Case Study
Patient Demographic: Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: College Campus Counseling Clinic Type of Counseling: Individual Counseling Presenting Problem: Depression and “Odd Behavior” Diagnosis: Bipolar 1 Disorder, Current Episode Manic Without Psychotic Features, Moderate (F31.12)
Mental Status Exam: Mental Status Exam: The client states that she slept for 4 hours the night before, which was the most she has slept in one night in the past week and that she now feels tired for the first time. The client had dark circles around her eyes and was wearing sweatpants and a t-shirt with stains on it. The client is oriented to person, place, time, and situation. The client’s affect and speech are
Presenting Problem: You are a licensed therapist working on a college campus in the counseling center. A 20-year-old female client comes to counseling following 8 days of experiencing the following symptoms: little to no sleep most nights with the longest stretch of sleep being 2 hours, several middle-of-the-night shopping sprees, and distractibility. She reports that some of her college professors have called on her to stop talking during class and that she has not been doing very well in school this semester. The client identifies that she has felt this way before over the past 2 years and that this last time scared her because she was more aware of the negative impact it is having on her schooling. The client continues to relate that she also experiences depression at times and that she does not understand where it comes from but that it happens for a few weeks at a time every few months. When in a depressive episode, the client experiences a depressed mood more often than not, decreased enjoyment of activities, hypersomnia, fatigue, and a significant decrease in appetite.
Other Contexts: You meet with the client during your regularly scheduled session. The client says that the manic behavior has stopped and that she is starting to enter a depressive episode. The client identified mild depressive symptoms including a down mood, difficulty enjoying activities, and fatigue. The client states that she still has not contacted the psychiatrist because she does not know if she is ready for medication. You process this thought with the client and identify that she is worried about the side effects of the medication. You encourage the client to meet with the psychiatrist and be open about her worries in order to get more information on the medication options. The client expresses worry that her academic success has been affected by cycling moods. The client’s grades are currently dropping, and she says that she does not have control over them. You empathize with the client and begin to talk about behavioral and cognitive interventions to improve functioning

Question: Based on the information that you already have, which of the following would be a clinically indicated behavioral intervention to manage increasing depressive symptoms?
(A): Encourage the client to spend time with friends because this makes her happy.
(B): Encourage the client to follow up with the psychiatrist in order to discuss medication for depression.
(C): Encourage the client to plan out pleasurable activities that she has enjoyed in the past, and mention that she should do them even if she feels like she will not enjoy them.
(D): Develop an exercise routine because exercise focuses on general well-being and can improve mood by releasing endorphins.

Correct Answer: Encourage the client to plan out pleasurable activities that she has enjoyed in the past, and mention that she should do them even if she feels like she will not enjoy them.
Explanation: Based on the information provided, it would be most beneficial to encourage the client to plan activities that she knows she has enjoyed in the past. The cognitive distortion associated with assuming that she will not enjoy herself is called fortune-telling because she is assuming an outcome without knowledge to support the assumption, and she may in fact enjoy things more than she thinks, even if it is not to the extent that she used to. Exercise can improve mood and well-being, but the client has not expressed any interest in this activity. The client already spends time with friends and should continue to do so. The client reports not feeling ready to take medication, so this is an ongoing discussion. Therefore, the correct answer is (B)
Competency: treatment planning