NRNP 6645 Psychotherapy With Multiple Modalities
Week 1: Foundations Of Psychotherapy
Unexpressed emotions will never die. They are buried alive and will come forth later in uglier ways.
—Sigmund Freud
While working with a patient in the late 1800s, Sigmund Freud discovered the health benefits of talking about emotions and illnesses. His efforts were met with considerable skepticism when Freud introduced his “talking cure” (fundamental psychotherapy). However, as more and more psychiatrists learned that Freud’s methods brought about a change in patients who suffered from various mental health issues, his methods were adopted and refined.
Today, psychotherapy is recognized as a viable treatment for various mental health issues—many of which are examined throughout this course—and it is used in various settings, such as individual, group, and family therapy.
This week, you explore the foundations of psychotherapy and consider its biological basis. You also examine the influence of culture, religion, and socioeconomics on psychotherapy treatments. Finally, you consider how legal and ethical considerations vary across psychotherapy settings.
Learning Objectives Students will:
■ Evaluate whether psychotherapy treatments have a biological basis
■ Analyze influences of culture, religion, and socioeconomics on personal perspectives of psychotherapy treatments
■ Compare legal and ethical considerations among individual, family, and group modalities of therapy
■ Explain how differences in legal and ethical considerations among individual, family, and group therapy modalities impact therapeutic approaches
Learning Resources Required Readings
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.)
Nichols, M., & Davis, S. D. (2020). The essentials of family therapy (7th ed.). Pearson. Chapter 2, “Basic Techniques of Family Therapy” (pp. 33–35 only)
Petiprin, A. (2016). Psychiatric and mental health nursing. Nursing Theory.
Wheeler, K. (Ed.). (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). Springer Publishing.
Chapter 1, “The Nurse Psychotherapist and a Framework for Practice” Chapter 2, “The Neurophysiology of Trauma and Psychotherapy” Required Media (click to expand/reduce)
Bambling, M. (2013). Neurobiology of behavior change [Video/DVD]
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/neurobiology-of-behavior-chang e
Boyd, L. (2017, April 27). After watching this, your brain will not be the same [Video]. [TEDxVancouver] YouTube. https://www.youtube.com/watch?v=LNHBMFCzznE
Harrigan, J. (Director). (2007). Human brain development: Nature and nurture [Video/DVD]. Davidson Films.
Shuttlesworth, M. (2013, August 14). Ethical and legal issues in abnormal psychology [Video]. YouTube. https://www.youtube.com/watch?v=pRXibYiorQ0
Getting Started: Analyzing Journal Articles
In this course, you will be asked to support your work with references to peer-reviewed, scholarly references. Scholarly journals publish papers by professional authors and experts in the field using a peer-review process to review the work and assure quality before publishing. The purpose of a scholarly journal is to provide accurate information for scholars and other researchers. The focus is on content rather than advertising, a direct contrast to popular media.
Scholarly journals publish both primary source and secondary source papers; the former usually is noted as original research and the latter as reviews and commentaries. You may still use professional publications (e.g., professional competencies or practice guidelines) or textbooks, but these should be supporting resources in addition to the required peer-reviewed, scholarly resources. Popular resources that are open source, rely heavily on advertising, or are opinion pieces should be avoided or used only sparingly for a specific purpose and identified as such.
Review the following resources for more information about scholarly articles and evaluating resources:
Carnegie Vincent Library. (2013, March 22). Scholarly and popular sources [Video]. YouTube. https://youtu.be/tN8S4CbzGXU
Walden Academic Skills Center. (2020). Critical reading for evaluation. https://waldenacademicskills.wordpress.com/2020/02/24/critical-reading-for-evaluation/
Walden Library. (2020). Evaluation resources: Introduction. https://academicguides.waldenu.edu/library/evaluating/introduction
Acknowledgment
Practicum Manual Acknowledgment
The Practicum Manual describes the structure and timing of the classroom-based and practicum experiences and the policies students must follow to be successful in the nurse practitioner (NP) specialties.
