Treatment Plan

Problems

1. Major depressive disorder– feeling sad, fatigue, avolition, hypersomnia, low self-worth, avoidance, helplessness, and false guilt

2. Disruption of family by separation or divorce – parental divorce 2 months ago, high conflict, affair, joint custody

3. Target of (perceived) adverse discrimination and persecution (provisional) – “Black kids can’t get a break.”

Goals for Change

1. Major Depressive Disorder (CBT)

· Understand the relationship between cognitive errors, maladaptive core beliefs, and depression.

· Decrease and potentially eliminate negative automatic thoughts of self and others.

· Increase engagement in non-depressed activities to reduce avoidance behaviors.

· Increase realistic relational schemas within the family system to reduce conflict and depression symptoms.

2. Disruption of family by separation or divorce

· Understand the impact of divorce on the perception of self, others, and the world.

· Eliminate the faulty core beliefs around the guilt of divorce.

· Decrease family dysfunction to reduce the negative impact on the client’s relationship with parents.

4. Target of (perceived) adverse discrimination and persecution (provisional)

· Understand how discrimination may influence negative thoughts of self, others, and the world.

· Eliminate faculty core beliefs associated with adverse discrimination and persecution.

· Increase resiliency to cope with perceived discrimination.

Therapeutic Interventions

The client will engage in 10 to 15 weekly, individual sessions of CBT (Beck Institute, n.d.; Schwitzer and Rubin, 2015; Murdock, 2017).

1. Major depressive disorder

· The counselor will provide psychoeducation about the relationship between negative self-talk, avoidance behaviors, and mood.

· The counselor will provide psychoeducation on good sleep hygiene.

· The client will identify and engage in good sleep hygiene activities.

· The client will write down “therapy notes” of each session and read them daily between sessions.

· The client will identify her maladaptive assumptions, poor coping strategies, and maladaptive core beliefs in session with the counselor using the cognitive conceptualization diagram.

· The client will identify adaptive behaviors by using the pleasure/mastery scale in the session.

· The client will challenge negative automatic thoughts connected with core beliefs by completing a weekly thought record and using coping cards.

· The client will use behavioral experiments for cognitive restructuring of maladaptive thoughts and core beliefs.

· The client will engage in activity scheduling such as self-care, exercise, and social events every week.

· The client will call the counselor weekly to report on the success of identified actions for that week.

· The client will identify and engage in actions to prevent relapse.

· The counselor will provide boosters sessions as needed to prevent and recover from relapse.

2. Disruption of family by separation or divorce

· The counselor will provide psychoeducation on divorce.

· The counselor will offer Bibliotherapy, The divorce helpbook for teens.

· The client will engage in the cognitive restructuring of “guilt” via a thought log.

· The client will process grief/loss of family system through Socratic questioning.

· The counselor will refer the client to family therapy to conjointly process the divorce.

· The counselor will refer the client to grief “teen” group counseling.

3. The target of (perceived) adverse discrimination and persecution (provisional)

· The counselor will provide psychoeducation of the CBT triad (feelings, thoughts, behaviors) to perceived discrimination.

· The counselor will conduct a cognitive conceptualization of perceived discriminatory events to assist the client in understanding the antecedents, behaviors, and consequences.

· The counselor will assist the client in identifying “normative” discriminatory perceptions leading to problem-solving actions through Socratic questions.

· The counselor will assist the client in the identification of maladaptive automatic thoughts and core beliefs about self, others, and the world through Socratic questions.

· Counselor and client will engage in the cognitive restructuring of maladaptive thoughts and core beliefs as needed via thought log.

· The client will use behavioral experiments for cognitive restructuring of maladaptive thoughts and core beliefs.

· The counselor will provide psychoeducation on distress tolerance and mindfulness, progressive muscle relaxation, and mastery/pleasure activities.

· The client will identify and engage in distress tolerance tools.

Outcome Measures of Change

Improved self-worth, improved mood, increased engagement in pleasurable activities, and increased support seeking.

· The client reported reduced maladaptive thoughts and behaviors along with increased pleasure and mastery activities.

· Pre-post measures on the Beck Depression II Inventory.

· The Counselor observation of improved mood via signs, symptoms reduction, and change talk around automatic thoughts, assumptions, and core beliefs.

· The Client reported reduced family disruption.

· The Client reported increased distress tolerance of perceived adverse discrimination.