Introduction

The client is Beatrice, a female aged 45, who is currently divorced from her husband. Beatrice is heterosexual and a mother. She is ethnically black and Caucasian white. The target issue in the case is Beatrice feelings of emptiness and depression. Through her terrifying life experiences, Beatrice is faced with a situation in life where she lacks meaning or purpose in life. These feelings of emptiness with emotional numbness and despair result in a deteriorated mental health to Beatrice. In the end, she suffers from depression, dystopia, and post-trauma stress. Her current condition of being divorced with three kids to take care off, being homeless, being bereaved, being financially unstable as well as suffering from several ailments hikes Beatrice’s feelings of emptiness and depression. In her own words, Beatrice feels like she has been misdiagnosed; she did not receive any assistance and had no help. This makes her feel neglected and does not require any support. These sudden changes make Beatrice feel emotionally numb, despondent, isolated, and anxious- which are all symptoms of emptiness and depression @$%&).

Behaviorally Defined Symptoms

Presenting Problems

Beatrice has felt misdiagnosed and have never had the opportunity to open up on issues affecting her. She has in the past felt neglected bearing in mind that the only immediate family are her kids who do not offer so much support. The pressure from the robust family settings has affected her. The abusive marriage by the husband and the whole burden of responsibilities put on her is also a huge issue of concern. She has experienced continuously physical-mental abuse from the husband and from the demanding situations she has been. The overwhelming situation has led to a lack of balance making her very lonely, vulnerable and worsened her condition putting her into a depressed state. The lack of employment on her and the enormous financial obligations is also a huge issue that has worried her and affected her as well.

She is not able to effectively relate to people as much of her social setting has been affected by the challenges and issues she has had in the past. Financially, she is deprived and is therefore not able to attend to matters requiring money. Thus financial functionality is missing. However evident that the client is spiritually stable and her spirituality has not been affected by the state of issues.

How the Problems are Evidenced in her Behavior

Beatrice is normal with limited performance and high levels of instability mental wise. She is weak physically owing to the beating and mistreatment by the husband. The state of affairs and conditions has further weakened her. Her performance has been affected by asthma, mental instability, post-trauma stress, bipolar and depression. These conditions do not have a direct relationship with her biological roots are only brought forward by the pressures and the dire circumstances and state of living. All of these factors influenced and shaped the development of Beatrice’s extreme feelings of emptiness and depression that she currently experiences. Decision making and judgment have been affected by her situations. She, therefore, undergoes a cycle of negative thoughts, feelings, and behavior. However, Beatrice can stabilize with the right interventions.

Behavioral and cognitive symptoms

Beatrice’s feelings of emptiness and depression develop as a result of her current condition, that is, the feeling of being financially unstable. Although she holds a bachelor’s degree in criminal justice, she finds it difficult to maintain her family as well as herself. As much this is not something that she had wished for, anytime she thinks of her past marriage life and some of the good memories she shared before her life turned sour, episodes of feelings of emptiness emerge. During the happy moments she shared with her husband, happiness and being joyous was her daily norm. However, after being subjected to domestic violence, the joy which was a neutral stimulus became a conditioned stimulus. Her condition of being financially unstable can be seen as the unconditioned stimulus, and her feelings of emptiness can be taken represent unconditioned response. The relationship between the search for happiness (conditioned stimulus) and being financially unstable (unconditioned stimulus) brings about the feelings of emptiness and depression (unconditioned stimulus) in her life. The more she experiences the feelings of emptiness, the more she becomes depressed, and her health significantly deteriorates. Here, the relationship between perceptions of emptiness (behavior) and poor health (consequences). She becomes punished regarding health due to her state of emptiness. This makes her in need of assistance to try to disorient that relationship.

Following the breakup and the eventual divorce from her husband, Rowe developed a core belief that she is hopeless and has no meaning or purpose in life. These belief emanates from the mind and makes her develop feelings of emptiness and become depressed. From the core knowledge, Beatrice extends an assumption that her life can never be healthy again and that she is poised to remain poor forever. The core belief also makes Beatrice formulate automatic thoughts such as no one likes her and no one wants to help her get out of her condition. These such thoughts as mentioned above results in an emotional consequence- the feelings of emptiness and depression.

