Vignette: Candice - Case Study Example

Case Vignette: Candice s affiliation Case Vignette: Candice Assessment of the case Candice has a difficulty in quitting smoking dueto various factors that are ongoing in her life. She uses this smoking as an escape route on a daily basis to shield herself from the daily ridicule and unpleasant events at her workplace. Being a transgender, she gets ridiculed at work and has been rejected by most of her family members with only Charles being the closest individual to her at the moment. She displays characteristics of being depressed and this is a dangerous situation since she has very limited support network. The smoking is the only other ‘support’ that she can fall back to since it can always be available when needed. That is why she smokes on a daily basis immediately after work to numb the pain of the day long ridicule. Such cases are very different from other conditions since the patients may not even be aware that they need help and if they are aware, rarely go to seek for the help needed. They mostly have a conviction of worthlessness and guilt that leads to extremely low self-esteem (Lichtenberg, 1998). This is the case with Candice she had to be literally dragged to seek health care. Large majority of patients who face major depression are smokers .The percentage actually stands at 60%. Most of them smoke to cover the underlying depression (Shorter, 2013). I will prioritize Candice’s condition in the following ways;- Talking to her from the beginning about their problems .This may be difficult at first but she may need someone else to talk to apart from Charles and this is the void I shall offer initially. I will have to reassure her that the treatment being proposed is very effective and that she will benefit immensely from my support. Treatment Plan For an effective treatment plan, I will have to identify the key symptoms being manifested in Candice’s case. The main symptoms are: sadness, poor-self-esteem, irritability, low energy and self-Isolation and excessive smoking. My long term goals will be to significantly reduce these symptoms of depression to level whereby they will no longer interfere with Candice’s normal daily routine and interaction with her colleagues and neighbors back at home (American Council on Science and Health, & Meister, 2003). I will use a t score of 50 or below on the depressed scale to measure the overall success of the treatment at the time of completion. My short term goals will be as follows;- Establish a healthy communication channel with her family This is critical since the family is normally the closest support group for depression patients. The case is unique since the patient had very minimal communication with the family due to her transgender situation mainly and other things which I will seek to establish. The family member that should be approached and seem like easier to convince is Candice’s sister with whom they have at least some form of communication. Achieving this goal is important since it will mean she will have a bigger support network at the end of the treatment which will prevent relapse. Identify a Co-curricular activity I will have to discuss with Candice what sort of activities are of interest to her. This can be most probably a sporting event like swimming, soccer or even surfing. A sporting activity is a great way to engage the mental faculties in constructive activities and offer someone a channel to vent out negative energies and daily stress that may lead someone to start smoking again and relapse into depression (American Council on Science and Health, & Meister, 2003). Teaching Coping Skills and emotional regulation Most people get into depression due to the fact that they have no means to cope with the daily negative energies and interactions with other people. This can be gauged by giving her small tasks that involve problem solving during treatment for about two consecutive weeks to ensure she is better off than when it all started. This is important since it is almost certain that she will encounter stressful situations at work, at home or even when outside working and she has to learn to cope with these situations without resorting to smoking that will ultimately lead to depression all over again and poor health (James & Wayne, 2002). Candice will have to learn how to identify negative and maladaptive thoughts and replace them with much more adaptive and positive thoughts in her mind. Family Involvement After establishing the family communications in the first goal, I will seek to provide essential education to the family members on depression to raise their awareness on depression and the role they have to play to help Candice improve her situation and hasten her recovery process. The conflict in the family is evident due to the breakdown in communication between the Candice and her sister as well as her other family. I will give her a chart to fill out that will contain the following;- The number of times Candice attempted to talk to her sister in a week about what she was going through and daily activities during the week. The number of times she has argued with her coworkers or even the number of times she has had a positive conversation with any of them in the course of one week. The findings of this case will enable me to evaluate what initiative she is personally taking to help improve her own social interactions at home and in the work place. It can also be best to link her up with counseling sessions that deal with transgender individuals and helps them cope with the stigma that comes about due to their conditions. Therapeutic Intervention Cognitive Behavior Therapy Depression patients normally possess a negative view about the world around them and themselves. This is normally the case due to the negative experiences they have been subjected to over the years by people close to them at home or at school during a specific period of their life and development (American Council on Science and Health, & Meister, 2003). Almost all of their experiences are distorted via a negative filter. James & Wayne (2002) states that this ultimately affects their thinking patterns, making it difficult for them to stop even the negative effects of their irrational thinking. The cognitive behavior therapy will help Candice see how her own thinking has a bearing on her mood and will help her think in a much more positive manner about herself and those surrounding her. This is based on the principle that negative thinking is a habit like any other and this habit can be broken through appropriate means and treatment (Lichtenberg, 1998). I will make use of one on one sessions to make it easier for her to open up to me which would be much harder in a group setting for someone who isolates herself from society and family and has