Marcella Petrini
DSM
November 3, 2013
Client Map Treatment Plan
Client “S.S.”
Diagnosis
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300.4, Persistent Depressive Disorder, late onset, with persistent major depressive
episode, moderate
Does not meet criteria for melancholic, atypical, mixed, psychotic, or anxious features
Client meets criteria for MDD, but it has lasted over 2 years, thus making it PDD
Rule out Depressive Disorder Due to Medical Condition (hypothyroidism), Depressive
disorder due to medicine
Objectives
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Reduce depressive symptoms
Increase level of activity, social support, self-esteem, motivation, and routine
Allow for and foster grieving process
Increase and attend to goal directed behavior to counter feeling “stuck”
Assessments
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Summary: 56 year old Caucasian woman experiencing depressive symptoms, for most
days, over the past 4 years. Symptoms include significant loss of motivation, loss of
pleasure, flat affect, overeating, hypersomnia, low energy, poor concentration, and low
self-esteem. Client reports that her functioning is moderately to severely impaired.
Client describes she used to be “full of life, vibrant, motivated, and ambitious.” The
client has endured considerable loss, which marks the transition into her depressive
period. Over the past 4 years, client’s mother died, her business began deteriorating with
the economy, broke up with her boyfriend, experienced family discord, close friends
moved away from the area, and her dog died. Client relayed her presenting issue as
depression due to unemployment.
PHQ-9 results indicate moderate-severe depression
Medical check-up to examine thyroid levels; client takes Synthroid. Reevaluate dosage
to see effect on depressive symptoms.
Just completed a psychiatric check-up; was taken off of Latuda because of side effects.
Client does not feel she is taking the best medicines/dosages. Continue seeing psychiatrist
to evaluate medicinal effectiveness of antidepressants.
Clinician Characteristics
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Rogerian core conditions
Structured and supportive
1
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Foster motivation, positive outlook, and activity
Balance attending to present symptomatic/functioning concerns and processing issues of
grief and loss
Location of Treatment
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Outpatient- Restoration Place Ministries
Interventions
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Continue Rogerian person-centered counseling throughout treatment
Interpersonal Psychotherapy to assist in facilitating the grieving process; client stated that
she feels she “has not grieved and does not know how but feels it is important.”
Emotive focused exercises to access emotions, considering how “flat” the client feels.
CBT to address maladaptive thought patterns and introduce more physical activity/
coping skills
Emphasis of Treatment
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Initially directive towards coping and increasing activity
Nondirective in facilitating grieving process
Affective emphasis in grief processing, then examine how thought patterns and behaviors
connected.
Help reestablish motivation, routine, and steps towards forward moving direction. Client
feels “stagnant.”
Preventative focus to help client cope when transitions and losses occur in the future.
Numbers
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Individual counseling
Client may eventually benefit from grief support group, depending on how her grief
progresses.
Timing
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Weekly sessions for next 3 to 6 months to attend to present symptoms and allow for
space to process past 4 years.
Follow up for at least 1 year.
Medications
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Client currently taking antidepressants but is not satisfied; reports trying “so many
different medications” through psychiatrist
Continue to monitor and assess medicinal effectiveness
Adjunct Services
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Exercise: client is currently assigned to go on 3 walks per week for at least 20 minutes
each
Increase social activity and support (groups?)
Suggest reading about loss, grief, and depression
Career counseling and resources
Prognosis
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Fairly good- is in the process of figuring out adequate medications, had high level of
functioning prior to past 4 years, has had good interpersonal skills, previously maintained
rewarding lifestyle, but is lacking in social support (single, few good friends in area, no
family in area). Depression seems to be directly correlated to her shift in circumstances
and losses over past 4 years, so it is possible that addressing some of those time specific
issues can alleviate long-enduring depressive symptoms.