NSG3MHI Mental Health And Illness
Answers:
Part A: MSE Documentation
Alison has been presented to see a general physician following an episode of low mood that her sister noticed for a few months. Alison is a 38-year old woman who has been divorced and is the mother of two children. She currently works at the local supermarket. Alison appears slightly older than her age. She is of endomorphic build and has short, wavy, brown hair. She is wearing a peach-pink long-sleeved top and a black pair of tracks, which are appropriate to the occasion and weather. She is mostly looking down during the conversation with intermittent eye contact with the GP. She is cooperative throughout the interview. No presence of abnormal psychomotor movements has been noticed. She uses controlled hand gestures while explaining something to the GP. She reports that her mood is ‘fed-up’, ‘miserable’, and ‘black’ in the morning (presence of diurnal mood variation – “I get up in the morning, everything seems very black.”). Her range of affect is labile and she is tearful (she comes into tears while describing a tearful experience at home). Her quantity of speech is in the normal range. The rate of her speech is normal, the tone is monotonous and soft and the fluency and rhythm are clear. No abnormalities have been detected in her thought-form or thought processes. Her thoughts are goal-directed. Her thoughts content are worthlessness, uselessness, helplessness, hopelessness (“there’s no point really”) of guilt (“I should be doing more for them really but I’m not, I’m bit useless at that..”) and burden (I am just a bit of a burden to everybody really). Her memory and concentration are slightly impaired. She reports having her attention aroused spontaneously but does not remain sustained. She is oriented to time, place, and person. She has insight into her difficulties related to her depression in ways that hampered her relationship with her children and her current boyfriend named Dave.
She reports that she has lost her appetite and is suffering from disturbed sleep. Furthermore, she reports that she does not find pleasure in going out with her friends or engaging in self-care activities. She reports feeling fatigued, exhausted, and having no energy to spend time with the kids. She also reports walking up early in the morning and having difficulty getting back to sleep. Alison reported that she has a previous episode of depression when she separated from her husband. She had a self-harming attempt (overdose on paracetamol) episode during that period as reported by her. According to her report, it can be concluded that she did not have suicidal ideation. She also had no concrete suicidal plan. Therefore, it can be concluded that there is no current possibility of self-harm in Alison’s case. However, through the report, it has been established that there is no possible harm to her children. Her judgment seems to be intact. She reports feeling hopeful about the near future stating that she has no plan of harming herself in the near future as she can now come to the GP for follow-ups.
Part B: Therapeutic Communication
The therapist began the session by greeting Alison as she entered the clinic. She introduced herself to Alison before beginning the session. It is clearly notable in the video that the therapist smiled while greeting Alison to create a positive and warm impression on her (Perrotta, 2020). Studies have noted that greeting the client with a smile and introducing oneself at the beginning of the session can help develop a foundation for a warm therapist-client relationship (Perrotta, 2020). The therapist is seen asking Alison how she would be liked to be addressed in the session. This question demonstrated the provision of client autonomy and respect (Perrotta, 2020). These are subtle qualities of a positive, respectful, and mutually collaborative therapeutic relationship (Totton, 2018). The therapist is seen implementing the SOLER non-verbal communication techniques from the beginning of the session (Nandini, 2020). She is sitting squarely from the client so that the client does not feel emotionally and physically invaded and threatened. The therapist has maintained an open posture of the upper body; however, the therapist is seen sitting cross-legged which can send conflicting non-verbal messages to the client (Yang, 2018). This might increase the client’s ability to open up and be comfortable around the therapist. She is slightly leaning forward and pointing her body towards the client while maintaining eye contact as appropriate (ErlinaYaumas et al., 2018). The therapist seems relaxed, poised, and confident about her role as a therapist (Nandini, 2020).
The therapist uses verbal cues like “okay”, “so”, “right”, and “alright” to communicate her genuine interest and undivided attention towards the client (ErlinaYaumas et al., 2018). The use of these verbal cues during verbal communication ensures that the client feels heard and understood. However, the rate of speech of the therapist is too fast, which might make her incoherent and incomprehensible. A moderate rate of speech should be maintained. To ensure that empathetic listening is exercised, the therapist should have allowed the client more time to reflect on and gather her thoughts before speaking (Bas-Sarmiento et al., 2020).
She used motivational interviewing skills in the session. As the therapist explored further into the thoughts and feelings of the client, she kept asking the client questions that helped her re-focus on the protective factors and her internal resources (strengths, hope, optimism, and resilience) (Ranjan, 2018). She also helped the client identify some people in her environment that might help her cope with the issues. She adequately used paraphrasing and summarizing techniques throughout the session. These techniques are used by therapists to ensure that they have properly understood the client and help the client summarize and reflect on the major discussions of the discussion.
The therapist had used adequate counseling skills like paraphrasing, summarizing, empathetic listening, verbal communication skills, and motivational interviewing skills in the session. However, the therapist should have used more emotional reflective skills in the session to allow Alison to recognize her emotions and thoughts. The therapist could have used enhanced summarizing skills to help the client better recapitulate the discussion.
References
NSG3MHI Mental Health And Illness
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