Additional History
It is possible to inquire about the following: Susan’s relationship with her daughters’ father and with men in general (how long did they last and when the last one finished, were they traumatic, etc.); her job (is she employed, does she dislike it, is it exhausting and does it tire her, etc.); her free-time activities (does she have free time, what does she do in her free time apart from sleeping, etc.); her bad mood and anxiety (how long has she been suffering from them, are they constant, etc.); her family (is her mother alive, does she keep in touch with her and/or her stepfather or brothers, etc.).
Provisional Diagnosis
According to Martin, Neighbors, and Griffith (2013), “traditional symptoms of depression” include “sad/depressed mood, loss of vitality, tiredness, ambivalence, anxiety/uneasiness, and complaintiveness (feeling pathetic)” (p. 1101); this is very similar to Susan’s situation. Thus, it is possible to provisionally diagnose Susan as having depression (Al Nima, Rosenberg, Archer, & Garcia, 2013; Martin et al., 2013).
Referrals
Susan should be referred to a mental health specialist to identify the severity of depression and the need for medication treatment.
Strengths
There are several strengths which could be helpful when treating Susan. For instance, she stated that she had no suicidal or homicidal intentions, no symptoms of thought disorders, and no history of physical, sexual or emotional abuse. However, this (specially the history of abuse) should probably be carefully checked in the future. Nevertheless, it is also good that her physical and mental states (x4 orientation, thoughts, motor activity, speech and language, memory and concentration, judgment, etc.) appear normal, and she is willing to attend sessions.
Barriers to Treatment
There are several potential barriers to treatment. For example, Susan is not socially active, has no friends, and is not willing to look for friends, which means she will have little support during her treatment (apart from that provided by her younger daughter). This unwillingness may have to be overcome during the therapy. She is also pessimistic, doubting that therapy will help her.
Problem Statement
On the whole, Susan can be diagnosed with a clinical depression (Al Nima et al., 2013), which is evidenced by the following symptoms: low mood, anxiety, guilt, discouragement, discomfort around others, dread about the future, apparently – lack of sexual drive, low energy, disordered sleep (frequent napping), and complaintiveness (feeling pathetic). These symptoms are included in the list of symptoms for depression as provided by Martin et al. (2013), which allows for diagnosing Susan with the above-mentioned clinical depression.
Goal One
Susan should change her perceptions about herself, as well as with respect to her situation in life (that is, her vocational situation, her family life, and so on).
Objectives for the First Goal
During the third session, Susan should learn about the potential causes of low self-esteem and the relationship between low self-esteem and depression (Sowislo & Orth, 2013). Susan will complete a questionnaire in order to assess her level of self-esteem; the Rosenberg Self-Esteem Scale will be utilized for this purpose (Mullen, Gothe, & McAuley, 2013; Supple, Su, Plunkett, Peterson, & Bush, 2013). During the period of two months of sessions, it will be needed to help her raise her self-esteem from (clearly) low to normal levels.
Goal Two
Susan ought to improve and/or build relationships with other individuals, such as her daughter, her colleagues at work, and her relatives.
Objectives for the Second Goal
By the end of a three-month period of regular attendance to sessions, Susan should change her perceptions and desires pertaining to her relationships with others. By the end of the first month of therapy, Susan should start regularly socializing with her younger daughter, Mandy. By the end of the second month of therapy, she should establish an amicable relationship with at least one of her colleagues. By the end of third month of therapy, she will need to have contacted her older brothers and attempted to organize a reunion with them.
References
Al Nima, A., Rosenberg, P., Archer, T., & Garcia, D. (2013). Anxiety, affect, self-esteem, and stress: Mediation and moderation effects on depression. PLoS One, 8(9), e73265. Web.
Martin, L. A., Neighbors, H. W., & Griffith, D. M. (2013). The experience of symptoms of depression in men vs women: Analysis of the National Comorbidity Survey Replication. JAMA Psychiatry, 70(10), 1100-1106. Web.
Mullen, S. P., Gothe, N. P., & McAuley, E. (2013). Evaluation of the factor structure of the Rosenberg Self-Esteem Scale in older adults. Personality and Individual Differences, 54(2), 153-157. Web.
Sowislo, J. F., & Orth, U. (2013). Does low self-esteem predict depression and anxiety? A meta-analysis of longitudinal studies. Psychological Bulletin, 139(1), 213-240.
Supple, A. J., Su, J., Plunkett, S. W., Peterson, G. W., & Bush, K. R. (2013). Factor structure of the Rosenberg self-esteem scale. Journal of Cross-Cultural Psychology, 44(5), 748-764. Web.