PRAC 6645 Assignment: Journal Entry

PRAC 6645 Assignment: Journal Entry

M.W is an 8-year-old A. A male client referred for psychotherapy by his PCP due to hyperactive, impulsive behavior that was more severe than children of his age. His impulsive behavior had caused problems at school and at home. Her mother reported that the child was often hyperactive, easily distracted, and engaged in activities without thinking of the consequences. The class teacher had reported that the client had a short attention span, makes many mistakes in his homework, talked excessively, and memory and thinking defects. He has no history of chronic illnesses. The PCP had prescribed Concerta 10 mg once daily.

Based on the client’s presenting features, he has a diagnosis of Attention Deficit Hyperactive Disorder (ADHD). The DSM-V criteria for the diagnosis of ADHD include inattentive and hyperactivity/impulsivity. Inattentive features include difficulty organizing things, not paying close attention to tasks, missing small details, failing to finish work, not seeming to listen when spoken to, avoiding tasks that require sustained mental effort, and being forgetful (APA, 2013). Hyperactive features include: fidgeting, climbing on things, leaving their seat, being loud, talking excessively, blurting out answers, having trouble waiting their turn, interrupting and intruding on others (APA, 2013). The client has a presumptive diagnosis of ADHD based on pertinent positive findings of hyperactive and impulsive behavior, being easily distracted, shortened attention span, making mistakes in his work, and talking excessively.

When counseling M.W, the PMHNP must consider ethical principles of autonomy, beneficence, and nonmaleficence. For instance, the therapist must obtain consent from the child’s parents and involve them in making decisions about his therapy (Wheeler, 2014). The PMHNP can uphold beneficence and nonmaleficence by selecting an evidence-based psychotherapy approach whose efficacy in ADHD has been established (Hooley, 2016). The therapist should also monitor the client’s progress to ascertain that the therapy approach promotes the best possible outcome (Hooley, 2016). Lastly, the therapist must maintain the confidentiality of the patient’s information and seek consent before sharing his information.


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

Hooley, I. (2016). Ethical considerations for psychotherapy in natural settings. Ecopsychology8(4), 215-221.

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.

Eleven weeks have gone by so quickly, and during this time, I have learned so much, and also increased in knowledge and confidence. One of my goals was to perform an initial psych evaluation on a client, and I had the opportunity of doing this successfully as the client was extremely gracious and cooperative, and my preceptor always gave positive and constructive feedback that enabled me to determine patient’s chief complaint and likely diagnosis.

On the first day of clinicals, my preceptor gave me a file summarizing questions to ask in an initial psych eval, likely medication choices for different psychiatric illnesses and contra indications, and developing and prioritizing differential diagnosis, all of which also boosted my confidence.

One of my most challenging patient on whom I did a case study was a patient with schizophrenia who was convinced she was pregnant for a man who had actually been deceased for years. I learned a valuable lesson as my preceptor handled this case with professionalism and patience. Patient’s delusions were not dismissed outrightly, but patient was told to take a pregnancy test and bring the result at her next visit.

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My second patient was so paranoid and delusional that she was suspicious of everyone including her therapist

convinced everyone was out to harm her. The legal process had to begin to enable her family make medical and other decisions for her so patient could get appropriate treatment that she needed.

I also had a patient who was very depressed and had gone through some trauma but was reluctant to use pharmacological intervention, insisting she only needed therapy even though it was obvious a combination of therapy and pharmacological intervention would be the best option for her.

In all of these cases, I would not have done anything different as I believe my preceptor handle each case with all the thoughtfulness it deserved, and the resources that would bring about the best outcome for the patient.

From my preceptor, I learned the art of how to manage patient flow and volume. Patients are never scheduled back-to-back as there is at least a 30—45-minute space that enables a seamless flow in which the patients are treated with dignity, respect and in atmosphere that allows for patients to express their thoughts without feeling pressured, and the clinician to evaluate the client and do a thorough assessment.

As I begin my third practicum, I hope to continue to improve in all aspects of learning to become a successful clinician as I believe learning is an ongoing process and we never stop learning and growing. I am grateful for the opportunity I have been given so far in learning to interact with clients in the clinical setting as it will in no small measure, prepare me to become the best I can be.