Treatment Summary
Background and presenting problem
The client, a 33 year old Caucasian female, received treatment at an outpatient Psychology Training Clinic over the course of 5 months. Developmentally, the client was from a low SES family of 6 and her parents were separated when she was very young. The client described a pattern of inconsistent employment history throughout adulthood. At the time of treatment, the client had started her graduate studies in performance arts and had a graduate assistantship.
The client’s stated reasons for seeking treatment included difficulties with attention and concentration and depressed mood. Specifically, she reported intermittent depressed mood for approximately 10 years and a life-long history of attention and concentration difficulties. Additionally, she was worried about losing her graduate assistantship and failing to fulfill the demands of graduate coursework. She reported a remote history of passive suicidal ideation and she denied suicidal ideation, intent, or plan at the time of the intake. Conceptualization and Diagnostic Formulation Due to prominent attention and concentration problems, a within-clinic ADHD screening was incorporated to the case conceptualization and treatment planning phases. The results of this screening showed impairment in the attention domain, which was consistent with the client’s reported history. Based on the ADHD screening results, evident functional impairment in academic and occupational domains, and self-report measures of mood, the client’s presenting problems were classified as follows: a) 314.00 Attention Deficit/Hyperactivity Disorder, Moderate, Predominantly Inattentive Presentation; b) 309.0 Adjustment Disorder with Depressed Mood. From a biopsychosocial standpoint, the client had neurodevelopmental vulnerabilities in attention and executive functioning domains. …show more content…
Developmentally, the attentional difficulties remained unaddressed throughout childhood due to the combined impact of financial instability in the family, parental conflict, and relative scarcity of parental support. As a consequence, the client struggled with academic achievement at school and experienced functional impairment at work during adulthood years. As a result of continued impairments in these domains, the client developed an image of herself as inadequate and unsuccessful, which contributed to her depressed mood. From a trans-diagnostic stand point, the client engaged in excessive rumination, which further impeded her ability to maintain focus, exacerbated depressed mood, and reinforced self-criticism through negative self-talk. Treatment Initial phases of the treatment focused on building rapport with the client, sharing the case conceptualization, eliciting feedback and identifying treatment goals. Motivational interviewing techniques and psychoeducation were employed to develop rapport, elicit a collaborative therapeutic environment, explain the case conceptualization, and present the implications of the clinical diagnoses to the client. A treatment plan was developed to address the functional impairments stemming from ADHD symptoms and depressed mood. The treatment plan involved cognitive behavioral techniques to address ADHD related impairment, experiential, and cognitive behavioral techniques to address depressed mood. Cognitive behavioral techniques were initially implemented to help the client develop behavioral schedules to manage daily, weekly, and monthly tasks; and to teach the client how to prioritize tasks based on importance and urgency, break the larger tasks to smaller chunks, sequence tasks, identify and reduce the environmental distractions at home and at work through space management, develop a self-reward schedule contingent upon timely completion of tasks, and identify long-term reinforcers to increase the desirability of distant rewards. Mindfulness techniques were utilized to increase the client’s awareness of self-critical cognitions and address excessive rumination. Behavioral activation was used to increase the frequency of pleasant events in the client’s life. Additionally, the client was referred to a psychiatrist due to the ADHD diagnosis, …show more content…
Termination was mutually initiated by the therapist and the client since all treatment goals were met. The last two sessions of the therapy were spaced across two months. During these sessions, the patient maintained the good prognosis, presenting with increased self-esteem, self-efficacy, motivation, and hopefulness about the future. At the time of the discharge the client was high functioning in several domains, including work, academic, and social relationships. The client no longer met the diagnosis criteria for 309.0 Adjustment Disorder With Depressed Mood, and continued to meet the diagnostic criteria for 314.00 Attention Deficit Hyperactivity Disorder, Moderate, Predominantly Inattentive Type, however the latter no longer interfered with the client's academic or occupational functioning. At the time of the termination, the client was expected to maintain the treatment
Background and presenting problem
The client, a 33 year old Caucasian female, received treatment at an outpatient Psychology Training Clinic over the course of 5 months. Developmentally, the client was from a low SES family of 6 and her parents were separated when she was very young. The client described a pattern of inconsistent employment history throughout adulthood. At the time of treatment, the client had started her graduate studies in performance arts and had a graduate assistantship.
