Adolescent Depression - Research Paper Example

?Adolescent Depression - Case Study Affiliation with more information about affiliation, research grants, conflict of interest and how to contact. Adolescent Depression - Case Study Referral Information: The client is a 14 years old girl who as referred to the student support center by her teachers. She was referred as the teachers were concerned about her increasing absence from school and her falling grades. Her teachers described her as slow, lacking in initiative. Her parents were also worried about her lack of concentration as well as her short attention span. Total Sessions with Client: The client attended 60 minutes of weekly counseling from 12th of June to 28th of August 2011. Prior to the counseling an initial interview was done on the 10th of June 2011. The therapy was terminated after 13 sessions. The client reported significant reduction depression and gained self confidence. She also stated that she always feels dispirited, gloomy, and blue. Client Presentation: The client presented herself as a shy person but she was shabbily dressed. She avoided eye contact and was not keen with the interview. When asked about how she feels and state of mind, the client replied saying that she often fell sad, lonely and unworthy. Even though the client was very shy, she articulated herself clearly with precision in her words. Her speech was at a normal rate and there was no evidence to show any signs of neither delusions nor hallucinations. The client was oriented to time, place and person. The client does not show any sign of perpetual disturbance or memory impairment. When talking about herself, she time and again displayed negative thoughts and inferiority complex about herself. Risk assessment was conducted on the client and there was no immediate risk noticed. When asked about her parents and siblings, the client was uncomfortable and was quite depressed. Problem Situation: The client reported feeling uneasy about herself among her classmates and always felt self conscious and unworthy. She also stated that she felt uneasy about life and felt that people think of her as a freak. The client sated that she does not like hanging out in a large group and she is feels uneasy with her classmates. She also stated that she hates attending extra circular activities in school and any other types of social gathering as it makes her depressed. The client feels at home by herself. She hated even just the ideas of interacting in a social group as she felt that they always judged her. She stated that life is not worthwhile living and often romanticize about suicide. The client reported having trouble concentrating on things especially on her school work. She also stated that she always feel lonely despite the fact that she longed to be alone most of the time. She also stated that she does not like her house either as it is always suffocating her. She further explained her large family and the deterioration in the relationships with the family members. She is also very concerned about what others think of her and her family. The teachers state that the client always seems to be in a world of her own. She does not have any strong relationship with anyone from her class. She was lacking behind academically and always looked sad, withdrawn and unwilling to cooperate with the teachers and her classmates. They further explained that she never completed her homework and never pay attention in the classroom. The client’s parents stated that she failed to have any bond with her peers and often felt excluded. They also stated that most of the time she choose to sit alone in her room and often refused to open the door  for her siblings and her parents. They further explained that she would often cry by herself and would retaliate by being silent for the whole week when asked to babysit her little brother and sisters. Her mother also reported that the client have difficulty in concentrating on anything for a long period and would often forget things. The client stated that she is unable to experience enjoyment or satisfaction. She also revealed she is pessimistic about the future. She further stated that she often felt abandoned and unwanted as her parents never gave her enough attention. The client also revealed that she is convinced that life has no meaning or value. Relevant Client History: The client was born and raised in Melbourne. She currently lives with her parents and her five siblings. She is the eldest and of six siblings. Her parents are both Australian and were also born and brought up in Melbourne. Her mother stated that her pregnancy was a normal one without any complications. She also stated that the client used to be happy and carefree kid. She stayed at home till kinder garden. The client does not have any difficulties settling in primary schools and her grades were above average. The mother also described the client childhood days as happy and social. The mother asserted that the client is an excellent daughter who always helped her out in the kitchen as well as with the kids. She helped her mother take care of the other siblings most of the time. The mother described her as a “good girl and good student” who is always well supported by her family. She helped her parents whenever she could and she even helped her mother take care of her younger siblings.  