Long Term Goals

To increase Beatrice’s coping skills and enable her depression, emotional, and despair while at the same time helping her to regain her lost purpose and meaning in life.

Short Term Objectives

• Reduce her depression episodes related to life experience and the feelings of emptiness from an average of 3-4 times per week to 2 or fewer episodes per week, as recorded by client self-report.
• To reduce to at least 25% characterizes of attitude and symptoms of depression in the client score on the Beck Depression Inventory (BDI) score at the end of the period of treatment (3 months).
• Reduce the client self-doubting and self-defeating thoughts from an average of 3-4 times per week to 2 times or less per week, as recorded by client self-report.
• To increase the clients score on the General Self-Efficacy Scale (GSE) to at least 20% at the end of the three months of the treatment period.

Intervention

The first two short term objectives of the treatment plan are based on improving the client’s behavior towards the treatment of depression and the feeling of emptiness. In this case, the best intervention for these objectives will be based on Behavior therapy intervention. According to &*7$$, a close relationship exists between enjoyable, practical events and favorable moods.

The behavior therapy intervention will focus on three areas. One, on teaching the client how to interact and communicate with different people within her cycle. The second area of focus will be through regular exercise an aspect that will enable the client to reduce her depression progressively. The third area of focus will be teaching her the importance of maintaining her diet. Proper nutrition will be of great significance during treatment.

In this sense, Beatrice will first undergo classes that provide her with psycho-education regarding depression and the cognitive-behavioral treatment approach. She will be engaged in a discussion about the connection between her thoughts, feelings, and behavior. Specifically, the therapist will focus on the behavioral perspective and will explain how antecedents and consequences can maintain or eliminate her depressed mood and loss of interest in activities. Afterward, she is engaged in working with the behavior chart. In this, the client will be required to complete a behavior chart to target times when her depression state arise. This task will aim to help identify patterns, barriers, and triggers her condition. Over the next few sessions, Beatrice will be taught new behavioral techniques to help manage the state of depression. Such methods will include progressive relaxation and deep breathing exercises. She will also be expected to practice these techniques in session with the therapist and outside of sessions. Lastly, she will be required to implement the behavioral techniques learned (both the relaxation and the deep breathing exercises) every time she is faced with the depressed mood and loss of interest in activities.

The last two objects focus on improving the cognitive aspect of the client. In this regards, cognitive simulation techniques will be used. To begin with, Beatrice will be provided with psycho-education regarding automatic thoughts, cognitive distortions, and negative thinking, and how her thoughts, feelings, and behaviors are all connected and influence her depression. She will also be introduced to thought records. The aim will be to identify automatic thoughts, cognitive distortions, and activating situations that trigger her depressed mood and loss of interest in activities. She will also be taught on specific cognitive techniques, such as positive self-talk. The therapist will ensure that she creates coping cards with positive statements that challenge her automatic thoughts. Lastly, the client will be required to practice positive self-talk and to create coping cards on her own. She will be required to practice and implement these techniques outside of therapy every time the depressed mood and loss of interest in activities arises.

Evidence-based theoretical orientations

Cognitive-Behavioral Therapy

According to @@#@, the CBT model provides that beliefs and behaviors are responsible for the psychological problems of patients. Through individuals through the system, he or she can develop and get mental disorders. Cognitive behaviorists believe that mental disorders such as anxiety, and depression results as a result of faulty thought system. When a specific thought becomes a disturbance, such a person is likely to develop a mental disorder. Social learning is therefore emphasized as a way of developing an individual as well as the ideas of reinforcements. The CBT model is used in psychological treatment to change faulty thought systems. It also involves changing irrational behavior. This as observed by  &-6&&*  can be attained education where positive experiences are strengthened. In the end, the patient thinking is altered and enhances the way individuals cope.

Eye Movement Desensitization and Reprocessing Therapy (EMDR)

The EMDR was developed to help therapist s in diminishing negative feelings that result from memories from traumatic events. Being a form of psychotherapy, Hower, according to yo %&544, EMDR model does not primarily focus on the event but instead emphasizes mostly on the emotions and symptoms that result from traumatic phenomena. The EMDR model works by guiding the patient’s eye movement from side to side. Though highly debated if it produces effective results, EMDR has been proven through research to effectively treat certain mental health conditions such as anxiety and feelings of emptiness $&%**.

