¶ … Practitioner who has referred a patient for help with problems in her life. The patient is a young lady who is experiencing psychological issues that causes stress in her life and affects her lifestyle. The young lady's name is Julie Coldwell, a twenty-five-year-old female who has not been feeling herself lately at work and at home. She reports that she has trouble sleeping and that she is very tired at work, which affects her job performance. Additionally, she is concerned that her co-workers have noticed how tired she is and that they are talking behind her back about her condition. Oftentimes, she does not wish to go to work and this affects her performance as well. There is a lot of information missing from Julie's profile and completing a psychological assessment on her, and her behavior, could likely lead to a discernment of what is causing her to feel the way she feels. There are likely underlying reasons as to why she finds herself feeling the way she does. Additional information is surely needed in this case, information such as; have there been any depressing or negative events in Julie's life lately? Oftentimes, such events can include breaking up with a spouse or boyfriend, a death in the family, a job loss, or other life-changing events. Discovering this information can often times be discovered with a thorough psychological assessment.

Assessing an individual from a psychological point-of-view is an exercise in patience and persistence. A psychological assessment can take place in any number of settings; one recent study determined that "the psychological adaptive mechanism (PAM) model for systematic clinical assessment can be applied in any human setting in which individuals adapt to the conditions of their lives" (Beresford, 2014, p. 466).

PAM, which can also be described as 'ego defenses' allows the individual a response or a method for taking adaptive measures to events or happenings in their lives. Understanding what causes the PAM or ego defenses to kick in, allows the clinician to determine what type of stress the patient is experiencing and oftentimes can lead to an understanding as well as a diagnosis and treatment that will be beneficial to the patient.

This case study looks at the patient, Julie Coldwell, who has been referred as a client. The patient has been experiencing a number of symptoms that need to be analyzed, diagnosed and treated in order for her to live a "normal" and productive life. Julie's ego defenses seem to be kicking in with her statement that other employees have noticed that her work is suffering. She believes that some employees are talking behind her back, this could be due to her ego defense informing her that there is a problem which she has to address. Methods to assist Julie in addressing her issues can include a number of assessments such as interviewing her, observing her and even using formal assessments. An informal interview could assist in discovering items about Ms. Coldwell that would lead the researcher into additional avenues of both assessment and analysis. Discovering whether Ms. Coldwell is suffering from anxiety, depression, somatizing or negative affect would be important items to discover. Additional items of concern could include whether Julie drinks alcohol (and how often if she does), her level of education, her income (or family income), and her belief system could all be probed during informal sessions. The Derogatis et al. study determined that the sociodemographic variables in logistic regression analysis, manifest anxiety and somatizing were still significantly related to alcohol habits" (p. 173).

As one recent study espoused "assessment in psychology takes many forms, and it intersects with everyday life and culture in a number of ways" (Macfarlane, Blampied, Macfarlane, 2011, p. 5). Psychologists use informal processes such as interviews and observations, or they can use more formal assessment methodologies such as the PAM, or the Psychometric Assessment Model. The psychologist must be careful in his/her approach as oftentimes the patient is quite leery of the process. A more formal assessment in this case may be necessary in the long-run as Macfarlane et al. states "the practice of formal psychological assessment is critical because it allows psychologists and other professionals to make relevant decisions in the context of formulating diagnosis, giving advice, and devising intervention programs that aim to achieve better outcomes for individuals experiencing difficulties in their lives and those who live and interact with them" (2011, p. 5 -- 6). According to Macfarlane then, this case would be a perfect example for using a formal assessment procedure.

The difference between an informal and a formal assessment is that a formal assessment gathers data that...

Because relatively little is known about Julie; her lifestyle, her race, the culture she was raised in or embraces, her living arrangements, this information has to be gathered to help her. This can be done by using the relatively pain-free manner of gathering data; the interview process. This can be done quite informally and should be the first step in the process. A more formal application can be used in later sessions if needed as Macfarlane et al. suggests.
In today's modern world there are a number of quite effective digital formal assessments that can be used to assist the busy psychologist or medical professional. One thing that is worrisome about this specific patient is that she seems to be tired and worn down which often leads to depression and other debilitating effects. In considering Julie's situation, she may be a Type D personality, or she could be experiencing negative affectivity (NA). As described in a recent article "negative affectivity denotes the tendency to experience negative emotions such as anger, hostility, depression, anxiety, and internal conflict" (Vilchinsky, Yaakov, Sigawi, Leibowitz, Reges, Levit, Khaskia, Mosseri, 2012, p. 235). Negative affectivity is one of the symptoms that can be analyzed with a formal assessment. One such formal assessment that can be used is the Hopkins Systems Check List (HSCL). A recent study describing the HSCL determined that "is comprised of 58 items which are representative of the symptom configurations commonly observed among outpatients" (Derogatis, Lipman, Rickels, Uhlenhuth, Covi, 1974, p. 2). Those 58 items are scored and tabulated in order to determine what, if any, the diagnosis should be. The items tabulated include 5 categories; 1) somatization, 2) obsessive-compulsive, 3) interpersonal sensitivity, 4) anxiety, and 5) depression. In Julie's case, she is definitely showing signs of both anxiety and depression. Therefore, the administration of a HSCL might help in determining what direction treatment(s) should take.

Even though Julie may not recognize the fact that she is suffering from the effects of depression, she very well could be. Oftentimes, a patient will suffer from the effects of depression and not even realize that they are suffering from that specific malady.

One recent study determined that "depression has a substantive negative impact on quality of life" (Stanners, Barton, Shakib, Winefield, 2014, p. 3) and certainly Julie has noticed a substantial decrease in her quality of life. Whenever a patient is losing sleep, feels tired all the time, and feels that those symptoms are affecting her capacity to work, then certainly her quality of life is being strongly affected. According to Stanners et al., many patients don't even understand that they are experiencing depression especially since "research over the last twenty years suggests that depression is under-diagnosed and under-treated" (Stanners, p. 3).

Obviously, if Julie is suffering from depression she is going to need specific diagnosis and treatment. There is a wide variety of depression symptoms, and there are different levels of depression as well. Additionally, there are treatment options that depend on the type of depression being experienced. Frequently, the patient can be experiencing treatment-resistant depression (TRD) which makes it doubly difficult to assist the patient in overcoming the effects and the symptoms. A recent study found that "TRD represents a chronic and complex illness that requires long-term management from health care professionals" (Rizvi, Grima, Tan, Rotzinger, Lin, McIntyre, Kennedy, 2014, p. 350).

Of course, some patients are diagnosed with TRD while in reality they are suffering from Major Depressive Disorder (MDD). A determination between the two diseases is important because, as one study reports, "occurrence of MDD has been reported to be higher or more aggravated in patients suffering from cardiovascular diseases, AIDS, cancer, alcohol dependence and several neurological conditions" (Kubitz, Mehra, Potluri, Garg, Cossrow, 2013, p. 2).

If that is true, then Julie might just have more going on inside her head and body than just feeling sleepy. An additional consideration in this particular case is that "MDD is more common among women than men and often begins in young adulthood (Hirschfeld, Weissman, 2002), both of which applies to Julie and her circumstances.

Methods for treating those patients that are suffering from anxiety, TRD or MDD are often accomplished through different types of medicines and intense counseling. One study determined that there are a number of incentives and disincentives that influence what type…