The client’s stated reasons for seeking treatment included difficulties with attention and concentration and depressed mood. Specifically, she reported intermittent depressed mood for approximately 10 years and a life-long history of attention and concentration difficulties. Additionally, she was worried about losing her graduate assistantship and failing to fulfill the demands of graduate coursework. She reported a remote history of passive suicidal ideation and she denied suicidal ideation, intent, or plan at the time of the intake. Conceptualization and Diagnostic Formulation Due to prominent attention and concentration problems, a within-clinic ADHD screening was incorporated to the case conceptualization and treatment planning phases. The results of this screening showed impairment in the attention domain, which was consistent with the client’s reported history. Based on the ADHD screening results, evident functional impairment in academic and occupational domains, and self-report measures of mood, the client’s presenting problems were classified as follows: a) 314.00 Attention Deficit/Hyperactivity Disorder, Moderate, Predominantly Inattentive Presentation; b) 309.0 Adjustment Disorder with Depressed Mood. From a biopsychosocial standpoint, the client had neurodevelopmental vulnerabilities in attention and executive functioning domains. …show more content…
Developmentally, the attentional difficulties remained unaddressed throughout childhood due to the combined impact of financial instability in the family, parental conflict, and relative scarcity of parental support. As a consequence, the client struggled with academic achievement at school and experienced functional impairment at work during adulthood years. As a result of continued impairments in these domains, the client developed an image of herself as inadequate and unsuccessful, which contributed to her depressed mood. From a trans-diagnostic stand point, the client engaged in excessive rumination, which further impeded her ability to maintain focus, exacerbated depressed mood, and reinforced self-criticism through negative self-talk. Treatment Initial phases of the treatment focused on building rapport with the client, sharing the case conceptualization, eliciting feedback and identifying treatment goals. Motivational interviewing techniques and psychoeducation were employed to develop rapport, elicit a collaborative therapeutic environment, explain the case conceptualization, and present the implications of the clinical diagnoses to the client. A treatment plan was developed to address the functional impairments stemming from ADHD symptoms and depressed mood. The treatment plan involved cognitive behavioral techniques to address ADHD related impairment, experiential, and cognitive behavioral techniques to address depressed mood. Cognitive behavioral techniques were initially implemented to help the client develop behavioral schedules to manage daily, weekly, and monthly tasks; and to teach the client how to prioritize tasks based on importance and urgency, break the larger tasks to smaller chunks, sequence tasks, identify and reduce the environmental distractions at home and at work through space management, develop a self-reward schedule contingent upon timely completion of tasks, and identify long-term reinforcers to increase the desirability of distant rewards. Mindfulness techniques were utilized to increase the client’s awareness of self-critical cognitions and address excessive rumination. Behavioral activation was used to increase the frequency of pleasant events in the client’s life. Additionally, the client was referred to a psychiatrist due to the ADHD diagnosis, …show more content…
Termination was mutually initiated by the therapist and the client since all treatment goals were met. The last two sessions of the therapy were spaced across two months. During these sessions, the patient maintained the good prognosis, presenting with increased self-esteem, self-efficacy, motivation, and hopefulness about the future. At the time of the discharge the client was high functioning in several domains, including work, academic, and social relationships. The client no longer met the diagnosis criteria for 309.0 Adjustment Disorder With Depressed Mood, and continued to meet the diagnostic criteria for 314.00 Attention Deficit Hyperactivity Disorder, Moderate, Predominantly Inattentive Type, however the latter no longer interfered with the client's academic or occupational functioning. At the time of the termination, the client was expected to maintain the treatment