CHAPTER 3, Conceptual Frameworks and Theories:

In completing the case study, students will be addressing the following learning objective:

Give examples of behavioral and cognitive-behavioral interventions.

The student nurse has been assigned a 37-year-old woman admitted to the psychiatric hospital with an anxiety disorder.  This morning, the student notices that the client has a tense facial expression and is walking constantly around the group room.   The student walked over to the client and used reflective communication by stating, “I see that you have a tense expression and are walking around almost all of the time.  Is there something that we could discuss?”  The client replied that she has talked on the telephone to her mother who was keeping her children while she was in the hospital.  The client said that her mother had told her that she was not a good mother, and then said, “I guess I am a bad mother, but I could never measure up to my mother’s expectations.”  The student has learned that negative self-talk can greatly aggravate anxiety and lead to depression.  The student decided to use a behavioral intervention with the client and asked the client who is a good artist and why the client liked the artist’s works. The student and the client then made a list of activities that the client liked. The student taught the client to engage in one of these activities when an unpleasant experience evoked negative thoughts.  The following day, the student decided that the client needed some cognitive restructuring for her relationship with her mother.  The student taught the client that during discussions with her mother, feelings of incompetence might be experienced when the mother made negative comments.  The client was instructed that if her mother made negative comments about parenting, she was to immediately tell her mother that she was a good parent to her children and terminate the conversation at the first opportunity.

(Learning Objective: 3)

a. Will the client be able to learn cognitive restructuring in her relationship with her mother?

b.    How will engaging in activities help the client with her anxiety?

Case Study, Mohr

CHAPTER 13, Individual Therapies and Nursing Interventions

In completing the case study, students will be addressing the following learning objective:

Discuss the goals of therapeutic modalities used with individual clients.

1. Frank, a 16-year-old adolescent, is a high school sophomore.  Frank is on the verge of failing his Spanish class.  After his grade fell to a “D” grade, Frank procrastinated about doing his Spanish homework, postponing it until last.  Then, saying he was tired, Frank played video games until bedtime and rationalized that he would get up early in the morning and do his homework. Frank often sleeps late and does not have time to complete his Spanish homework.  Frank is now very distressed over his grade in the Spanish class. His mother brought Frank to the counselor to help with his problem.  The counselor suggested a parent-teacher conference to explore any learning difficulties and the possibility of a tutor to help Frank.  The counselor also said that perhaps Frank’s mother could supervise the completion of his Spanish homework as the first step.  Frank appeared relieved at these suggestions, and said, “That sounds great! Maybe I can improve my Spanish grade and pass the class. Then I won’t be a loser!”

(Learning Objective: 2)

a. Using a cognitive-behavioral approach, write three goals for Frank’s individual counseling sessions.

b. Explain why cognitive-behavioral therapy (CBT) can be successful for Frank.