DISSEMINATED GERMINOMAS The Therapeutic Challenge INTRODUCTION The prospect of tumours in the paediatric population is heart wrenching for parents and caregivers alike. The instinctive need for humans to care and protect their offspring leads to emotions of despair, anguish and hopelessness. Neurosurgeons are familiar with these emotions, as brain tumours represent the second most common paediatric tumour(1). Germinomas, even though rare, are unique to the paediatric population and adequate treatment of these tumors tend to have a good prognosis. In a few patients, there can be spread of the tumour, usually along the cerebrospinal fluid pathways with distant metastases being rare(2). Patients with this disseminated disease tend to present a unique challenge in managing the disease process. CASE A 16 year girl presented to the Accident and Emergency department of the University Hospital of the West Indies with a history of worsening headaches, vomiting and drowsiness. She had a history of having a suprasellar lesion resected one year previously that was diagnosed histologically to be a germinoma. A ventriculoperitoneal shunt had been placed to treat her postoperative hydrocephalus and she received conformational radiotherapy post operatively and was during well until the time of presentation. On presentation she was completely blind, and had no history of fever, seizures or weakness. On examination she had a Glasgow Coma score of 15 with no motor
Solution focused therapy is a model of therapy developed by Steve de Shazer and Insoo Kim Berg in the late 1970's (Dolan, n.d.). This model has become well known for its non-traditional approach to client problems as it does not explore clients issues in relation to their cause and affect but rather the goals and solutions to achieving a future free of any present issues. i will be discussing the evident concepts, principles and intervention techniques of this particular model. it will be explored in the context of a case scenario of a therapy session to observe how the model can be actively applied to therapy sessions and why this is the best model to meet the client's needs. The effectiveness of the model
Strategic Therapy or Strategic Family Therapy is one of the oldest theories used in the practice of marriage and family therapy today. It was developed by Don Jackson and others affiliated to the Palo Alto group. Jay Haley and the Milan Group are also important practitioners of the model Strategic Therapy. This theory is portrayed as focused on altering family dynamics, eliminating problems and focusing on the presenting problems rather than the past, and often giving homework and behavioral tasks to clients. In this essay is a detailed description of the history of strategic therapy, beliefs, techniques and problems presented by this theory.
Brief therapy helps people by focusing on solutions, instead of problems. The therapist asks questions thereby facilitates the client by helping formulates solutions. The client leads the meeting by actively formulating ideas in which he/she can serve to improve the client's negative circumstances. This is contrary to cognitive therapy, which focuses on a client's cognitive processes (how he or she thinks about people/places/things). The therapist collaborates with the client to help the client develop alternative solutions.
Most contemporary psychological treatment approaches are predecessors of the ancient and medieval philosophies and theories. Cognitive behavioural therapy as one of the modern treatment method in not an independently formed treatment, different theories have contributed to its present shape and application.
A therapeutic relationship is a key component in the nursing profession. Without therapeutic relationships, the best possible care can never be provided. The foundation in which trust is built upon is created from the nurse’s ability to truly listen and respond appropriately. Listening creates the base in developing a strong, trusting relationship. Sometimes it is simply hearing what a patient says that makes all the difference, empowering them to open up and become more comfortable with the nurse (Hawkins-Walsh, 2000).
Describe a particular patient in the clinical setting, WITHOUT identifying information: Why was the patient at the clinic? Describe the clinical findings, kind of care, education, communication, and extra services that occurred with patient and family in this agency.
In it's simplest form, Cognitive Behavioral Therapy, (or CBT as it will be referred to from here on out), refers to the approach of changing dysfunctional behaviors and thoughts to realistic and healthy ones. CBT encompasses several types of therapy focusing on the impact of an individual's thinking as it relates to expressed behaviors. Such models include rational emotive therapy (RET), rational emotive behavioral therapy (REBT), behavior therapy (BT), Rational Behavior Therapy (RBT), Schema Focused Therapy, Cognitive therapy (CT). Most recently a few other variations have been linked to CBT such as acceptance and commitment therapy (ACT), dialectic behavioral therapy (DBT), and
What applied clinical problem would you most like to focus on in your PsyD studies and in the PsyD Clinical Psychology dissertation/doctoral project? Tell us something about your knowledge of the relevant theory and concepts, research, and the application of that scholarship to clinical practice.
Research has shown that a strong therapeutic alliance is necessary for establishing a beneficial contact between the therapist and the client. If the therapist does not encourage the creation of a reliable therapeutic alliance from the beginning of the treatment, it will be hard to develop a constructive relationship with the client later. Establishing the therapeutic alliance will increase the chances of achieving the goal of the treatment because the clients will be willing to cooperate if they trust and respect the therapist. Clients are not likely to cooperate with therapists who impose their authority aggressively. Instead of imposing their authority on the patient, therapists should develop work with their patients by
The history of family therapy began around 1960, when Gregory Bateson coined the term, “system thinking.” This type of therapy was a daring departure, both technically and philosophically, from traditional and individual treatment during the 1960s. Gregory Bateson was inspired. He felt that the unit known, as “the family” needed to be celebrated and that is exactly what he did” (Family Therapy, 2010, Para 1) Along with Gregory Bateson, are a list of several others who contributed to the evolution of Marriage and family counseling. This list includes the founder of social work, Mary Richmond, Mr. W. James, who researched the organic expression of social systems intervention and Mr. J. Dewey. Each of these
This essay will explore the nature of the therapeutic process; using my fifty minute long real play session with one of my colleagues. Also, I will explore my experience of the therapeutic relationship and how it influences therapeutic change and increase the affectivity of the therapy.
The therapist and client relationship is important in effective therapy. The therapeutic relationship must be built upon before any technique and theory will be effective. Communicating real empathy and showing a genuine interest in the client will begin a solid therapeutic foundation. However, the therapist must “have the ability to stay outside the system while maintaining some emotional attachment to its members” (Patterson, Williams, Edwards, Chamow, & Grauf-Grounds, 2009, p. 107). This paper reviews and critiques an interview I recorded of a couple that pertains to clutter building up around the house. The goal of this activity was to seek out information using various questioning techniques and basic interviewing skills, and
Founded by Frederick (Fritz) and Laura Perls in the 1940's, Gestalt therapy is a phenomenological -- existential methodology which emphasizes experience and experimentation. Gestalt is a German term that means a "complete pattern or configuration" (p. 112). Though there are many modalities and styles in Gestalt therapy, it is holistic in its approach uniting mind, body, and feeling (p. 112). Some concepts at the core of Gestalt therapy are "the organism as a whole", emphasis on the "here and now", and "awareness" (pp. 223-225).
Rehabilitation technology services are utilized to assist clients who need technology to eliminate barriers to employment. The technology is all items that maintain, improve, or enhance the functional capabilities of clients with disability. These services can include mobility aide devices, vehicle modifications, prosthetics, hearing aids, and equipment for the visually impaired. These services are based on the needs of the client and vary. According to research, rehabilitation technology is a significant service for individuals who cope with multiple sclerosis, cerebral palsy, and cancer survivors (Chiu, Chan, Bishop, Cardoso, & O’Neil, 2013; Huang, et al., 2013; Strauser et al, 2010). These individuals and other clients utilize the technology to provide the necessary accommodations that they may