The discussion in this paper involves the formulation and treatment plan for a Mr. Jones, who was referred to my facility feeling low in mood, being lethargic, and low self-motivation. Mr. Jones works as an administrative assistant in a large insurance company and had started to miss days at the workplace. He was reported to have been spending a lot of time in bed, was isolated and had lost appetite. His social background is a troubled one, having divorced by his wife of 15 years, his parents having separated when we was 11 years, and having fallen out with his sister who is 4 years older than him. The discussion will involve three sections, where the first one will consider the diagnosis for Mr. Jones in relation to the DSM criteria. The second section will deal with formulation, including factors for the depression and a treatment plan. The entire discussion, especially the treatment plan will borrow from Beck’s cognitive model of depression (Wills, 2013, P. 168), which was formulated in relation to the cognitive theories of depression.

Depression Diagnosis (DSM-IV Criteria)

According to the DSM-IV criteria for the diagnosis of depression, a person suffering from depression is likely to have depressed moods, or even to be easily irritable (Sadock & Sadock, 2011, P. 532). Sadock and Sadock continue to say that a person is likely to portray a lack of interest in pleasuring activities, or even in work activities. Additionally, a weight change might be significant, or even a change in appetite in regard to the loss of food (Bilsen, 2013). Hammen and Gotlib (2014) report a change in sleep patterns, where one can have hypersomnia or insomnia. Indeed, the DSM-IV criteria also record instances of retardation, or psychomotor retardation, which Sadock and Sadock (2011) refer to as a change in activity. One is also likely to record fatigue. A significant symptom recorded by the DSM-IV criteria is a feeling of worthlessness or guilt. Further, one may experience suicidal thoughts, and their concentration towards work is completely diminished.

The features of depression, as outlined by the DSM-IV criteria, are very evident in the patient in the current case study. Just as recorded in the DSM-IV criteria for depression, Mr. Jones was reported to have suffered from low moods for a long time, through the level at which he was brought to the hospital was severe. The case records that he had suffered ‘low moods over the years, but not as severe as this.’ Such evidence points to the possibility that Mr, Jones might be suffering from depression. The evidence from the case study also shows that Mr. Jones had difficulty motivating himself, which is in line with the DSM-IV criteria since he had a decreased sense of pleasure. The fact that he had lost appetite and had isolated himself from others, and also his difficulty forming relationships show clearly that his symptoms are in line with the DSM-IV diagnosis for depression. Mr. Jones was also lethargic, a term that the DSM-IV criteria refer to as ‘fatigue.’ The case also records that he was ‘spending time in bed,’ which is also an evidence. According to Sadock and Sadock (2011), a person suffering from depression is likely to spend sleepless time in bed. There has also been a record of inability to concentrate on daily activities, evidence that occurred well to Mr. Jones, who was unable to concentrate his work. The case recorded that he was not able to go to work for a number of days, despite his holding an administrative position at his job place.

Formulation: Factor’s for Jones’ Depression

Mr. Jones, who forms the basis for the current case study, is surrounded by a number of factors which have contributed to his depression case, either directly or indirectly. These factors can be grouped into either perpetuating factor, cognitions and behaviors, predisposing factors and precipitant factors.

As can be seen from the cases study, Mr. Jones’ perpetuating factors are related to the tendency of his continual feelings of low moods and some anxiety. As the case study evidenced, Mr. Jones has been suffering from low moods for a long time, although currently he was referred having suffered a major depressive episode. The fact that he has suffered these symptoms of depression for a long time portrays such factor as a

Mr. Jones’ cognitions and behavior factors are several. He already has the feelings of depression, as supported by the cognitive theories of depression (Marshall & Turnbull, 1996). In relation to the cognitive theories, such are evidences of depression and altered behavior, as Jones portrayed low moods, lethargy, and low motivation. He had also isolated himself socially, meaning that he had lost appetite in pleasuring things. Mr. Jones’ main precipitating factor was the traumatic ending of a 15-year old marriage with his wife. Considering that this was a long-term relationship, the ending of such a union is likely to precipitate Jone’s depression condition. The end of the relationship is likely to trigger dysfunctional thoughts which would lead to depression as supported by Dr. Beck in his model of cognitive depression (Sadock & Sadock, 2011).

