Case Study 1 Depressive Disorders PDF

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CLP 4143: Abnormal Psychology | Colleen Jungersen | Fall 2019

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CASE STUDY #1: DEPRESSIVE DISORDERS Source: Oltmanns, T. F., Martin, M. T., Neale, J. M., & Davison, G. C. (2012). Case studies in abnormal psychology (9th ed.). Hoboken, NJ: John Wiley & Sons, Inc. Note: Some wording has been changed slightly for clarity. Janet called the mental-health center to ask if someone could help her 5-year-old son, Adam. He had been having trouble sleeping for the past several weeks, and Janet was becoming concerned about his health. Adam refused to go to sleep at his regular bedtime and also woke up at random times throughout the night. Whenever he woke up, Adam would come downstairs to be with Janet. Her initial reaction had been sympathetic, but as the cycle came to repeat itself night after night, Janet’s tolerance grew thin, and she became more argumentative. She found herself engaged in repeated battles that usually ended when she agreed to let him sleep in her room. Janet felt guilty about giving in to a 5-year-old’s demands, but it seemed like the only way they would ever get any sleep. The family physician was unable to identify a physical explanation for Adam’s problem; he suggested that Janet contact a psychologist. This advice led Janet to inquire about the mental-health center’s series of parent-training groups. Applicants for the groups were routinely screened during an individual intake interview. The therapist began by asking several questions about Janet and her family. Janet was 30 years old and had been divorced from her husband, David, for a little more than a year. Adam was the youngest of Janet’s three children; Jennifer was 10, and Clare was 8. Janet had gone back to college on a part-time basis when Adam was 2 years old. She had hoped to finish her bachelor’s degree at the end of the next semester and enter law school in the fall. Unfortunately, she had withdrawn from classes 1 month prior to her appointment at the mental-health center. Her current plans were undecided. She spent almost all of her time at home with Adam. Janet and the children lived in a large, comfortable house that she had received as part of her divorce settlement. Finances were a major concern to Janet, but she managed to make ends meet through the combination of student loans, a grant from the university, and child-support payments from David. David lived in a nearby town with a younger woman whom he had married shortly after the divorce. He visited Janet and the children once or twice every month and took the children to spend weekends with him once a month. Having collected the necessary background information, the therapist asked for a description of Adam’s sleep difficulties. This discussion covered what happened on a typical evening. It was clear during this discussion that Janet felt completely overwhelmed. At several points during the interview, Janet was close to tears. Her eyes were watery, and her voice broke as they discussed her response to David’s occasional visits. The therapist, therefore, suggested that they put off a further analysis of Adam’s problems and spend some time discussing Janet’s situation in a broader perspective. Janet’s mood had been depressed since her husband had asked for a divorce. She felt sad, discouraged, and lonely. This feeling had become even worse just prior to her withdrawal from classes at the university (1 year after David’s departure). When David left, she remembered feeling “down in the dumps,” but she could usually cheer herself up by playing with the children or going for a walk. Now she was starting to feel desperate. She cried frequently and for long

