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This paper aims to analyze the case of a 30-year-old female client, Alex, who presents with several symptoms of major depression. Her key complaint can be formulated as follows: “I took antidepressants for several years, but I still feel frustrated and unfortunate”. Alex’s symptoms include complicated and abusive relationships with her husband, her doubts in herself, inability to make decisions, and a high level of self-criticism. In terms of an interpersonal therapy (IPT), the client’s case can be conceptualized as an example of major depression. It is a person with a history of depressive episodes and several attempts to treat them. Alex’s strengths include her self-awareness of the problem she needs to resolve. She understands that her quality of life can be better and that her relationships can also improve. Among the client’s weaknesses, there is social isolation caused by her parents’ problems. It is possible to assume that Alex experiences issues in communicating with people in general.
Based on family history, the presentation of psychological problems, behavioral and emotional difficulties, preliminary diagnostic considerations refer to depression and social isolation. It is likely that Alex’s current condition deteriorated with time, beginning from her childhood. It seems to be beneficial to use the Hamilton Rating Scale for Depression (HRS) and the Beck Depression Inventory-II (BDI) to better understand the client’s current state (Fonagy et al., 2020). According to the mentioned assessment tools, it is possible to discover somatic and psychiatric anxiety, agitation, the feelings of guilt, suicide, and mood-related behaviors. The effectiveness of these tools is confirmed by numerous studies, which makes them reliable instruments (Fonagy et al., 2020). In addition, they can be applied after a course of therapeutic sessions to identify any progress.
A dynamic interpersonal therapy (DIT) can be recommended for Alex since this intervention views depression as one’s reactions to perceived threats to attachments. As stated by Fonagy et al. (2020), DIT focuses on attachment-related interpersonal problems, which allows working on client’s responses to others feelings and behaviors. In the given case, it would be useful to identify the patterns in Alex’s relationships and reconsider her responses to her partner. Another benefit of DIT for Alex is the opportunity to enhance her capacity to reflect on her feelings and emotions, thus understanding her depressive symptoms and working on their origins.
Working with Alex, a counselor should take into account that her parental family immigrated when her mother was pregnant. It means that she can be of different cultural background that probably dictates some rules of behavior. Even though the case study did not clearly identify her origin, additional information about her cultural views is necessary. In particular, her experience growing in her family, ethnical and religious beliefs, traditions, the ways that were used to resolve problems, and any other issues that she wants to share should be asked.
If Alex made an expensive gift, it would be an ethical dilemma to whether accept or reject an expensive necklace. On the one hand, the American Counseling Association Code of Ethics cautions counselors that they should avoid gifts since they can worsen therapeutic relationships or create a sense of power and control. On the other hand, the necklace is engraved and probably gifted as gratitude. It seems to be possible to accept it with caution, but any potential issues should serve as a signal to return it since it is up to the counselor to make a decision.
Reference
Fonagy, P., Lemma, A., Target, M., O’Keeffe, S., Constantinou, M. P., Wurman, T. V., & Pilling, S. (2020). Dynamic interpersonal therapy for moderate to severe depression: A pilot randomized controlled and feasibility trial. Psychological Medicine, 50(6), 1010-1019.
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