Running Head: CASE CONCEPTUALIZATION

Case Conceptualization

Name

Institutional Affiliation

Date
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Description of problem

Mari is a 29-year-old African American woman who comes to the clinic for

psychotherapy. She says that she's been happily married for five years and lives in a friendly,

diverse neighborhood. Mari has a successful career as a realtor, and her husband is a

cardiologist. Mari has lived quite happily and contentedly for most of her life, but lately, she

has been feeling, her words- hollow inside. It has resulted from wanting very much to have a

child. She hasn't been on any birth control the five years she's been married but has not

conceived. All doctors that she has visited tell her that all is well, and she will get pregnant in

time. She feels that her infertility is bringing strains on her marriage and shall affect her

relationship with her in-laws. She has missed several work appointments due to oversleeping.

Sometimes she wakes up with lethargy and other times feeling sick. She has also been taking

more than her two wine glasses every night, and sometimes she has downed the whole bottle

before going to bed. She feels that her home is empty (without a child), and this has brought

on the profound sadness that has made her lose her appetite; she only eats ice cream and other

desserts. She's worried that she may end her marriage because lately, she's become quite

irritable and finds herself raising her voice at her husband and being generally rude. Also,

she's been coming up with reasons not to go out whenever invited to the numerous gatherings

they are often asked to, which she’s usually happy to attend. It has pushed her friend to

advise her to see a therapist insistently. She denies any thoughts of wanting to injure her or

others; she just wishes that everyone would understand how powerless she is in her situation.

Client’s vulnerabilities.

Mari was raised alongside her elder sister Keisha by a single mom. Her parents had

divorced when she was five years old. Her father was a compulsive alcoholic who had led to

divorce. He’d tried to get help many times but always ended up relapsing. Her mother had
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said that she couldn't raise her daughters alongside such a person because he was

unpredictable, and his drunken condition ever paused a threat to the kids. She was a staunch

catholic and raised her kids in the same way. Mari felt terrible that her parents could not settle

their differences to give her a normal childhood. She grew distant with her father, whom she

felt valued the bottle more than her children. When Mari was a teenager, she realized that her

sister Keisha who was only three years older, had gotten pregnant. Her sister had begged her

so much not to tell on her saying that she would reveal the news to their mother when she

was ready. Mari agreed and started entraining the oncoming visitor's though the was going to

become an aunt. A month and a half later, to her utter dismay, she came to realize that her

sister had procured an abortion. Her sister also begged her to keep the matter between them.

Mari felt so betrayed by her sister, and she had no heart to tell their mother such terrible

news, she knew it would break her heart. She also felt profound guilt for having to keep such

a secret. She felt that perhaps if she’d broken the news to their mother, her sister would not

have had the abortion and so in some way it was her fault. Abortion was also very much

condemned by the religion that she believed. Her love for her sister slowly turned into

contempt, and even now, they hardly ever talked.

Clients triggers

Mari and her husband had been invited to a child's birthday party by one of her

husband’s colleagues. Everyone was merry, and the party was going on well. However, Mari

noticed that she and her husband were the only couples without a child. Though she was

always consciously aware of the fact, it had never bothered her before. She also noticed that

everyone else was taking their time with their drinks while she ever had a glass of wine in her

hand. Also, she seemed to be the only one drunk. She realized that everyone else was high on

having to yell at their kids to behave well, not to overeat- generally looking after them
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seemed to give them a joy that she hadn't noticed before. She feels that she was joyful

because tipsy from all the wine she had drunk. Few days after the party, she asks her husband

what he thinks about them having a child. He said that he'd love to be a father, but he was not

in a rush. He said that at God's time, they would become parents. Mari feels that her husband

may not have meant what he said and only said it to hurt her feelings. She says that she has

seen her husband play on so many occasions with the neighborhood's children in a way that

was intimate and sure that deep down, he was longing to be a dad. Once, her mom in law

peers into the room that would be converted into a nursery when the baby came for some

brief seconds then walks away. She also says that she also noticed that the in-laws kept

glancing at her tummy, perhaps looking for signs of a baby bump.

Core Beliefs.

Mari believes that sin should be punished. She believes that the act of abortion done

by her sister constituted great sin, and as punishment for it, she is unable to conceive. She

believes that no one truly loves her, and the people closest to her can betray her. She says that

those closest to her would never make a sacrifice to make her happy or let her have a tranquil

life; instead, they always use her to work out well for them. She says she feels this because

her father could not stop drinking so that he could be there for his family. Also, her sister put

a heavy burden on her shoulders, making her keep such a deep dark secret from their mom.

She also hurt Mari because she got rid of the babe that Mari had gotten excited about coming

into their lives. Mari blames herself for the bad things that happen in her life; she blames

herself for her parents’ divorce, her sister’s abortion, and now her inability to get pregnant.

