Final Case Analysis
Lona seems to be suffering from a Dysthymic Disorder. This is because the fact that her state of depression has been persistent for more than two years due to the circumstances and changes in her life. In the initial interview, there was no information that the issues Lona has been experiencing could be hereditary. In reviewing the facts, it is evident that Lona is experiencing an extreme change of routine in her life. This has prompted her illness and sense of lack of control. Lona's history is that she has been married for ten years, five into her marriage she gave birth to a female baby. Before the child seriously entered into her husband and her life, she had a great control of her life and career, which provided a comfortable living. Both Lona and her husband made six figures each.
Instead of delegating the household tasks and caretaking, Lona took everything upon herself all through without a rest. She was practically working three full time jobs. This is inappropriate because, as we know from the journal of health and social behavior, there is data that supports that exertion from, "working and doing the majority of the work associated with raising children increases distress among married women" (king et al., 1983, p. 112). Therefore, Lona was subjecting herself into possible distress in her life, which eventually, overcame her and provoked her to seek help.
Over four years of maintaining this hectic schedule, she began to show symptoms of depression where she was eating less, sleeping less, and lost interest in activities she once enjoyed due to low energy. Every day she would make unrealistic expectations for herself through creating an endless to-do list, which created an environment of being consistently overwhelmed. She quit her high paying job to take a stay at home position and began expelling negative comments to her husband in regards to him needing to pick up the slack around the house. Statements like these were not constructed and expressed in a desire for him to recognize her need for him to help her maintain a similar lifestyle they once had, but to hurt him became she is feeling a loss of control in herself. Through consistent therapy sessions I believe we can help her learn to delegate in ways to gain the desired outcome.
These symptoms would lead me to believe Lona meets the DSM Criteria for Persistent Depressive Disorder (Dysthymia) because she meets three of the six symptoms defined in the DSM provided in the Abnormal Psychology textbook (King, 2014, p.133). Lona seems to meet the requirements for this diagnosis but also shows signs of Anxiety disorder due to her irritability she seems to have toward her husband. With Anxiety disorders there is a tendency to focus on the negative aspects of life, which she does when Lona talks with her family. But more than half of those that are diagnosed with anxiety disorders show signs of major depressive disorder. This assignment is to share the primary diagnosis I would give Lona, which is Dysthymia, but I do not want to ignore nor negate the fact that anxiety symptoms such as nervousness, mood swing and problem related her social environment are present. This will lead to panic disorder if Lona does not work towards full recovery. Due to the desire and expression of eagerness for help, I am certain that she will be able to set goals to help her achieve a healthy and in control lifestyle once again. I am ultimately sure that she will recover because Lona meets all criteria for Dysthymia from C to F. Lona's symptoms of poor appetite, low self esteem, fatigue, low energy, and feeling of hopelessness justifies this.
Dysthymia refers to a deep depressive and persistent mood disorder also known as Dysthymic disorder. It can be distinguished from other depressive disorders due to its unique characteristics. These include loss of interest and apathy. The two characteristics may occur in different psychiatric trends such as schizophrenia, dementias and a progressive palsy. The disorder has a history of affecting about three to six percent of community individuals. A higher proportions of these are outpatient mental patients. However, the disorder is not that severe enough and is accomplished by social impairment and distress. Occupational and home routines come as disturbance. The disorder persists for at least two years with insomnia and hypersomnia the later stages of symptoms. Within the DSM ranking, the early symptoms begin to show at the age of 21 years. Here, situations like weight gain, increase of appetite and paralysis feelings arise. The disorder grows into severe functional impairment with age. People suffering From
Dsythymia start with at least one major depression episode, a situation known as double depression.
A series of psychotherapy and medication has been the common used treatment methods for Dysthymia (Buszewicz & Beecham, 2010). In the medical part, serotonin and inhibitors with antidepressants have been used to cure many patients. However, there are side effects such as abnormal weight gain for dysthymic people who use these kinds of medication. Though psychotherapy carries the bigger part in the treatment process, both clinical and psychotherapy medication is the most effective. There are different types of psychotherapy. Psychodynamic, behavioral and interpersonal therapies are the most appropriate types for persons with dysthymia. The level of Lona's depression makes me choose the cognitive psychotherapy. This is because this type has provided the best treatment for chronic depression.
With the use of cognitive psychotherapy, my treatment goals for Lona will be assisting her recover her lost apathy, reduce the higher levels of depression and gain control of her life like before. To start with, apathy refers to the existence of symptoms of dsythymia to a level where one loses interest and passion for everything. This includes lack motivation to perform daily routines. It is evident that Lona has lack of passion as she is at crossroads. She is at a point of despair having seen that her efforts have not born fruits for the four years of hard work. The usual self-generated voluntary will do perform is no longer present. Lona has purpose for doing something anymore. Cognitive therapy in steps will gather the distress into collective information that will help Lona rediscover her worth once more.
