Psychology Psychotherapy Counselling and Depression Case Study

PSYCHOLOGY, PSYCHOTHERAPY AND COUNSELLING Assignment

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CASE STUDY ON DEPRESSION

Assessment

Psychotherapy is a type of treatment or counselling for the reduction of psychological and behaviour issues. Based on the case study, the aim of this study, different assessment techniques and diagnoses will be discussed here. Relationship management importance between patient and psychotherapist will be the crucial aspect of this study.

This study aims to determine the client's psychological issue is Smith, which has developed due to a change in his organisational functionalities. The purpose of this assessment is to identify the root cause of the psychological issue of the client and provide possible solutions to recover from that issue. Further, specific therapeutic approaches that will help to cure the issues of Smith will be discussed in this study. Emotions are an essential player in maintaining the psychological performance of an individual's absence that causes disorder (Zhou, Hu & Wang).

The nomothetic approach generally indicates a strategic approach that helps in the generalisation of social patterns on a large scale. Nomothetic approaches can provide an average of the total information simply to any individual psychotherapist (Frumkin, Haroutounian & Rodebaugh, 2020). The advantages of the nomothetic approach indicate its strategic techniques of measurement using a controlled method. Further, this method helps predict and completely control an individual's cognitive behaviour. In contrast, Nowak (2020) has explained that the nomothetic method is helpful for the formulation of historical laws in treating psychological disorders. The idiographic approach includes the price of treating any individual as a unique agent with a complete history of life. Ideography is a required method that uses an individual's traits during the determination of behaviour. According to Beck & Jackson (2020), idiographic methods generally lagged; however, qualitative approach strongly suggests that this approach is mainly poised for a strong resurgence. In contrast, Piccirillo & Rodebaugh (2019) have said that idiographic treatment start is rarely used in any psychological therapy systematically.

These two psychological treatment strategies collect details about the client's condition, subjective aspects, and issues. This collection is based on the maintenance of a proper relationship between Smith and the psychologist while gathering information about the client.

Smith is referred by his wife Maria to a reputed psychological service for identifying the psychological issues of Smith. Idiographic details collected from Smith are his mood condition, thoughts, depression level, and reason of thoughts, motivational conditions, and plan. PHQ-9 questionnaires for the determination of psychological conditions are followed for this collection of idiographic information from Smith. PHQ-9 is considered an inexpensive and effective strategic way to identify and differentiate the actual degree of acute depression of an individual patient (Forbes.com, 2018). Major disorders regarding depression such as MDD and social disorder of anxiety (SAD) can occur accurately in any individual man. GAD-7 is a street price of measuring the acute anxiety issue of any psychologically depressed patient such as Smith. GAD-7 is a strategic process to measure anxiety levels, as it is easier to use and receive scores after implementation (Toussaint et al. 2020). These two measuring strategies are effective enough to gather information about Smith.

Nomothetic measures that are used for Smith are PHQ-9 and GAD-7 strategy of the questionnaire. However, some limitations are associated with this questionnaire, such as self-reporting can contribute to bias during data gathering. GAD-7 has been selected for the measure as it helps in the determination of other disorder issues among psychological patients easily, along with anxiety (Ahmad et al. 2017). Further, collecting data from Smith may not always be perfect due to its unacceptable psychological condition. Measures of moods are also taken for measuring nomothetic data. Proper monitoring and elimination of unnecessary questions have supported the authenticity of using such processes for measurement.

Formulation

The 5Ps strategy indicates five essential considerations for treating psychological patients such as Smith. The first stage is past things that have happened with Smith that has caused the issue of psychological condition. Smith is a well-established software developer in a reputed company; however, the issue of change in management and organisational structure has caused psychological pressure for Smith. Therefore, the past connection with the trigger indicates the reason for such psychological change in Smith. Both the past and triggers have a relationship with the current thing through which treatment of the psychological disorder can be measured. Smith recently has felt that he is a complete failure and is not up to the mark compared to others in the organisation. The recent situation indicates an improper work-life balance of Smith due to such depression issues.

