Multiple treatments have yielded little effect.

HERE IS THE CASE STUDY: Juanita Delgado, a single, unemployed Hispanic woman, is seeking therapy at age 33 for treatment of depressed mood, chronic suicidal thoughts, social isolation, and poor personal hygiene. She has spent the prior six months isolated in her apartment, lying in bed, eating junk food, watching television, and doing more online shopping than she can afford. Multiple treatments have yielded little effect.
Ms. Delgado is the middle of three children in an upper-middle-class immigrant family in which the father reportedly valued professional achievement over all else. She felt isolated throughout her school years and experienced recurrent periods of depressed mood. Within her family, she was known for angry outbursts. She had done well academically in high school but dropped out of college because of frustrations with a roommate and a professor. She attempted a series of internships and entry-level jobs with the expectation that she would return to college, but she kept quitting because “bosses are idiots. They come across as great and they all turn out to be twisted.” These “traumas” always left her feeling terrible about herself (“I can’t even succeed as a clerk?”) and angry at her bosses (“I could run the place and probably will”). She dated men when she was younger but never let them get close physically because she became too anxious when any intimacy began to develop.
Ms. Delgado’s history includes cutting herself superficially on a number of occasions, along with persistent thoughts that she would be better off dead. She says that she is generally “down and depressed” but that she has had dozens of one- to two-day “manias” in which she is energized and edgy and pulls all-nighters. She tends to “crash” the next day and sleep for 12 hours.
She has been in psychiatric treatment since age 17 and has been psychiatrically hospitalized three times after overdoses. Treatments have consisted primarily of medication: mood stabilizers, low-dose neuroleptics, and antidepressants that have been prescribed in various combinations in the context of supportive psychotherapy.
During the interview, she was a casually groomed and somewhat unkempt woman who was cooperative, coherent, and goal directed. She was generally dysphoric with a constricted affect but did smile appropriately several times. She described shame at her poor performance but also believed she was “on Earth to do something great.” She described her father as a spectacular success, but he was also a “Machiavellian loser who was always trying to manipulate people.” She described quitting jobs because people were disrespectful. For example, she said that when she worked as a clerk at a department store, people would often be rude or unappreciative (“and I was there only in preparation to become a buyer; it was ridiculous”). Toward the end of the initial session, she became angry with the interviewer after he glanced at the clock (“Are you bored already?”). She said she knew people in the neighborhood, but most of them had “become frauds or losers.” There were a few people from school who were “Facebook friends,” doing amazing things all over the world. Although she had not seen them in years, she intended to “meet up with them if they ever come back to town.”
THE TWO TREATMENTS ARE DIALECTICAL BEHAVIOR AND SCHEMA-FOCUSED THERAPY
Instructions on how to do the Treatment Recommendations: Utilizing the professional literature and your textbooks, find at least two (2) treatment recommendations for individual counseling. Clearly delineate what you believe will be of most help treatment path for your client by connecting the key issues with the treatment recommendations. You will need to take into account what might be the most motivating treatment approach for your client, taking multicultural and social justice factors into consideration.
Each recommendation requires at least one (1) citiation to support its use from the peer reviewed lituarature and needs to be less than 5 years old. Use of your textbook as a starting place is encouraged but does not replace the required peer reviewed liturautre use. Medication or referral to another type of therapy/ service may be a recommendation, but since these are case management, they do not count towards the two required therapy recommendations. Approach this part of the assignment as your exploration of what you would do with this type of client in office based individual counseling.
SPECIAL NOTE: USE TREATMENT TO RELATE TO CLIENT SYMPTOMS AND WHY IT WOULD WORK
EXAMPLE: The first treatment option that I will start with is Interpersonal Therapy based on her symptoms of being depressed, medication not making her feel right, and her daily routine functioning. Interpersonal Therapy is the idea that depression occurs in contact with social and interpersonal events (Lemmens et al., 2017). Lemmens et al. (2017) suggest that IPT help to understand how depressive symptoms occur and how they relate to the current social/personal context. Crystal already knew what she wanted to talk about when she came into the clinic about the concerns worrying her the most. Crystal stated that she has trust issues with her in-laws, marriage problems with her husband, and her job duties as a mother. Interpersonal Therapy focuses on individuals’ thoughts and tries to connect to the symptom. In Crystal’s situation, ITP would help her connect her problems and allow her to see the things she is constantly worrying about. Crystal’s depressive symptoms will decrease, and her self-esteem will begin to flourish. Reduction of interpersonal problems and improved marital adjustment is associated with the Interpersonal Therapy treatment outcome (Lemmens et al., 2017). From looking at Crystal’s situation, Interpersonal Therapy will primarily focus on Crystal life of being depressed from junior high school to adulthood.
The last treatment that I will utilize for Crystal is Mindfulness-Based Cognitive Therapy which will focus on Crystal thinking process. Mindfulness-Based Cognitive Therapy combines mediation practices that pull from Cognitive Behavioral Therapy. Press (2018) stated that the combination of CBT used within MBCT helps individuals recognize their negative thoughts and reduce depressive symptoms and future risk of depressive relapse. Mindfulness Cognitive Therapy will help Crystal recognize her symptoms of depression before they become worse. Mindfulness positively impacts attention, memory recall, and other cognitive abilities in healthy aspects (Shapero. et al., 2018). Crystal negative thoughts will decrease, and she will be in the self-control of her own emotions. Mindfulness Cognitive Therapy will help Crystal not relapse and improve her ability to function correctly. With the Mindfulness Cognitive Therapy approach, Crystal will better function at doing her duties as a mother, expressing her feelings to her husband, and returning to her usual self.