Case Study

Case Study

Introduction

The following essay is a case study of a client named Mrs. Diamond is an 85yr old woman who has been widowed for just over a year. Mr & Mrs Diamond lived in the same borough as their only daughter Jane, who is married and has a four year old child. The grand parents used to child mind their grand child twice a week while Jane went back to work on a part time basis. After Mr Diamond died Mrs Diamond told her daughter that she wished to carry on with her life as usual, like going to bingo, having lunch two days per week with friends and childminding her grand child. She however seemed less communicative and 'bubbly' as she used to be. Her friend confided in Jane that her mother was reluctant to socialise and appeared not to be coping with the grand child. Mrs Diamond never complained.

Section 1: Conceptualization of the Problem

As is clear from the patient's description of her problems, most of the symptoms that she has described --- sleeplessness, weight loss, loss of appetite, loss in interest in major activities --- fit in very well with the American Psychiatric Association (APA's) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. (DSM-IV criteria). So my diagnosis was that this patient suffered from major, clinical depression.

Further I realized that since, personal reactions, thoughts, and expectations play a significant role in the etiology and maintenance of many mental health and sociological problems, these cannot be addressed by pure behavior therapy, but with the Cognitive Behavior Therapy (CBT) model evolved by Clark, Beck, & Alford (1999).

The main goal of CBT is to help individuals and families cope with their problems by changing their maladaptive thinking and behavior patterns and improve their moods (Blackburn et al, 1981). Intervention is driven by working hypotheses (formulations) developed jointly by patient, her/her family and therapist from the assessment information. Change is brought about by a variety of possible interventions, including the practice of new behaviors, analysis of faulty thinking patterns, and learning more adaptive and rational self-talk skills. (Hawton, Salkovskis, Kirk, and Clark, 1989).

A probable reason why CBT works with depressed patients is that depression interacts with both cognitive and motivational processes. This is well evidenced in experimental analogue research with healthy and depressed individuals. Individuals with depression show deficits on a range of cognitive tests (Brown, Scott, Bench, 1994) with the pattern of dysfunction having many of the characteristics associated with fronto-subcortical impairment. Reischies and Neu (2000) found that depressed individuals displayed mild cognitive impairments in comparison with matched controls, particularly in the areas of "adverbial" memory, psychomotor speed and verbal fluency. Further in these patients there appears to be considerable variation in the recovery of cognitive function with remission of the depressive episode.

Depressed individuals also show a loss of enjoyment and decreased interest in previous activities, which can result in a reduction in purposeful or "goal-directed" behavior. This is because motivational deficits also interact with a range of cognitive tasks ...