■ Field Experience: MSN Nurse Practitioner Practicum Manual
Click here and follow the instructions to confirm you have downloaded and read the entire MSN Nurse Practitioner Practicum Manual and will abide by the requirements described in order to successfully complete this program.
PMHNP Study Support Lounge
The PMHNP Study Support Lounge is offered throughout the course as a place of academic refuge, where you can ask questions, offer insights, and interact with your peers. Your Instructor may also weigh in to provide global feedback to the group based on trends, common problems, and common strengths in student posts.
As a peer, you are encouraged to provide constructive, helpful feedback to your peers. Advanced practice nurses always benefit from the feedback of others.
Your Study Support Lounge posts may be procedural (“How do I attach a Kaltura video to a Discussion post?”), conceptual (“How does this relate to the other therapy approaches we have studied?”), or analytical (“What do these diagnostic results actually mean in the context of this specific patient case?”). Although not mandatory, this is an opportunity to interact and study together as you navigate the assignments, so you are highly encouraged to take part in this activity. Full participation in activities like these is a statistically significant predictor of success.
To participate in this Discussion:
PMHNP Study Support Lounge
Discussion: Biological Basis And Ethical/Legal Considerations Of Psychotherapy
Many studies have found that psychotherapy is as effective as psychopharmacology in terms of influencing changes in behaviors, symptoms of anxiety, and changes in mental state. Changes influenced by psychopharmacology can be explained by the biological basis of treatments. But how does psychotherapy achieve these changes? Does psychotherapy share common neuronal pathways with psychopharmacology?
Psychotherapy is used with individuals as well as in groups or families. The idea of discussing confidential information with a patient in front of an audience is probably quite foreign to you. However, in group and family therapy, this is precisely what the psychiatric-mental health nurse practitioner does. In your role, learning how to provide this type of therapy within the limits of confidentiality is essential.
For this Discussion, you will consider whether psychotherapy also has a biological basis and analyze the ways in which legal and ethical considerations differ in the individual, family, and group therapy settings.
To prepare:
■ Review this week’s Learning Resources, reflecting on foundational concepts of psychotherapy, biological and social impacts on psychotherapy, and legal and ethical issues across the modalities (individual, family, and group).
■ Search the Walden Library databases for scholarly, peer-reviewed articles that inform and support your academic perspective on these topics.
By Day 3
Post an explanation of whether psychotherapy has a biological basis. Explain how culture, religion, and socioeconomics might influence one’s perspective on the value of psychotherapy treatments. Describe how legal and ethical considerations for group and family therapy differ from those for individual therapy, and explain how these differences might impact your therapeutic approaches for clients in group, individual, and family therapy.
Support your rationale with at least three peer-reviewed, evidence-based sources and explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.
Read a selection of your colleagues’ responses. By Day 6
Respond to at least two of your colleagues on 2 different days by providing an additional scholarly resource that supports or challenges their position, along with a brief explanation of the resource.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Submission And Grading Information Grading Criteria
To access your rubric:
Week 1 Discussion Rubric
Post By Day 3 And Respond By Day 6 To Participate in this Discussion:
Week 1 Discussion
Week 2: Family Assessment And Psychotherapeutic Approaches
A family’s patterns of behavior influences [sic] the individual and therefore may need to be a part of the treatment plan. In marriage and family therapy, the unit of treatment isn’t just the person—even if only a single person is interviewed—it is the set of relationships in which the person is embedded.
—American Association of Marriage and Family Therapy, “About Marriage and Family Therapists”
When issues arise within a family unit, the family often presents with one member identified as the “problem.” However, you will frequently find that the issue is not necessarily the “problem client,” but rather dysfunctional family patterns and relationships. To better understand such patterns and relationships, and develop a family treatment plan, it is essential that the practitioner appropriately assess all family members. This requires you to have a strong foundation in family assessment and therapy.