Psychodynamic psychotherapy Theoretical Orientation

The focus of this orientation is on how the unconscious affects the behavior and thinking of patients with mental health conditions. When used as a form of psychotherapy, psychodynamic therapy encourages the understanding as well as the self-awareness of patients. This understanding is essential in helping patients to resolve their past experiences. As observed by &**$67, in most cases an individual’s past experiences play a significant role in their present conditions.

The connection between the Theoretical Orientation and Corresponding Intervention

Research has it that a combination of skilled, focused approaches with cognitive-behavioral approaches is the most effective in treating feelings of emptiness and episodes of depression. According to Brenninkmeijer, et al. (2018), both CBT and therapy provide extensive empirical support for treating depressive symptoms. TF-CBT model and Eye Movement Desensitization and Reprocessing (EMDR) model are also mentioned by Brown et al. (2015), as alternatives in the treatment of depressive symptoms. Echoing the word of Nyer, et al. (2015), depression if not treated early enough can cause devastating effects to an individual’s health. A study conducted by Ellison et al. (2016), reveals a cognitive modification treatment to be the most effective in treating depression in adults. This kind of treatment utilizes insight-oriented therapy with a modification desensitization procedure. Some sections of research suggest that psychodynamic psychotherapy leads to symptom improvement related to trauma, depression, and anxiety (Brenninkmeijer et al. 2018).

The rationale for the Integration of Multiple Theoretical Orientations

Mental health conditions and especially depression are complex yo treat with only one intervention. By using multiple theoretical orientations, it becomes easier to understand the different interventions to be used in the treatment of the disorders.  It is therefore right to say that using multiple theoretical orientations provides the therapist or the psychologist with the best treatment method for the problems.

Treatment modalities

The treatment modality that fits this case is individual therapy that will involve the client going through different therapy sessions. With this therapy, the client will improve her cognitive functioning.

Evaluation

The efficiency of Evidence-Based Interventions

Cognitive simulation intervention is one of the most used interventions involving depression, anxiety and the feelings of emptiness &-6%*. A study on the effects of cognitive simulation found that patient is treated through this intervention developed self-confidence by believing about themselves. The patients were observed as being able to approach life and challenging situations with calmness and peace. Keeping in mind that Beatrice problems emanate from past experiences, the intervention will thus help her be able to handle situations by being more relaxed and less anxious. Another observation from study ***54*, is that patients who were treated through the cognitive simulation intervention were able to cope well with challenging situations like the death of their loved ones and financial crisis.

When psychologists researched the effectiveness of the behavior therapy intervention, they conclude that it is equally effective as the cognitive simulation intervention. A study conducted by *75%-76 on the effectiveness of the behavior therapy intervention had the following deductions: it prevents addiction relapse; useful in anger management, effective in coping with grief and loss and helps in the management of chronic pain.  Another study by **%*- found that this intervention is effective in overcoming trauma and sleep disorders. ;&&**, after researching the effectiveness of the intervention concluded that it is essential in resolving relationship difficulties.

Ethics

Potential Ethical Dilemmas

The possible ethical dilemmas that may arise during the implementation of this is plan is the issue of dual relationship. In such a way the therapist may develop a second, significantly different relationship the client in addition to the traditional client-therapist one. In this case, it becomes a challenge for therapists to attend their duties professionally. The second ethical dilemma that can arise is when the client perceives the different interventions used as extra workload. If this happens to be the case, the therapist will have it rough trying to convince the client otherwise. The extra workload can be viewed by the client as psychological torture. The last ethical dilemma is that of the client losing the ability to make an independent decision. At this stage, the therapist may be required to decide on behalf of the client.

Ethical Principles

Some of the ethical principles that can be used to resolve the ethical dilemmas are respected for people’s rights and dignity and informed consent. Regarding the former, the therapist or the psychologist is required to respect the worth and dignity of the client. He or she is also responsible for protecting the client’s right to self-determination, privacy, and confidentiality. Regarding the latter, it is required of the psychologist to seek informed consent from the client before making any decision that concerns her. The consent might be written or oral.

References