A 30-year-old woman named Teresa came to see a psychotherapist. During a conversation with a doctor, Teresa showed symptoms of major depressive disorder. Teresa explained that she started sleeping poorly at night, eating more than usual, and crying for no reason. She said she had great difficulty resting, and if she managed to relax, sleep took 2 hours. Teresa says she has depressive intrusive thoughts all the time.
Teresa was worried that she was not a good enough mother and that she was a problem for her husband. In addition, she mentioned her stormy relationship with her mother. At the same time, Teresa said she did not have suicidal behavior or thoughts. Furthermore, she understood that such a depressive state could affect her life in many ways (Corcoran & Walsh, 2015). This affects her relationships within the family, including her husband and child. Furthermore, Teresa said that it is difficult for her to leave the house for work, which affects the family’s financial situation.
It was decided to observe the patient’s childhood for a deeper analysis of the problem. Teresa talks about how she had a lot of stressful situations in her childhood. This is because her mother had problems with alcohol addiction and did not take care of the child. She lived separately, constantly leaving and returning to the family. This situation began when Teresa was about ten years old. As a result, the child did not receive proper maternal care, and the example of the older generation. The entire responsibility for the upbringing and life of the younger brothers and sisters was placed on the patient during a period of severe emotional maturation, which led to a problematic relationship with her mother.
Teresa’s father was forced to fully provide for the family, in connection with which he constantly entrusted the patient with the care of younger children and doing household chores. According to Teresa, this led to an emotionally unstable childhood, where there was no family support, after which she began to experience anger towards her mother. Moreover, Teresa spoke about her current married life with her husband. She got married six years ago at the age of 23, and currently, the family has three children. Teresa describes herself as a happy wife with a hardworking and reasonable partner. However, she spends most of her time at home, playing the role of a housewife and overseeing the discipline and upbringing of children.
Teresa’s condition changed during the last pregnancy, and she felt tired and depressed. She took birth control pills, but this led to an unplanned pregnancy. However, she claims to love all of her children equally. At the same time, Teresa explains that her attitude towards the last child causes her stress. There is regular communication in the family, but many disputes are due to unresolved problems. Teresa is under a lot of pressure as she tries to be the best person for everyone. She wants to be a good mother and wife, sister and friend, and make everyone happy. At the same time, Teresa forgets that she has her feelings and needs to be realized. However, the desire to be a better mother than she was outweighed these needs.
Teresa mentioned an event that she constantly remembers and feels guilty about. This incident is connected with her grandmother’s death, when instead of helping her, Teresa went for a walk. Her grandmother died that evening, leaving Teresa with a pang of heavy guilt for what had happened. Thus, the patient found solace in constant food consumption to distract herself. This is her first visit to a psychotherapist, so Teresa has not taken any medication before. Moreover, she stated that two of her aunts had been diagnosed with mental illness. The diagnosis was bipolar personality disorder; the second aunt was diagnosed as mentally ill.
Teresa smokes about ten cigarettes a day and attributes this to fatigue and stress from financial problems and the constant care of three children. Moreover, she is worried about the difficulties in caring for her youngest child and the fear that her husband may leave the family if her psychological condition does not improve. Additionally, Teresa worries that her relationship with her mother will continue to negatively affect her life and the lives of her loved ones.
In Teresa’s case, symptoms can be observed that stand out in Major Depressive Disorder. Major Depressive Disorder is characterized by losing interest in activities and problems with sleep, weight, and appetite. It shows the presence of changes in psychomotor activity and energy (DSM-5, 2013). Teresa’s condition is characterized by constant feelings of guilt and difficulty concentrating and thinking about problems, leading to decision-making issues. Even though suicidal attempts and thoughts are excluded from the anamnesis, the patient says that he would like to disappear, not live in the current situation. Thus, the symptoms noted in the patient correlate with the clinical manifestations of the depressive disorder.
However, major depressive disorder is treatable in several ways. First, Teresa can attend group therapy to discuss and work through her problems. This will allow her to reduce her stress levels and start connecting with new people. The second way is to take medication to reduce anxiety and depressive thoughts. Sedatives, tranquilizers, and hypnotics may be present in the treatment regimen, but not as the main ones, but as auxiliary agents, while the primary means of treating depression are antidepressants (Kennis et al., 2020). Additionally, a biblical worldview is included in the assessment and treatment. Thus psychotherapeutic treatment may be conditioned by the scripture “sanctify them by the truth; your word is truth” (The Holy Bible, 1984, John 17:17). This approach will help establish trust and let the client know that her words are perceived truth.
References
Corcoran, J. & Walsh J. (2015). Mental health in social work: A casebook on diagnosis and strengths-based assessment. Boston: Pearson Education.
DSM-5: Diagnostic and statistical mental disorders. (2013). (5th ed). American Psychiatric Association.
Kennis, M., Gerritsen, L., van Dalen, M., Williams, A., Cuijpers, P., & Bockting, C. (2020). Prospective biomarkers of major depressive disorder: A systematic review and meta-analysis. Molecular Psychiatry, 25(2), 321-338.
The Holy Bible, new international version. (1984). Grand Rapids: Zondervan Publishing House.