Case Study
Patient Demographic: Client Age: 32 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Latina; Mexican American Relationship Status: Married Counseling Setting: Community Mental Health Type of Counseling: Individual and Psychoeducation Presenting Problem: Depression Diagnosis: Major Depressive Disorder (MDD) with Psychotic Features 296.24 (F32.3)
Mental Status Exam: Mental Status Exam: The client is well groomed and appropriately dressed. Her voice is soft and low, and she avoids eye contact, mainly when talking about her family. She states, “I’ve put them through so much. And I feel so ashamed when I’m unable to care for them.” She endorses feelings of hopelessness but denies suicidal and homicidal ideations. The client says that she hears voices and believes that they are the voices of her deceased ancestors trying to communicate with her. She explains that the “spirits” whisper her name in the middle of the night and come to her when she is alone. The client denies command hallucinations. Her appetite is poor, and she has difficulty sleeping “most nights.” She has experienced depressive symptoms most of her life, but, outside of the recent hospitalization, she has not sought treatment due to believing that mental illness is a sign of weakness. History of Conditio
Presenting Problem: You work in a community mental health setting. Your client is a 32-year-old Latina presenting with symptoms of depression and psychosis. She reports that she was hospitalized more than 6 months ago and did not attend follow-up appointments due to losing her health insurance coverage. The client currently reports anhedonia, sadness, feelings of worthlessness, and poor concentration. She explains that there are many days when she cannot get out of bed and is unable to fulfill her role as a wife and mother. The client also reports audio hallucinations and says this began when her grandmother died more than a year ago. She explains that her grandmother lived in her home and that her loss was “devastating” to the client. The client is fluent in Spanish and English.
Other Contexts: The client informs you that she is upset because of a recent incident involving her two sons. She states that her teenage sons were walking in a neighborhood park when they came across a group of white men who used xenophobic slurs and threatened them. The boys said the men spit on them and told them to “go back to where they came from.” The client’s bouts of depression persist, and this is now coupled with the feeling that she has somehow failed to protect her sons. The client is also concerned that her husband is becoming increasingly intolerant of her inability to cook, clean, and care for their boys. The client states this makes her feel “worthless” and a “nobody.” She has also become more isolated and misses “having the energy” to connect with those in her community.  You use behavioral activation to help the client with social isolation

Question: You use behavioral activation to help the client with social isolation. Which treatment plan goal reflects this approach?
(A): The client will identify two ways of reducing ambivalence and engaging in “change talk.”
(B): The client will identify at least four individuals who fit into her “quality world.”
(C): The client will engage in a minimum of two “values-based” activities each week.
(D): The client will list a minimum of three faulty assumptions contributing to her “failure identity.”

Correct Answer: The client will engage in a minimum of two “values-based” activities each week.
Explanation: Behavioral activation is a cognitive-behavioral approach for treating depressive symptoms, including those associated with social isolation. It works by positively reinforcing activities related to one’s values and enjoyment rather than waiting for depressive symptoms to diminish before engaging in these activities. Motivational interviewing is used to reduce ambivalence and elicit change talk. Identifying concepts and faulty assumptions contributing to one’s failure identity is associated with Adlerian therapy. Lastly, reality therapy suggests that one’s “quality world” is at the core of life. One’s quality world includes individuals we are closest to and those who supply us with satisfying experiences. Therefore, the correct answer is (A)
Competency: treatment planning