Case Formulation

Based on the timeline and interpersonal inventory, the therapist provided Helen with the tentative formulation that the onset of her depression appeared linked both to her chronic role dispute with Hank and to her “complicated pregnancy,” a role transition involving psychosocial complications such as an unplanned pregnancy, lack of social or financial resources, or medical complications (Spinelli, 2001). The therapist explained to Helen that her pregnancy seemed to have several complications: that it was a big, unexpected change in her life; that she was concerned about getting emotional and financial support from Hank; and that she was worried that her financial and medical illness, such as chlamydia, would hurt her baby. Helen readily agreed with this formulation. Then the therapist asked Helen which of the two problem areas seemed more immediately concerning and manageable to work on, given her level of depressive symptoms and the time constraints of the therapy. They discussed the chronicity of Helen’s conflict with Hank and how it wore her out, worsening her mood. They agreed that the remaining six weekly acute treatment sessions would be best spent achieving depressive remission before the birth by focusing on the complicated pregnancy and helping Helen prepare for the challenges of motherhood, including activating her social supports, deciding how to manage her financial and workplace concerns, and discussing her medical illness with her obstetrician. The therapist conveyed to Helen the expectation of a time limit for the acute phase of therapy—that she would likely achieve full or partial improvement from her depression after six more weekly brief IPT sessions. The therapist suggested that after Helen’s depression remitted and the baby was born, she might have more energy to address her longstanding dispute with Hank (which was at an impasse) during the monthly maintenance IPT phase. The therapist explained that the main purpose of monthly IPT maintenance was to help Helen sustain her recovery from depression after the acute-phase weekly brief IPT sessions ended.

Brief IPT Homework

At the end of the first and second IPT sessions, the therapist encouraged Helen to do something during the week to give herself a break, such as engaging in a previously pleasurable activity with someone she liked. Helen decided to see a movie with Rhonda for pleasure and to clean her apartment for a sense of accomplishment. The therapist worked with Helen on specifying when she would do these activities, what might interfere, and how likely it was that she could do them. The therapist asked Helen how she planned to buffer the downturn in her mood were she to have contact with Hank. Helen planned to rely on coping strategies that had helped her mood in the past, like talking to her mother and praying in church for guidance. At this point, Helen decided not to ask Hank for what she needed because she was sure conflict would ensue that would make her feel worse.

< Prev   CONTENTS   Source   Next >