very limited social interaction with other people in society. I will have to take time to make her look much more logically on her negative thoughts so as to enable her adjust the thoughts of the world and people around her. Interpersonal Therapy The main triggers of depression can be attributed to the person’s social interactions (relationships, social roles, work) and personality. Interpersonal therapy is based on the assumption that interpersonal problems and depression are interconnected (James & Wayne, 2002). The goal of this therapy will be to therefore help Candice see how her interpersonal relationships with co-workers and family are leading her to her current predicament which can transform into much a much more complex form of depression. This therapy will be done under the following phases;- Evaluation of the history of the patient A careful examination of patient’s interpersonal problems which will lead to the drawing up of a treatment contract. Consolidating and recognizing by Candice of what she has learnt and coming up with ways of identifying and preventing symptoms of depression in the future. Resources to the Patient and Family Candice, her partner Charles as well as her immediate family need to be accorded both long-term and short term resources to help them deal with the needs of a depression patient. They need to be equipped with enough knowledge and skills to provide her with the most conducive environment that will hasten the recovery process. If not well equipped we can end up creating another batch of depression patients due to the demands of caring for a depression patient. This can affect them as well leading to depression amongst the care givers as well. The family and partner can be educated on several ways to help ease the pain and anguish that the patient is undergoing. They can make use of the following several simple but effective means;- Using music as a welcome distraction from the stress and worry. It is very effective for relaxation and also aids in sleeping just before bedtime. Encouraging frequent interaction with pets if Candice is a pet person. If not, frequent walks along the beach or hiking mountain trails in groups will help ease loneliness. They can frequently encourage reminiscence and discussing past recollections from the particularly happy periods of Candice’s life .This will help her remember that she at one time had self-worth and it can be rekindled if she has the will to do so. The aftercare is very important to Candice as it will help her to start the process of her transitioning into her new life and routine in recovery and raises their independence levels. Psychosocial treatments, medications and alternative approved holistic care will set to continue but with much less intensity than during her residential treatment phase. Over time, Candice can chose to let go of some therapeutic support but only upon the express advisory of the therapist administering and after fulfilling and attaining certain milestones during the treatment phase. Legal Mandates and/or ethical standards If a patient does not respond positively to the conventional treatment options, some doctors may opt for the prescription of placebos in the hope it will help the patient deal with depression (CUE Article, 2000). This method is accompanied by a lot of controversy in the medical community. This is because it lacks consistency with normal medical guidelines in the U.S. The use of the placebo forms the background of almost every medical trial since they serve to assess the efficacy of a new drug that is being developed for introduction in the market. Their widespread usage in psychiatry started in 1922 when the first placebo-controlled test was conducted. (Shorter) Ethical arguments agree that placebos can be used in a research setting provided that the trial follows ethical guidelines like using a placebo only without the presence of existing proven therapy (Judith, & Beck, 2007). It is however very controversial when these placebos are used by physicians during clinical practice. This is deceivingly done on patients so as to extract the placebo effect (Bannink, 2007). Due to this controversy, we have to analyze the ethics of using placebos on Candice. We have to carefully check the guidelines to determine whether this goes against them. The American Medical Association guidelines stipulate that the use of placebos without consent from the patient could influence negatively the patient-doctor relationship. Another means of treating depression that is effective but still attracts a lot of controversy is the use of Electroconvulsive therapy (ECT). A review has been conducted that demonstrated that ECT is slightly more effective than placebo. ECT has been viewed as being harmful by psychiatric patients, the general public and some mental health professionals (Judith, & Beck, 2007). When using ECT, it affects several central nervous system components including neuropeptides, hormones, neurotransmitters and neurotrophic factors (Arthur, & Christine, 2001). Bannink (2007) states that even with this in mind it is still recommended for specific patients with major depressive disorders like schizophrenia, bipolar disorder and other disorders. Conclusion Candice’s diagnosis and subsequent treatment will require several methods to be used so as to come up with the best method or combination of treatment options that will ensure quick recovery of the patient with minimal burden on her family. Her work place environment will also need to be reviewed and if possible changed since it appears like a very toxic environment for a recovering depression patient. References Lichtenberg, P. A. (1998). Depression in geriatric medical and nursing home patients. Detroit: Wayne State University Press. Shorter, S. (2013). How Everyone Became Depressed: The Rise and Fall of the Nervous Breakdown. Oxford University Press American Council on Science and Health., & Meister, K. A. (2003). Cigarettes: What the warning label doesnt tell you: the first comprehensive guide to the health consequences of smoking; updated and revised for the 21st century. New York: American Council on Science and Health. Judith, S., & Beck, M. A. (2007). Cognitive Therapy CUE Article (2000), Advances in Social Work. Volume 1 Paul, A. B., Jan, B., & Jos, K. (2003). Traumatic Grief as a Disorder Distinct From Bereavement-Related Depression and Anxiety: A Replication Study With Bereaved Mental Health care Patients. James O.P., Wayne F.V. (2002). The Science of Health Promotion: The transtheoretical model of Health Behavior Change. University of Pennsylvania Libraries Bannink, F.P. (2007). Solution-Focused Brief Therapy. Springer Science Business Media Arthur, M. N., & Christine, M. N. (2001). Journal of Psychotherapy Integration: Problem Solving Therapy. Read More