Psychopathology: Diagnosis and Prognosis of Clinical Depression - Case Study Example

Case Study: Clinical depression Aim An attempt to understand the background, diagnosis and prognosis for a woman suffering from Major Depression. Outline of the condition The client (Mary) has been experiencing depressive symptoms for some time. Previous treatment with antidepressants and hormones has not been successful. When presented, her symptoms were very severe to the extent that she felt no interest in anything was distant from her children and spouse and was also experiencing physical symptoms like trembling, palpitations and irregular menstrual cycle. There are long term symptoms of constipation and bad breath that started when her parents separated (Mary was 6 years old then). The symptoms that cause most concern are the suicidal feelings that Mary has had throughout this period. Triggering event Mary’s eldest daughter became pregnant unexpectedly at the age of 16, which triggered Mary’s anger which settled into the presenting symptoms. Diagnosis Severe episode of Clinical Depression; possibly with a history of Dysthemia. Definitions Clinical depression has been defined as “A condition of mental disturbance characterized by such feelings to a greater degree than seems warranted by the external circumstances, typically with lack of energy and difficulty in maintaining concentration or interest in life.” Profile of the Individual Age: 46 years old. Gender: Female. Nationality: English Employment record: Mary trained and worked as a Secretary at first. Later she studied to become a fashion designer and interior decorator and followed that career path until marriage. Family profile Parents Mary’s father had an addictive personality, and was an alcoholic. He was very promiscuous and had known relationships with as many as 9 women that Mary knows of. He was given to physical and verbal abuse, which led to Mary’s mother separating from him when Mary was six years old. Mary’s mother also had an addictive personality and was abusive. After her separation, she moved to London, and the stress of providing for the children brought out her abusive side, till Mary left her house at age 17. Siblings Mary has younger siblings who she was responsible for after leaving her mother’s house. This includes brothers as well as sisters. Mary was their primary caregiver till they reached adulthood after they left their mother. Mary has felt protective and responsible towards them as she was the oldest. Her father had sired 23 children; but Mary is not in touch with all her step siblings. Partners Mary found it difficult to have relationships as she experienced trust issues – possibly stemming from her parents dysfunctional relationship and eventual separation. She eventually met her present husband, a dentist belonging to a middle class background who convinced her that he would be loyal to her and would never leave her. They have now been married for 17 years; but their present relationship is somewhat distant. Children She has 2 daughters, who she has devoted all her time to. Her relationships with her daughters are not very healthy at the moment, especially since her elder daughter aged 16, found out that she was pregnant. This incidence was the triggering point that started the depressive experiences that Mary has presented with. Culture Mary comes from a small town culture, but moved to London with her mother at an early age. The middle class notions of propriety were what forced her mother to move to London; but Mary seem to identify with them and holds her family to the same measures. Onset of condition Mary has had trust and relationship issues since her youth. She found it difficult to develop relationships with partners till she met her husband. She also has few friends, and the one friend that she does trust, she depends on and confides in. Mary has attempted to block out her past, and never speaks of it; possibly because she has unresolved issues which are very painful to cope with. The presented symptoms find their onset in the discovery that her eldest daughter was pregnant. This experience made her feel like she had failed in everything that she had tried to do, and she responded initially with frustration and anger, which then settled into her present state of despondency. Progression of condition Mary’s initial anger and frustration over time developed into a lack of interest in anything at all. She also developed physical symptoms like trembling, palpitations and an irregular menstrual cycle. The antidepressant medication and hormone therapy she received has further increased her problems. Mary has developed suicidal feelings, and her resentment towards her mother has resurfaced. She also feels angry and frustrated with her daughter. Developing Trusting Relationships Mary has profound trust issues; and would find it difficult to build a trusting relationship with her therapist as with other persons in her life. The therapist needs to make a commitment to Mary about the time and involvement that she can expect; and help Mary understand that this would be a binding commitment. Mary fears abandonment, and the therapist needs to explain to her how the sessions would be conducted, and reassure her that