CASE STUDY RESPONSE

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Counselor’s Name: Dr. Friess Date:

I. Assessment

Jaz is a 21-year-old female. She lives with her father. Her parents are divorced, and

both are originally from Mexico. Their primary language is Spanish while Jaz states that

she speaks English better. She is in college majoring in English Literature. Jaz recently

attempted suicide and was in a coma for 3 months. She then received outpatient

treatment. She did not want to continue taking meds for depression because that is

how she attempted suicide. She has been hospitalized two times for attempted suicide.

She has not seen a counselor in the last 6 months. She came into counseling stating that

she needed some support because she was very anxious and depressed. She stated she

hated herself and she couldn’t stand to be around other people because she felt out of

place. She reports feeling distant from her husband and mother after her last suicide

attempt and feels guilty that she is not a good daughter. She hasn’t talked to her mother

since her last attempt because she feels she must choose her mother or husband. She

stated that they blame each other for her suicide attempts. The Beck Depression (BDI)

inventory suggests that her depression is moderate. The Beck Anxiety Inventory (BAI)

indicates her anxiety is also moderate.

Diagnosis: Major Depressive Disorder moderate-severe with anxious distress (F32.1)

Differential diagnosis:

Case Conceptualization Form

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R/O Mood disorder due to another medical condition. Client will seek physical to rule

out medical conditions. She does report slow heart rate after coma.

R/O Bi-polar disorders such as Manic episodes with irritable mood or mixed moods.

There has been no history of manic or hypomanic episodes.

R/O Substance/medication induced depressive or bipolar disorder. There is no

indication of substance use or medication

R/O Attention-deficit/hyperactivity disorder disturbance in mood is not irritability but

sadness and loss of interest.

Legal and ethical issues: Informed consent and client rights. Professional disclosure and

exceptions to confidentiality. Continual assessment for suicide potential. Suicide safety

planning. Cultural considerations and anxiety. Client reports his culture does not value

counseling and she has been raised to not share anything with outside of family members.

II. Case Conceptualization

Client was raised in a culture different from her parent’s upbringing. She has been

taught that “girls are taken care of and spoiled” per her words, in her upbringing. She

reports that she was not taught how to problem solve to care for herself. Her anxiety

and depression seem to stem from negative thoughts about herself. She talks about

self-hate and constantly feeling not good enough. These are cognitive distortions that

Cognitive Behavioral therapy (CBT) targets for improvement of her condition. Some

cognitive distortions that she is displaying include “all or nothing thinking”, such as all

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good or all bad. Mental filter in that she tends to focus on the negative aspects while

ignoring other positive evidence. She also disqualifies the positives and doesn’t

recognize her strengths. For example, although she is successful in college, she reports

she isn’t as far along as she should be, like her high school classmates. She jumps to

conclusions about herself not being good enough instead of looking at other

interpretations of events.

III. Treatment Plan

Problem, Issue, Challenge, Obstacle, Symptom: Excessive worry and depressed mood that is

difficult to control more days than not for at least 6 months.

Treatment Goal 1: Reduce depression and anxiety scores on the BDI and BAI by from

moderate to mild.

Objective: Client will Identify three strengths related to successes.

Objective: Client will describe situations, thoughts, feelings, and actions associated

with anxiety and depression and the impact on functioning by participating in mood

log daily for one week.

Objective: Cl will consult with medical to r/o health problems that may be related to

depression and anxiety.

Objective: Client will practice relaxation exercises at least 1 x per week and

report the impact on mood/anxiety in the next session.

Problem, Issue, Challenge, Obstacle, Symptom: Feelings of worthlessness and excessive guilt.

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Treatment Goal 2: Increase assertiveness, self-efficacy, and self-worth by getting needs met

through healthy communications and improving at least one positive social relationship, per

self-report by 2 points on a scale of 1-10 of getting needs met.

Objective: Client will practice communication with husband at least 1x per week

Objective: Client will practice behavioral/social experiment 1x per week, related

to evidence in jury trails of self-beliefs.

IV. Evidence Based Interventions (Beck, 2011; Jongsma, Peterson, &Bruce, 2014)

Develop level of trust, provide support and emphatic to encourage client to feel safe expressing

depression and anxiety symptoms

Provide behavioral, emotional, and attitudinal information about anxiety and depression

Educate client on mood log so client will be able to identify thoughts, feelings, and actions related to

her moods.

CBT to explore thoughts, feelings, behaviors, related to depression and self-hate.

CBT weekly to assess core beliefs and reframe anxiety provoking thoughts.

Practice jury trials to support or refute beliefs about self and self-talk.

Educate on relaxation skills – progressive muscle relaxation.

Educate thought stopping skills and mindfulness practices.

Educate healthy assertive communication, practice through role play and modeling.

Referrals

Medical doctor for physical

Potential group support to increase social engagement.

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References

Beck, J. (2011). Cognitive behavior theory basics and beyond. New York, NY: Gilford Press.

Jojgsma, A. E., Peterson, L.M., & Bruce. T.J. (2014). The complete adult psychotherapy treatment

planner. Hoboken, NJ: Wiley.