Therapeutic Video Case—Geriatric Safety Planning

Instructions

Read through the assigned case study for this week.

Week 13—Lonely Client who Recently Experienced Loss

You are seeing a current client for a follow-up session with new developments after a recent loss. This is not an initial interview. For this session, focus on the interpersonal therapy modality to engage with the client

Interpersonal therapy—This type of therapy focuses on relationships with other people and life transitions. It is based on the foundation that relationships are at the center of psychological problems.

Case Study: An isolated 70-year-old Asian man, Raymond, lost his wife six months ago. Though he has long disliked people, he now finds himself suffering “unbearable” loneliness. He states he hasn’t considered suicide but has increased his alcohol consumption. He notes typically drinking “a six-pack every evening in order to stop thinking so that I can fall asleep.” Before his wife passed, he had been sober for 20 years. He states he just feels like he is withering away and that he feels like he is almost dead.

Mr. Zing also remarks that, independent of his dizziness symptoms, he feels unsteady on his feet when walking. He has started using a cane but doesn’t like to use it inside. When asked about previous falls, he says he hasn’t fallen. However, he says his elderly neighbor recently fell and is now in a nursing home. Now he’s fearful about falling and becoming a burden to his family. Although Mr. Zing has spinal stenosis, a recent steroid injection has relieved severe low back pain. Now he suffers only from lower back stiffness for several hours in the morning. He denies any specific weakness in his legs.

Medical Problem list

• Hypertension
• L3-5 spinal stenosis and chronic low back pain and leg numbness/paresthesias
• Depression
• Benign prostatic hypertrophy, with 3-4x/night nocturia and occasional incontinence
• Hyperlipidemia
• Gastroesophageal reflux disease
• B12 deficiency
• Allergic rhinitis
• Glaucoma
• Nummular eczema

Medications

• Valsartan 80 mg daily
• Citalopram 40 mg daily
• Flomax 0.8 mg at bedtime
• Finasteride 5 mg daily
• Lipitor 40 mg at bedtime
• Omeprazole 20 mg daily
• Cyanocobalamin 1 mg daily
• Claritin 10 mg daily
• Flonase nasal spray two puffs to each nostril daily
• Gabapentin 300 mg tabs 2 tabs three times daily
• Tylenol 500 mg one to two four times daily prn
• Brimonidine tartrate 0.15% ophth 1 drop OU twice daily
• Cosopt 2%-0.5% 1 drop OU at hs
• Latanoprost 0.005% 2 drops OU at hs
• Trazodone 25 mg at hs
• Calcium carbonate 500 mg 1-2 tabs three times daily

Review of Systems

Positive for fatigue, poor vision in his left eye, constipation, nocturia three to four times a night, frequent urinary incontinence, low back stiffness, difficulty concentrating, depression, dry skin, hoarseness, and nasal congestion.

Vitals:

• Supine – 135/76, 69; Sitting – 112/75, 76; Standing – 116/76, 74
• R 20
• T 96.8
• O2 98%
• Pain 3 on 0-10 scale
• BMI: 19

Physical Exam Constitutional: This is a thin, alert, older Asian male in no apparent distress, pleasant and cooperative, but with a notably flat affect.Head: Normocephalic / atraumatic.ENMT: Wearing glasses.Acuity 20/30 R, 20/70 L.CV: Regular rate and rhythm normal S1/S2 without murmurs, rubs, or gallops.Respiratory: Clear to auscultation bilaterally.GI: Normal bowel tones, soft, non-tender, non-distended.Musculoskeletal: Strength: UE strength 5/5 B biceps, triceps, deltoids; LE strength 4+/5 bilateral hip flexors and abductors; 4+/5 bilateral knee flexors/extensors; 5/5 bilateral AF/AE; 5/5 bilateral DF and PF. No knee joint laxity. Foot exam shows no calluses, ulcerations, or deformities.

Neurology: Cognitive screen: recalled 3/3 items. Whisper test for hearing: Intact. Tone/abnormal movements: Tone is mildly increased in both legs; normal tone in both arms. Sensation is intact to light touch and pain throughout. Reflexes are normal and symmetric.

Psych: PHQ-2 = 4/6.

Contact Your Partner

• Identify a time that both of you can meet online to record your video. Allot about 60 minutes for discussion with your partner and the recording of the video.
• Your partner groups were assigned in the first few weeks of the course . You will keep the same partner group throughout the entire semester. During the video session, you will both practice the assigned skills for this week, which are based on your readings, handouts, and other weekly materials.
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During Your Meeting with Your Partner 

1. Each session should include the skills you used in prior weeks in the current video; don’t forget the skills you previously learned .
2. In your practice session, role play the case study with your partner using empathy and other skills you have reviewed this week. Your partner becomes the client. You play the role of the therapist.
3. Each partner will record a 15-minute video for each week using Zoom (see the instructional video on how to record a video at the beginning of the course). Provide a brief description (verbally) of the patient situation at the beginning of the video.
4.  

Video Recordings Need to Have the Following Components 

• The recording should show both you and the client during the entire session.
• Both of your faces and body language should be shown.
• Attire should be appropriate and professional.
• Set up the room as if it were a therapy office (that is, chairs; a quiet, private space).
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• The recording needs to be clear and audible. Ensure there is no background noise when you are recording.
• The lighting of the room needs to be appropriate; that is, it should illuminate the faces of the client and the therapist.
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After the Video Recording 

• After your recording is complete, follow these instructions to create an unlisted YouTube video. You will need the YouTube video URL for this assignment. Submit your YouTube video URL. The best way to do this is to copy and paste the hyperlink URL for the YouTube video into a Word document. Your faculty will access your video via the link. Do not upload a video file (mp4).
• Then complete the SOAP Note and Reflection Template (Word) and turn it in to the assignment dropbox.