THE CASE STUDY OF SAM 2
The Case Study of Sam
Sam is a single female who is Caucasian and is 25 years old. She is enrolled full time in a
master’s degree program at a university. She is the oldest child and has two siblings, a brother
and a sister and her parents were divorced when she was 14 years old.
Sam has been experiencing episodes of depression that have lasted for months at a time.
She also reported an episode of mania that lasted 12 days where she was only sleeping one to
two hours per night and was hallucinating during that time as well. Sam has recently been feeling
fatigued even though she reports that she sleeps 12 – 13 hours per day.
Sam has also reported hearing voices at times and she has also had thoughts of suicide as
recent as 4 days ago and has gone as far as to contemplate how and when to do it. She has
expressed these feelings to a roommate and often wonders if she would be better off dead.
She has been struggling in school as a result of her feelings and fears she will fail out of
college as she has been struggling to maintain acceptable grades. In addition, Sam has
experienced mood swings that have not only affected her, but those around her as well.
Sam has reported her mother also has a history of depression and Sam cites that as a
primary reason that her parents became divorced. Sam states that she has a good relationship
with her family and speaks to them occasionally.
Client Concerns
Symptoms Behaviors Stressors
Mania Isolation School
Hallucinations Not Eating Worrying about
friendships
Highs Sleeping Excessively Stress
Hearing Voices Worrying Social Settings
Sadness Getting Upset
Suicidal Thoughts Missing follow up Psychiatrist
appointments
Trouble
Concentrating
Not taking medications
Mood Swings
Fatigue
Sadness
THE CASE STUDY OF SAM 3
No Appetite
Loss of interest in
activities
Low self-esteem
For the case of Sam I would recommend the Beck Depression Inventory 2 (BDI-II). Sam
presents symptoms of severe depression and the BDI is a self-administered test consisting of 21
questions that was created by Aaron T. Beck which measures the severity of depression.
According to Whisman and Richardson (2015) the BDI-II results showed depression to be
widespread among College students. Sam is in college so she falls within the category of the
study that was competed. In addition, The BDI-II would measure the severity of Sam’s
depression.
Diagnostic Impression
Signs and Symptoms
DSM-5-TR Diagnostic Criteria:
disorder name and code number
Client’s Signs/Reported
Symptoms:
Criterion A: Persistent Depressive
Disorder
Poor appetite, Insomnia, fatigue,
low self-esteem, poor
concentration, feelings of
hopelessness, ongoing for more
than two years, not schizophrenic,
no drug abuse or medical
conditions, symptoms cause
distress
ICD-9-CM 300.4 ICD-10-CM
Criterion B: Moderate-Severe
Unspecified Depressive Disorder
with anxious distress, mixed
features, and mood-congruent
psychotic features
Delusions and Hallucinations are
present and consistent with typical
depressive themes of personal
inadequacy and guilt, feeling
tense, unusually restless, difficulty
concentrating as a result of worry,
feeling of losing control, Elevated
mood, more talkative than usual
during manic episode, flight of
ideas, increased energy during
THE CASE STUDY OF SAM 4
manic episode, decreased need for
sleep during manic episode, mixed
observable symptoms, full mania,
lack of pleasure
ICD-9-CM 33 ICD-10-CM F32.9
Criterion C:
Criterion D:
Criterion E:
Criterion F:
Other DSM-5-TR Conditions Considered
In addition to Persistent Depressive Disorder and Moderate Unspecified Depressive
Disorder, Sam also shows symptoms of major depressive disorder with mixed features and
anxious distress. Sam did meet four symptoms needed however a minimum of five were needed
for major depressive disorder. Sam has experienced depressed mood, but it is not a constant
feeling that disrupts her everyday life as she can still function at times. Her case notes also did
not note any psychomotor agitation or retardation every day, or insomnia or hypersomnia every
day, as those have been on and off. She has mentioned that she has had trouble with sleep
patterns but her sleep times have varied at times.
Developmental Theories and/or Systemic Factors
Sam was raised in an environment where depression was a part of everyday life. She
mentioned how severe her Mothers depression was and some of the things she witnessed as a
result. Sam also mentioned that her sister also struggles with depression. She said the depression
that her mother was going through was the primary cause of her parents getting a divorce.
Depression can be genetic in some ways so Sam could have already been at an elevated risk for
depression.
THE CASE STUDY OF SAM 5
Sam mentioned her parents were married at a young age and that she does not want to be.
Same mentioned that she does not want to settle down and get married early in her life, and Sam
worries that she will be a failure in relationships as well. She grew up in a household where she
witnessed her parents fighting and she may be afraid to commit to a relationship as a result.