Including the lack of motivation to attend a physical fitness centre or gym and make fun with the family has made the situation critical for Smith. Therefore, avoidance of attending any vocational tour and forgetting the attendance time of a meeting are the everyday things that stuck Smith to improve his behaviour. However, the relationship between the stick phase and the current phase indicates a positive aspect of attending a psychological service to improve the mental condition of Smith. Behaviourist theory indicates that an individual's behaviour can be identified based on the interaction of that individual with the environment. Behaviourism generally strived for the analysis of any object effectively for which internal processes are neglected (Murtonen, Gruber & Lehtinen, 2017). This theory further indicates that inherited factors do not have a strong influence in managing the behaviour of any individual. Depression syndromes of Smith include behavioural issues, poor time management and lack of interactivity with family and environment. However, Smith’s wife to overcome this issue provides social support.

5 areas CBT strategy

Based on the outcome from the case study, it is clear that Smith has experienced a substantial issue with occupational responsibilities. After the change of organisational functionality, Smith has faced issues regarding maintaining his performance with other team members. That has negatively influenced Smith and has caused the issue of psychometric behavioural issues. The situation is that Smith does not go outside for fun or even does not attend the gym to maintain his physical fitness. The current situation is well aligned with the thoughts of Smith. Therefore, these thoughts have influenced Smooth's behaviour, as he cannot behave smoothly with his wife and children. Even the condition has deteriorated so much that Smith has thought he is a complete failure compared to other team members in his software development group. Cognitive theory in psychology regarding depression indicates that the thinking of any depressed person is entirely different compared to any non-depressed individual. Therefore, at this point of view, it is clear that the physical reaction and the mood of Smith are adequate to determine his mental and psychological condition.

Diagnostics

Cognition and formulations are associated with the recent psychological issue of Smith. The complete symptoms of Smith regarding depression are correctly mentioned in the case study. Therefore, DSMV specific criteria indicate the depression outcomes from Smith that is helpful to determine the level of depression without any issue.

Different types of assessment tools are used for the identification of the depression level Smith. Smith has displayed different symptoms such as behavioural problems with his family, improper balance of work and personal life, lack of attraction for the environment, lack of physical fitness and eagerness and issues with attending fun activities that can motivate Smith effectively. Differential considerations include differences in past and present behaviour of Smith due to the severe issue of depression.

During the treatment decision by a psychotherapist, it is evident that Smith has fulfilled the five criteria out of the eight in the DSM-V method that indicates his seriousness of depression level. Further, evidence of his behaviour is supportive enough to provide particular treatment to Smith for overcoming these critical psychological issues. Effective 5Ps and the CBT strategy of treatment or identification of depression level are utilised to understand the actual situation of Smith.

DSM-V criteria

Criteria	Presence	Evidence
1. Depressed mood	Yes	Lack of interest in going out for fun with family and attending gym for physical fitness
2. Markedly diminished the interest	Yes	Improper attendance of office meetings due to depressed mood
3. Weight loss	No
4. Showering of practical thoughts	Yes	The inappropriateness of work procedure and thoughts of failure
5. Fatigue	No
6. Inappropriate guilt	Yes	Thought of failure and have no class compared to other staff in the organisation
7. Diminished concentration	Yes	Lack of concentration during work and poor behaviour issue due to depression
8. Recurrent death thoughts	No

NICE guidelines are mainly developed for the identification of depression issues in adults. The committee developed for depression treatment indicates a menu treatment to test the decision-making condition of a patient (Nice.org.uk, 2021). Therefore, all the tests followed the guidelines of NICE to treat Smith effectively. These guidelines of NICE has helped to maintain proper questioning of Smith for achieving the authentic reply.

Course of treatment

Before working on each session, the patient Smith is given the task of completing the PHQ-9 test. Throughout this particular assessment, the aspects associated with CBT are thoroughly explained. The issues regarding ‘homework’ tasks associated with each specific session are explored. Basically, a glimpse regarding the overall outcome of the previous sessions is thoroughly explained in this report. Initially, all the responses and ideas of Smith, a software developer, regarding working and personal life scenarios are considered the significant parts of every session.

