. (2019).Retrieved 30 July 2019, from Pathophysiology and Pharmacologic TherapyThe gastrointestinal (GI) tract entails a pathway where food is acquired, passedthrough various digestive systems, absorbed into the body and the excess excreted as feces. The GI tract is verysensitive to the types of foods ingested. Through this aspect, a proper diet guarantees optimal functioning in nutrient delivery and repairing of damaged intestinal epithelium. Besides, it helps restore normal luminal bacterial populations and promote excellent immune functions. Oshima& Miwa (2015) state the foods ingested by human beings have various effects on the GI functioning. The nutrients greatly influence the development of GI pathology for instance dietary intolerance and antibiotic responsive diarrhea. Through these aspects, many people suffer from various GI disorders like abdominal bloating and heartburns.  Such disorders can be treated through correct administration of medicine approved by Food and Drug Administration (FDA). However, it is common to encounter people accessing over-the-counter (OTC) to help suppress their conditions.  It is imperative to consider theuse of FDA- approved drugsto treat GI disorders to avoid long term health predicaments in the future.Assignment : Practicum – Client Termination Summary PaperOverviewGastrointestinaltractdisorders are common amongst many populations and can be treated through various medications. The discomforts include constipation, heartburns, irritable bowel syndrome and hemorrhoids. According to Pennazio et al. (2015), timely administration of relevant medicine can help alleviate the situations. Besides, maintaining a healthy lifestyle and including good bowel practices ensures free flow and digestion of food throughthe gastrointestinal tract. There are various drugs used to treat gastrointestinal (GI) disorders in the market today. Most of the medications are advertised in the media through television, social media platforms and newspapers. Pharmaceutical corporations aim at manufacturing drugs and sellingthem to medical institutions. It is mandatory for drugs to be approved by the FDA before human consumption. This practice helps avert eventualities of consuming poisonous chemicals.Assignment : Practicum – Client Termination Summary PaperApparently, most of the drugs are FDA approved. These drugs are advertised freely by the media platforms. However, numerous over-the counter (OTC) medications are not FDA sanctioned. Albeit these shortcomings, the drugs are widely used and even appear in adverts.Advert Critique: Phillips Colon Health Probiotic CapsPhillips Colon Health Probiotics Caps is a drug used to stabilize individuals who suffer from constipation and bloating. The drug is FDA approved and is widely used especially in the United States. In the advert, a lady wearing a t-shirt with the name “Phillips” enters a contemporary office where two women are seated. The Phillips lady asks the two women whether they experience bloating, diarrhea, farting and constipation. The women respond by pointing at each other.  The Phillips lady advises that the pills have three types of bacteria and that they should be taken each day.The advert is insightful, since it provides short term reprieve to individuals who suffer from various GI disorders. Specifically, the office setting is relevant since it presents most of the employed population which suffers from GI disorders. It is common for office staff to experience upsets related with bloating and constipation due to the various foods eaten at such settings. However, the advert is not clear on what extent the Phillips caps would help alleviate constipation and bloating. Specifically, the adverts states that ingesting one Phillips Colon Health probiotic cap each day would help solve issues related with gas bloating, diarrhea, and occasionalconstipation. Through these statements, one many think that a Phillips cap is the ultimate solution to all GI disorders. In the long run, individuals would be coerced to feed irresponsibly. The real meaning of the Phillips Colon Health Probiotic is to solve short term and occasional incidents of gas bloating and constipation. These issues ought not to be caused by ingesting harmful foods and overfeeding.Advert Critique: Tums SmoothiesTums Smoothies is an antacid used to stabilize heartburn conditions.  Antacids are very common in various pharmaceuticals, and most of them do not need the approval of the FDA. It is apparent that they are not FDA approved. The advert starts by displaying a youngbearded man eating junk food, and suddenly, is affected by a heart burn. The producers used the figures of big coiled buns punching theman on the chest, to display the severity of heartburns. The advert displays a fire-like flowing impression that displays how fast the tums smoothies act on the heartburns.  The man can be seen sitting on the spiral buns which represent the heartburn,displaying theeffectivenessof the Tums Smoothies. The advert successfullyconveys the message on how fast the antacid acts on heartburns. However, it does not explain on how regular one should take the chewable pellets of the drug.Assignment : Practicum – Client Termination Summary PaperPathophysiology of Bloating and ConstipationAbdominal bloating and constipation is very common amongst men and women of all ages. Specifically, individuals who suffer from irritable bowel syndrome experience these predicaments. Bloating affects patients and clinicians on a regular basis, since effective treatment interventions are not universally successful. Bloating cause significant patient distress the patients, and reduces their daily productivity. According to Elsenbruch and Enck (2015), its pathophysiology is complex. It entails a deeper understanding of gas production, gut micro-flora, intestinal propulsion of gas, intestinal transit and sensory functioning within the GI tract. However, the most common cause is eating disordersand aerophagia.Assignment : Practicum – Client Termination Summary PaperConcomitant Symptoms of BloatingVarious studies posit that increased gas production in the GI causes bloating. Besides, impaired gas transit through the GI system leads to gas buildup. This aspect is brought about by impaired gas