practicum Week 9 Journal Entry Essay assignment

Practicum Week 9 Journal Entry Essay assignment

Practicum – Week 9 Journal Entry
Learning Objectives
Students will:
• Develop diagnoses for clients receiving psychotherapy*
• Analyze legal and ethical implications of counseling clients with psychiatric disorders*
* The Assignment related to this Learning Objective is introduced this week and submitted in Week 10.
Select a child or adolescent client whom you observed or counseled this week. Then, address the following in your Practicum Journal:
• Describe the client (without violating HIPAA regulations) and identify any pertinent history or medical information, including prescribed medications. practicum Week 9 Journal Entry Essay assignment.
• Using the DSM-5, explain and justify your diagnosis for this client.
• Explain any legal and/or ethical implications related to counseling this client.
• Support your position with evidence-based literature.

Week 9 Journal Entry



This journal entry presents a description of a 16-year-old Caucasian female who presented with her mother with complaints on symptoms such as sadness, loss of appetite, feeling of worthlessness, social withdrawal, irritability, poor academic performance, among other symptoms. In addition, the diagnosis of the client will be made and justified according to the DSM-5 criteria. Finally, the legal or ethical implications related to providing psychotherapy to the client will be discussed.

Client Description

The client was a 16-year-old Caucasian female staying with both parents and her two siblings. The client presented with her mother. The mother reported that the client had become relatively difficult to handle unlike before. Her parents were experiencing significant marital issues and were currently separated and planning to officially divorce. The mother reported that the father has bipolar disorders and he has been hospitalized numerous times for psychiatric symptoms. practicum Week 9 Journal Entry Essay assignment.

The client’s academic performance had significantly dropped, she was skipping classed and she was having problems at school and hence the family was looking for a transfer because she was not even getting along with her classmates.

The client presented with these symptoms as reported by the mother and self: sadness for the most part of the day, crying spells, loss of appetite and weight loss, nicety, anger tantrums, irritability, low self-esteem, social withdraw, loss of interest in former activities such as watching television, sleeping problems, feelings of worthlessness and hopelessness, and concentration problems. Additionally, the client also reported difficulties in interpersonal relationships especially with her parents, friends and her classmates as well. practicum Week 9 Journal Entry Essay assignment. She also reported persistent negative thoughts regarding her physical appearances and academic abilities, in addition to guilt and remorse over her parents’ impending divorce.

The medical history of the client indicated that she has asthma, and has always been overweight. The mother further reported that the client was diagnosed with major depressive disorder 3 years ago and was provided treatment intermittently with supportive psychotherapy and pharmacological treatments that included sertraline and fluoxetine. This depressive episode was triggered by the death of her maternal grandmother whom she was very attached to. The most recent psychiatrist episode seemed to be related to the marital problems her parents were experiencing, as well as the academic problems and social difficulties.

Diagnosis of the Client

The diagnosis of the client is major depressive disorder, According to the DSM-5 diagnostic criteria, the clinical features of major depressive disorder include the following symptoms: depressed mood and sadness; reduced interest in nearly all activities; significant appetite and weight changes; sleep problems; psychomotor agitation; sleep problems, feeling of hopeless and worthlessness; fatigue; concentration problems; and suicidal thoughts (American Psychiatric Association, 2013). These symptoms significantly impair social, academic, occupation or any other vital functioning area. The client manifested symptoms such as sadness, loss of appetite, weight loss, irritability, social withdrawal, loss of interest in former interesting activities, sleep problems, concentration problems, and feelings of worthlessness and hopelessness. These symptoms have impaired the client’s academic and social functioning as indicated by declining academic performance and problems in relating to her classmates. Therefore, the client fits the diagnostic criteria of Major Depressive Disorder (American Psychiatric Association, 2013) practicum Week 9 Journal Entry Essay assignment.

Legal and/or Ethical Implications Related to Counseling the Client

The legal and ethical issues implicated to counseling this client include the clinical competence of the therapist, the issue of autonomy and informed consent, as well as the issue of confidentiality. The psychotherapist is ethically obligated to obey the law and protect the client’s best interests. However, working with the adolescent client presents a role conflict situation because children and adolescents are mostly brought to seek mental health services by their parents and sometimes the parents’ or guardians’ interests may not be congruent with the adolescents’ interests (Parsapoor et al, 2014). practicum Week 9 Journal Entry Essay assignment.  Therefore, the psychotherapist is legally obligated to conduct her/his independent assessment of the needs of the client while recognizing that the parent or guardian may have different “best interests” from the client’s best interests (Parsapoor et al, 2014). Therefore, the therapist should focus on the adolescents “best interest” clinically.

The issue of autonomy and decision making capacity may also affect the clients’ counseling. Parents normally give permission and informed consent while children and adolescents assent; this is an active process where all patients are engaged including children. While dealing with pediatrics, therapists encounter various cognitive difficulties regarding the parental participation in the decision-making process; this along with the parents who have the right and duty to care for their children (Grootens-Wiegers et al, 2017). For example, sometimes the adolescent may not be willing to participate in some treatment yet the parent consents to the treatment option due to the evidence health benefits.

Another aspect when counseling this client is the issue of confidentiality. According to Bista et al (2016) confidentiality of mental health records for pediatric clients receiving psychotherapy is not an absolute right. This is because parents or their legal guardians have the right to access the health records for their children who are still minors. The Health Insurance Portability and Accountability Act (HIPAA) stipulate that psychotherapists should normally cede to parents of minors the rights that the minor may exercise in regard to their health information (Colorafi & Bailey, 2016). Therefore, this client presents the issue of confidentiality and privacy because she is a minor and any information shared during treatment may be accessed by the parents. practicum Week 9 Journal Entry Essay assignment.


The client was a 16-year-old Caucasian female who presented with her mother. The client was manifesting symptoms such as sadness, loss of appetite, feeling of worthlessness, social withdrawal, irritability, poor academic performance, among other symptoms. The client’s symptoms fit the DSM-diagnostic criteria of major depressive disorder. The legal and ethical issues involved in counseling this client include informed consent, decision-making capacity, clinical competence of the psychotherapist, and the issue of confidentiality. practicum Week 9 Journal Entry Essay assignment.


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders  (5th ed.). Washington, DC: Author.

Bista B, Thapa P, Diksha S, Suman S & Paras P. (2016). Psychosocial Problems among Adolescent Students: An Exploratory Study in the Central Region of Nepal. Front Public Health. 4(158).

Colorafi K & Bailey B. (2016). It’s Time for Innovation in the Health Insurance Portability and Accountability Act (HIPAA). JMIR Med Inform. 4(4): e34.

Grootens-Wiegers P, Hein I, Broek  & Vries M. (2017). Medical decision-making in children and adolescents: developmental and neuroscientific aspects. BMC Pediatr. 17(120).

Parsapoor A, Parsapoor M, Nima R & Fariba A. (2014). The autonomy of Children and Adolescents in Consent to Treatment: Ethical, Jurisprudential and Legal Considerations. Iran J Pediatr. 24(3), 241–248. practicum Week 9 Journal Entry Essay assignment.


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