1. Respond
to at least
two
of your colleagues by providing constructive feedback
concerning their presentations of their client groups and by
recommending alternative therapeutic approaches that may be
used with the groups. Support your feedback with evidence-
based literature and/or your own experiences with clients.
NOTE: POSITIVE COMMENT
Main Post
The patient I was focusing on was not responding to any of his
treatment plan we prepared. The young man was 18-year-old
white male who has a history (F31.31) bipolar with depression
and (F10.1) alcohol abuse (American Psychiatric Association
(APA), 2013). He lives with his father and stepmother whom
his father just married 3 months ago. He had 2 other siblings 3
months old stepsister and a brother who is 25 years old who
lives in Ohio with his wife. He dropped out of high school in
the 10 grade and moved in with his dad. He was brought to the
medical facility due to excessive alcohol abuse and bizarre
behavior. The young man refused to participate in group
therapy. He would not response to general questions or any
activity lessons. He was very disrespectful to the other patient
in therapy. He was constantly getting into argument and
instigating flights with others. During the session he was
invaded other patient space and was redirected several times by
medical staff. He presents as anger, irritated by others and

2. withdrawn. The only thing he would say to express himself is
“You’re not like me and you don’t know me”.
Group therapy starts at 1030am and end at 1130 before
lunch time. The age group was between 17 years old to 20
years old both male and female patients present. The group was
made up of 10 patients along with1 mental health tech, social
worker and me. He stated privately during his intake “he was
not happy with living with his stepmother”. He drinks to forget
his problems. The young man was escorted out of the group
therapy because he continued to be aggressive to others and he
was causing the other in the group to become agitated resulting
in physical altercation to erupt. The patient denied suicidal
ideations or attempts. The patient denied any past medical
history and psychiatric history including past hospitalization.
The patient also denied any family medical history and
described his father as “healthy.” The patient reports that he
drinks every day starting when he wakes up. He drinks about of
one to two bottle of vodka a day. We administered the PHQ-(2)-
(9) assessment where he scored 13 indicating moderate
depression. The doctor was notified of the behaviors during
therapy and new order placed.
My therapeutic approach with this patient started out to
be psychodynamic and group cognitive-behavioral therapy
(CBT). We use “group work to help each patient become aware
of there inner feels and needs” (Wheeler, 2014 p.410). CBT was
attempted by trying to help the young man view his inner
feeling and emotions along with identifying the trigger that
influence the behaviors (Wheeler, 2014 p.410). CBT is a short-
term psychotherapy which should be seen within 6 to 11
sessions where the patient participates in the therapy. We used
psychoeducation to create some structure in the group according
to the book of Wheeler (2014) “psychoeducational groups can
be directed by nurses, social worker and license professional
counselor (LPC).

3. The reason I think that group CBT was not helpful to the
patient is mainly because he would not participate in group but
would open up to one on one counseling at times. My treatment
plan was to increase more one on one therapy and slowly
implement group therapy with the same participates within the
same age group. According to the video with Microtraining
Associates (2009) this patient follows the typical “conflict of
interpersonal relationship, this mean we had find another
approach by using group therapy in a way to get more of the
patient peers involved with the discussion”. This helped the
patient to relate to the others in the group which allowed the
patient to feel better with the acceptance to modify his behavior
and value what is being expressed from his peers. This
therapeutic approach would not look like the adult in the room,
is tell him anything but rather he understands it from a selected
similar position of his peers.
We used the CBT approach to help this patient to
recognize and understand his negative thoughts and feelings in
order to ultimately substitute them with positive ones but to
help this young adolescent man, we must implement other
approaches to help achieve a positive out for the patient. The
journey for this client can be achieved but would require a long
time with individual, group therapy along with substance abuse
counseling to confront the under lying issues with this patient.
Since this patient doesn’t interact with the group it is hindering
his progress though group sessions. We notified the doctors and
followed up on this patient with referrals for more frequent
visits by the psychologist and psychiatric included medication
changes to help with improving behaviors.
References
American Psychiatric Association. (2013). Diagnostic and
statistical manual of mental disorders (5th ed.).

4. Washington, DC: Author.
Microtraining Associates (Producer). (2009). Leading groups
with adolescents [Video file]. Alexandria,
VA: Author.
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced
practice psychiatric nurse: A how-to guide for
evidence-based practice (2nd ed.). New York, NY:
Springer Publishing Company