This week, you practice assessing and diagnosing client families presenting for psychotherapy. Learning Objectives
Students will:
■ Apply concepts, theories, and principles related to patient interviewing, diagnostic reasoning, and recording patient information
■ Formulate differential diagnoses for patients using DSM-5 criteria
■ Formulate plans of care for patients that incorporate family psychotherapy interventions
■ Develop psychotherapy genograms Learning Resources
Required Readings (click to expand/reduce)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.)
■ For reference as needed
Nichols, M., & Davis, S. D. (2020). The essentials of family therapy (7th ed.). Pearson. Introduction
■ Chapter 2, “Basic Techniques of Family Therapy”
■ Chapter 3, “The Fundamental Concepts of Family Therapy”
■ Chapter 4, “Bowen Family Systems Therapy
Therapist Aid. (2012–2020). Genograms for psychotherapy. https://www.therapistaid.com/therapy-guide/genograms
Therapist Aid LLC. (© 2012-2020). Genograms for psychotherapy. https://www.therapistaid.com/therapy-guide/genograms
Document: Comprehensive Psychiatric Evaluation Note Template Document: Comprehensive Psychiatric Evaluation Note Exemplar Required Media (click to expand/reduce)
Gehart, D. R. (2013, August 29). Progress note [Video]. YouTube. https://www.youtube.com/watch?v=CEB1vBObUqc
Masterswork Productions. (2003). Mother and daughter: A cultural tale [Video/DVD]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/mother-and-daughter-a-cultural- tale
Sommers-Flanagan, J., & Sommers-Flanagan, R. (2013). Counseling and psychotherapy theories in context and practice [Video].
■ Family Systems Therapy (starts at 4 hours)
Assignment: Family Assessment
Assessment is as essential to family therapy as it is to individual therapy. Although families often present with one person identified as the “problem,” the assessment process will help you better understand family roles and determine whether the identified problem client is in fact the root of the family’s issues.
To prepare:
■ Review this week’s Learning Resources and reflect on the insights they provide on family assessment. Be sure to review the resource on psychotherapy genograms.
■ Download the Comprehensive Psychiatric Evaluation Note Template and review the requirements of the documentation. There is also an example provided with detailed guidance and examples.
■ View the Mother and Daughter: A Cultural Tale video in the Learning Resources and consider how you might assess the family in the case study.
The Assignment
Document the following for the family in the video, using the Comprehensive Evaluation Note Template:
■ Chief complaint
■ History of present illness
■ Past psychiatric history
■ Substance use history
■ Family psychiatric/substance use history
■ Psychosocial history/Developmental history
■ Medical history
■ Review of systems (ROS)
■ Physical assessment (if applicable)
■ Mental status exam
■ Differential diagnosis—Include a minimum of three differential diagnoses and include how you derived each diagnosis in accordance with DSM-5 diagnostic criteria
■ Case formulation and treatment plan
■ Include a psychotherapy genogram for the family
Note: For any item you are unable to address from the video, explain how you would gather this information and why it is important for diagnosis and treatment planning.
By Day 7
Submit your Assignment. Submission And Grading Information
To submit your completed Assignment for review and grading, do the following:
■ Please save your Assignment using the naming convention “WK2 Assign+last name+first initial.(extension)” as the name.
■ Click the Week 2 Assignment Rubric to review the Grading Criteria for the Assignment.
■ Click the Week 2 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
■ Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK2 Assign+last name+first initial.(extension)” and click Open.
■ If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
■ Click on the Submit button to complete your submission.
Grading Criteria
To access your rubric:
Week 2 Assignment Rubric
Check Your Assignment Draft For Authenticity To check your Assignment draft for authenticity:Submit your Week 2 Assignment draft and review the originality report. Submit Your Assignment By Day 7
To participate in this Assignment: Week 2 Assignment
Foundations Of Group Work And Types Of Therapy
And as participants improve, the group as a whole benefits. Members can be agents of change for each other. Seeing others’ progress can help group members realize they, too, can cope and feel better.
