Running head: DISCUSSION 1

Discussion: Clinical Supervision

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Psychiatric mental health nurse practitioners play a very important role in the provision of mental health services. This means that they see and counsel different types of clients. In some cases, the clients are members of a family that need help in getting over an issue that has been affecting them or an event that they experienced and is causing disturbance in their lives. Counselling or dealing with a family can be challenging to mental health nurse practitioners because the dynamics might not be the same as when a practitioner is dealing with an individual. For instance, it might be easier to give an individual the focus and attention that they deserve than having to focus on each member of a family. It should be noted that interventions in mental and psychiatric health may not necessarily have the expected outcomes. In a particular research, it was concluded that different challenges face nurses as they provide care to psychiatric and mental health patients. The challenges include cases of patients falling through the cracks, failure to establish a relationship based on trust in order to overcome taboo, guilt and shame and restrictions due to inadequate knowledge as well as resources in taking care of this patient population (Bjorkman et al., 2018). When all these factors are compared with other patient-related factors such as genetics, interventions may fail to have the expected outcomes. This paper shall discuss the case of a family that is not effectively progressing based on the expected clinical outcomes.

A family had visited the office because of a major issue that seemed to affect the husband and the wife. This was a young family where the husband served in the military. He had gone for two tours just recently and he went for the last tour immediately after marrying his wife. They did not have any children because they wanted to make sure that the father was present for the baby. However, they have been struggling because after the husband returned from his last tour, he was diagnosed with PTSD. He lost two members of his unit in an explosion and he was also injured but he survived. He started having nightmares and flashbacks about the event after he came back and this lasted for 3 months before he decided to seek help. When the wife tried to make him talk about what happened, he avoided the conversation. He has been detached from other people and he has been expressing anger, irritability and lack of concentration. Based on the DSM-5, all these symptoms helped in confirming a case of PTSD (APA, 2013). The wife on the other hand was with generalized anxiety disorder and this was related to the fact that she was in constant fear of losing her husband. She pointed out that when he came back and she realized that he was not the same, she feared that he would do something bad like hurting himself or others. She was therefore unable to control her worry which caused significant disturbance in her life, especially at work where it was becoming hard to focus, knowing her husband is home alone and going through a hard time.

The implemented intervention while counselling the client was cognitive behavioral therapy which is known to be very effective in clients having PTSD as well as in those that have generalized anxiety disorder. CBT has been recommended especially for veterans having PTSD because it is trauma-focused and helps in addressing thoughts as well as memories that are associated with the traumatic event (Watkins, Sprang & Rothbaum, 2018). CBT is also a first-hand intervention in the management of generalized anxiety disorder (Hirsch et al., 2019). This intervention was implemented for both of them where the husband and wife agreed to talk about their worries and disturbances caused by their diagnosis and events that happened in the past. It was expected that this intervention will help them see how they can both help each other in overcoming the disturbances and be hopeful about a better future together where they can start a family. However, after about 8 weeks, the clients expressed their concern about the nightmares and flashbacks that the husband still had. For the wife, she said that she was feeling much better and she was able to control her worry but whenever her husband had an episode, she experienced a relapse in the anxiety attacks.

After additional interview, it became very clear that the family really wanted to have a baby but they were skeptical about their ability to raise the baby considering their conditions. The fear of bringing a child into a world where they were not able to take care of their issues was preventing them from overcoming the disturbances that presented with their diagnoses. The husband was specifically affected by this and this prevented him from taking charge and having control over his thoughts and memories, hence leading to the continued flashbacks and nightmares. For the wife, her relapse was majorly dependent on how the husband reacted to the therapy because she needed him to be alright in order for them to start a family. At this point, there was need to consider prolonged exposure therapy for the husband and inclusion of pharmacological interventions for both of them. This way, the symptoms and disturbances can be managed effectively and an adequate response to the interventions can be established. The family was educated about this and they gave an informed consent to proceed.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub

Bjorkman, A., Andersson, K., Bergström, J., & Salzmann-Erikson, M. (2018). Increased mental illness and the challenges this brings for district nurses in primary care settings. Issues in mental health nursing, 39(12), 1023-1030

Hirsch, C. R., Beale, S., Grey, N., & Liness, S. (2019). Approaching Cognitive Behavior Therapy for Generalized Anxiety Disorder From A Cognitive Process Perspective. Frontiers in psychiatry, 10, 796

Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A review of evidence-based psychotherapy interventions. Frontiers in behavioral neuroscience, 12, 258

 

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