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How to Help Mr. John Smith

Lanyia Allen

Intro. to Counseling

April 24, 2020

Indicators of Diagnosis

John Smith (30) is dealing with Persistent Depressive Disorder (PDD) (formerly known as Dysthymia). A low-grade depression that is less severe, but more chronic.

Overview

He shows most symptoms for PDD:

-Sleep Disturbances

-Loss/Poor Appetite

-Intrusive Thoughts

-Feelings of Hopelessness

-Fatigue

-Low Self-Esteem

Issues

Some things that Mr. Smith brought up that I thought were interesting were his frequent and intrusive thoughts of inadequacy and worthlessness, his implosion of emotions, and some evidence of self-sabotage. These assumptions were corroborated when Mr. Smith made many direct statements about his low self-esteem, worthlessness, hopelessness, and troubles concentrating and sleeping during his first session.

Mr. Smith's Issues

Other Red Flags...

Some other red flags I noticed were him mentioning that he's had mostly sad days for over 10 years, so much so, that his despair has become his new normal. He feels that he'll never amount to anything, despite him doing fine at work and being married to his caring wife that urged him to receive help. His intrusive thoughts about his past failures make it difficult for him to return to sleep once he awakens. His depression and unhappiness have made it difficult for him to enjoy things the things he once found comfort in (i.e. his family and friends). His fatigue and loss of appetite have most likely contributed to his weight loss as well.

Issues Cont...

Theories That Would Help Mr. Smith

Theories

Since there's no specific cause for PDD, although, it could be any combination of psychological, biochemical, genetic, and environmental factors. Luckily, there are some theories and techniques that could aid him in managing his PDD. There's Cognitive Behavior Therapy (CBT), which would focus on changing negative thoughts and identiying the problem(s). Interpersonal therapy would address any life transitions he may be experiencing and help him cope with any interpersonal disputes he could be having.

Cognitive-Behavior Therapy

CBT

CBT is one of the "empirically-based psychotherapeutic interventions" for mood disorders, along with Interpersonal Therapy (IPT). The focus of CBT is to teach your mind how to think and let your thinking influence your behavior. Since it is goal-oriented, time-limted via sessions, and present-focused it will help him "regain control of mood and functioning", which is an area that Mr. Smith has the most trouble, and needs the most assistance, with (Markowitz & Weissman, 2004).

CBT Techniques

With CBT, I could take either a Relational Emotive Behavior Therapy (REBT) or Cognititve Therapy (CT) route. Both would help him it would be my decision to choose which route would be the best one for my client. His expressions of inadequacy, worthlessness, and the fact that he thinks he's "just pessimistic". Using a CT approach the techniques that I would propose to Mr. Smith, and work with him on, would be (Corey, 2016):

  • Engage in Socratic dialogue
  • Carry out homework assignments
  • Conduct behavior experiments
  • Examine/Discuss dysfunctional thinking and form alternative interpretations (Guided Discovery)

CBT Techniques

Interpersonal Therapy

Interpersonal Therapy (IPT) is also a "time-limited, present-focused, and empirically-validated treatment for mood disorders", like CBT, and works for non-mood disorders as well. It's two main principles stand on the foundation that 1. Depression is a mental illness and excuses the client from symptomatic self blame and 2. Mood and life situations are related. Meaning that Mr. Smith's PDD could be triggered from chronic stress and anxiety in his life, a disrupting life event (i.e. loss of a loved one, marital disputes, etc.) and as a result he thinks about those things and makes himself depressed as an after effect.

Interpersonal Therapy

Interpersonal Therapy Techniques

With IPT it can be triggered by many things that then can cause the disorder to manifest, in this case PDD for Mr. Smith. So the techniques involved in IPT focus on identifying those triggers and formulating a plan to cope with those feelings. Therefore, the process and techniques go a little something like this:

  • Identify target diagnosis & interpersonal interactions that may be attached to it (i.e. complicated bereavement, role dispute, etc.)
  • Conducting various behavioral assesments & interpersonal inventories
  • Discuss one (or more) of the potential problems (i.e. role transition, interpersonal deficits, etc.)
  • Reflect on previous week's sessions & analyze/reconstruct (if needed)

Theories Cont...

Supportive Therapy

Supportive Therapy

Supportive therapy is a treatment that "uses direct measures to [improve] symptoms and maintain, restore, or [ameliorate] self-esteem, ego functions, and adaptive skills" and relies heavily on the client-therapist relationship and the rapport that is developed (Rothe & AAPDP, 2017). It can also involve the family being educated on what the client is going through and the type of disorder they have. Which could help improve his mood if Mrs. Smith was involved and understood what her husband is going through. Thus providing him support at home, on a personal/intimate level. I would provide support professionally.

Best Medications for Mr. Smith

Some medications that help people with PDD are mainly Selective Serotonin Reuptake Inhibitors (SSRIs), which increases seratonin in the brain and should improve the mood of the client:

  • Fluoxetine (Prozac)
  • Sertraline (Zoloft)
  • Duloxetine (Irenka)
  • Amitriptyline (tricyclic antidepressant)

Referring back to Mr. Smith's comment about feeling sad for 10+ yrs. I find that any of these SSRIs, in conjunction with therapy, would greatly benefit Mr. Smith's quality of life.

Medications

There's Hope for Mr. Smith

At the end of the day, I see no reason why he can't have and experience the quality of life that he deserves. Using Cognitive Behavior Therapy via Cognitive Therapy techniques, Interpersonal Therapy and it's techniques, along with some sort of SSRI prescription he could see improvement within 16-20 weeks. The support from his therapist, his wife and, eventually, himself should improve his mood and outlook on life. There is hope for Mr. Smith.

Hope for Mr. Smith

References

Corey, G., (2016). Theory And Practice Of Counseling And Psychotherapy. 10th ed. Boston, MA: Cengage Learning US.

Furukawa, T. A., Efthimiou, O., Weitz, E. S., Cipriani, A., Keller, M. B., Kocsis, J. H., ... & Schramm, E. (2018). Cognitive-behavioral analysis system of psychotherapy, drug, or their combination for persistent depressive disorder: personalizing the treatment choice using individual participant data network metaregression. Psychotherapy and psychosomatics, 87(3), 140-153.

Kriston, L., Wolff, A. V., Westphal, A., Hölzel, L. P., & Härter, M. (2014). Efficacy And Acceptability Of Acute Treatments For Persistent Depressive Disorder: A Network Meta-Analysis. Depression and Anxiety, 31(8), 621–630. doi: 10.1002/da.22236

References

References Cont...

Markowitz, J. C., & Weissman, M. M. (2004). Interpersonal psychotherapy: principles and applications. World psychiatry : official journal of the World Psychiatric Association (WPA), 3(3), 136–139.

Rothe, E. M., & American Academy of Psychoanalysis. (2017). Supportive Psychotherapy in Everyday Clinical Practice: It's Like Riding a Bicycle. Retrieved from https://www.psychiatrictimes.com/psychotherapy/supportive-psychotherapy-everyday-clinical-practice-its-riding-bicycle

References Cont...

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