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ravimons

last minute PMP help SOS,SOS

4 posts in this topic

1)A patient with mild depression and low self esteem concedes to you that she is seeing a Gestalt therapist for her depression as she doesn't like the pills you prescribed.

The therapist invites her to go on a blind date with a fellow patient of his.

She asks whether she is in good hands.

How would you manage this case?

2) A 35 yr old attractive lady you have referred to psychotherapy for treatment of depression reports that the Spr has developed an attraction towards her and she finds the situation rather uncomfortable...... how would you proceed?

it is 3 months into the treatment...

she has histrionic personality disorder...

what is erotic transference

3) 32 year old female,refereed for being depressed and anxious.Had a background of being most of the time with grandparents along with a younger sister,This was coz of parents away owning some business.Took the role of caring her sister.

Later on living in a big house,with sister and brother in law[is that right??not sure]Dislikked brother in law.Arguement one day with him,Stormed out and shot himself in the garden!! Our lady tells this without any emotions.

You are seeing for couple of sessions and start feeling angry at her

So whats happening here!!

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Holy moly, where'd you get these stinkers from? I think I'd have run out of the room if I'd got these ones in the exam! :lol:

1) Issues: is she vulnerable because of her depression? Is her depression mild enough for psychotherapy alone to be effective?

Gather info, speak to GP, check notes, speak to Gestalt therapist with her consent.

Speak to patient and check symptoms, rule out psychosis, severity, risk of suicide. Discuss why she doesn't want meds - ?side effects, ?poor understanding.

Speak to her about therapy, is it effective? Does she feel it suits her? Recommend CBT quoting NICE for alternative talking therapy.

With regards date, not really our role to say. She should speak to the Gestalt therapist about it. Seems inappropriate to say the least, and breaches both her and the fellow patient's confidentiality. May need to speak to therapist directly and clarify if this story is true. If it is then need to advise him to contact his defense union or supervisor to discuss this issue. Encourage him to do this voluntarily, but state you are very concerned about breach. Speak to your own defence union and the GMC, follow GMC good practice guidelines. May need to report him.

2) (Would it make a difference if she was ugly 35 year old? :lol:)

Issues: Patient alleging SpR attracted to her and uncomfortable about this, patient may be falsely accusing or mistaken.

Read notes, speak to GP ?similar accusations in past, speak to SpR to inform him of the complaint and get his version of events. Speak to her and get details, also take history and mental state of depression, rule out psychosis, suicidality, risk to others (esp the SpR). Ask what she wants to happen - she may be thinking of pressing charges, etc.

Management - GMC, defence union, Psychotherapy Consultant for advice. Most likely would need to find different therapist. Would suggest female therapist in future. Continue treatment, add antipsychotic if psychotically driven.

Not sure what else....

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3) Ooh she's a psychopath! No but seriously... Not sure. Did he shoot himself?

You're angry because of projective identification, or transference or some such thing. Psychotherapy was never my forte! Sorry I can't help with this one, but I think most people would struggle. If it did come up then every one would score badly and the marks would even out.

Good luck!!!!

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