Case Study of a Client With Depression Paper Example

Relevant Childhood Characteristics (Pre-Disposing Factors)

The client describes her childhood as chaotic characterized by a great deal of stress and instability. She stated that her parents argued frequently and the main reason for this was because of her mother's use of alcohol. The client notes that when she was 11 years old, her mother left their home and was absent until she was 16 years old. During her mother's absence from their family, the client reported that her father had to take responsibility of raising the children on his own. The client observed that during this period, her father was emotionally hurt because their mother had left. She further notes that although he was physically present, ensuring that they had all that they needed, completed their assignments and even punished them (not physically) for their transgressions, he was not emotionally present for them. The client describes her personal relationship with her father as somewhat 'distant,' because they never talked much.

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The client states that during her teen years before her mother returned, she was responsible for preparing dinner for her siblings and doing other chores around the house (chores that were supposed to be undertaken by her mother). Although the client states that she was angered by her mother for leaving them, she had no one to talk to. She states that she was afraid to talk to her father about the situation and its impact on her life because she thought that he was not strong enough to handle the situation. The client also pointed out that her father never made an attempt to talk to her, or even inquire how she felt about taking some of her mother's responsibility in their household. The client further points out that her entire family avoided talking or communicating about the situation, and this led to the formation of emotionally distant relationships. Furthermore, when she discussed about the abandonment of their mother with her siblings, her brother Brian always made excuses for her, and the client reported that it was difficult for her to listen to the vindications that he provided for their mother.

The client stated that she continued to have strong feelings of anger and resentment towards her mother even after she returned home. This could be an indicator that even after her mother returned, she did not provide an explanation to the client on why she felt, seek to know the impact of the situation on her, and ask for forgiveness. This contributed to the client being involved in impulsive behaviors such as dating multiple men who had a questionable character and becoming pregnant by a man she describes as unstable and irresponsible.

The predisposing factors in her childhood that affected her are living in a family that she felt was unstable and emotionally unsupportive. She was forced to assume the role of a parent when her mother abandoned them and she resented it. The client has strong unresolved feelings of anger towards her mother. In addition to that, she dated a few 'bad,' men as a teenager as a way of acting out against her mother when she finally returned to live with them after five years of abandonment.

Core Beliefs

The client is worried that she is not a good mother to her three children, which led her to have feelings of guilt. This is contributed by the fact that she feels that although she is physically present for her children and organizes activities such as trips to the beach and circus; she is not 'emotionally there' for them because of her current state of depression. She points out that she feels that she is cheating her children on what they deserve from her.

The client also feels that her husband has left her alone in terms of taking care of their children. She reports that she is frustrated because her husband works for long hours to 'catch up with the bills,' after missing several weeks of work when he hurt his back and therefore cannot help out with the children as the client would have liked. She therefore assumes the role of being the major caretaker and disciplinarian for their children. The client further notes that taking care of their youngest child is physically exhaustive as she tries to keep up with him as he is too energetic, and she describes him as a difficult child from his conception. The reason for this is that she recalls that she was sick during her pregnancy with Zeke, which was different from her previous pregnancies.

The client complained that she does not spend time alone with her husband as she would have liked. The reasons for this is that as has been pointed out before he works for long hours, and when they spend time together it usually is with friends present. In addition to that, although her husband does not have a drinking problem, she wants her to stop taking alcohol as she feels it could ruin their relationship. Her negative reactions to alcohol are based on her past experiences with her mother when she was an alcoholic.

The client also is worried that she is a problem to her husband. The reason for this could be based on the arguments that they have on him being a social drinker, her depression having affected her socially and keeping her from participating in family events, and her inability to work outside their home, which has had a negative financial impact on their family. The client has also put extreme pressure on herself to become a good mother, daughter, sibling, wife and friend so that she can make everyone happy even if it is at the expense of her feelings and needs. For instance, she wants to be a good mother to her children.

The client also feels that other people are taking advantage of her and they avoid assisting her whenever she needs or requires their help. She complained that her mother was selfish and did not want to participate in taking care of her grandchildren whenever she asked her to. Also, the friends that she has previously baby-sat for rarely offer to reciprocate. This has led her to develop angry feelings and feel that they have taken advantage of her. In addition to that, she realized that she has also taken the caretaker role on her brother's child as he does not spend time with her.

