Case Study on "Create aFictitious Client Who Exhibits Symptoms of Major Depression"

Case Study 7 pages (1864 words) Sources: 5

[EXCERPT] . . . .

Fictitious Case Study: Client With Major Depression

Presentation (Barlow and Durand, p. 6): The client presents as a well-nourished Caucasian female who is well-kempt. The client reports that she turned 33 y.o. two months ago. She is single, employed, has no children, exercised daily until about five days ago, eats nutritiously, is not a vegetarian, drinks alcohol, beer, or wine about 4-5 times per month, usually wine, as much as two to three glasses of wine when socializing with clients and friends. The client states about five days ago she woke and did not want to get out of bed; so she didn't. She called in sick, and has not been to work since that time. She does not take phone calls from clients or friends. Out of concern, her mother came to her home today and "put me in the car and brought me here." The client says, "But I wanted to come. I want help. I know something is not right with me."

During the interview the client cried uncontrollably. Even as she spoke to answer questions and discuss why she was seeking help, tears flowed freely. The client looks healthy, and has the appearance of being physically-fit. The only outward appearance of distress, other than the free-flowing tears, is that the client presents at 1 p.m. In the afternoon dressed in bedtime lingerie. The lingerie appears clean. Throughout the interview the client remained lying down on the couch. Though she talked freely and openly about why she was seeking help, she seldom made eye-contact with this interviewer.

The client states she considers herself fortunate, because she is successful in her career as a celebrity agent, and earns six-figures annually. She states that her studies at Princeton University prepared her for her career. She graduated with an undergraduate degree in accounting. She attended graduate school at UCLA for two years, and holds a Master's Degree in Marketing. She states that up until five days ago, she led a normal and active career and lifestyle. She reports that she works a minimum of 60 hours a week, but that her work takes her out of her office and "into the world of celebrity." The client states that enjoys her work, finds it only moderately stressful at times, but also has personal interests and socializes with her friends who are not celebrities and in a more private lifestyle. She reports that she has spent a lot of her free time with her parents during her father's prolonged illness. Her father passed away three months ago, and she has been very supportive of her mother since his passing. She reports that she is not currently in a relationship, because she does not have the time that it takes to be successful in a relationship at the present time. She states that she believes she will have more time to devote to a relationship "later."

History and Physical: Client states she sees her gynecologist on a yearly basis for check-ups, and reports that she has no problems. She reports that she sees her dentist two times a year for check-ups and cleaning of her teeth. She states that she sees her family doctor for colds, flu shots, and any health-related issues throughout the year. She reports that she has not seen her family MD since her flu shot last year, but will see him for her flu shot this year.

Client reports no family history of alcoholism or drug addiction. She reports that while drugs are present in her work and personal lifestyles, she does not take drugs because "I need to be in control of what I do." Client reports her father's prolonged illness was due to stomach cancer. She reports her mother and one male sibling who is younger than her and herself as being healthy. She reports no family history of mental health problems or health problems except for her father's cancer. She reports that for the last five days she has felt exhausted, unable physically or mentally to get out of bed, dress, eat, work, and that she has no desire to be in the company of others, even her mother or brother.

The client states that she has not had suicidal ideations and has not formulated a plan to commit suicide. She states she has no feelings of anger, aggression, or desire to harm another person.

Observations: Throughout the interview the client cried free-flowing tears. She continued to dab at her tears with tissues, but this did not prevent her from talking freely when asked questions by this interviewer about her presentation and history and physical. The client was a good historian on her health and that of her family. The client speaks with hand gestures that emphasize her points and feelings. The client is very motivated to resolve whatever she experiencing at the present time.

Precipitating Factors: While the client does not know what caused her to experience this episode of withdrawal from her professional, social, and family life, she does not consider the loss of her father as a traumatic event because his illness was prolonged and expected. During her father's illness she did not take time away from her daily work or the time she had to devote to her clients, but says that she often spent less time with them than she would have if her father had not been ill. She did increase the time she spent with her father, mother, and brother while her father was ill over the past year. She states she spent much less time with friends and doing the activities that she pursued with her friends socially. She states she never missed her daily workout class. Client states that her father was her partner in business until he fell ill two years ago, and that she has picked up his responsibilities in the business and her business is thriving. She states her father's absence has increased her workload from forty hours a week to sixty. She states she spent about twenty hours a week with her family during her father's last year of illness

Impression: This interviewer concludes that client might be suffering from major depression precipitated by her father's prolonged illness, having to assume the responsibilities for her father's role in the business, the need to maintain her father's business success, provide through the business for the needs of her mother, father, and, to some extent, her brother who is attending college. The client has not dealt with her father's death, but keeps him alive through her work efforts that have assumed her father's responsibilities, and by the ways in which she continues to support her mother and brother. The patient's depression culminated five days ago in a physical and mental impact that prevented her from being able to continue in that role.

When I discussed these issues with the client, she acknowledged that she made an effort to carry on her father's work in a way that he "would not be missed." She continues to minimize the negative impact it has had on her, stating, "I just need a vacation." She is in moderate, possibly severe denial about her own mental health, believing that a vacation to Cabol, Mexico and warm weather would resolve her current withdrawal from her life.

The patient has a good family support system in her mother and brother. Her mother, though concerned about her daughter's mental health, appeared strong and capable, and stated she would "do whatever it takes to get her back on her feet." In a show of concern and support, the client's brother arrived during the interview, although this interviewer has not yet spoken with the brother; believes the brother is supportive and capable of taking care of himself in a way that the client does not yet recognize. The client has expressed a desire for "things to remain the same," even though her father has passed.

Axis I Diagnosis: 296.2 Depressive psychosis, single episode or unspecified

Axis II Diagnosis: 308.0 Acute reaction to major stress with depressive symptoms

The Literature

Jane Hunt (2008) talks about the manifestations of grief (p. 205):

Inhibited grief denial of grief

Isolated grief selective remembering

Insulated grief reduced emotional involvement

Intellectualized grief rationally explaining events

Immortalized grief inability to let go of loss

These symptoms can manifest singularly, or in a combination of ways. Hunt says that problems begin when "we block the natural process of grieving (p. 205)." Darian Leader (2009) says"

"Depression is a vague term for a variety of states. Mourning and melancholia, however, are more precise concepts that can help to shed light on how we deal -- or fail to deal -- the losses that are part of human life (p. 4)."

When one fails to initiate the mechanisms by which they cope with the major stressors in life, Joseph J. Luciani (2009) says, then they invariably begin to exhibit the signs of major depression that manifest this way:

Depression, sadness, and/or irritated nearly everyday

Loss… READ MORE

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