Ms. K Case Study. Ms. K, a 60-year-old divorced, home health aide, presented for outpatient psychotherapy a week after discharge from a 5-day inpatient stay at the local psychiatric hospital after her ex-husband moved in with another woman. Ms. K had subsequently recurrent suicidal thoughts and voluntarily admitted herself. She was started on fluoxetine 30 mg and participated in group therapy but remained depressed after discharge.
In her initial session with the therapist, Ms. K scored 40 on the Beck Depression Inventory (BDI), indicating severe depression and described sadness, loss of interest in pleasurable activities, guilt, loss of energy, tearfulness, hopelessness, fatigue, loss of appetite, middle of the night insomnia, a 10-pound weight loss, and concentration problems over the past month. The patient’s identified complaint at the time of intake was, “I am helpless, hopeless and will never have a good life.” She denied memory problems, substance abuse, delusions, or present suicidal ideation. Her depression, lack of social supports, hopelessness, and no spouse were risk factors for suicide. However, she did not have an organized plan to hurt herself and her voluntary hospitalization for previous suicidal ideation as well as current denial of suicidal thoughts indicated that the risk for self-harm was present but not high.Ms. K Case Study.
DISCUSSION QUESTIONS
What tools do you believe would be appropriate outcome measures for psychodynamic, cognitive behavior, and interpersonal psychotherapy approaches? Review the instruments included in this book and identify specific tools reflecting indicators theoretically consistent for each model.
A patient says that he or she will be stopping psychotherapy after the current session. You do not believe this is in the person’s best interests. Discuss how you would handle this.
Compare and contrast several practice guidelines available for a specific diagnosis. Identify any discrepancies. How would you go about choosing the best one for use for a patient you are seeing for outpatient psychotherapy?
You have a patient who has not paid you in several months but says that he or she will. Discuss how you would deal with this situation and how you would decide whether to terminate.
Review the ANA Code of Ethics. Do you believe that it adequately addresses issues related to the APPN conducting psychotherapy? If yes, state how it does so; if not, discuss how it does not and whether you feel it should.
Discuss the importance of outcome measurement for APPNs conducting psychotherapy.
Review the literature and identify three or four other specific outcome measures not listed in this chapter that you think would be good holistic indicators of improvement in psychotherapy. Provide the instrument’s name, the concept measured, type of tool, why it would be an appropriate holistic measure, normative data (reliability and validity), and how to obtain it.
What psychotherapy approaches “fit” the best with how you like to work? How do you plan to continue to expand the ways you work with patients?
Use APA referencing style.