—Dr. Nina W. Brown, “Power in Numbers”
Group therapy can be very beneficial for clients. In fact, research has shown that for many clients, group therapy is as effective as individual therapy. Members of groups are not only able to influence change within one another, but they are often able to more easily relate to the guidance of peers than that of a therapist. With the increasing popularity of this therapeutic approach, it is essential for you to have a strong foundation in psychotherapeutic techniques for groups.
This week, you explore group therapy and consider how you might apply current literature to your own clinical practice.
Learning Objectives Students will:
■ Evaluate the efficacy of group therapy techniques in counseling sessions
■ Recommend strategies for leading group therapy sessions Learning Resources
Required Readings (click to expand/reduce) American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) Wheeler, K. (Ed.). (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). Springer Publishing.
■ Chapter 12, “Group Therapy”
Yalom, I. D., & Leszcz, M. (2005). The therapeutic factors. In The theory and practice of group psychotherapy (5th ed.) (pp. 1–18). Basic Books.
Credit: The Theory and Practice of Group Psychotherapy, 5th Edition by Yalom, I. D., & Leszcz,
M. Copyright 2005 by Basic Books. Reprinted by permission of Basic Books via the Copyright Clearance Center.
Yalom, I. D., & Leszcz, M. (2005). Interpersonal learning. In The theory and practice of group psychotherapy (5th ed.) (pp. 19–52). Basic Books.
Credit: The Theory and Practice of Group Psychotherapy, 5th Edition by Yalom, I. D., & Leszcz,
M. Copyright 2005 by Basic Books. Reprinted by permission of Basic Books via the Copyright Clearance Center.
Yalom, I. D., & Leszcz, M. (2005). Group cohesiveness. In The theory and practice of group psychotherapy (5th ed.) (pp. 53–76). Basic Books.
Credit: The Theory and Practice of Group Psychotherapy, 5th Edition by Yalom, I. D., & Leszcz,M. Copyright 2005 by Basic Books. Reprinted by permission of Basic Books via the Copyright Clearance Center.
Required Media (click to expand/reduce)
Cats Cats. (2016, September 29). Interpersonal group therapy for addiction recovery demonstration [Video]. YouTube. https://youtu.be/szS31h0kMI0
Gerber, B. (2013, November 21). Psychotherapy group for schizophrenia [Video]. YouTube. https://www.youtube.com/watch?v=t8Dzus8WGqA
Henson, B. A. (2017, April 27). Role play: Group counseling for adolescents with anxiety [Video]. YouTube. https://www.youtube.com/watch?v=h6CF09f5S1M
PsychotherapyNet. (2009, May 6). Irvin Yalom inpatient group psychotherapy video [Video]. YouTube. https://www.youtube.com/watch?v=05Elmr65RDg
PsychotherapyNet. (2009, May 7). Irvin Yalom outpatient group psychotherapy video [Video]. YouTube. https://youtu.be/PwnfWMNbg48
Optional Media
Psychotherapy.net. (n.d.-a). Group therapy: A live demonstration – With Irvin Yalom [Video]. https://waldenu.kanopy.com/video/group-therapy-live-demonstration
Psychotherapy.net. (n.d.-b). Group therapy for addictions: An interpersonal relapse prevention approach [Video].
Assignment: Analyzing Group Techniques
Group therapy can alleviate feelings of isolation and foster a supportive and collaborative environment for sharing difficult feelings in order to facilitate healing. For many people, being part of a group that has a shared understanding of a struggle provides a unique opportunity to gain understanding of their own experiences.
As you examine one of the group therapy demonstrations from this week’s Learning Resources, consider the role and efficacy of the leader and the reasons that specific therapeutic techniques were selected.
