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NRNP 6660: Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent
The practitioner came up with what he considers as ground rules when interacting with the patient and he made it clear to him right at the beginning of the session. He showed his respect for patient confidentiality and privacy and stated the general rule as well as its exception. Confidentiality could only be broken if the patient talked about causing harm to self or others. When starting a session with a client, it is always important to make sure that he or she is aware of the instances where breach of confidentiality will be necessary before doing anything else. This is in order to avoid complaints from clients as well as civil lawsuits about breach of confidentiality which are very common in psychotherapy (Lamont-Mills, Christensen & Moses, 2018). In this particular session, these rules of engagements were made immediately after he politely invited him to have a seat. At this point, a first impression about the client is observed by the practitioner in as far as communication is concerned and a first impression about the practitioner is also seen by the patient. In any form of clinical assessment, the experience of the clinician and the first impression about the patient are very important (Nielsen et al., 2020).
The other good thing that was evident in this session is that the practitioner valued the importance of turn taking during a conversation. He prompted the client to answer different questions and gave him enough time to answer the questions. He did not interrupt the client at any point during the interview. Just like any form of human communication, communicative exchanges in psychotherapy should be well-organized. Turn-taking should be respected in order to avoid cases where co-construction of meaning as well as communicative relationship are hindered (Del Giacco, Salcuni & Anguera, 2019). By respecting the rules of communicative exchange, the practitioner made sure the communicative relationship was not ruined, considering that this is a teenager that is there because of problems with his anger. The practitioner has an opportunity to improve in different areas.
First, he might have generalized a problem about teenagers and their relationship with their parents even though this is not the truth all the time. This way, he validated an issue that the teenager believed to be the root cause of the problem between him and his mom without considering the possibility that his anger could be a manifestation of many other things in the life of the client. Simply put, his choice of word shows that he was getting to a conclusion that the client did not really have a problem and that it was his mom that was nagging him. Secondly, he did not consider asking the client what he thinks about his anger or temper. He should have asked him whether he thinks his temper is a problem or whether it is at times too much to the extent that his mother and him fail to have a good relationship. The practitioner should have also considered whether the client only has this problem with his mom or at times, he is angry when other people are involved. These are questions that should have been asked instead of completely agreeing with the client about something that is not actually true. It was wrong for him to completely conform to the ideas and thoughts of the client without delving deeper to find the cause of the problem.
At this point of the interview, the most compelling concern is that if the same approach is used by the practitioner, he might not be successful in helping this family. He might not be able to identify the problem that actually causes the teenager to behave like he does. Therefore, in proceeding with the sessions, he should consider the questions that have been described above in order to look for issues that may be causing the client to be irritable and angry with his mother. It is clear that the client looks at his coach like a father. It is possible that the parents of the client might be separated for a while leading to his behavior issues. Separation of parents is a common cause of child behavior problems (Xerxa et al., 2020).
Del Giacco, L., Salcuni, S., & Anguera, M. T. (2019). The communicative modes analysis system in psychotherapy from mixed methods framework: introducing a new observation system for classifying verbal and non-verbal communication. Frontiers in psychology, 10, 782
Lamont-Mills, A., Christensen, S., & Moses, L. (2018). Confidentiality and informed consent in counselling and psychotherapy: a systematic review. Melbourne: PACFA
Nielsen, P. B., Schultz, M., Langkjaer, C. S., Kodal, A. M., Pedersen, N. E., Petersen, J. A., … & Hølge-Hazelton, B. (2020). Adjusting Early Warning Score by clinical assessment: a study protocol for a Danish cluster-randomised, multicentre study of an Individual Early Warning Score (I-EWS). BMJ open, 10(1).
Xerxa, Y., Rescorla, L. A., Serdarevic, F., Van IJzendorn, M. H., Jaddoe, V. W., Verhulst, F. C., … & Tiemeier, H. (2020). The complex role of parental separation in the association between family conflict and child problem behavior. Journal of Clinical Child & Adolescent Psychology, 49(1), 79-93
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