Assumptions

The client assumes that she is not a good mother to her children. This could be attributed by the fact that she does not feel that she is emotionally present for her children. The client also assumes that she is a problem to her husband. The client also assumes that her mother is selfish and does not care about her and her grandchildren as she should.

Triggers (Precipitating Factors)

The client noted that she gets into arguments with her husband about his drinking. She added that when her husband's friends are around, he tends to drink more, and this makes her feel anxious. This is despite the fact that she does not feel as if her husband has a drinking problem. She confesses that her reactions to alcohol came from her past experiences with her mother. She is afraid that alcohol may ruin their relationship (husband and the client).

The client feels that she does not receive adequate assistance from her husband, family members and friends to take care of her three children. She reported that she is frustrated because her husband works for long hours and therefore he is unable to assist her as she would like. The client pointed out that getting baby-sitters was a problem, and that she does not receive assistance from either her mother or friends that she has baby-sat for in the past. The result of this is that she gets angry feelings and also feels that she is being taken advantage of by them.

The client also reported that she considers her youngest child, Zeke as being difficult. She states that the baby was unplanned for, and therefore when she realized that she was pregnant, she felt drained and depressed throughout her pregnancy. The client states that the baby is too energetic and that he has been a difficult child from the date that he was conceived. Furthermore, she describes her relationship with her youngest son as being a source of stress, and therefore this is considered a precipitating factor for her depression.

Automatic Thoughts (Maintaining Factors)

Although the client describes her relationship with her youngest son as a considerable source of stress for her, she states that she loves all of her children and tries to be a good mother. Stating that she loves all of her children and that she tries to be a good mother are automatic thoughts. Also, during the initial intake interview, the client provided an immediate response that she felt 'all right,' which was an automatic thought.

Coping/ Compensatory Strategies (Maintaining Factors)

The client stated that she regularly plans outing with the kids such as trips to the beach, circus and various places of interest. This is to compensate on her thoughts that she is not a good mother. The client stated that she liked her niece and takes her shopping and does other activities with her because her father (the client's younger brother) does not spend time with her. The client has assumed a caretaker role for her niece. It seems she does not want her to have a similar experience of growing up without a mother-like figure in her life.

Treatment Plan Using CBT for Depression

It is imperative to point out that people who suffer from depression are mainly pre-occupied by negative thoughts that lead them to form false realities, which alternatively affect their lives. When the client presents her problem, she states that her sleep is affected by spending most of her time thinking and worrying. She is pre-occupied by thoughts that she is not a good mother, and that she is a problem to her husband. Cognitive behavioural therapy is a type of treatment process that can enable a patient to correct false self-beliefs that have contributed to negative moods and behaviors (David, Cristea, & Hofmann, 2018). The assumption that is made by therapists who support this treatment method is that thoughts precede an individual's mood, and therefore by helping a patient to substitute the negative thoughts with healthy ones will lead to an improvement in the patient's mood, self-concept, behaviour and overall physical state. In this section, it presents a treatment plan for the first five sessions for the client.

First Session (Locating the Problem and Brainstorming Solutions)

In this session, the client will be encouraged to practice journaling and also talk to the therapist who will assist the patient to discover the root or source of their depression. Journaling can be defined as a technique or method of collecting or gathering data, in this case focusing on the client's moods and thoughts (David, Cristea, & Hofmann, 2018. The journal will be expected to include:

• Information on the time when the client experienced a negative mood or thought
• The source of the negative thoughts and moods
• The extent and intensity of the negative moods or thoughts
• Their responses to these negative moods and thoughts

The purpose of writing a journal for the client is to help her identify her thought pattern and emotional tendencies. She will also be better placed to describe them, and find out the techniques that she can use or apply to change, adapt or cope with the negative thoughts and emotions.

Actively talking with the therapist can help the client to discover the root of her depression. The therapist will inform her why certain thoughts such as worrying that she is not a good mother, or that she is a problem to her husband have contributed to her feeling a sense of hopelessness, whereby she does not believe that things will ever get better. Although the client is expected to write a journal throughout her therapy sessions, the therapist can encourage her to write down her current thoughts and moods, or her thoughts when she has been unable to sleep in the past,...