The other goal is to help Lona reduce her deep depression that has brought her functional impairment. This will involve setting targets that will help her overcome emotional distress and intellectual impairment. This will be the main consideration at the middle stages of the therapy process. I would suggest to her that doing this the way she does may not her any longer. This would include aspects of time management. I would tell Lona that there is time for everything. One needs to organize themselves well to get the best of the situation. For example, Lona should set time for work and delegate the other household duties to other people in the house. This will prove the need to hire a house help and a babysitter if possible. Proper organization will relieve her from unnecessary congestion of duties. This will be critical towards avoiding instances of panic and anxiety and enable her rediscover her life control like it was before.
As from the beginning of the therapy process, I could see some areas of strengths from Lona. First, despite her lost confidence, she is a very hardworking woman. Lona does not at any point loose her ambitiousness to gain something positive in her life. She always identifies an opportunity to get the best from any condition. This is like a talent, and I would do everything possible to integrate it towards enhancing the realization the therapy objectives. For instance, I would tell Lona that she must work extra harder and smart in every aspect of life. This does not mean working around the clock, but working with a good schedule organization. I am certain that as Lona is used to working hard, she will take no time to grasp and adopt the new trends and routine sequences.
I could also tell that Lona is courageous and has high levels of determination even though she suffers dysthymia. This is because Lona has the determination to carry all duties herself alone. She has the courage to believe that she can do all duties alone. She does not need help from her husband even though he is present. This courage would be very essential in influencing the outcome of the therapy process and treatment (Zimbardo et al., 2001). I would ask Lona to believe and exhibit the same courage with determination to achieve the best from the therapy process. More so, I would urge to her that she should have the courage to face her husband and trust other people's work for her. She should believe and trust that a house maid will complete the household work without any complications. This would greatly help her get the deserved rest and the preparation for some other duties.
Towards the end of the therapy process, I notice many areas of improvement for Lona. First, her levels of depression have had gone down to remarkable margin. I could see that this was as a result of a continuous conversation and contact during the therapy sessions. Since Lona was able to unleash she inner problems, she was likely going to feel the relief. It is normal that somebody gets some relief after talking about her problems to other people. Making use of this development to assist Lona further becomes my responsibility. I would organize for further sessions to instill the much needed awareness that things of the past are never to be practiced again.
Another area of improvement is the extinction of apathy. The passion for living was slowly resuming. There were signs that Lona now thinks positively about her life and every situation in her family. Grasping my ideas worked miracles for Lona even before the treatment was to come to an end. I could notice her eagerness change her routine, talk much of her issues with family and especially her husband. It seemed like an again reignited strength that existed before but had a lack of motivation for a goal. I see Lona as a very positive individual. This strength would be appropriate for instilling other desired effects such as strengthening her relationship with her family members. I would make maximum use of this strength to build an everlasting cohesive relationship.
There was also an improvement on how Lona controls her life. Unlike before, Lona is now a partially change person. This is because, she can now engage freely with other people that matters a lot on her life. They include her husband, daughter, close friends and neighbors. Lona began to rethink about her dealing with issues of work and family. She has shown some characteristics of change of attitudes towards others. I would still give Lona a regular motivational talk to impact this strong positive change of her life.
I would also give very important assignments to Lona. They include doing some relaxation exercise at home on a routine. For instance, I would ask her to take a walk at teach her special body exercises. Furthermore, I would ask Lona to take the initiative to intervene other people problems. This would include visiting her neighbors regularly. This particular assignment will help her realize how much people deal with problems (Kingdon et al., 2005). It will make her identify strengths about other people in dealing with issues. As a result, Lona will learn how to cope with day to day matters of life and hence know how to work smart.
Towards the end of the therapy process, I would consider strengthening other areas of concern to establish a steady positive life for Lona. This would include exploring and offering advice about Lona's marriage life with her husband. The next thing would be talking directly to Lona's husband about their life for the wellbeing of Lona. Addition to this, I would also advice Lona on matters of professional and occupational goals. The reason to looking these areas in a critical way is to make sure that Lona does not go back to suffer from dysthymia again. This is only possible through establishing a good environment that disallows a reemergence of stress and the other symptoms of dysthymia.
Buszewicz, M., & Beecham, J. (2010). Evaluation of a system of structured, pro-active care for chronic depression in primary care: a randomised controlled trial. BioMed Central.
Kingdon, D. G., & Turkington, D. (2005). Cognitive therapy of schizophrenia. New York: Guilford Press.
Zimbardo, P. G., Annenberg/CPB Project, & WGBH (Television station : Boston, Mass.) (2001). Psychotherapy. Boston, MA: WGBH.
King, A. M., Johnson, S. L., Davison, G., Neale, J. (2014).Abnormal Psychology (12th ed.). Hoboken, NJ: John Wiley & Sons, Inc.