Psychotherapy Treatment Plan-Jill 50-Year-Old Woman

Risks: Risks for Jill involve her susceptibility to isolation due to feeling burdensome and strained family relationships. The recent diagnosis of her husband’s heart problem could heighten family expectations and contribute to her anxiety. Her reliance on alcohol as a coping mechanism poses health risks, and her busy schedule with school and work may limit her time for self-care.

Strengths: Despite Jill’s struggles, she has shown resilience and the ability to seek help. Openly expressing her challenges demonstrates insight and willingness to engage in therapy. Her improved sleep patterns and medication adherence indicate a commitment to her treatment plan (McLeod, 2019). Additionally, Jill’s decision to embark on starting her own company displays moments of motivation and determination. Having supportive family members attending the session further bolsters her resources. Acknowledging her alcohol use shows self-awareness, which will aid in addressing coping strategies (Sheade, 2020).

Outcome tool used and results:

Outcome tool: Generalized Anxiety Disorder 7 (GAD-7)

Results: Jill’s score on the Generalized Anxiety Disorder 7 (GAD-7) scale was 15. The GAD-7 is a self-report questionnaire that measures the severity of generalized anxiety symptoms. Jill’s score falls within the moderate anxiety range, indicating significant distress. Monitoring her GAD-7 scores throughout the treatment will allow us to track her progress and assess the effectiveness of the psychotherapy interventions (Sapra et al., 2020). The goal is to observe a reduction in the GAD-7 score as her anxiety symptoms improve.

Psychotherapy Modality: Integrative Psychotherapy incorporates elements of Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Acceptance and Commitment Therapy (ACT).

Frequency: Initially, Jill will attend weekly sessions to provide intensive support and intervention, given her recent crisis and suicidal ideation. As she progresses and stabilizes, the frequency may be reevaluated and transitioned to bi-weekly or monthly sessions. The treatment plan will remain flexible, with the option to increase sessions if necessary.

Long-Term Goals:

Achieve Remission of Generalized Anxiety Disorder:

Short Term Goals:

Reduce the frequency of anxiety episodes by recognizing triggers and early warning signs.

Practice daily relaxation techniques, such as deep breathing and progressive muscle relaxation (Sapra et al., 2020).

Develop Healthy Coping Skills:

Short Term Goals:

Attend weekly psychotherapy sessions to learn and practice coping strategies.

Incorporate mindfulness exercises into the daily routine to manage stress and anxiety.

Improve Interpersonal Relationships:

Short Term Goals:

Enhance communication skills through role-playing and assertiveness training.

Identify and address negative thought patterns that impact relationships during therapy sessions.

Enhance Self-Esteem and Self-Compassion:

Short Term Goals:

Challenge negative self-talk and replace it with positive affirmations.

Engage in self-care activities regularly and acknowledge personal achievements and strengths.

OBJECTIVES

INTERVENTIONS

1. Enhance Emotional Regulation

1: The therapist will teach Jill emotion regulation skills, including identifying and labeling emotions, understanding triggers, and recognizing the physiological and cognitive responses to emotions.

2: Using cognitive behavioral techniques, the therapist will help Jill challenge irrational thoughts and cognitive distortions contributing to emotional dysregulation (Sapra et al., 2020).

3: The therapist and Jill will work together to develop an emotion regulation plan, which includes coping strategies to manage intense emotions in various situations (Sheade, 2020).

2. Develop a Crisis Coping Plan

Intervention 1: The therapist will collaboratively create a crisis coping plan with Jill, including identifying her support system, coping strategies, and emergency contacts in case of heightened anxiety or suicidal thoughts.

Intervention 2: The therapist will teach grounding techniques and mindfulness exercises that Jill can use during times of crisis to manage distress and prevent impulsive actions (McLeod, 2019).

3: Improve Sleep Hygiene

Intervention 1: The therapist will assess Jill’s current sleep patterns and provide education on the importance of consistent sleep hygiene practices.

Intervention 2: The therapist will guide Jill in developing a bedtime routine, incorporating relaxation techniques to promote better sleep quality (McLeod, 2019).

Intervention 3: The therapist and Jill will set specific sleep goals and monitor progress throughout the treatment.

4: Address Maladaptive Coping Mechanisms

Intervention 1: The therapist will explore Jill’s reliance on alcohol as a coping mechanism and educate her about the potential negative impact on her mental health and overall well-being.

Intervention 2: The therapist will work with Jill to identify healthier coping strategies and stress management techniques, such as engaging in hobbies, exercising, or spending quality time with loved ones (Sheade, 2020).

5: Enhance Social Support

Intervention 1: The therapist will help Jill identify individuals within her social circle who can provide emotional support and encouragement.

Intervention 2: The therapist may suggest further participation in support groups or peer support to enhance her social network (Sheade, 2020).

Intervention 3: The therapist will assist Jill in improving her communication and assertiveness skills to strengthen her interpersonal relationships (McLeod, 2019).

6: Increase Awareness of Automatic Thoughts

Intervention 1: The therapist will introduce the concept of automatic thoughts and their impact on emotions and behaviors.