evacuation from the body. In fact, patients who suffer from functional bloating are known to ineffectively release infused gas, and are more likely to develop abdominal distention (Elsenbruch&Enck, 2015). Additionally, abnormal abdominal-diaphragmatic reflexes lead to viscera-somatic activities leading to abdominal girth.DiagnosisClinicians are required to examine the medical histories of patients with benign conditions of bloating. Besides, evaluation of a complete blood count, upper endoscopy and celiac sprue serology with duodenal biopsies should be conducted (Oshima& Miwa, 2015). Additionally, physicians can conduct bowel examinations for vomiting patients.Assignment : Practicum – Client Termination Summary PaperTreatmentElsenbruchandEnck (2015) posit that there is no standard evidence-based algorithm for the treatment of bloating. In fact, each patient receives an individualized intervention plan for recovery. Gastroenterologists however, follow a stepwise framework, which includes identification of chief symptoms of the underlying pathophysiologic mechanism. Besides, patients are educatedonbetter lifestyle practices and recommend on probiotics and pro-kinetic agents. Specifically, probiotics entail live microorganisms which benefit the host when ingested in the correct amounts. Notably, ElsenbruchandEnck (2015) state that correct ingestion of drugs containing Lactobacillus acidophilusreduces bloating significantlyPathophysiology of HeartburnsHeartburns are caused by the stomach acid refluxing back into the esophagus. Heartburns may be symptoms of gastro-esophageal reflux disease (GERD). Its risk factors include eatingfoods which increase acid contents in the body for instance caffeine, alcohol, ibuprofen drugs and acidic juices. Additionally,pregnancies and obesity increase pressure along the abdominal cavity, leading to acid reflux.Assignment : Practicum – Client Termination Summary PaperSymptoms and DiagnosisThe acid reflux into the esophagus causes severe pain on victims. Specifically, the discomfortsare experiencedon the lower part of the chest, leading to various coughing episodes and hoarseness.Diagnosis for heartburn begins with history examination of the patient (Pinn, Aroniadis& Brandt, 2015).Besides, patients may be required to swallow barium whilephysicians conduct x-rays and observe its movement down to the stomach.TreatmentClinicians advise patients to indulge on better eating lifestyles. However, administration of antacids is most common. Antacids act as neutralizers to the acid that overflows to the esophagus (Pinn et al., 2015). They contain salt compounds, specifically Calcium Carbonate, which counterbalances the acid levels in the GI, leading to stabilization of apatient.Assignment : Practicum – Client Termination Summary PaperContrastbetween the Two Commercials`The Phillips Colon Probiotic Caps and the Tums Smoothies adverts both offer short-term solutions for gastrointestinal disorders. Specifically probiotics like Phillips caps contain an array of micro-organisms specifically saccharomyces boulardii and bactriea like bifidobacterium (Oshima& Miwa, 2015). The bacteria and micro-organisms helprestore normal composition of flora in the GI tract, which become altered through lengthy travels and use of antibiotics. Phillips caps can be chewed or swallowed whole. Physicians recommend using the drug 2-3 hours before administration of any antibiotic, since Phillips contains live bacteria. Besides, patients are warned fromusing it if they suffer from high fever for more than two days. Additionally, patients are warned about its possible side effects which include stomach bloating. However, manufacturers state that Phillips caps do not lead to serious allergic reactions. Victims are urged to inform pharmacists of any allergic history beforeprescription.Assignment : Practicum – Client Termination Summary PaperContrariwise,Tums Smoothies are antacids used to treat heartburns.Tums Smoothies contain Calcium Carbonate salts, which react with the refluxed acid to heal affected victims. One needs to chew it well to allow increased surface area for effective reaction (Elsenbruch&Enck, 2015). Patients are urged to report of any allergic pasts before OTCdrugs administration. Besides, it is important to report of high Calcium levels and issues with tartrazine before using the drug. However, victims are warned of constipation and hard stool as themain side effect.Assignment : Practicum – Client Termination Summary PaperConclusionGastrointestinaltract disorders are common amongst most average individuals worldwide. However,timely interventions and relevant administration of the correct drugs help regaining of stability amongst patients. There are many drugs available which are meant to treat GI tract disorders. However, it is evident that most of them are not FDA approved. Phillips Colon Caps is a probiotic used to treat stomach bloating. It is FDA approved and contains micro-organisms used toregulate the normal occurrence of bacteria in the GItract. Besides, Tums Smoothies is an OTC antacid, which is not FDA-regulated. Many individuals use it to solve heartburn problems. It is important for patients to give their medical histories before use of these drugs, to avert casesof long term medical predicaments.Assignment : Practicum – Client Termination Summary Paper ReferencesElsenbruch, S., &Enck, P. (2015).Placebo effects and their determinants in gastrointestinal disorders.Nature reviews gastroenterology &hepatology, 12(8), 472-485. doi:10.1038/nrgastro.2015.117.Oshima, T., & Miwa, H. (2015).Epidemiology of functional gastrointestinal disorders in Japan and in the world.Journal of neurogastroenterology and motility, 21(3), 320.doi:  10.5056/jnm14165.Pennazio, M., Spada, C., Eliakim, R., Keuchel, M., May, A., Mulder, C. J., …&Barbaro, F. (2015). Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy, 47(4), 352-376.doi: 10.1055/a-0576-0566.Pinn, D. M., Aroniadis, O. C., & Brandt, L. J. (2015). Is fecal microbiota transplantation (FMT) an effective treatment for patients with functional gastrointestinal disorders (FGID)?.Neurogastroenterology& Motility, 27(1), 19-29. Assignment : Practicum – Client Termination Summary Paper

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