Session 1: Mental health psycho-education

PHQ-9 = 18/27

This session is all about promoting the concept of self-care, awareness and the ability to be content with one. This particular session is arranged so that Smith can have an understanding regarding the way of coping with depression, especially the depressive symptoms. During this session, Smith has stated that he has suffered from burnout not depression. He has worked on this aspect by following the ‘go with the flow’ factor as part of managing the work stress. David, Cristea & Hofmann (2018), CBT is also about the recording and working in the thought patterns of the individuals as a part of the stress reduction technique. This CBT has been already applied for Smith and it is identified that opening up or telling about the current problems has helped Smith to work on analysis of the root issues that have affected the reluctance of Smith to work on the work stressor management. In this aspect, Kurasaki & Terjesen (2020) have explained the importance of the ABC tool that helps in managing aims and overall processes of CBT, which helps demonstrate the beliefs as well as behaviors of the patients. Use of role-play has been used to examine the mental health of Smith and his response to the management of the symptoms. Based on the social modeling theory, the situation of Smith and his connection with his hierarchy in the workplace and his family members are analyzed, which is planned to be discussed in the next sessions. In this aspect, the combination of mediation and this therapy provides the patient to work on this issue.

Session 2: 5 Ps’ and 5 ‘areas’ completion

PHQ-9 = 20/27

The cognitive ability of Smith is analyzed as well as explored based on the completion of ‘5 Areas’ along with ‘5 Ps’ models in this session. Throughout this session, flashbacks and some negative thoughts are noticed in the case of Smith that he has experienced at the time of the completion of this session. Some automatic self-harming tendencies are seen to have emerged in Smith. Using the ‘5 Ps’ models, the management concept and its success factors are identified by Smith and his idea regarding professional success is explored. As part of homework, Smith is asked to identify the periodic symptoms of depression and the stressors associated with the episodes of depression. In this factor, Smith is advised to work on the ‘5 Areas’ model with the necessary aspects prior to the next session. It is identified that the working withdrawal and loss of motivation from the side of Smith are the main reasons for the lack of productivity to a certain extent.

Session 3: The goals of effective treatment

PHQ-9 = 21/27

Analyzing the factors of cognitive behavior treatment, it can be assumed that CBT is one of the most effective methods of analyzing and identifying the issues of the patients, which provided the patients with the understanding to work on the issues like mood swings and sleep deprivation. Dweck (2017) has explained that implementing SMART goals is one of the most effective ways of managing the structural focus of any goals. The potential outcome and the aspects of measuring the goals can be seen as one of the most significant aspects that has effectively affected Smith's motivation. The goals of Smith are identified as:

• Improved mood
• Effective socialization
• Ability to find good job
• Elated mood
• Ability to manage work-life balance

These goals are planned based on the numbering of personal importance from the side of Smith. These goals are mainly planned so that overall well-being of Smith can be developed with the attainment of these goals from time to time. After all these well-analyzed and defined issues faced by Smith, all these goals are explored based on the SMART' framework and these are amended aligned based on that:

The therapy goals are illustrated below:

• Score on PHQ-9 is required to be less than 15 by week five as this would indicate better mood as well as efficiency from the part of Smith
• Ability to make time for the kids and wife as the part of managing the work-life balance
• Attending the meetings in the office from time to time so that the business plans can be adequately understood.
• It is upgrading the existing CV so that readiness for session four can be managed. This would include creating great cover letters, uploaded on efficient job searching sites for better career up-gradation.

Action planning and monitoring the progress of these goals can be seen as significant parts of the attainment of the objectives.

Session 4: The planning regarding activities for each week

PHQ-9 = 15/27

Analyzing the factors of the previous sessions, it is identified that one of the prime motives of this session is to analyze the reduction of score of PHQ-9 test and needless to mention, that has become successful for the case of Smith. However, it was planned to reach 14, but he has scored 15. However, it can be seen that the mood of Smith has improved along with his sincerity in creating CV and cover letter, which are required for better life goals planning.

Smith has identified that he had previously enjoyed the aspects like gardening, playing with two kids, listening to music, and other aspects. As part of managing the balancing work and life, these aspects are targeted by Smith. According to Janssen et al. (2021), Behavioural Activation is one of the most effective methods of combating depression. The patients are provided with training regarding the problem-solving aspects from time to time. As part of CBT, the structural activity planning is prioritized so that Smith's low mood can be improved, making him interested in investing time in more productive approach from time to time. As the p; the art of this method, Smith, has been given the option of rating hisd mood from 0-10 during as well as after all the activities that he has planned to undertake. Most of the activities that Smith plans are hedonistic activities. Mobility is one of the vital factors and mobility helps one keep depression at bay while enhancing the level of self-efficacy.

