From your perspective as Miriam’s psychiatric nurse practitioner, answer the following questions in a two- to three-page double-spaced paper (not including the reference page) in APA format. Include at least two peer-reviewed, evidence-based references (not including your textbooks).
Identify what interview questions you would have used to determine the underlying eating disorder, self-mutilation, and rape.
Using the interpersonal therapy model, identify three specific goals for Miriam’s treatment, and in which phase each goal should be accomplished.
Sarah, Miriam’s mother, asks why you are choosing interpersonal therapy and how it will be beneficial for Miriam. How do you respond? Compare and contrast it with humanistic-existential or solution-focused psychotherapy.
What are the legal and ethical implications for you relative to a patient reporting a sexual assault? What is the best way for you to proceed? Reference your state of practice’s laws.
Self-Injurious behavior (SIB) is a condition common among adolescents who have a history of eating disorders. Patients with SIB are highly likely to have bulimia nervosa, history of abuse, binge eating or purging. In the case study, the 16-year-old female, Miriam Rosen, shows signs of eating disorder alongside other concerns such as SIB. The focus of this paper is to explore Miriam’s case study to understand the condition and the different factors which result to the disorder.
Different interview questions can be utilized to provide a determination of the eating disorder. To determine the factors which result to the patient’s underlying eating disorder and self-mutilation, I would engage the patient and ask various questions to understand her diet and weight. What was your previous weight and how much have you lost to date? How do you feel about your current weight? Are your current feeding patterns satisfactory? Have you ever relied on taking pills, vomiting or starving to lose weight? Do you engage in constant exercising? Is there any experience which has prompted you to lose weight? I would also ask her how she feels after she looks herself in the mirror. What are your thoughts and perception bout your self-image? In addition, I would also inquire to understand what is always present in the teenager’s meal on a daily basis.
With an aim of accessing the patient’s self-mutilation, I would ask her if she normally have thoughts of harming herself. Have you ever tried ending your life? How often have you been cutting yourself? When did you last cut yourself? How do you feel when you cut yourself?
With an aim of assessing the instance of rape, I would inquire about the nature of relationship that Miriam has with her friends. How do you feel about the rape ordeal? Have you sought professional help to help you overcome the trauma?
Interpersonal Therapy Model
The first specific goal to be considered includes pointing out the patient’s depressive symptoms and how they influence the interpersonal relationships that a person has with others. This goal will be achieved at the assessment stage of the interpersonal therapy model. Isolation, self-mutilation and eating disorder will be considered as the depressive symptoms (Markowitz, Lipsitz & Milord, 2014). The second goal includes the implementation of the strategies focused on preventing cases of isolation, self-mutilation and eating disorder to improve the relationship that the patient has with her parents. This is implemented at the treatment stage when the patient is already showing signs of developing new relational patterns. The third goal is to prevent a relapse. This is implemented at the termination stage whereby the therapist will start to prepare the patient about the fact that she may lose support after the therapeutic sessions and the actions to be considered to avoid relapsing (Markowitz, Lipsitz & Milord, 2014).
Importance of Interpersonal Therapy
Interpersonal Therapy is utilized because it has the potential of assisting the patient point out the factors and emotional changes which affects how Miriam relates with others. Moreover, the therapy assists the patient in becoming better by remedying her depressive symptoms (Markowitz, Lipsitz & Milord, 2014). No major differences are experienced between interpersonal therapy and the Humanistic-existential and Solution-Focused Therapy. Notably, the Humanistic-existential therapy operates on the notion that people are unique and can engage themselves to make choices which influences their behavior (Churchill, Davies, Caldwell, Moore, Jones, Lewis & Hunot, 2010). Solution-Focused Therapy derives its strength from self-awareness as a natural existence, thus enabling one to organize their lives in a meaningful manner. Under Humanistic- existential and Solution-Focused Therapy, priority is provided to the subjective experiences of the client which grants him/her with the power of behavioral change (Churchil et al., 2010). In both cases, the client is used as the person with the power to solve problems through self-actualization and determination.
Legal and Ethical Implications
Having knowledge about the patient’s sexual assault situation and the failure to report it can result to legal ramifications for me as a health professional. Evidently, in Florida, the Sexual Assault and Abuse Law considers therapists as mandated reporters who should report any cases of sexual abuse experienced by the clients (RAINN, 2020). Therefore, the best way to proceed in Miriam’s case is to report the rape incident to the relevant authorities to avoid instances of potential legal ramifications (RAINN, 2020). Failure to report the rape shows that the therapist will be failing to meet the states criteria of mandated reporting.
The major ethical implication evident in this case is that of confidentiality. Notably, the ethical code guides that confidentiality of the patients should always be observed. Reporting the rape incident mean jeopardizing this ethical code. However, being a mandated reporter, I am obliged to still report the matter to the law enforcement as guided by the state law of sexual abuse. However, it is fundamental that I should inform the patient about rape being a crime and the fact that I have a duty to report it. Moreover, I am obliged to ensure that the patient is assured that reporting the case is for her better good and that the situation was not her fault. I would also advise the patient to inform the parents to ensure that they provide a safer environment for her to help her overcome the trauma and distress related with the situation which prompted the distress and even drove her towards instances of self-injury.
Churchill, R., Davies, P., Caldwell, D., Moore, T. H., Jones, H., Lewis, G., & Hunot, V. (2010). Humanistic therapies versus other psychological treatments for depression. The Cochrane database of systematic reviews, 2010(9), CD008700. doi:10.1002/14651858.CD007800
Markowitz, J. C., Lipsitz, J., & Milord, B. L. (2014). Critical review of outcome research on interpersonal psychotherapy for anxiety disorders. Depression and anxiety, 31(4), 316–325. https://doi.org/10.1002/da.22238
RAINN, (2020). Florida. Retrieved from https://www.rainn.org/laws-your-state-florida