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The client whose case is presented in the paper is a non-Hispanic white female who is 35 years old. The patient has a wide range of psychological problems that significantly decrease her life quality and affect her working capacity. A lot of issues that she reports can be attributed to her personal life and difficult relationships with her ex-husband that still impact her mental state. The patient has divorced from her husband recently because of his aggressive behavior and suicidal thoughts he expressed to attract her attention. The client has had a great number of individual therapy sessions with my preceptor during the past two years as a part of depression and PTSD treatment.
The Presenting Problem and Symptoms
Prior to the most recent psychotherapy session, the patient formulated her key problem as the inability to start with a clean slate after having relationships with a mentally ill spouse who posed a threat to her and her little son. In other words, the woman whose case is discussed in the essay has difficulties in adapting to sudden changes (decidedly positive) in her lifestyle and still needs help to cope with post-traumatic stress and depressive episodes. The client’s case deserves close attention due to her psychological characteristics, such as emotional instability and propensity for self-aggression, which increase the probability of suicide-related behaviors. Among the symptoms indicating the presence of PTSD and depression are flashbacks that occur in stressful situations, posttraumatic nightmares, the feeling of detachment, the loss of interest in life, fatigue, and persistent sad mood.
Mental Status Assessment
In terms of the mental status examination, the patient demonstrates certain signs of psychological problems that affect her physical state. As for general behavior, eye contact is piercing, whereas movements seem to be normal. At the same time, the client’s psychomotor activity is retarded. The rate of speech is decreased; it is monotonous and soft; the patient uses a limited number of intonation patterns and a lot of pauses. The client uses the following words to describe her mental state and mood: “alienated, pointless, no way out, fixation.” The effect is dysphoric and mood-congruent. Despite the seeming restraint and deferred reaction, the client’s thoughts are well-connected, and all statements have clear communicative goals. However, the patient sometimes needs time to make everything in her answers logically aligned.
As for the content of thoughts, the client often mentions her family, whereas little attention is paid to her personality and interests. The patient does not have hallucinations or suicidal ideas but indicates signs of depersonalization, such as the fear of madness. The inappropriate ideas of reference are also absent. In terms of cognition, the patient’s alertness is clouded, but she is able to concentrate on something. However, focusing on certain things for a long time presents a difficult task for her. There are issues related to her long-term memory since she has minor problems in recollecting the capitals of countries, etc. The patient can identify, analyze, and combine abstract concepts. She seems to be aware of her current problems and psychological needs.
Social Factors Affecting the Client
As it is clear from the results of the social wellness assessment, the client has a few close friends but indicates communication problems. The client feels that her friends are unable to understand her problems since they are happily married. Apart from that, being obsessed with her negative experience, the patient sometimes fails to pay enough attention to other people’s needs. Another area of concern is her ability to collaborate – the client acknowledges that she “hogs the cover” in any relationships. Among the most important social factors that may impact the client’s mental health are gender and economic position. As for the former, the patient claims that she has become the victim of gender role attitudes supported by her parents. According to the patient, they believe that a woman is responsible for the psychological climate and the psychological well-being of her husband. Due to the impact of such attitudes, the patient used to blame herself for her husband’s verbal aggression and deep dissatisfaction with life. At the beginning of the treatment two years ago, the patient’s working efficiency was extremely low, which threatened her socioeconomic position. The patient’s economic situation has improved since then, but she still fears that her mental state can impair her further career development.
Interventions and Outcomes
Interventions that were used to help the patient primarily referred to her attitude to ex-husband and other people. To begin with, IPT techniques that are known as effective in depression treatment were used during individual psychotherapy sessions with the client (Lemmens, de Rubeis, Arntz, Peeters, & Huibers, 2016). I can be used in cases of mild depression. The approach is highly recommended for dealing with depressive episodes in adult patients since it decreases the severity of depression measured using BDI and other tools (Lemmens et al., 2015). During eight sessions with the patient, supportive listening, and role-playing exercises were used to facilitate her psychological recovery.
To begin with, supportive listening turned out to be a helpful technique. The client was encouraged to tell anything about her past or current relationships with people, paying special attention to her feelings about her ex-husband’s behavior. The patient seemed to blame herself for the divorce, and it was not easy for her to accept her new role as a single mother. Thus, role-playing techniques were used to teach her to answer others’ questions about her personal life calmly and feel valuable. Many exercises included in the sessions touched upon the way that she communicated with her child. Considering the child’s needs, shifting the focus of her attention from ex-husband to her son was pivotal.
Paired with keeping a mental health diary, the interventions helped the patient to become more interested in the outside world and distract from negative feelings (Toly, Blanchette, Musil, & Zauszniewski, 2016). From an objective point of view, the patient has become more self-confident, which manifested in both appearance and behavior. Importantly, she went back to some of her hobbies (handicraft and drawing) and taught her son how to draw. As for her feelings after the end of the most recent session, she now understands that her husband’s problems were not caused by her mistakes. Analyzing her diary entries, we have defined people who negatively impact her well-being by blaming her in an implicit way.
The Significance of the Case and Further Questions
The decision to choose the case is related to the fact that it illustrates the impact of toxic relationships on an emotionally unstable person. Apart from that, working with the patient was especially important because there was a person who depended on her both emotionally and physically – her son. Given that the patient still needs help, the following CDM reflection questions are important:
- What self-help measures can the client implement to cope with flashbacks?
- What can be done to prevent the development of PTSD in the client’s son?
In the end, the case demonstrates the destructive effect of toxic relationships and gender stereotypes on personal well-being and the ability to adapt to lifestyle changes. Also, it supports the effectiveness of interpersonal therapy for cases of depression. Personally, I consider the described experience to be extremely helpful for my future practice.
Lemmens, L. H., Arntz, A., Peeters, F. P., Hollon, S. D., Roefs, A., & Huibers, M. J. (2015). Clinical effectiveness of cognitive therapy v. interpersonal psychotherapy for depression: Results of a randomized controlled trial. Psychological Medicine, 45(10), 2095-2110.
Lemmens, L. H., de Rubeis, R. J., Arntz, A., Peeters, F. P., & Huibers, M. J. (2016). Sudden gains in cognitive therapy and interpersonal psychotherapy for adult depression. Behaviour Research and Therapy, 77, 170-176.
Toly, V. B., Blanchette, J. E., Musil, C. M., & Zauszniewski, J. A. (2016). Journaling as reinforcement for the resourcefulness training intervention in mothers of technology-dependent children. Applied Nursing Research, 32, 269-274.