To prepare:
■ Select one of the group therapy video demonstrations from this week’s required media Learning Resources.
The Assignment
In a 3- to 4-page paper, identify the video you selected and address the following:
■ What group therapy techniques were demonstrated? How well do you believe these techniques were demonstrated?
■ What evidence from the literature supports the techniques demonstrated?
■ What did you notice that the therapist did well?
■ Explain something that you would have handled differently.
■ What is an insight that you gained from watching the therapist handle the group therapy?
■ Now imagine you are leading your own group session. How would you go about handling a difficult situation with a disruptive group member? How would you elicit participation in your group? What would you anticipate finding in the different phases of group therapy? What do you see as the benefits and challenges of group therapy?
■ Support your reasoning with at least three peer-reviewed, evidence-based sources, and explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.
By Day 7
Submit your Assignment.
Reminder The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.
NRNP 6645 Week 4 Psychodynamic Psychotherapy
Contemporary psychodynamic psychotherapy, also referred to as psychoanalytic therapy, is rooted in Dr. Sigmund Freud’s proposal that unconscious thought processes, or thoughts and feelings outside of our conscious awareness, are responsible for mental health issues. This therapeutic approach is unique because its goal is to help patients achieve changes in personality and emotional development.
Like most therapeutic approaches, however, psychodynamic psychotherapy is not appropriate for every patient. In your role as a psychiatric-mental health nurse practitioner, you must be able to properly assess patients to determine whether this therapeutic approach would improve their clinical outcomes.
This week, you explore psychodynamic psychotherapy and examine the application of current literature to clinical practice.
Learning Resources
Required Readings (click to expand/reduce)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.)
■ For reference as needed
Nichols, M., & Davis, S. D. (2020). The essentials of family therapy (7th ed.). Pearson.
■ Chapter 8, “Psychoanalytic Family Therapy”
Wheeler, K. (Ed.). (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). Springer Publishing.
■ Chapter 5, “Supportive and Psychodynamic Psychotherapy”
■ Review the sections on psychodynamic therapy only.
■ Chapter 21, “Psychotherapeutic Approaches with Children and Adolescents”
■ pp. 790–791 only Required Media (click to expand/reduce)
Alexander Street. (2014, February 24). Jungian play therapy and sandplay with children: Myth, mandala, and meaning [Video]. YouTube. https://www.youtube.com/watch?v=qOj4MPCFiDU
Grande, T. (2016, January 29). Adlerian therapy role-play – “Acting as if” technique [Video]. YouTube. https://www.youtube.com/watch?v=nsp3JZ4uYF4
Grande, T. (2016, February 23). Psychodynamic therapy role-play – Defense mechanisms and free association [Video]. YouTube. https://www.youtube.com/watch?v=z9fF9F5w1cI
PsychotherapyNet. (2018, December 7). Youtube Kernberg psychoanalytic psychotherapy [Video]. YouTube. https://www.youtube.com/watch?v=xkYIdEO4jQg
Optional Resource
Sommers-Flanagan, J., & Sommers-Flanagan, R. (2013). Counseling and psychotherapy theories in context and practice [Video].
■ Psychodynamic Therapy (starts at 3 minutes)
Exploring Psychodynamic Theories
When thinking of classic Freudian techniques, what images come to mind? Perhaps the omniscient Freud smoking a pipe, sitting behind a client, passively taking notes—or troubled clients lying sprawled on a couch, speaking about their sexuality or early experiences in dealing with aggression or angst.
Though many associate all psychodynamic theories with well-known images of Freudian psychoanalysis, the works of Jung, Adler, and other prominent psychodynamic theorists took strides to significantly depart from Freud’s theory of personality and therapy.
Modern psychodynamic approaches place the therapist across from the patient, actively engaging the patient in the psychotherapeutic process. During this process, however, therapists place much focus on the unconscious mind and past relationships of the patient—a focus unique to psychodynamic theories.