Session 5: Cognitive restructuring sessions

PHQ-9 = 14/27

Majeed & Naseer (2021) have illustrated that cognitive appraisal theory has focused on the environmental influence on consumers' emotional responses. This theory mainly explains the way the patients can work on their negative cognition. In that aspect, negative thoughts are recorded so that the episodes of depression can be easily spotted. On the other hand, Schema Theory works on the impact of past experiences on the feeling of shame. Initially, maladaptive schemas can be seen in the behaviour of Smith as he has expressed his past issues with active listening and problem-solving aspects which have impacted his ability to take training in the professional sphere. There is a sense of defensiveness from Smith's side, which has led to his present failure to adjust to new managerial changes in the workplace.

As part of homework, Smith has been told to complete thought records so that the complete notion of his excellent and negative thoughts can be analyzed based on the sequence of thoughts occurring. This can be effective in tracking the emotional well-being of Smith. It is suggested to Smith's wife to accompany him in activity scheduling and thought recording so that progress of communication can be easily tracked and marked from time to time.

Season 6: Cognitive Restructuring 2: reinforcing new beliefs and assumptions

The thought diary of Smith, along with his weekly activity planner, has become influential in analyzing the outcome of the 5 Areas' completed model so that the weekly progress of Smith's mood can be analyzed as part of analyzing the efficiency of the intervention. Smith has recognized the stressors are associated with the work-related setting and his inability to cope with the organizational changes. By reassuring the 5 Areas' tool, Smith has felt more confidence regarding the management of his shortcomings which has helped him identify the ability to work on the SMART goal setting that he has planned as part of the meeting. As part of his goal, Smith had taken the initiative to upload his CV on several websites to get influential job roles that could provide him relatively better opportunities. Smith has rated his mood 6.5, indicating that he has learned to reassess his values and priorities. All his leisure activities have helped him to elate his mood. This aspect has become helpful in recovering from mindfulness-based CBT alleviates symptoms. However, Smith is encouraged to rely on CBT sessions if further issues arise.

Session 7: Final session

PHQ-9 = 12/27

Smith is asked to express the overall innovative progress of psychological therapy. Smith has expressed strongly the development of condition using different tools (12 scores in the specific session of 8). Therefore, this answer presents the achievement of actual goals, improvement of thoughts, and relationship with his family members. Smith can motivate himself and innovate in tasks smoothly after treatment

References

Journals

Ahmad, S., Hussain, S., Shah, F. S., & Akhtar, F. (2017). Urdu translation and validation of GAD-7: A screening and rating tool for anxiety symptoms in primary health care. J Pak Med Assoc, 67(10), 1536-40. Retrieved from: https://www.researchgate.net/profile/Sadiq-Hussain-4/publication/320056952_Urdu_translation_and_validation_of_GAD-7_A_screening_and_rating_tool_for_anxiety_symptoms_in_primary_health_care/links/59cdc6f8aca272b0ec1508c7/Urdu-translation-and-validation-of-GAD-7-A-screening-and-rating-tool-for-anxiety-symptoms-in-primary-health-care.pdf

Beck, E. D., & Jackson, J. J. (2020). Idiographic traits: A return to Allportian approaches to personality. Current Directions in Psychological Science, 29(3), 301-308. DOI: https://doi.org/10.1177/0963721420915860

David, D., Cristea, I., & Hofmann, S. G. (2018). Why cognitive behavioural therapy is the current gold standard of psychotherapy. Frontiers in psychiatry, 9, 4. https://www.frontiersin.org/articles/10.3389/fpsyt.2018.00004/full

Dweck, C. S. (2017). From needs to goals and representations: Foundations for a unified theory of motivation, personality, and development. Psychological Review, 124(6), 689. https://moodle2.units.it/pluginfile.php/358466/mod_resource/content/1/2017%20Dweck%20PR.pdf

Frumkin, M. R., Haroutounian, S., &Rodebaugh, T. L. (2020). Examining emotional pain among individuals with chronic physical pain: Nomothetic and idiographic approaches. Journal of Psychosomatic Research, 136, 110172.DOI: https://doi.org/10.1016/j.jpsychores.2020.110172

