psychological case study using IPT

Dawn's presenting problems, such as a sleep-related disorder and anxiety symptoms, it is possible that she may be diagnosed with a mild depression, or to use the DSM-V code, F32.0 Major depressive disorder, single episode, mild. Measured on the Ham-D scale of depression, Dawn's score will likely fall between 9-12 (Weissman, Markovitz & Klerman, 2007). However, monitoring Dawn over time will be necessary to see if the depression is recurrent.

It is unclear when her "feeling stressed" about her grades began, exactly, or when her sleep patterns started to be disrupted. Therefore, if a DSM-V diagnosis is necessary, the F32.0 diagnosis is the most sensible for now. As Hayes, Pistorello & Levin (2012) also point out, the DSM diagnoses are limited in applicability and accuracy. They have "failed to give rise to functional diagnostic entities, which is a major goal of syndromal diagnosis," (p. 976). The process of diagnosis also occurs in the absence of theory. Theories like Acceptance and Commitment Therapy (ACT) offer "a unified model of behavior change applicable to human beings in general, not just those fitting certain diagnostic criteria," (Hayes, Pistorello & Levin, 2012, p. 978). ACT also avoids overreliance on diagnoses (Hayes & Lillis, 2012; Twohig, M.P., 2012).

In Dawn's case, Interpersonal Therapy (IPT) might be indicated due to the proven efficaciousness of the modality: deMello, Mari, Bacaltchuk & Neugebauer (2005) performed a meta-analysis and found that IPT leads to results comparable to medical interventions for depression, and in fact the results "did not increase when combined with medication," (deMello, et al., 2005, p. 75). IPT also offers a "time limited" method of helping Dawn, who may benefit from a targeted and brief approach. deMello, et al. (2005) also found that IPT proved more efficacious when treating depression versus cognitive behavioral therapies. Because IPT has proven results with depression specifically, it is recommended to proceed with Dawn's treatment using IPT.

Dawn's treatment plan within an IPT framework will begin with a brief explanation of the treatment and theory. The therapist can explain what depression is and why it is believed Dawn exhibits symptoms. Dawn's use of alcohol to fall asleep should not be viewed as a sign of substance abuse at this time; she only "discovered" her appreciation of alcohol's ability to relax her recently. The therapist's goal is to prevent Dawn's use of alcohol from becoming habituated, to impede the goals of therapy, or to lead to her reaching for other sleep aids that may contain opioids. All this should be told to Dawn immediately, and her responses solicited. Medication is contraindicated, not only because of the deMello, et al. (2005) study showing that IPT is more efficacious than medication, and does not lead to improved results when used concurrently with medication.

Reviewing Dawn's "interpersonal inventory," as suggested by Weissman, Markovitz & Klerman (2007) would be the next step in the treatment, as IPT is designed to help the client contextual her problems within the interpersonal framework, her relationship with her parents. Helping Dawn to draw the direct connection between her anxiety, sleeplessness, and relationship with her parents will help begin the process of IPT in earnest. Dawn may be given a symptom checklist, too, to help the therapist better target interventions and make more accurate diagnoses over time. The therapist can also help Dawn see that these are in fact "symptoms and not personal flaws," (Weissman, Markovitz & Klerman, 2007, p. 13). The checklist also helps the therapist to educate Dawn about the nature of depression to help her to understand why she feels the way she does and how interpersonal therapy can help her. At this point, the therapist might also be able to recommend concurrent modalities like ACT, which Dawn might appreciate if she has prior experience with mindfulness techniques or wishes to incorporate mindfulness as part of her ongoing strategy.

The goal of Dawn's treatment and specific interventions will be multifaceted, including helping Dawn to cope with the external pressures of her parents, liberating herself from the fear of underperforming in school, and becoming mindful of her stress and alcohol use. Dawn may need to confront her parents, alerting them to the effects of their pressure. It is possible that initiating dialogue with her parents will help Dawn to feel more in control and empowered, and her parents may realize that their pressuring her has been counterproductive and harmful. Over time, Dawn can cultivate new internal dialogues linked to her performance, as well as new external dialogues with her parents. Dawn should also set as her goals the ability to fall asleep without alcohol, and the ability to enjoy her work in graduate school with strong future-oriented performance linked to her intrinsic motivation and not on parental pressure.

As Weissman, Markowitz & Klerman (2007) point out, depression is often linked to transitional stages in a person's life. Dawn is indeed going through such a stage, as she remains at once tied to her parents psychologically but also poised towards a new era of her professional life. IPT will provide the opportunity for Dawn to learn new coping mechanisms and new communication strategies to modify one or more of her interpersonal relationships. She has identified her "parents," both, not singling out whether it is her mom or her dad. If this is the case, Dawn can explore new ways of reacting to them, new ways of asserting her needs, or new ways of distancing herself from them until she finds out why she reacts to their pressure even more than to the pressure of her work. Through IPT, it is expected that Dawn can regain passion for her work and perhaps evolve coping strategies that will help her in the future.

References

deMello, M.F., Mari, Jdj., Bacaltchuk, J. & Neugebauer, R. (2005). A systematic review of research findings on the efficacy of interpersonal therapy for depressive disorders. European Archives of Psychiatry and Clinical Neuroscience 255(2): 75-82.

Hayes, S. C. & Lillis, J. (2012) Acceptance and commitment therapy. Washington DC: APA

Hayes, S.C., Pistorello, J. & Levin, M.E. (2012). Acceptance and Commitment Therapy as a Unified Model of Behavior Change. The Counseling Psychologist 40(7): 976-1002.

Twohig, M.P. (2012). Acceptance and commitment therapy. Cognitive and Behavioral Practice. 19(4): 499-507.

Weissman, M.M, Markowitz, J. C. & Klerman, G. L. (2007) Clinician's quick guide to interpersonal psychotherapy. New York: Oxford University Press