CLP 4143: Abnormal Psychology | Colleen Jungersen | Fall 2019

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periods of time. Nothing seemed to cheer her up. She had lost interest in her friends, and the children seemed to be more of a burden than ever. Her depression was somewhat worse in the morning, when it seemed that she would never be able to make it through the day. Janet was preoccupied with her divorce from David and spent hours each day thinking about the events that led to their separation. These worries made it hard to concentrate and seemed directly related to her withdrawal from the university. She had been totally unable to study assigned readings or concentrate on lectures. Withdrawing from school led to further problems. She was no longer eligible for student aid and would have to begin paying back her loans within a few months. In short, one problem led to another, and her attitude became increasingly pessimistic. Janet blamed herself for the divorce, although she was also very resentful of David and his new wife. She believed that her return to school had placed additional strain on an already problematic relationship, and she wondered whether she had acted selfishly. The therapist noted that Janet’s reasoning about her marriage often did not seem clear or logical. She argued that she had been a bad wife and cited several examples of her own bad behavior. These included events and circumstances that struck the therapist as being very common. ... For example, Janet spent more money than he did on clothes, did not share his enthusiasm for sports, and frequently tried to engage David in discussions about his personal habits that annoyed her and the problems with their relationship. Of course, one could easily argue that David had not been concerned enough about his own appearance (spending too little effort on his own wardrobe), that he had been too preoccupied with sports, and that he had avoided her sincere efforts to work on their marital difficulties. But Janet blamed herself. Rather than viewing these things as simple differences in their interests and personalities, Janet saw them as evidence of her own failures. She blew these matters totally out of proportion until they appeared to her to be terrible sins. Janet also generalized from her marriage to other relationships in her life. If her first marriage had failed, how could she ever expect to develop a good relationship with another man? Furthermore, Janet had begun to question her value as a friend and parent. The collapse of her marriage seemed to affect the manner in which she viewed all of her social relationships. The future looked bleak from her current perspective, but she had not given up all hope. Her interest in solving Adam’s problem, for example, was an encouraging sign. Although she was not optimistic about the chances of success, she was willing to try to become a more effective parent. Social History Janet was reserved socially when she was a child. She tended to have one or two close friends with whom she spent much of her time outside of school, but she felt awkward and selfconscious in larger groups of children. This friendship pattern lasted throughout high school. She was interested in boys and dated off and on until her junior year of high school, when she began to date one boy on a regular basis. She and her boyfriend spent all of their time together. Janet remembered that the other kids teased them about acting as if they were married. Unfortunately, she and her boyfriend broke up during Janet’s first year in college. Janet met David a few weeks afterward, and they were married the following summer. Janet later wondered whether she had rushed into her relationship with David primarily to avoid the vacuum

CLP 4143: Abnormal Psychology | Colleen Jungersen | Fall 2019

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created by her previous boyfriend’s sudden exit. Whatever her motivation might have been, her marriage was followed shortly by her first pregnancy, which led to her withdrawal from the university. For the next seven years, Janet was occupied as a full-time mother and homemaker. When Adam was 2 years old and able to start attending a day-care center, Janet decided to go back to college. Her relationship with David became increasingly strained. They had even less time than usual to spend with each other. David resented his increased household responsibilities. Janet was no longer able to prepare meals for the family every night of the week, so David had to learn to cook. He also had to share the cleaning and drive the children to many of their lessons and social activities. A more balanced and stable relationship would have been able to handle the stress of these changes, but Janet and David were unable to adjust. Instead of working to improve their communication, they argued constantly. The final blow came when David met another woman whom he was attracted to and who offered him an alternative to the increasing hostility with Janet. He asked for a divorce and moved to an apartment. Janet was shaken by David’s departure, despite the fact that they had not been happy together. Fortunately, she did have a few friends she could turn to for support. The most important one was a neighbor who had children about the same ages as Janet’s daughters. There were also two couples that she and David had socialized with. They were all helpful for the first few weeks, but she quickly lost contact with the couples. It was awkward to be a third wheel, and Janet had never been close enough with the women to keep their friendships on an individual level. That left the neighbor as her sole adviser and the only person with whom Janet felt she could discuss her feelings. For the next few months, Janet was able to continue her studies. With the children’s help, she managed the household chores and kept up with her work. She even found time for some brief social activities. She agreed to go out on two blind dates arranged by people she and David had been friends with. The dates were unpleasant: One was boring and unattractive, and the other was obnoxiously aggressive. Janet stopped making any efforts to develop new friendships. As time wore on, Janet found herself thinking more and more about the divorce. She was gaining weight, and the children began to comment on her appearance. To make things worse, Claire became sick just before Janet’s midterm exams. The added worry of Claire’s health and her concern about missed classes and lost studying time made Janet’s mood worse. She finally realized that she would have to withdraw from her classes to avoid receiving failing grades. By this point, 1 month prior to her appointment at the mental-health center, she had lost interest in most of her previous activities. Even casual reading had become a chore. She did not have any hobbies because she never had enough time. She also found that her best friend, the neighbor, was becoming very distant. When Janet called, she never talked for more than a few minutes before finding an excuse to hang up. Their friendship decreased to an occasional wave across the street or a quick, polite conversation when they picked up their children from school. It seemed that her friend had grown tired of Janet’s friendship. This was Janet’s situation when she contacted the mental-health center. Her mood was depressed and anxious. She was concerned about finances and her lack of social relationships. Adam’s

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sleeping problem, which had begun about a week after she withdrew from classes, was the last straw. She felt that she could no longer control her difficult situation and realized that she needed help....