Running Head Progress Note Lisa Bell Week 7 Nursing

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The purpose of this paper is to write progress note and a privileged psychotherapy note regarding the family assessed in a prior comprehensive assessment. Clients: A.W., a 31-year-old Caucasian female, and P.G., a 47-year-old Latino male. Their diagnosis includes relationship distress with an intimate partner and Generalized Anxiety Disorder (GAD). The clients experience relationship difficulties rooted in personal mental health issues, past negative relationships, and a desire to learn conflict management and evaluate their future together.

The treatment modality used is family therapy with a Cognitive Behavioral Therapy (CBT) approach. Progress has been minimal; realistic expectations have been identified, and a temporary breakup has occurred. The client goals involve assessing whether their relationship is worth saving and fostering a healthy partnership that models strength for their children. External stressors such as work, school, and social obligations have intensified A.W.’s anxiety and bipolar manic episodes, creating disruptions and leading P.G. to suggest a short breakup.

Modifications to the treatment plan have been made to address A.W.’s psychological turmoil by integrating mindfulness-based CBT techniques, aimed at increasing presence, understanding partner thoughts and emotions, and decreasing anxiety (Gillihan, 2017). Clinical observations note increased anxiety and bipolar symptoms impacting their relationship, with difficulty coping with stress and a tendency to terminate conflicts prematurely.

From the original assessment, there was a brief relationship breakup after a heated conversation, but the couple reconciled, reaffirming their love. No safety issues have been reported, and there are no clinical emergencies. A.W. is prescribed Latuda, Lamictal, and Propranolol, while P.G. takes Plavix, Coreg, and Prozac; both are compliant with medications but somewhat noncompliant with therapy practices.

Collaborative efforts include referrals for couple therapy and continuation of medication management with a PMHNP. Recommendations involve ongoing family therapy, establishing couple therapy appointments, practicing mindfulness strategies like acknowledging feelings and journaling anxieties. They are informed of the impact of their relationship instability on their children and understand confidentiality and mandated reporting obligations concerning child or elder abuse.

Clinically, it appears that their attachment issues are rooted in past familial experiences and prior failed relationships, challenging the development of healthy boundaries. A.W. needs to continue developing coping skills for her mood swings and anxiety, while P.G. needs to accept her emotional volatility and learn alternative coping strategies to sustain their relationship health.

Paper For Above instruction

The complexities of mental health significantly influence couple dynamics, especially when compounded by past trauma and personality factors. In the case of A.W. and P.G., their relationship struggles are exacerbated by their individual mental health conditions—GAD and bipolar disorder—and their unresolved attachment issues stemming from familial backgrounds. Cognitive Behavioral Therapy, supplemented with mindfulness techniques, offers a promising approach to improving their relationship by fostering emotional regulation, mindfulness, and effective communication.

Research indicates that CBT effectively reduces anxiety symptoms and enhances interpersonal skills crucial for relationship stability (Beck, 2011). Mindfulness, integrated within CBT, helps individuals increase present-moment awareness, decreasing ruminative thinking and emotional reactivity—a common issue in anxiety and bipolar disorders (Kabat-Zinn, 2015). For A.W., managing her anxiety and mood swings through mindfulness techniques such as breathing exercises, thought journaling, and acceptance strategies can alleviate her emotional volatility, ultimately reducing relationship stress.

Similarly, P.G. needs to develop acceptance and resilience regarding A.W.’s mood fluctuations. Cognitive restructuring can assist P.G. in reframing perceptions about her emotional states and understanding her behaviors in context, promoting empathy and patience. Therapies focusing on couple communication skills show efficacy in reducing misunderstandings and increasing emotional intimacy (Gottman & Silver, 2015). The couple’s willingness to reconcile after conflicts suggests motivation to improve their relational dynamics, but ongoing therapy and skill development are crucial.

Multimodal treatment approaches—combining individual therapy, family therapy, and psychiatric management—are recommended. Engagement in couple therapy facilitates shared understanding and problem-solving, addressing issues like emotional disconnection and unmet needs. Ensuring medication adherence is fundamental, given their diagnoses, and requires collaboration with psychiatric providers to optimize pharmacotherapy (Bauer et al., 2014). In addition, psychoeducation about their conditions can promote mutual understanding and reduce stigma or frustration.

The role of the therapist extends beyond symptom management to fostering hope and resilience. By modeling supportive communication and emotion regulation, therapists can help clients develop sustainable coping mechanisms. Encouraging mindfulness and cognitive restructuring in daily routines enhances emotional stability, ultimately benefiting their children and overall family dynamics. The couple’s acknowledgment of their issues and willingness to seek help is an essential step toward potential relationship growth.

In conclusion, effective couple therapy for clients with mental health disorders necessitates an integrated approach that considers individual psychopathology, interpersonal communication, and familial influences. For A.W. and P.G., ongoing therapy, medication management, and mindfulness practices can support the development of healthier relationship patterns, offering hope for a more stable and fulfilling partnership in the future.

References

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
• Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). Guilford Press.
• Bauer, M. S., McBride, L., Abraham, K. M., et al. (2014). Clinical strategies for medication adherence in bipolar disorder: Insights from adherence research. Bipolar Disorders, 16(4), 333-341.
• Gottman, J., & Silver, N. (2015). The seven principles for making marriage work. Harmony Books.
• Gillihan, S. (2017). 8 ways CBT can improve your relationship. Psychology Today. https://www.psychologytoday.com/us/blog/the-moment-you-choose/201703/8-ways-cbt-can-improve-your-relationship
• Kabat-Zinn, J. (2015). Mindfulness-based stress reduction (MBSR). In P. M. Lehrer, R. L. Woolfolk, & W. E. Sime (Eds.), Principles and Practice of Stress Management (4th ed., pp. 137-162). Guilford Press.
• Garett, M., & Wainberg, M. (2017). Integrating mindfulness into clinical practice for mood and anxiety disorders. Journal of Clinical Psychiatry, 78(2), 187-191.
• Overall, J. E., & Simpson, G. M. (2013). Psychotherapy for bipolar disorder: A review. Bipolar Disorders, 15(4), 325-336.
• Shadish, W. R., & Baldwin, S. A. (2003). Meta-analysis of Behavior Therapy and Cognitive-Behavioral Therapy for Child and Adolescent Anxiety Disorders. Journal of Consulting and Clinical Psychology, 71(2), 245-259.
• Johnson, S. M., & Whiffen, V. (2015). Integrating attachment theory and emotion-focused therapy to enhance couple therapy outcomes. Family Process, 54(2), 278–292.