Intervention 2: Through cognitive restructuring exercises, Jill will learn to challenge and reframe negative automatic thoughts with more balanced and realistic alternatives (Sheade, 2020).

7: Implement Relaxation Techniques

Intervention 1: The therapist will teach Jill various relaxation techniques, such as deep breathing exercises, progressive muscle relaxation, and guided imagery.

Intervention 2: Jill will practice these techniques during therapy sessions and as part of her daily routine, using them as coping tools to manage anxiety (McLeod, 2019).

Objective 8: Foster Self-Compassion and Positive Self-Image

Intervention 1: The therapist will explore self-critical thoughts and help Jill develop self-compassion by acknowledging her strengths and achievements.

Intervention 2: Jill will be encouraged to engage in self-care activities and positive affirmations to promote a more positive self-image and boost her self-esteem (Sheade, 2020).

9: Improve Problem-Solving Skills

Intervention 1: The therapist will guide Jill through problem-solving techniques, helping her identify specific challenges and develop effective solutions.

Intervention 2: Jill will practice problem-solving exercises in therapy sessions and real-life situations, enhancing her ability to approach difficulties with a more structured and constructive mindset (McLeod, 2019).

10: Enhance Distress Tolerance

Intervention 1: The therapist will introduce distress tolerance skills, such as grounding exercises and self-soothing techniques, to help Jill manage overwhelming emotions without resorting to maladaptive coping mechanisms.

Intervention 2: Jill will learn to tolerate distressing situations by focusing on acceptance and finding healthier ways to cope with discomfort, leading to increased emotional resilience (McLeod, 2019).

Provider Signature: ANNA SMITH, PMHNP-BC

Patient Signature: Jill Smith

References

McLeod, J. (2019). EBOOK: An Introduction to Counselling and Psychotherapy: Theory, Research and Practice. McGraw-Hill Education (UK).

Sapra, A., Bhandari, P., Sharma, S., Chanpura, T., & Lopp, L. (2020). Using generalized anxiety disorder-2 (GAD-2) and GAD-7 in a primary care setting. Cureus, 12(5). DOI: 10.7759/cureus.8224

Shade, H. (2020). Equine-assisted counseling and psychotherapy: Healing through horses. Routledge.

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Question

For this assignment, you will build on your initial assessment and safety plan from the Week 4 Case Study. The case study is listed below for your review.

Psychotherapy Treatment Plan-Jill 50-Year-Old Woman

Jill is a 50-year-old woman who lives with her husband and two children (aged 20 and 18). She has come to see her PMHNP with worries about a number of health problems, including extreme tiredness, agitation, and pains in her chest. Past history Jill has been a frequent attendee at the practice over the years, often with concerns about her or her children’s health. She experienced postpartum depression with her second child. She has a history of GAD and Depression and has been on and off antidepressants for the past 30 years. When she was 23 she took an overdose following the break-up of a relationship. She had some sessions of counseling about 10 years ago that she found helpful. She was referred to a primary care mental health worker in the practice two years ago for help with anxiety and low mood. She had some sessions of individual-guided self-help, but she found that this made no difference. She was put in touch with a voluntary sector self-help group for people with anxiety around this time – but did not pursue this. She has no other health history or complaints today related to medical health and no military history. She currently takes no medications and has no allergies. She considers herself healthy as she eats a vegan diet and walks 2 times a week around the local lake.

On examination, Jill says she has always been a very ‘nervy’ person who finds dealing with everyday stresses difficult. She worries a lot about herself and her family and easily gets “in a state” and assumes “the worst” – for example, if family members are unwell or if they are late coming home. Sometimes things get so bad that she needs someone around her constantly to reassure her and feels that she can’t be left on her own. The intensity of these problems has varied over the years but has become worse again during the past eight months following her husband’s diagnosis of heart problems. She has been drinking wine most evenings to try to calm herself down. More recently, things have become so bad that she has sometimes felt that if she were left on her own, she might harm herself. Her family has been very supportive and stayed with her during these periods until she calmed down, but is now finding this difficult to manage. Last night she had an extended period of feeling like everyone would be better off without her. She describes a plan “to drink alcohol, take some of her husband’s pain medications, start her car in the garage, and pass out.” She states the only thing that ever helps her is to walk and hum to herself, and in the winter, she sometimes knits.

Vitals:
BP: 122/68
HR: 74
R: 18
T: 97
O2: 99%
Pain: 2 on 0–10 scale

Wt.: 147

Ht.: 66”

At the initial assessment, you decided that the best interest of the patient and safety would be admission to the psychiatric unit. The patient remained for six days in the inpatient psychiatric unit. During her stay, she attended group meetings, was started on Zoloft for anxiety and depression, and was stabilized. Upon discharge, the patient agreed to attend psychotherapy treatment and continue with her prescription for 50mg Zoloft PO daily.

This is your first follow-up appointment with your patient, Jill, two weeks after her hospital discharge. The goal of today’s appointment is to assess her as a follow-up and to develop a psychotherapy treatment plan to continue treatment.

Use the Individual Psychotherapy Treatment Plan template in Course Documents. You are required to use APA format with evidence-based references to support your treatment plan.

Psychotherapy Treatment Plan-Jill 50-Year-Old Woman