Case Conceptualization for Depressive Disorder

Presenting Problem 

Mary is a 6o year white American woman who has been married for 30 years, and they have been blessed with two kids. Mary lives together with her husband and their two children. The family had been living a happy life until her husband was diagnosed with stage three cancer. Mary, who is working as a nurse in the local hospital, has since ditched her job to take her ailing husband. Her elder son has been too much into drugs because he never listened to his mother's advice the father being. He has been squandering the small family business, which is the family's main source of income. Her second-born daughter is focused and is currently taking an undergraduate degree at the State University. Mary struggles to earn a living with a small family business since she has quit her job, but her ailing husband and stubborn son's pressure has been too much. Besides, her ailing husband's condition has been deteriorating so fast that she fears she could lose him if no proper action is taken. 

Patient History 

Mary is 60 years old white American woman who presented with depressive symptoms. The client stated that she had trouble sleeping at night, feeling sad most of the time, and experiencing daily crying spells. Mary had noted a drastic change in her mood and had become short-tempered overtime. She has found herself overreacting even in petty issues at times, thought of committing suicide. Mary reported that her sleeping was becoming a matter of concern because of spending several hours sleeping and, in some cases, could spend the entire night with no sleep at all. She spent the better part of the time thinking about the family. Mary was often worried about her husband's health condition, plus her son, who has become a drug addict. At some point, she could blame herself for not being a good mother to her two children and even went to the extent of blaming herself for her son's substance use of misbehavior. She often thinks about her family, the good times they use to spend together, the happiness and joy, and now the difficult life that she is going through. According to Mary, her depression worsened when her husband's health condition deteriorated, and her son became deep into drugs. She recalled that at times she could spend several hours staring at her husband and shading tears. Since then, things have never been the same again; she has constantly been thinking about her husband's health and how she could bring back the joy and happiness in the family again. With various issues crisscrossing her mind, Mary had lost her appetite significantly and noted some slight weight reduction. She often feels weak and unable to carry her activities the way she used to do. 

Even though she had not undergone any proper diagnosis, Mary believed that she was depressive, and the condition was tearing her apart; she becoming too much short-tempered was even ready to engage in a physical fight with her son. Mary admitted that she had lost herself, and the depression affected her relationship with family members, particularly her son. Mary also stated that her social life had been affected by a lack of interest in family events. Additionally, the depression might be why the client quitted her job because she was finding it very difficult to cope at work. Her medical career had not been an easy journey, and besides her family struggles, she had developed some of the workplace stress where pressure from the patients was extreme. Her current financial status was also giving her stress. Together with her husband, she had quitted their job and depended on a small family business, which could not meet their financial obligations. Mary was feeling very hopeless and unhappy with her life; Depression was overtaking and preventing her from achieving her dreams. 

Vulnerabilities to Depression 

Mary believed that her depression started when her husband was diagnosed with stage four cancer. She started experiencing strange things about herself and felt more stressed than ever. Since her husband was the family breadwinner, Mary had to provide for the family strongly; something she was never used to. After her husband's diagnosis, she stated that she started developing some internal pressure within herself because she had to up all the responsibilities that her husband was playing. When Mary's husband became ill, he had to resign from work, and he could no longer manage the family. All the roles shifted Mary, something that she has never done before. She became so worried about how she could balance her husband's sickness and the family demands that were increasingly becoming. Mary believed that her condition worsened when she noted that her elder had become a drug addict and could no longer take care of himself; it implies that Marry had to take care of her ailing husband and the two children. With family and pressure and job pressure, Mary did not balance her family roles and the job; she decided to quit the job to focus on the struggling family business. The continuous chain of events in Mary's life made it more weak and vulnerable to depression. Mary was more likely to be vulnerable to depression than other family members because her roles and responsibilities had completely, and she was in completely a new world of providing for the family, taking care of her ill husband, and bringing her drug addict son back to normal. Six months ago, Mary had gone to the hospital to seek assistance, but she was only given some depressant that she has taken so far, but no improvement has been recorded. Her condition has continued to deteriorate. 

Depression Triggers 

Even though one can just become moody or sad without any event or situations necessarily happening in their lives, there are common circumstances under which an individual is most likely to develop stress and set off a negative mood (Epel et al., 2019). Mary indicated that they lived a happy life while her husband was healthy, but hell broke loose when he was first diagnosed with stage four liver cancer. Since then, things have never been the same again in Mary's life. Based on the client's story about her family and job life, some of the possible triggers for her depressive condition include her husband diagnosis with cancer, her elder son becoming a drug addict, becoming the head of the family, her husband losing his job and becoming a liability and finally, she also lost her job pressure. Being a nurse at the local hospital, there were possibilities that she was receiving too much pressure from both the family and the workplace. Mary was stressed how she could take care of her sick husband, manage their struggling business, control her addicted and meet the rising family demand; both socially and financially. 

Physical therapy Core Beliefs 

Core beliefs refer to other people's basic beliefs, ourselves, and the world we are living in. Core beliefs are beliefs that guide our actions because they have become of our lives. It provides us with a better interpretation of the world and enhances a given state of mind regarding some things ( Eze et al., 2020). Core belief goes with one's psychological state of mind. For instance, when an individual has not taken her lunch, they might develop a belief of being hungry. 

