Case Study
Patient Demographic: Client Age: 32 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Depressed Mood Diagnosis: Bipolar II 296.89 (F31.81), current episode depressed
Mental Status Exam: Mental Status Exam: The client is dressed casually and is somewhat disheveled. She avoids eye contact and displays a flat affect. The client admits to having suicidal thoughts in the past but currently denies both suicidal and homicidal ideations. Her speech is soft in volume and tone. She tends to provide one-word responses but is cooperative when asked to elaborate. The client denies audio-visual hallucinations, and her thought content is coherent. The client’s mood is depressed, and her affect is flat. She appears tired and reports she has insomnia at night and is sleeping most of the day. The client has experienced depression off-and-on, beginning in late adolesc
Presenting Problem: You work at a community mental health agency providing outpatient services to adults. Today, you are meeting with a 32-year-old female who presents with her husband for an initial intake session. The client’s husband is concerned about his wife’s depressive symptoms. She is experiencing sadness, decreased appetite, and hypersomnolence. The client also expresses hopelessness and has lost interest in doing the things she once enjoyed. Until recently, the client worked at an art gallery. When employed, she reports that she, “just couldn’t get out of bed” and was eventually let go due to excessive absences. After her employment ended, her depressive symptoms worsened. The client was able to recall a time nearly one year ago when she felt “almost the opposite” of how she feels now. During this time, she experienced increased energy and felt more inspired and creative. The client explains that she and her husband used to travel selling their art at juried art exhibitions most weekends, but it has been awhile since she has joined him.
Other Contexts: The client reports that she has been feeling less depressed. Her affect is full-range and appropriate to the situation. She continues to have sleeping difficulties that seem to worsen when experiencing unexpected stressors. The client explains that she has been arguing with her daughter’s father about financial matters, which developed after the client lost her job. The client believes her depressive symptoms are exacerbated after spending significant periods of time on social media. The client remarks, “My husband’s patience with me is growing thin. I don’t think I can ever live up to his expectations

Question: Given the client’s current clinical presentation, which approach would best address the client’s concerns?
(A): Mindfulness based relaxation and stress reduction (MBSR)
(B): Rational-emotive behavioral theory (REBT)
(C): Interpersonal social rhythm (IPSRT)
(D): Behavioral modification (BMOD)

Correct Answer: Interpersonal social rhythm (IPSRT)
Explanation: While all approaches can be used to address the client’s concerns, interpersonal social rhythm therapy (IPSRT) would best address the client’s level of functioning and clinical symptomatology. IPSRT is a best practice for bipolar disorder and is based on the premise that psychosocial stressors influence biological rhythms. When biological systems, such as the circadian rhythm, are disrupted, symptoms can be exacerbated for individuals experiencing bipolar disorder. The goal of IPST is to restore an individual’s social rhythm by enhancing coping skills for stressful life events, regaining healthy routines, and determining how to best return to (or create) appropriate psychosocial and interpersonal rhythms. The client states that unexpected stressors have interrupted her sleep, making IPSRT the best approach for addressing the client’s concerns. Mindfulness-based stress reduction (MBSR) uses meditation and relaxation practices to improve depression, anxiety, and pain. MBSR is an appropriate intervention for bipolar disorder but does not explicitly address social, interpersonal, and biological rhythms in the way IPSRT does. Because behavioral modification is a part of IPSRT, behavioral modification alone would not address concerns to the extent that IPSRT does. Rational-emotive behavioral theory is a cognitive theory based on the assumption that maladaptive thoughts contribute to emotional and behavioral difficulties and interfere with positive life experiences. When appropriate, this approach can help with depressive symptoms, however, IPSRT is just as effective for treated bipolar disorder and can address the client’s interpersonal stressors, improve self-esteem, and enhance social support required for extended symptom abatement. Therefore, the correct answer is (B)
Competency: treatment planning