Multicultural and/or Social Justice Considerations
Sam may feel oppressed because her family has not received the help they need and that
may have affected her thought process regarding getting help. Sam’s family background plays a
major role in why she feels the way that she does. Sam feels worthless at times and at other times
she feels like she can accomplish her goals (writing a book). I believe Sam may feel worthless
because there are things in her past that have happened that were beyond her control and she may
feel like she may responsible. I also believe that Sam will not share how she feels with her
family because she sees how it negatively affected her parent’s relationship and Sam also knows
that her mother and sister do receive help and do not take medications for their depression so that
may also affect her willingness to open up to her family, especially if she decides to take
medication for it
Treatment Recommendations
Key Issues for Treatment
Thoughts of suicide: Sam has had thoughts of suicide and I think one of the first things
that need to be addressed is whether or not she is currently a danger to herself or others.
If Sam is in danger of hurting herself, she may need to be put in an inpatient setting
where she could be protected. If she is not in immediate danger, I would work with her to
find out why she is having these thoughts are and how deep they are. I would also find
THE CASE STUDY OF SAM 6
out how often and when these thoughts most commonly occur (under stress, at night
before bed, in the morning, all day, etc.).
Stress: Sam is clearly experiencing a significant amount of stress resulting from worry
about school, losing her friends, hurting herself, and mood swings. I think it is important
for her to find out what she can reasonably handle, prioritize and still function.
Sam mentioned that her faith plays an important part of her life and that she would like to
integrate it in her counseling sessions so I think working with her to find out what she
believes, her values, religion, etc. is important.
Recommendations for Individual Counseling
The first thing I think Sam should do is follow up with the psychiatrist that she was
referred to. She may need medications to help her with her suicidal thoughts, mania, and
depressive symptoms. A Doctor in the ER had already given Sam medication that helped with
her sleep and also helped with her manic episode. As her counselor I feel it would be important
to find out what medications that she was prescribed.
Based on the fact that Sam was prescribed medications once already and referred to a
Psychiatrist, the first counseling method that I would use is Interpersonal Psychotherapy (IPT).
Studies have found that IPT has proven highly effective treating depression over 12 – 16 weeks
when used in conjunction with pharmacotherapy (Cuijpers et al., 2011). In addition the results of
IPR showed increased self-esteem, less depression symptoms and an increase in social and
occupational functioning (Huibers et al., 2022) Sam experiences many different symptoms that
IPT has been proven effective in treating.
The next recommendation for counseling would be Dialectical Behavioral Therapy
(DBT). According to Darrow et al. (2022), studies have shown that DBT has been effective in
THE CASE STUDY OF SAM 7
reducing suicidal behaviors in young adults. Sam has experienced suicidal thoughts to the point
of beginning the planning stages so I feel that it important to use a counseling method that
focuses on her suicidal thoughts and behavior.
Specific Considerations
Sam has said that she was raised Catholic and wishes to integrate her faith into the
therapy process. I hold different beliefs so I believe that it is important for me to have a
discussion with Sam to learn about Catholicism and what it means to her. I would also like to
find out if Sam has been experiencing more of her symptoms since she stopped going to mass.
She mentioned that her GPA was higher in the bachelors program and at that time she was
attending mass every week, and now she has been struggling when she has not been going to
mass. There could be a peace that Sam found while attending mass that she has not been finding
since she stopped going. Sam may also feel better attending confession as that was more than
likely part of her life as a Catholic
Sam’s family history also plays a large role in her depression. It seems to be hereditary.
Both her mother and sister experience depression and are not receiving help. I think it is
important to learn more about her background and more about her family. I would also want to
make it a point to see if there is a history of suicide in her family as well.
References
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Cuijpers, P., Geraedts, A. S., van Oppen, P., Andersson, G., Markowitz, J. C., & van Straten, A.
(2011). Interpersonal psychotherapy for depression: A meta-analysis. The American
Journal of Psychiatry, 168(6), 581-592. https://doi.org/10.1176/appi.ajp.2010.10101411
Darrow, S. M., Maliken, A. C., Piatigorsky, A., Stuart, B. K., Todd, N., Yaeger, A. M., &
Londahl‐Shaller, E. A. (2022). Effectiveness of the family‐based model of dialectical
behavior therapy for both suicidal adolescents and young adults in an academic medical
center. Journal of Clinical Psychology, 78(7), 1422-1435.
https://doi.org/10.1002/jclp.23317
Huibers, M. J. H., Van Bronswijk, S. C., Peeters, Frenk P. M. L., & Lemmens, Lotte H. J. M.
(2022). Does psychological process change during psychotherapy predict long-term
depression outcome after successful cognitive therapy or interpersonal psychotherapy?
secondary analysis of a randomized trial. Psychotherapy Research, ahead-of-print(ahead-
of-print), 1-17. https://doi.org/10.1080/10503307.2022.2064251
Whisman, M. A., & Richardson, E. D. (2015). Normative data on the Beck Depression Inventory
- second edition (BDI-II) in college students. Journal of Clinical Psychology, 71(9), 898–
907. https://doi.org/10.1002/jclp.22188
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