Table of Contents
John knows there is a problem but did not want to feel worse about what he was feeling by seeing a counselor. He admits that it has gotten the best of him. Feels like his world has been turned upside down, and that it is his fault. He explains that there are problems in his marriage and blaming self for the problem. He is having difficulties at work, by things that he is motivated to do, but does not know what causes the motivations or how to stop them. He is in the Army, he was in Iraq, but not the most dangerous parts of the country. He became saddened by the news of the deaths and war. Doubting life in general. He has been home for about six months. Lost motivation to go to work on the base, he would go into work late, and is not getting any work done while at work. He was getting into trouble with the sergeant, but it did not matter to him.
He is having difficulties sleeping, although he spends a lot of time in bed attempting to get sleep. His boss, wife, parents and friends have noticed a difference in him. He feels that he is depressed and wants to get past it. He is at a point where he does not care about anything. Unable to motivate himself to do the things that he needs to do. Has difficulties remembering things. Gets angry easily. He snapped at his son, because his son wanted him to play ball with him and he just wanted to rest. He feels like he is disappointing everyone. Family and friends tell him he needs to stop drinking because it makes him feel worse. Only able to work out when he is feeling bad about himself. He has support in his wife who helps him to see what is happening to him. The past two months he feels like his is drinking too much. His drinking is upsetting his wife and he says that it helps him forget about what he is feeling. Wants to be happy, like before, the depression to be gone, and to feel good again, wants his wife to be able to stop looking at him with disappointment, and to be able to play ball with his son again. Addressing the depression and anger, he feels would help him to feel motivated again.
Lack of motivation; Started doubting life from the news of deaths and war, while in Iraq; Experiencing difficulties sleeping; Difficulties remembering things; Experiencing feelings of disappointing everyone; Family and friends are telling him he has to quit drinking, and he also feels like he is drinking too much; Wants to feel happy again, without the depression, and to feel motivated again, to have his wife look at him without disappointment and to play ball with his son.
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It seems that his tour in Iraq with the Army, and hearing about the deaths and war brought about his depression. This may also have something to do with his drinking more and his family and friends telling him he needs to quit drinking. Furthermore, it appears that his lack of motivation is also caused by his tour in Iraq, which created the depression. Anger expression leads to a greater risk of depression (Smith, et al., 2016). Addressing his anger may be one way of dealing with his depression. People returning from war torn countries can experience different psychological difficulties such as ‘feelings of anger and frustration, upsetting memories, and trouble sleeping, lacking social support, and problem-alcohol use’ (Griffith, 2017).
Six months after coming home, military individuals can develop symptoms of PTSD. It would be necessary to discuss whether he had difficulties before he was deployed, since this creates a vulnerability to PTSD. Rem sleep is important for an individual’s memory to work effectively, this may be why John is having problems remember things, since he explains that he is having difficulties sleeping (van Liempt, et al., 2013). When individual’s sleep, their bodies work through “five distinct phases of sleep.” The rapid eye movement (REM) sleep, and because sleep cycles repeat, an individual spends more time in REM sleep. For the body to re-energize itself, REM sleep is needed. Additionally, REM sleep is needed for memory, learning and balancing moods. The cerebral cortex is important as during REM sleep, signals are sent through different regions of the brain to process the learning, thinking and organizing information (US Department of Health and Human Services, 2016).
Brief behavioral treatment of insomnia for the military (BBTI-MV) helped clients with improvements in their sleep quality. The improvements that were present, were maintained six months later (Germain, et al., 2014). However, those clients that received Cognitive Behavioral Therapy for Insomnia (CBT-I), experienced better sleep, and improvements in their depressions (Karlin, et al., 2013).
The Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI-A) was able to show a significant result for veterans with PTSD, and it correlated with ‘poor sleep quality, combat exposure, PTSD symptoms, depression, and anxiety’ (Insana, et al., 2913).
Assessment is intended to look at the symptoms of what the client is facing. Counselors need knowledge between “categorical and dimensional approaches to diagnostic classification (Jones, 2012). The classification can be considered a guide for the observation and interpretation of a clients’ natural world (Jones, 2012). An action of assembling or positioning items into collections or groups according to the source of its associations. Categorial is a way that compound, complicated, and disorderable phenomena of psychopathology are arranged (Jones, 2012). A counselor’s use of classification helps them to connect, choose useful interventions, expect a path of diagnosis, and distinguish among diagnoses and non-diagnoses. It separates mental diagnoses into categories according to the basis of their descriptive structures.