In the case of Mary, she anxious and stressed about herself. Therefore, one of her core beliefs would be that "she is weak." Mary believed that her current depressive condition has made her feel weak because she is going through a lot of stress. Another possible core belief for Mary is stress; she generally believed that she is stressed even if things might be getting better. Mary also has a general feeling that she needs and outside help to overcome the challenges that she is facing. Based on the information she provided, Mary believes that her husband's ailment and her son's condition are the ones contributing to her depressive status. 

According to the client's family and her husband's state, the therapist tended to believe that Mary's great source of depression is her husband, who has been diagnosed with liver cancer. Her son's story was also an issue of concern; the therapist believed that the son gave her much pressure, thus facilitating the depression. Financial constraints are a possible core belief for having depression among the clients; many therapists believed that those clients with financial challenges are more likely to develop depression. Therefore, they tend to ask the clients financial related questions even before they give such information. 

Most central thoughts, feelings, memories, sensations, and situations 

Generally, people tend to think a lot regarding their lives and experiences, which they undergo. At extreme, thoughts can develop into stress and, eventually, Depression ( Cooper et al., 2020). There are memories, thoughts, and situations for Mary's case, and she found it very difficult to forget they kept unfolding in her mind. The most central memories include the day her husband was diagnosed with liver cancer. Mary remembered that everything has never been the same again since the new thing about her husband's sickness was broken. Another memorable incident is the day she noted that her son is a drug addict; she always trusted and believed in him. Mary never imagined that one day her son would use drug addicts. Mary still remembered the day that her husband resigned from the job and the day she lost her job; their way of life changed as they could no longer afford the kind of life they used to live when both working and healthy. The most past and current that was stressing too much was the state of her husband. Being diagnosed with cancer implied that his life was in danger and could lose him anytime. Mary was so disturbed if she could ever recover from the dieses given that stage four liver cancer is untreatable and deadly. 

Diagnosis of and Diagnosis differential for depression 

  Based on DSM-IV-TR, Mary displayed characteristics that matched that one of a Major Depressive Disorder; she was experiencing a feeling of guilt and worthlessness, loss of interest in most activities, low energy level, lack of sleep, and a slight reduction in weight ( Workman, 2016). Mary was also experiencing feelings of guilt, and she had difficulty concentrating on one thing; this hugely affected her decision-making. Mary also became short-tempered and was even ready to engage in a physical fight with her son. Even though she did not have suicidal ideation, her main concern was to get out of her current situation. Mary's symptoms had existed for at least three weeks before she came to interpersonal psychotherapy for depression. These symptoms were accompanied by sorrow, thus resulting in a deficit in her occupational and social functioning. Mary was assigned the diagnosis of Major Depressive disorder because she met the criteria for major depressive disorder as per DSM-IV-TR. The therapist identified the events that were leading to Mary's Depression and created a treatment plan based on the response 

Coping Strategies 

Mary had admitted her condition and was ready to do all it takes to counter the condition. She informed one of her close friends who are checking on her regularly. Mary made several attempts to receive counseling that would help manage the depression; she was keen on the advice she was receiving and strictly following them. Mary had developed some cope up mechanisms to help her manage the disease. However, not all of her coping strategies would lead to a positive outcome. Some were negative. The positive coping strategies included physical exercise, seeking guidance from friends, and seeking therapy. She also resorted to smoking to manage her stress; this strategy was negative because it could harm the client's health. 

Treatment Plan 

Mary's treatment plan's target was to reduce her anxiety and depression and improve his social and functioning interaction with her son. The plan aimed to give Mary some hopes in life and make her believe that she can make it despite the challenges. It was also to reduce the stress over her husband's conditions and accept things as they are. 

Evidenced-based intentions 

Reduce depressive rumination; Therapist encouraged Mary to normalize the impact and symptoms of depression and to act like it never happened; this would help him do away with negative thinking that was affecting her significantly 

Pleasure: Mary was advised to spare some time for pleasure since this would motivate her and rub some of her most memorable overtime experience. She should be having pleasure after the thorough engagement. 

Investigate whether improved communication skills could restore her relationship with her son. Mary was urged to embrace different communication skills in the bid to come to a common understating. Reconnect with other family members and friends whom she had abandoned. Start with a friend or a family member that would be easiest to contact and engage in friendly talk. 

References  

Cooper, K. M., Gin, L. E., Barnes, M. E., & Brownell, S. E. (2020). An exploratory study of students with depression in undergraduate research experiences.  CBE—Life Sciences Education ,  19 (2), ar19. 

Epel, E. S., Crosswell, A. D., Mayer, S. E., Prather, A. A., Slavich, G. M., Puterman, E., & Mendes, W. B. (2018). More than a feeling: A unified view of stress measurement for population science.  Frontiers in neuroendocrinology ,  49 , 146-169. 

Eze, J. E., Ifeagwazi, C. M., & Chukwuorji, J. C. (2020). Core beliefs challenge and posttraumatic growth: Mediating role of rumination among internally displaced survivors of terror attacks.  Journal of Happiness Studies ,  21 (2), 659-676. 

Workman, C. I. (2016).  The Role of Moral Cognition and Emotions in Remitted Major Depressive Disorder . The University of Manchester (United Kingdom).