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Vignette

To complete your Signature Assignment you are required to examine the presented clinical vignette and address specific questions attached to the vignette. Please support your answers with references to the readings assigned throughout this course. Also, when providing your reflections pertaining to the ethical decision, please provide references to the AAMFT Code of Ethics. Please be mindful to outline your reasoning for each decision that you are making pertaining to the chosen course of action. In addition, you can modify the information of the vignette by adding any necessary details that will help you to illustrate your ethical and legal decisions.

Vignette:

Your client is a 10-year-old boy, who was referred by his mother following his disruptive behavior at school and at home. The mother was the referring person, while the father also supports the mother’s decision to initiate therapy. You are able to establish a good rapport with the boy and work through some of his issues.

Provide your answers to the following questions:The mother informs you that a family physician who recently diagnosed her son with a Sleeping Disorder, would like to know more about the boy’s therapeutic work and his success in therapy.  The mother informs you that the physician will be contacting you shortly. Describe how you will manage the mother’s request to establish communication with the physician in light of therapeutic mandates for privacy and confidentiality.

One day, your client comes to the session and tells you that if he refuses to go to bed at a certain time his father closes him in a bathroom for the rest of the night and does not give him anything to eat the next morning. Please describe your actions in light of your obligations as a mandated reporter.

One day you conducted a family session: the boy, the mother, and the father are all present. After the session, you realize that the boy’s father was your parent’s lawyer. Please discuss your possible actions keeping in mind Standard 1.3 from the AAMFT Code of Ethics.

Ten sessions into the therapy, your client’s mother informs you that their insurance panel did not approve further treatment. Discuss your actions, keeping in mind Principle 1.11 from the AAMFT Code of Ethics.

One year after the termination of the therapy, you receive a subpoena from the mother’s lawyer asking you to be part of the court proceeding, following the divorce of your client’s parents. The mother is asking the court to end joint custody in favor of sole custody.  The subpoena asks you to provide information concerning the divorce and child custody as addressed in the previous therapy and that you will be called to testify. Please describe your actions.

Please provide an outline of your notes using SOAP or an alternative format. Describe essential components of the progress notes and address how long you will be required to keep records on file.

Length: 350-450 words per question – 6-8 pages

 

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Vignette:

 

Jack brings his 23-years-old daughter, Gretchen, to your office because he cannot understand how someone who did
so well in school could “suddenly (his words) be unable to respond to even the simplest instructions to care for
herself.
Gretchen was at college completing her sophomore yare when “she fell apart.” When you question Gretchen, she looks
at you and after a bit of positive commentary on her bravery in coming to your office, she is able to respond to
you with single word sentence. Her father leaves her with you and you again remind her that it must be pretty
scary to be in your office. At this comment she begins to cry. You ask her if she is willing to give you any
information that might give you a sense of how best to support her. Through her tears she makes statements that
indicate she experienced a frightening assault with she was in school.

1. What part of her memory system must your access to help her connect with her trauma?
Limbic system: The hippocampus, amygdale

2. What symptoms tell you that she is dissociating?
a. Difficulties functioning at school
b. Not able to take care of herself: feel overwhelming
c. Lack of response: she replied back by single word sentence
d. Emotionally unstable: Crying

3. How will you help her move her implicit (knowing how) memories in to explicit (knowing what) memory?

Due to her assault incident, her parts of the brain are putting her terror experience to long-tem/explicit memory
and shut down and only encoded in implicit memory. Her terror experience remains in implicit memory such as body
memory triggered by reminders of the trauma. Her case is not clear but she may have sleeplessness, flashbacks.

4. What theorist do you feel will be appropriate to explore in developing a treatment plan for Gretchen?
Through the Cognitive therapy: educate client about common distortions, engage in reality testing and self-talk
designed to counteract negative reflective statements and ease resistance.

 

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