A categorical diagnosis has only two values: the presence or absence of a disorder. Counselors assess clients using a polythetic (i.e., checklist) approach, where by a client must meet a minimum number of symptoms to receive a diagnosis. help unify a client’s pathology by integrating seemingly diverse elements or symptoms into a single coordinated configuration. A categorical model allows clinicians to group together intricate and ambiguous diagnostic phenomena. Most clinicians prefer categorical models because they are generally easier to use in making rapid diagnoses with numerous clients. short-comings with model: mental disorder categories are problematic and frustrating because they suggest uniformity of diagnoses and homogeneity of pathology that seem rarely present in clients. Categories often fail to identify or include significant aspects of symptomatology because they do not fit into the set of predetermined diagnostic characteristics. The DSM-IV-TR routinely fails in the goal of guiding counselors to the presence of one specific disorder.
The manual is replete with problems of excessive comorbidity, boundary disputes, and excessive use of the NOS categories. Co-occurring disorders (i.e., comorbidity) refers to the presence of multiple diagnoses or pathologies within the same individual. The existence of excessive diagnostic co-orcurrence has been widely recognized as a significant limitation in the DSM. It also challenges the validity of the diagnostic categories themselves, providing evidence that mental disorders are not discrete clinical entities. ‘members of a diagnostic class are homogeneous’ and ‘there are clear boundaries between classes.’ Because mental disorders are neither homogeneous nor divided by clear boundaries, the DSM has a history of problematic and irresolvable boundary disputes. To attempt to reduce boundary problems and to fill the gaps in boundaries existing in diagnostic categories, previous editions of the DSM have added more diagnoses, subtypes, and specifiers. Conceptualizing diagnostic entities; communicating information to clients, families, and other relevant parties; selecting effective treatments; and predicting future clinical management needs. Any change in the DSM that improves clinicians’ ability to more effectively achieve any of these functions can be said to improve clinical utility. User acceptability refers to the extent to which ‘a diagnostic system is used at all by its intended end population’ (Jones, 2012).
Subjective, Objective, Assessment, and Plan:
SOAP provides counselors with a way to evaluate a treatment with a client. S= subjective which is the information provided by the clients’ experiences. O = objective which is the observation of what the client is experiencing and are measurable. A = assessment is when the counselor takes information from both subjective and objective to develop a diagnosis. P = plan provides information on additional testing that may be required, and consultation with fellow professionals to discuss the clients situation (Lenert, 2016).
SOAP Note
- S = subjective: self-reports, opinions, colored by perceptions and feelings.
- Lack of motivation, sleep difficulties, difficulties remembering things, feelings of disappointing everyone, depression.
- O = objective: data that is measurable and observable
It seems that his tour in Iraq with the Army, and hearing about the deaths and war brought about his depression. This may also have something to do with his drinking more and his family and friends telling him he needs to quit drinking. Furthermore, it appears that his lack of motivation is also caused by his tour in Iraq, which created the depression. Anger expression leads to a greater risk of depression (Smith, et al., 2016). Addressing his anger may be one way of dealing with his depression. People returning from war torn countries can experience different psychological difficulties such as ‘feelings of anger and frustration, upsetting memories, and trouble sleeping, lacking social support, and problem-alcohol use’ (Griffith, 2017).
- A = Assessment: Therapists conclusions based on the S & O
Brief behavioral treatment of insomnia for the military (BBTI-MV) helped clients with improvements in their sleep quality. The improvements that were present, were maintained six months later (Germain, et al., 2014). However, those clients that received Cognitive Behavioral Therapy for Insomnia (CBT-I), experienced better sleep, and improvements in their depressions (Karlin, et al., 2013).
The Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI-A) was able to show a significant result for veterans with PTSD, and it correlated with ‘poor sleep quality, combat exposure, PTSD symptoms, depression, and anxiety’ (Insana, et al., 2913).
- P = Plan: action therapist and / or client will take as a result of assessment
Wants to be happy, like before, the depression to be gone, and to feel good again, wants his wife to be able to stop looking at him with disappointment, and to be able to play ball with his son again. Addressing the depression and anger, he feels would help him to feel motivated again.
References
- Healthline – Depression
- Mayo Clinic – Depression
- American Psychiatric Association – Depression
- National Institute of Mental Health – Depression
- Anxiety and Depression Association of America
- WebMD – Living with and Managing Depression
- HelpGuide – Coping with Depression
- PsychCentral – Major Depressive Disorder Treatment & Management
- Verywell Mind – Coping Skills for Battling Depression
