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Ellen and Edward represent Essay

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Ellen and Edward represent the dynamic challenge of working with two people who enter therapy together, but present different levels of clinical symptomatology. In this case, Ellen appears to be experiencing the most difficulty functioning in her life. She reports a lack of energy, persistent sadness, and even occasional suicidal ideation. These problems are not new for Ellen as she has likely suffered from clinical depression for several years. Her termination of individual therapy may have triggered or intensified her recent increase in symptoms.

Ellen’s diagnosis is Major Depressive Disorder. Her severity ranges from moderate to severe. At this time, Edward does not meet criteria for any Axis I disorders, but further information would be necessary to understand his personality and other areas of functioning more thoroughly. Neither member of this partnership meets criteria for an Axis II diagnosis. There are no medical conditions reported and therefore, no Axis III diagnosis. Axis IV psychosocial problems for Ellen include her previous abuse.

As a couple, psychosocial difficulties include communication problems and marital discord.

Ellen’s GAF is estimated to be 35 while Edward is functioning more effectively at a GAF of 65. The couple’s level of functioning is more reflective of Ellen’s more severe difficulties (Weeks & Hof, 1995). They are failing to communicate, meet basic needs of the household, and sustain meaningful aspects of the relationships. Because Ellen has experienced a mood disturbance for longer than the duration of her marriage, it is possible that even her mate selection of Edward was related to her diagnosis (Weeks & Hof, 1995).

For this reason, Ellen’s individual diagnosis should be seen in the context of the relationship for the purposes of couple’s therapy. It is an integral part of their relationship and cannot be extracted if the couple wishes to fortify their relationship through marital counseling. Ellen would still be encouraged to seek her own individual therapy and consultation with a psychiatrist to address the severity of her depression. Ellen’s diagnosis was reached through the decision-tree method presented in the DSM-IV (American Psychiatric Association, 2000).

This method is a thorough way to match the presenting symptoms to the most appropriate clinical diagnosis. In this case, Ellen’s experience of a mood disorder was clear early in the initial session. The details she described about her past provided enough clinical information to eliminate bipolar disorders and more mild forms of depression. Major depressive disorder encompasses the duration and severity (i. e. occasional suicidal ideation) of her condition. The single criticism of the decision-tree method may be its tendency to over-diagnose.

While this client clearly met criteria, there are very few paths out of the decision-tree should a client present mild symptoms that do not yet merit a full diagnosis. There are many different medication options that may supplement Ellen’s participation in psychotherapy. Lexapro and Zoloft, members of the selective serotonin reuptake inhibitor (SSRI) class, may be useful. If Ellen does not respond to these drugs or is at-risk for their adverse side-effects, Wellbutrin is another option. This drug has a complete different action mechanism than the others in the SSRI class.

Ellen’s response and compliance with any antidepressant medication should be monitored closely. Her history of abruptly terminating treatment could indicate a potential to also stop taking her medication without warning. Many antidepressants need to be tapered off in gradually decreasing dosages. Abruptly ceasing treatment can cause dangerous side effects.

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM IV- TR. (4th ed. ). Washington, DC: Author. Weeks, G. R. & Hof, L. (1995) Integrative Solutions: Treating common problems in couples therapy. New York: Psychology Press.

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