Janssen, N. P., Hendriks, G. J., Baranelli, C. T., Lucassen, P., Voshaar, R. O., Spijker, J., & Huibers, M. J. (2021). How does behavioural activation work? A systematic review of the evidence on potential mediators. Psychotherapy and psychosomatics, 90(2), 85-93. https://www.karger.com/Article/FullText/509820

Kurasaki, R., & Terjesen, M. D. (2020). Rational Emotive and Cognitive Behavioral Therapy in Working with Parents. In Rational-Emotive and Cognitive-Behavioral Approaches to Child and Adolescent Mental Health: Theory, Practice, Research, Applications. (pp. 125-142). Springer, Cham.https://link.springer.com/chapter/10.1007/978-3-030-53901-6_6

Majeed, M., & Naseer, S. (2021). Is workplace bullying always perceived harmful? The cognitive appraisal theory of stress perspective. Asia Pacific Journal of Human Resources, 59(4), 618-644. https://onlinelibrary.wiley.com/doi/abs/10.1111/1744-7941.12244

Murtonen, M., Gruber, H., &Lehtinen, E. (2017). The return of behaviourist epistemology: A review of learning outcomes studies. Educational Research Review, 22, 114-128.DOI: https://doi.org/10.1016/j.edurev.2017.08.001

Nowak, M. (2020). Nomothetic and idiographic approach in management sciences. Humanities and Social Sciences, 27(1), 50-56. Retrieved from: https://journals.prz.edu.pl/hss/article/download/36/21

Piccirillo, M. L., &Rodebaugh, T. L. (2019). Foundations of idiographic methods in psychology and applications for psychotherapy. Clinical Psychology Review, 71, 90-100.DOI: https://doi.org/10.1016/j.cpr.2019.01.002

Toussaint, A., Hüsing, P., Gumz, A., Wingenfeld, K., Härter, M., Schramm, E., &Löwe, B. (2020). Sensitivity to change and minimal clinically important difference of the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7). Journal of affective disorders, 265, 395-401.DOI: https://doi.org/10.1016/j.jad.2020.01.032

Zhou, T. H., Hu, G. L., & Wang, L. (2019). Psychological disorder identifying method based on emotion perception over social networks. International journal of environmental research and public health, 16(6), 953. DOI: https://doi.org/10.3390/ijerph16060953

Websites

Cbt-edinburgh.co.uk, 2021. Cognitive Behavioural Therapy. Retrieved on 24^th November, 2021 from: http://www.cbt-edinburgh.co.uk/cbt.html

Cntw.nhs.uk (2019). Understanding what influences your mental health and wellbeing.Retrieved on 24^th November, 2021 from: https://www.cntw.nhs.uk/content/uploads/2018/03/5ps-and-formulation.pdf

Forbes.com (2018). Diagnosing Depression By Blood Biomarkers: A Viable Approach?. Retrieved on 24^th November, 2021 from: https://www.forbes.com/sites/robertglatter/2018/07/31/diagnosing-depression-by-blood-biomarkers-a-viable-approach/?sh=59901cfd3412

Nice.org.uk (2021). NICE creates new menu of treatment options for those suffering from depression. Retrieved on 24^th November, 2021 from: https://www.nice.org.uk/news/nice-creates-new-menu-of-treatment-options-for-those-suffering-from-depression

Appendix 1: Initial assessment

Smith is a software developer in a reputed IT firm, and he is 32 at present. He is married with two daughters, one is six years old, and another is three years old. He has not experienced any issue until now that requires therapy to improve his mental condition.

Restructuring of the management in his organisation has increased the job risk and has strongly influenced Smith. Smith has started to believe that he is a failure and he is not as good as others are in the organisation. This situation has influenced the performance of Smith and he has started to feel as if he is a complete failure. He cannot attend the office within time or even forgets to attend virtual meetings within time. Smith's behaviour is influenced due to such depression issues, and his relations with his family gradually deteriorate. Health condition is also affected due to such depression as he cannot sleep properly or even do not go anywhere for fun. He has even stopped going to the gym to maintain physical fitness. However, his wife Maria tries to adjust and support him strongly and suggest an excellent psychological treatment for him.