Treatment on the Go

As I lie in bed trying to rest to eliminate my bad flu, I am contemplating going to the doctor to medicate me before this overloaded week of: client demo, a clinical science test and our presentation. I am also contemplating whether it is just a virus and not wasting my parent’s money. But with my tight chest, sore throat and weakness I do not feel my immunity will handle the stress of the upcoming week. My arms ache as I type this and all I want to do sleep. ‘Sleep’ that I won’t get much of this week. ‘Rest and Sleep’ – an important area we treat as students, but fail to achieve ourselves.

My interviewing and assessment skills definitely require work. I feel as though I should not need the file to identify the most important areas of treatment. However, I should not put myself down too much considering the complexity of Schizophrenia cases and the clients’ change in approach of answers, as they hear the words “Pass Out” and “Discharge”. For example, I know that medication compliance is often a problem in Schizophrenia patients and is a very important aspect of relapse prevention. When a client has been given his medication for months in an institution, he will certainly reply that he complies with it. However, when reading his file, non-compliance was his main reason for submission and when talking to the client’s nephew, the client believes the injection he receives poisons him.

I titled this Blog ‘Treatment on the Go’ after I treated my client on his walk from P4 to the car park upon discharge. I did this to try my best to alter his thoughts towards his medication with my words, as well as imply that he should listen to his extended family as they only want what is best for him. His nephew smiled as I did this, knowing the client displays a completely different persona in the hospital and towards me and that he will become the moody, ill-tempered, disobedient uncle as soon as he climbs into the car again. The nephew has dealt with him for many years; tying up his hands and legs to carry him over his shoulder when hospitalization is necessary, once again.

Whilst my client described the visions and delusions he experienced; I would prompt him to tell me more. I need to learn to prompt during the most important aspects, which I may be afraid to ask. For example, when the client explained to me that the ‘Tamils have been poisoning him’, I did not prompt him to explain further. This may be the reason he does not comply with his injection and medication, as he believes it is the Tamils poisoning him. Had I realized this without needing the nephew’s input and the files, my title would not need to be ‘Treatment on the go’, as a result of only recognizing important treatment aspects last minute - upon client discharge.

After flipping through the file and discussing the client with his nephew, I realized the most important aspects of treatment. My two treatment sessions would have definitely prioritized Medication compliance and Substance abuse to prevent relapse, rather than social skills and leisure.

I feel as though my treatment skills have improved since my first attempt, using an icing activity. My second attempt at treatment was leisure, because the client does not have a job and poorly uses his time, most liekly resulting in drug abuse. I therefore discussed the opportunity for different leisure outlets which can make his days more interesting and hopefully reduce temptation for drug use.

On Friday I treated my P2 client for the first time. I could tell he really enjoyed the session. This made me happy. The client was required to answer yes or no statements and I tried my best to pronounce the Zulu sentences I had translated for him. The client participated actively, motivated to beat his previous time and answered most social judgement or insight questions with the correct yes/no answer before shooting at the goals. When we reviewed the session, I realized the importance of this in treatment. The client had answered some questions correctly but with a different thought process than the student therapist's. For example: “I should only take my medication every third day”, this was correctly answered: No. However, his explanation for this during the review was that it was because he feels he does not need to take his medication at all. I therefore provided him with intellectual insight about his diagnosis and plan to do a medication compliance chart with the client on Tuesday. Anger management also requires attention after discussing the social judgement and insight questions.

I am now sat finishing off this blog in the doctors waiting room. My thoughts trailing about how I am going translate my entire demo into isiZulu... I seriously need to start my case study and find time to study for the test.

I am learning how to perform treatment better each day, evaluating my poorer sessions from my better ones and I know that my skills will improve in time. I am finding this semester very interesting and am grateful for my opportunity to learn in an acute setting, despite the added stress this may cause.