Treatment Plan for Mr. Jones:

The treatment plan for Mr. Jones will adopt a cognitive behavioral approach and also the third wave therapies, in consideration of his situation and the need to get him healthier, and back to work. As Marshall and Turnbull (1996) notes, Cognitive Behavioral Therapy (CBT) treats a client with the assumption that their moods portray their patterns of thought. Such sentiments have been reflected by the Beck model of cognitive therapy (Hammen & Gotlib, 2014)

In order to help Mr. Jones, I will work with him and make him participate in the treatment. Through such, I will be able to identify what he thinks, and help him to think positively. Working closely with Mr. Jones, I will identify his problem thinking and problem behaviors and work on them for improvement. The treatment will also involve a teaching plan in which I will teach Mr. Jones about monitoring and writing down his negative thoughts, with an aim of recognizing how his thoughts affected his moods and physical condition and improve on them. Mr. Jones homework will involve recording his dysfunctional thoughts, and what he did to replace them, and daily thought records, among other assignments. As the therapist, I will monitor the assignments closely to ensure they are effective in the treatment.

The other task in the treatment plan for Mr. Jones, as supported by the Beck’model of cognitive depression, will involve helping Mr. Jones to schedule enjoyable activities, in relation to behavioral activation. This task will be targeting Mr. Jones’ symptom of isolating himself, and withdrawing from relevant activities. After helping him to schedule these activities, I will help him to go about implementing them in so that he can benefit from them behavior-wise. Hammen and Gotlib (2014) note that a person who is depressed stops to do the normal things thinking that they are not worthy anymore. I would like to change such understanding in Jones mind in order to get him back on track. In making sure that Mr. Jones takes an active role in the treatment plan, I will require Mr. Jones to take a record of all the activities and also record what he felt, and suggest ways of improving.

In order to ensure that this treatment plan succeeds, I will start all sessions by checking Mr. Jones’ mood and ask him to participate in the meeting’s agenda. We will then revisit the previous session, review and do that agenda before setting a homework. I would make sure I summarize the main points of every session before ending it.

Third wave therapies will also be beneficial in reinforcing the treatment. In this case, considering the situational functionalism of Mr. Jones, Acceptance and Commitment Treatment (ACT), related to functional contextualization will be very pivotal in helping Mr. Jones get back to work. According to Kahl, Winter and Schweiger (2012), such a therapy can be applied to promote committed behavior. Such is needed to help Mr. Jones get back to work.

Conclusion:

In sum, Mr. Jones is suffering from depression, as evidenced by his symptoms which are in line with the DSM-IV criteria for depression. His case has been facilitated by various factors, which fall into cognitive and behavioral, perpetuating factors, precipitating factors and predisposing factors. A good treatment plan implemented with the active participation of the client will be successful in treating Mr. Jones.

References

Bilsen, V.H. (2013). Cognitive behavior therapy in the real world: Back to basics. London, UK: Karnac Books

Hammen, L.C., & Gotlib, L.I. (2014).Handbook of depression. New York, NY: Guiford Publications

Kahl, G.K., Winter, L., & Schweiger, U. (2012). The third wave of cognitive behavioral therapies: What is new and what is effective? Current Opinion Psychiatry, 25(6), 522-528.

Marshall, S., & Turnbull, J. (1996). Cognitive behavior therapy: An introduction to theory and practice. London, UK: Balliere Tindall.

Sadock, J.B., & Sadock, A.V. (2011). Kaplan and Sadock’s synopsis of psychiatry: Behavioral sciences/Clinical Psychiatry. Hoboken, NJ:Lippincott Williams & Wilkins.

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