She believes that not having a child will cost her her marriage and destroy her relationship

with her in-laws.

Most Central Thought Client is infused with

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Mari believes that the bad things happening around her are her fault, including her

inability to conceive, which she has no control over. She feels that she is not good enough for

people to love her sincerely. Her closest loved ones always betrayed her in some way. She

thinks that somehow she is going to cause her marriage to fall. She does not trust her

husband’s reassurances about their not having a baby. She is paranoid about her in-laws and

thinks that she will jeopardize her relationship with them too.

Differential diagnosis

Paranoia

PPD (Paranoid Personality Disorder) is a DSM-5 (Diagnostic and Statistical Manual

of Mental Disorders, fifth edition), diagnosis assigned to individuals who have a pervasive,

persistent, and enduring mistrust of others, and a profoundly cynical view of others and the

world (American Psychiatric Association, 2013).[Porter, 2020]. There are several diagnostic

criteria for people with PDD. In line with Mari’s case, the tendency to mistrust others and

thinking that they have harmful intentions to them or are trying to use them without any

proof. People with PDD also hold grudges. They also try to read too much between the lines,

looking for criticism in casual and innocent remarks or something that someone does.

Alcohol Use disorder

It is drinking alcohol in more copious amounts or for longer than was intended. The

significant for Mari is she wakes up hangover, which makes her miss work appointments. It

also causes irritability, which puts a strain on her marriage.

Diagnosis

Major Depression Disorder.

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The patient appears to have a major depressive disorder, is characterized by loss of

interest in activities she once enjoyed, and has trouble performing everyday activities. (Kerr,

2018).She manifests significant depressive disorder symptoms such as melancholy and

feeling empty inside, oversleeping, lack of energy, loss of appetite, and social withdrawal.

She has lost interest in going out to social gatherings when invited. Her successful career is

suffering because she is jeopardizing it by not showing up to work. The use of other

substances is not triggering these symptoms. Her symptoms cause her to dysfunction socially

and in terms of her job.

Coping Strategies

Mari has been coping with her situation with increased drinking of wine. She says it

has been helping her lift her melancholic feelings, but she’s worried because sometimes she

wakes up hungover and irritable. Mari becomes rude towards her husband. She also gets a

euphoric feeling by sitting on a bench in the park and watching kids play. However, Mari

feels even sadder as she walks away from the parks. She thinks that her coping strategies are

not working.

Treatment Plan.

Treatment For Mari shall include Pharmacotherapy as well as psychotherapy. The

therapy aims to reduce the depressive disorder symptoms until the patient reaches their usual

functioning level. To achieve this, the Mari is advised to sign up for frequent psychotherapy

sessions where there will be an interpersonal exchange. It will help her to identify negative

beliefs and behaviors and replace them with healthy, positive ones. Also, she can explore

relationships and experiences and develop positive interactions with others (Mayo

Foundation for Medical Education and Research MFMER, 2018). She shall be advised to try
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becoming a parent through other means such as surrogacy or adoption, which will help her

move on from her depressed state.

Mari agrees to treatment through pharmacotherapy. It shall be administered based on

Mari’s tolerability and anticipated side effects, preference regarding the cost, and

pharmacological properties of the medication(American Psychiatric Association, 2010). She

will be prescribed 75 mg/day of venlafaxine (Effexor XR). It falls under the category of drug

serotonin and norepinephrine reuptake inhibitors (SNRIs), a class of medications that are

effective in treating depression. They work by affecting brain chemistry and communication

changes in brain nerve cell circuitry known to regulate mood to help relieve depression. They

block the neurotransmitters' reabsorption of serotonin and norepinephrine,, which are

hormones that make one feelfeel happy or pleasant (MFMER, 2019). The increase in these

hormones means ones get to feel good, thus alleviating depression. Mari will return on set

appointment dates for monitoring recovery progress.

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References

Porter, D.(2020) Paranoid Personality Disorder DSM-5 301.0 (F60.0)retrived from:

https://www.theravive.com/therapedia/paranoid-personality-disorder-dsm--5-301.0-

(f60.0)#:~:text=PPD%20(Paranoid%20Personality%20Disorder)%20is,American

%20Psychiatric%20Association%2C%202013).

Kerr, M.(2018) Major Depressive Disorder (Clinical Depression) Retrieved

fromhttps://www.healthline.com/health/clinical-depression

Mayo Foundation for Medical Education and Research (2018) Depression (major depressive

disorder) Retrieved from https://www.mayoclinic.org/diseases-

conditions/depression/diagnosis-treatment/drc-20356013

Mayo on for Medical Education and Research(2019) Serotonin and norepinephrine reuptake

inhibitors (SNRIs) Retrieved from https://www.mayoclinic.org/diseases-

conditions/depression/in-depth/antidepressants/art-20044970