Use the case study I have attached to answer the following question below.
- How would you use therapeutic communication and principles of cognitive behavioral therapy with the client?
- Describe your assessment process. What are some likely co-morbid conditions? List one nursing diagnosis and an appropriate nursing intervention.
- What interdisciplinary referrals might be appropriate?
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CaseStudy.docx
Borderline Personality Disorder Case Study
S.is a 48-year-old divorced woman with one adult daughter and three grandchildren. She is currently working as an LPN part-time in a nursing home and works at a convenience store one or two days per week. She has had many jobs over the last 22 years, usually changing every one or two years to a new job. S notes that she has been called less often to work in the convenience store and worries that they don’t like her anymore. She reports being written up several times for arguing with customers. She also reports that she liked her supervisor at; first; she says, “Now I hate her; she’s trying to get me fired.” S. reports that she has tried to get full-time jobs five times in the last four years was hired for three but only lasted one or two weeks at each one.
S. reports that she is currently not talking to her daughter because “she is mean to me and she needs to apologize, or I won’t talk to her again.” She is upset that she hasn’t seen her three small grandchildren in about a year. She sends them presents and cards frequently that say “I still love you! Grandma” but hasn’t called them since she stopped talking to her daughter. She is considering reporting to the county that her daughter is keeping her grandchildren from her.
S. is very unhappy that she isn’t in a relationship. She was abused by her ex-husband and had a pattern of meeting and dating men who eventually abused her. She states that her last relationship was very good; the man was not abusive, and “I loved him very much.” The relationship ended for reasons that S. doesn’t understand. However, she does report many arguments that ended in “scenes,” such as her throwing chairs, stomping out of the house, making crank phone calls to his family, and calling the police with false reports. But S. also reports that she “couldn’t have loved him more, and I showed it.” She gives examples of going to her boyfriend’s place of work with flowers, buying him expensive presents, surprising him with tickets to Mexico at the last minute – she was very upset that he wasn’t willing to drop everything and go with her. S. reports asking him why he didn’t love her and what she was doing wrong regularly. When the boyfriend asked to break up, S. reported sitting outside his house for weeks, crying; she called his mother, called his boss, and called and texted him until he filed a restraining order. This occurred about four months ago.
S. admitted herself to the mental health unit when she felt suicidal. She reports that she had stopped her psychotherapy three months ago and stopped going to DBT. She also stopped her anti-depressant at that time, as she felt it wasn’t working, and missed her last two psychiatrist appointments.
USEFUL NOTES FOR:
How would you use therapeutic communication and principles of cognitive behavioral therapy with the client?
Introduction
Communication is the key to good healthcare, and the way you communicate can make all the difference. Therapeutic communication is all about listening, understanding, and responding in a way that makes the client feel heard and understood. In this article, we’ll explore some of these principles as they apply to therapeutic communication with clients who are dealing with issues such as anxiety or depression.
Be nonjudgmental.
Being nonjudgmental means avoiding labeling, judging, or criticizing. It also means avoiding making assumptions. You should avoid using language that is judgmental in any way—for example:
“You’re a loser,” said my friend to me when I lost his money at poker. He was using a word like loser to label me as someone who had failed to win an important game of cards. If he’d used another word instead (like “poor”), it would have been much more accurate and helpful for him to communicate his feelings about himself without making me feel bad about myself!
Be honest.
Be honest with yourself, your client and the other members of your team.
Be honest about what you know and don’t know. If a client comes to therapy because of a problem that has been causing emotional distress for years, it can be tempting to think they are exaggerating their symptoms or that they have a different problem than what they say they do (e.g., “You’re just making things up!”). However, if someone has been struggling with an issue for years without getting any better despite multiple attempts at treatment or intervention by professionals in various fields including mental health professionals like therapists and psychologists then there may be something more serious going on here than just bad self-image or poor coping skills as we sometimes see in cases where clients come into therapy because their problems seem minor compared with others’.
Be honest about your own biases when working with clients: You might think someone who has been in therapy since childhood will never change their behavior so long as this person continues seeing him/herself as broken; but maybe if he/she saw another therapist once-a-week instead of every day then maybe…?
Be caring and respectful.
Be caring and respectful.
Show compassion for your client, even if you feel angry or frustrated with them. You want to be able to speak clearly, so take a few minutes to calm yourself before starting therapy sessions.
Respect their right to make decisions about their care—for example, they might choose not to have certain treatments or medications that are recommended by doctors because they don’t feel comfortable taking them (or simply because they don’t think they’ll work). This can be upsetting for therapists who want everything done right away but realize that sometimes patients need time alone with themselves before making important changes in their lives; however, it’s important not only for therapists’ own mental health but also those of clients who prefer self-determination over authority figures telling them what’s best for them!
Use open-ended questions.
The open-ended question is a great tool for getting your client to think about their feelings and experiences. These questions help you understand the client’s perspective, which can be helpful in identifying what they might need or want from therapy. For example:
“How did that make you feel?”
“What was going through your mind at the time?”
“Has something like this happened before?”
Clarify understanding.
When you are communicating with a client, it is important to clarify their understanding of what was said. This can be done in a variety of ways:
Ask the client to paraphrase what you said and explain why they understand it this way.
Ask the client if there are any questions about your message or its meaning.
Inquire as far as possible into how they feel about this topic or situation, asking them questions like “How do you feel?” or “What would make sense in terms of how things should go at this time?”
Provide support through active listening.
Active listening is a way of listening that shows you are paying attention and understanding what the person has said. To demonstrate active listening, paraphrase what they say and ask questions to clarify their message. For example:
“When did this situation occur? How did it make you feel?”
“What was going through your mind at that time?”
Use silence effectively.
Use silence effectively.
Silence can be used to build trust and confidence in the relationship between therapist and client. It also gives the client a chance to think, allowing them to process their feelings, thoughts, and memories of what happened with their past treatment experiences.
Use silence when you want your client to think about something else (for example: “What do you think about that? How did that make you feel?”). You could also use silence if they seem lost or unable to find their way through an issue they are working on at this time in treatment. By using this technique consistently during conversations with clients over time, we hope our clients will come into therapy feeling more comfortable sharing their thoughts with us without feeling judged or pressured into answering questions right away!
Communication is the key to good healthcare, and the way you communicate can make all the difference
Communication is the key to good healthcare, and the way you communicate can make all the difference. In order to use therapeutic communication effectively with your clients, it’s important that you understand how they think and feel. What they say doesn’t always match up with what they mean or have in mind—and this can be confusing for both parties involved. It’s also important for clinicians not only to listen but also respond appropriately when patients ask questions or express concerns about their health care situation.
Therapeutic communication requires patience; sometimes patients need time before they feel comfortable opening up about their feelings or sharing information about themselves (or others). However, if you want your client’s trust in their provider as well as yours then using therapeutic communication is an essential part of building rapport between patient-provider relationships which leads towards better outcomes overall!
Conclusion
It may be difficult to remember everything we’ve covered today. But remember that the key is to keep practicing and practicing! Your goal should be to make any critical thinking skills you learn with each client a permanent part of your mind’s toolkit. And if you’re ever stuck on what else to say in a given situation, just ask yourself “What would cognitive behavioral therapy have told me?” You’ll find the right words