The client’s father is a well do businessman and her mother is a housewife who takes care of the kids. They do not have a nanny as her mother is not comfortable with strangers taking care of her children. The client mother reported that the client started to withdraw from everything around her after the fifth sister was born. After the fifth kid, the client started showing extreme behavior which often led her parents to wonder why the way she did acted. When questioned about it she would just withdraw herself to the room and would not talk with anyone in the house for one or two weeks. The client father often worked long hours to support the family as he is the bread winner. His business is demanding and he rarely stays at home. He is a loving father but he does not talk much with his children. He expects everyone to above average and set high expectations for his kids. The client stated that she had a good relationship with her mother even though she is an alcoholic but she described her relationship with her father as somewhat distance. The client also revealed that her mother often passed out in the middle of the day and that she often had to take care of her siblings. The client does not have any friends from her locality or her school. When asked about her relationship with her other siblings she interpreted her relationship as turbulent. She was not comfortable talking about her siblings and her mother. She became quite depressed when asked about her siblings and her mother. When questioned about her mother her voice became shaky and she started crying. The client described herself as shy, efficient and reliable person. She also described her relationship with her father as a normal father- daughter relationship, but a distant one. She described her relationship with her mother as loving yet demanding. The client stated that the reason she did not form any social relationship is because she felt that people are not interested in her and that she is embarrassed to approach anyone. She also stated that she is scared that other people are making fun of her and her family. The client’s father and mother did not have any history of mental illness. The client also does not have any previous reported psychiatric history. Assessment/Sources of Information: The following steps were taken to assess the client’s functioning. Structured interview with the client. Semi- structured interview with the client’s father. Semi- structured interview with the client’s mother. Semi- structured interview with the client’s teachers. Behavioral assessment conducted during the recesses and lunch hour at school. Behavioral observation conducted at home to assess the client’s relationship with her siblings. Mental Status Exam and Risk Assessment conducted. DASS-42 (Depression 21) The multidimensional child and adolescent depression scale: Psychometrical properties were used to assess her behavior. Case Formulation: The client’s upbringing predisposed her to suffering from extreme depression and fear of rejection. Her father is unemotionally unavailable and her mother is extremely busy with the other kids which often made the client feel neglected. The client’s mother is an alcoholic with six children. All these factors made her believed that she is not lovable, neglected as well as rejected. The client’s mother behavior, her father’s unavailability and her five siblings who constantly cried for attention precipitated the client’s social anxiety and withdrawal from society. She found it hard to function under such a dysfunctional family. She experienced great anxiety in the classroom and other people and often felt short in comparison with other students in the classroom. The client depression and withdrawal from social life is perpetuated by her academic failure, emotional withdrawal and avoidance behavior. Her grades dramatically drop due to her inability to concentrate and her emotional withdrawal from the class. She also had ongoing long absence from the class and avoids making any contributions or presentations in the classroom. The client seems to have coped with problems around her through avoidance, emotional and physical withdrawal from the society. Consequently, this in turn made her believed that she is unworthy and rejected. The main factor of her fear and depression is because of her avoidance of social gathering. The client is reported to be extremely intelligent, mature for her age, creative and talented. All her positive assets and abilities could be utilized with the proper treatment.  Throughout the interview she appeared compliance which indicated that she is open for therapeutic alliance. Her teachers support and motivation as well as her parent’s cooperation with her complications are her protective factors. Formal Diagnosis:        A specific and detailed client history from interviews, a mental status examination, direct observation, and the client’s results on the psychometric assessment tool was basis for the following Diagnostic and Statistical Manual of Mental Disorders-IV-TR (DSM-IV-TR) diagnosis.  Axis I  mood disorder, including major depression and slight bipolar disorder. Axis II                 No diagnosis Axis III                No diagnosis Axis IV                No diagnosis Axis V                 GAF=67 (current)                              GAF: 89 (at discharge)  Psychometric Assessment: The DASS-42 was administered in the initial interview and anxiety was in the severe range with a score of 20, normal range for Depression with a score of 9 and moderate range for Stress with a score of 21 when compare to normative population. The Multidimensional Anxiety Scale for Children (MASC) was also administered, which is a child self-report. In the Anxiety Disorders Index total T-score of 68 (Much above Average), and Social Anxiety total T-score of 75 is clinically significant which is very much above average. Discussion of Evidence Based Theories: “Adolescent depression is a disorder that affects teenagers. It leads to sadness, discouragement, and a loss of self-worth and interest in their usual activities” (Berger, 2011). It affected many teenagers and if not treated properly it can lead to a serious mental breakdown and even suicide. “True depression in teens is often difficult to diagnose, because normal teenagers have up and down moods. These moods may go back and forth over a period of hours or days. Sometimes when children or adolescents are asked, they will say that they aren't happy or sad. Health care providers should always ask children or adolescents about symptoms of depression” (Berger, 2011). Only in the past two decades has depression in children been taken very seriously. The depressed child may pretend to be sick, refuse to go to school, cling to a parent, or worry that the parent may die. Older children may sulk, get into trouble at school, be negative, grouchy, and feel misunderstood. (Depression in Children and Adolescents, 2011). Because normal behaviors vary from one childhood stage to another, it can be difficult to tell whether a child is just going through a temporary "phase" or is suffering from depression. Sometimes the parents become worried about how the child's behavior has changed, or a teacher mentions that "your child doesn't seem to be himself" (Depression in Children and Adolescents, 2011). Treatment Objectives: After establishing a therapeutic, in consolation with the client and her caretakers, it was agreed that the following treatment and cognitive behavior plan would be used for the treatment goals. 