This week there is no assessment, but you will explore unique interventions and strategies derived from the psychodynamic theoretical approach through the Learning Resources.
Week 5 Cognitive Behavioral Therapy
When first introduced, cognitive behavioral therapy (CBT) was unlike any other therapeutic approach. For years, psychotherapeutic techniques were driven by psychoanalytic theories. These techniques were time consuming, leaving many therapists frustrated with the length of time involved in helping their patients achieve a sense of relief. With the development of CBT, however, therapists were able to help their patients heal more quickly. This poses the questions: If CBT is more efficient than other techniques, why isn’t it used with all patients? How do you know when CBT is an appropriate therapeutic approach?
This week, you examine CBT and its use across individual, family, and group modalities. Learning Objectives
Students will:
■ Compare the use of cognitive behavioral therapy across individual, family, and group settings
■ Analyze challenges of applying cognitive behavioral therapy approaches and techniques across therapy modalities
■ Recommend effective strategies for overcoming challenges in applying cognitive behavioral therapy
Learning Resources
Required Readings (click to expand/reduce)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.)
Nichols, M., & Davis, S. D. (2020). The essentials of family therapy (7th ed.). Pearson.
■ Chapter 9, “Cognitive Behavioral Family Therapy”
Wheeler, K. (Ed.). (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). Springer Publishing.
■ Chapter 8, “Cognitive Behavioral Therapy”
■ Chapter 21, “Psychotherapeutic Approaches with Children and Adolescents”
■ pp. 793–802 only
■ Chapter 22, “Psychotherapy with Older Adults”
■ pp. 840–844 only Required Media (click to expand/reduce)
Beck Institute for Cognitive Behavior Therapy. (2018, June 7). CBT for couples [Video]. YouTube. https://www.youtube.com/watch?v=JZH196rOGsc
MedCircle. (2019, December 13). What a cognitive behavioral therapy (CBT) session looks like [Video]. YouTube. https://www.youtube.com/watch?v=8-2WQF3SWwo
PsychExamReview. (2019, April 30). Cognitive therapy, CBT, & group approaches (intro psych tutorial #241) [Video]. YouTube. https://www.youtube.com/watch?v=A2_NN1Q7Rfg
Optional Media
Beck, A. (1994). Aaron Beck on cognitive therapy [Video file]. Mill Valley, CA: Psychotherapy.net.
Eysenck, H. (n.d.). Hans Eysenck on behavior therapy [Video file]. Mill Valley, CA: Psychotherapy.net.
Psychotherapy.net. (Producer). (2009). Rational emotive behavior therapy for addictions [Video file]. Psychotherapy.net: Author.
Sommers-Flanagan, J., & Sommers-Flanagan, R. (2013). Counseling and psychotherapy theories in context and practice [Video].
■ CBT (starts at 2 hours 27 minutes)
Discussion: Cognitive Behavioral Therapy: Comparing Group, Family, And Individual Settings
There are significant differences in the applications of cognitive behavior therapy (CBT) for families and individuals. The same is true for CBT in group settings and CBT in family settings. In your role, it is essential to understand these differences to appropriately apply this therapeutic approach across multiple settings. For this Discussion, as you compare the use of CBT in individual, group, and family settings, consider challenges of using this approach with groups you may lead, as well as strategies for overcoming those challenges.
To prepare:
■ Review the videos in this week’s Learning Resources and consider the insights provided on CBT in various settings.
By Day 3
Post an explanation of how the use of CBT in groups compares to its use in family or individual settings. Explain at least two challenges PMHNPs might encounter when using CBT in one of these settings. Support your response with specific examples from this week’s media and at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly and attach the PDFs of your sources.
Read a selection of your colleagues’ responses. By Day 6 Of Week 1
Respond to at least two of your colleagues by recommending strategies to overcome the challenges your colleagues have identified. Support your recommendation with evidence-based literature and/or your own experiences with clients.