she would not be left in the lurch. The therapist also assures Mary about the process and the possible reasons why sessions could have to be rescheduled from the therapist’s side. This would help Mary understand that she is important to the therapist. The therapist also helps Mary understand under what circumstances Mary could be referred to other doctors and specialists if and when required. Mary’s experiences in life have socialized her to expect hurt and pain from close relationships. In response to this she tends to put all her energy into keeping her relationships safe by investing in the people all the time. The amount of effort she invests makes her expect a perfect relationship in return. When she does not get this perfect relationship, she feels cheated, the cycle starts again. Mary has always played the role of the supportive responsible person, whether as a sibling, or as a parent. She finds it difficult to trust people easily, as her trust has been broken multiple times in the past. Mary needs help in exploring the unmet needs that she experienced in her roles as a child, spouse or mother, and address them to find closure. A necessary intervention is to help Mary become closer to her family since she values them a lot. Initially, the therapist needs to help Mary in identifying the needs she is attempting to meet through her family. She should be helped in understanding the reasons for these needs, as well as in understanding the various perspectives with which the situation may be viewed. Once Mary is ready, the therapist can help her interact with her family members in a supportive environment, and voice out her needs and feelings to them. The therapist then helps her assimilate their responses, and then helps her identify which they needs can meet. Once Mary has a better understanding of her family’s needs and they of hers; the therapist can now help them to build healthy relationships by teaching them ways to communicate effectively. Therapeutic interventions undertaken Initially, the therapist needs to address the extreme depression that Mary is experiencing with medicines. Since Mary is feeling very suicidal, it may be necessary to hospitalize her initially, till the medicines take effect. It is necessary to check for what medicines have not worked before, so as to refrain from repeating the same chemical and dosage. Once Mary feels lees emotional, the therapist needs to help her address the most important issue – her resentment towards her mother and anger towards her daughter. Cognitive therapy and a Humanistic approach would help Mary, as the Humanistic approach will provide the supportive and caring environment that Mary craves, and cognitive exercises will help her evaluate her relationships and view them as an adult rather than as a child or a parent. If the therapist discovers unresolved issues that are deep-seated, there is a possibility that Transactional Analysis could help Mary achieve closure with the issues she has with her mother; and also view her daughter as an individual who makes her own choices. The supportive environment of the humanistic approach will help Mary assimilate the learning that occurs in these sessions, and then apply that learning to her relationship with her family, and thus improve her relationships and her perspective n the event occurring around her. Mary can be eased off medicines once she feels capable of coping with her life experiences. It should be noted that as per her age, Mary may be undergoing menopause, and care should be taken that the medicines do not conflict with the biological responses of her body. Effectiveness of interventions The interventions will be considered as effective if they help Mary experience a reduction in stress and distress. The therapist should also be able to achieve an interaction between Mary and her family, especially her pregnant daughter. This interaction should be open and healthy, and helpful to all concerned so that the relationships between the concerned parties improve as a result. Likely prognosis Mary will need a few months in order to deal with her deep-seated problems. Even after these problems are dealt with in therapy, the assimilation of the outcome can take a long time, especially for long-term problems like those that stem from Mary’s relationship with her mother. Thus, the therapist needs to have follow-up sessions for 6 months up to a year after ending therapy to ensure that Mary is dealing with her life experiences well and not letting the past cast a shadow over her present. Mary is likely to recover fully and become fully-functioning post therapy, and there is reason to hope that her relationships will improve with adequate care taken during therapy. Summary Mary suffers from Clinical depression with suicidal tendencies; but can be helped in getting over it and reaching a place where she deals with life situations effectively and is at peace with her past. References Bennett, P. 2003. Abnormal and Clinical Psychology: An Introductory Textbook. New York: Open University Press.  Hansell, J.; Damour, L. 2005. Abnormal Psychology. Michigan: Von Hoffman Press.  Barlow, D. H.; Durand, V. M. 2004. Abnormal Psychology: An Integrative Approach. Bellmont:Thomson Wadsworth.  Read More