CH: 7 Scenario: Case Study: Joe Experiences Depression
Joe is a 35-year-old Caucasian middle manager of a large construction company. He has been married for five years and has no children.
Presenting Problem: Joe is concerned about his feelings of depression. He experiences sadness, hopelessness, feelings of worthlessness, and general lassitude. He reports that these feelings occur about 10 or so days each month and are usually associated with a conflict or problem at work. The following is a transcript from a segment of the initial interview conducted by a clinical psychologist.
Interviewer: How long have you had these feelings of depression? (duration of problem)
Patient: Oh, probably about 20 years.
Interviewer: Do you remember what happened 20 years ago that started these feelings? (etiology of problem)
Interviewer: Have you ever sought professional help for these problems during the past 20 years? (previous history of treatment)
Patient: No. I have never seen a psychologist or anyone else about them before. In fact, other than my wife, I don’t think anyone knows about them.
Interviewer: What made you decide to do something about them now? (antecedents for current help seeking)
Patient: Well, my wife encouraged me to see someone–I think because she recently saw a psychologist for feelings of panic and anxiety whenever she drives over a major bridge. Since she found it helpful, she thought I might talk this over with someone. Also, my new insurance plan at work allows me up to 12 free sessions, and so I thought I might as well take advantage of it.
Interviewer: Do you feel comfortable doing this? (assess feelings associated with help seeking)
Patient: Yes. I feel good about finally doing something about my depression.
Interviewer: What exactly happens when you feel depressed? (assess patient symptoms)
Patient: Well, I just feel worthless, like my self-esteem takes a hit.
Interviewer: So you generally feel bad about yourself?
Patient: Yes, definitely.
Interviewer: Any troubles or changes with sleeping or eating? (assess vegetative signs)
Patient: Not really. I sleep okay and eat fine. In fact, I probably could lose a few pounds. I have a weak spot for chocolate, especially dark chocolate cremes.
Interviewer: How do you try to cope with these feelings when they occur?
Patient: I generally talk it over with my wife, who is very supportive. I also usually try to do some exercise like taking a hard run or bike ride. I think the distraction of exercise helps me a great deal. Sometimes, when I feel especially bad, I cry a little and the release makes me feel better.
Interviewer: So you either distract yourself with physical activity or cry when things are really bad.
Interviewer: Do other members of your family have trouble with depression or other mood problems?
Patient: Not really. My mother had bouts of depression now and then but nothing serious. My brothers and sisters, my father, my grandparents all seem to have no significant trouble with depression or mood problems.
Interviewer: Do you (or any family members) ever experience the opposite of depression? Do you or do they ever feel very euphoric, maybe get little sleep, spend a lot of money, feel on top of the world?
Patient: No, if you mean do I ever feel manic, I don’t. No one in my family does either, that I know of.
Interviewer: Do you ever feel so low that you think of hurting yourself?
Patient: Not really, I might have a fleeting thought that I wish I were dead, but I never feel what I would call suicidal and I would never hurt myself.
Interviewer: Have you ever tried to hurt yourself?
Patient: No, never.
Interviewer: What do you think contributes to your feelings of depression?
Patient: Well, I work really hard. Usually I start work at 7 A.M. and finish at 7 to 8 P.M. Sometimes my boss drives me crazy. He is so controlling. You always feel like he stands over your shoulder and tells you how you could be doing your job better. Generally, I like my job. It pays very well and I like the type of work I do, but I don’t like the hours or my boss.
Interviewer: So the job has some major pros, like money, yet major cons like long hours and a challenging boss.
Interviewer: Does your boss remind you of anyone else in your life?
Patient: Well, to tell you the truth, he does remind me of my dad a bit. My dad, bless his heart, is a loving guy, and I have a good relationship with him, but his one major flaw is that he is controlling and always has an opinion on how you could do something better. He means well, but he sure can be annoying.
Interviewer: Do you think the similarity between your boss and your father might have anything to do with your depressive feelings?
Patient: I’m not sure. I never really thought about it or made a connection between the two.