1. Psycho-education on the nature of the client’s depression and phobic behavior for the client and her family. 2. Awareness and understanding the behavior of depression. 3. Reduce avoidance of emotional and social withdrawal (both in class and at home) 4. Reduce negative thinking and fear of scrutiny by others. 1. To reduce her depression and emotional withdrawal related to social interactions through cognitive restructuring through modification of helpful beliefs. 2. To develop pliancy in encountering with negative thoughts and participating in various activities to boost her confidence through Social Skills Training.  Treatment Plan: 1. To impart awareness and give in-depth insight about depression. Teach the client about Psycho education of adolescent depression. Increase awareness on adolescent depression to the parents and teachers. 2. To reduce physical anxiety symptoms. Teach the client relaxation exercise of progressive muscle relaxation. Teach the client deep breathing exercise and techniques to avoid anxiety provoking situation. 3. To reduce the client’s fear of scrutiny, evaluation and negative thought. Teach the client to identity automatic thoughts, beliefs as well as emotions related to her recent social situation. Train and regulate the client to develop realistic assumptions, beliefs and to comprehend the difference between negative and positive thoughts. 4. To reduce avoidance of social performance by enhancing her exposure to social gatherings (exposure therapy). Boost her confidence by teaching new means of interacting with other people.  Conduct imaginary exposure exercise 5. To reduce the client low esteem and augmentation her self-confidences. Restructure her thought processes in terms of her self-image and encourage her to more productive beliefs. Restructure her to counter her negative thoughts. Encouraging her to expose herself with things that she thrives in. Application of Appropriate Interventions: 1. To impart awareness and give in-depth insight about adolescent depression. The Psycho-education was carried out with the client and her family. Instructions and awareness were given to them about cognitive, psychological and behavioral components of adolescent depression. They were also given a hand book about depression for further reading and guidance. The Psycho-education helped the client and her family an in-depth understanding. 2. To reduce physical anxiety symptoms. The client was taught how to relax different areas of her body through progressive muscle     relaxation, breathing technique and distractions. The client was also taught how to comprehend between tense muscle and relaxed muscles. The client was also taught deep breathing exercise and techniques to avoid anxiety provoking situation. 3. To reduce the client’s fear of scrutiny, evaluation and negative thought. Antecedents, Beliefs/thoughts and consequences analysis was used on the client to demonstrate the effects of thoughts and feelings. The client was asked to jot down her negative thoughts as well as rational response to her negative thoughts. This intervention was implemented to redirect her negative thoughts into something constructive. This exercise taught the client the importance of controlling her thought process. 4. To reduce avoidance of social performance by enhancing her exposure to social gatherings (exposure therapy). The client was asked to develop a list of depression evoking thoughts hierarchically (from low to high). This was done to make her feel at home with people around her. 5. To reduce the client low esteem and augmentation her self-confidences. The client was encouraged to take up a hobby to occupy her free time. She was also taught how to restructure her thought processes in terms of her self-image and encourage her to more productive beliefs by encouraging her to expose talents. Evaluation of Treatment Interventions: The interventions applied above were able to assist the client to fulfill each treatment objective effectively. The psycho-education was able to teach the client and her family about her disorder and it taught them that there are possible interventions to this disorder. The exposure therapy helped her act accordingly in intense anxiety environment. The cognitive restructuring interventions provided the client with alternative coping strategies and constructive thinking patterns. After completing the treatment, the client promulgated feeling unusually comfortable in front of her peers. Her depression about life in general was also reduced dramatically. The client also reported to have improved relationship with her peers. Limitations and Future Modifications: Further sessions involving parents with treatment intervention is mandatory to reinforce positive, supportive and cooperative strategies. For further modification, the Supervisee will explain her ethical principal and the nature of her work at the beginning of the counseling session. Reference List Berger, F. K. (2011). Adolescent Depression. Medline Plus. U. S. National Library of Medicine. Retrieved Dec. 09, 2011 from http://www.nlm.nih.gov/medlineplus/ency/article/001518.htm Depression in Children and Adolescents, (2011). National Institute of Mental Health. USA.Gov. Retrieved Dec. 09, 2011 from http://www.nimh.nih.gov/health/topics/depression/depression-in-children-and-adolescents.shtml Read More