Question 1: Diagnosis

After using the DSM-5-TR (2022), I would give Crystal a diagnosis of F32.0, Major

Depressive Disorder, Mild, With Anxious Distress. Based on the information Crystal gave, she

meets at least five of the symptoms needed to meet Criteria A. Crystal has reported feeling sad

for at least two consecutive weeks, having trouble sleeping and feeling restless, and is most

likely experiencing psychomotor agitation due to her anxiousness, frustration, restlessness and

being fidgety. She reports struggling to concentrate and has been having thoughts of

worthlessness as a mother, which are numbers one, four, five, seven and eight of Criteria A.

Crystal expressed that she and her husband have been arguing and she has more fear

about the type of mother she is to her kids, meeting Criteria B. She reported that she has no past

or current substance use issues, is taking no medications and there is no family history of mental

health problems which meets Criteria C. Crystal has no complaints of any delusions or other

symptoms that would indicate she may be suffering from a psychotic disorder, meeting Criteria

D. It does not seem Crystal has experienced a manic or hypomanic episode, which is Criteria E.

Lastly, I stated that I feel Crystal has the specifier of anxious distress as well. Crystal has almost

all of the symptoms required for anxious distress, which puts the specifier at moderate-severe.

Question 2: Goal and Task

I think that Crystal is in the preparation stage of change because she wants to change and

feel better but has not made any changes yet. A goal for Crystal based on her vignette could be to

increase her awareness of what is going on in her life that has led to her experiencing the

symptoms that she is. A task could be using psychoeducation about anxiety and depression,

which could help foster her awareness of her situation, as well as allowing Crystal the freedom to

tell her story and figure out what was going on in her life when her symptoms first began.
Crystal has the desire to get better but may not have an understanding of what she is

experiencing and why. Gaining personal insight will help her work towards decreasing her

symptoms and challenging the negative thoughts she has of herself.

Question 3: Client Map

Diagnosis

Crystal’s symptoms match a diagnosis of Major Depressive Disorder, mild, meaning that

she has not met the required number of symptoms in excess of what is needed. She is also

experiencing anxiety symptoms such as worry that her husband will leave her or that something

bad will happen to her kids that fit under the specifier of anxious distress.

Objectives of Treatment

Objectives of treatment for Crystal include reducing the symptoms she is experiencing,

assisting Crystal with learning coping skills for depression and anxiety, improving her

communication skills with her husband, and helping Crystal realize what her values and

strengths are. Objectives should include reducing Crystal’s anxiety and depression symptoms,

but having Crystal focus on the positives in her life and her accomplishments is just as important.

Assessments

An assessment that can be used for Crystal would be the Beck Depression Inventory.

This inventory is easy to take and could help solidify the diagnosis given to Crystal. It goes along

with the DSM 5 and the criteria it states is needed for a diagnosis of Major Depressive Disorder.

Clinician Characteristics

Clinician characteristics that will foster the therapeutic alliance include being supportive

and creating a safe space for the client, being empathetic, and being knowledgeable about

depression and anxiety and the potential medications the client may be on at some point.
Location of Treatment

The location of treatment for Crystal is an outpatient setting since she is not currently

having suicidal ideations or planning to act on any.

Interventions to be Used

Interventions include psychoeducation for Crystal on her diagnosis or at least the

symptom she has, exploration of her emotions, and coping skills she can use. It would be helpful

to also look at relationship patterns between Crystal and her husband, symptom management,

cognitive challenging, restructuring, and reframing skills. Mindfulness and cognitive behavior

therapy approaches would fit with these interventions.

Emphasis of Treatment

An emphasis on support and symptom alleviation would be beneficial for Crystal as she

needs to feel heard and that she has support while decreasing the symptoms she has. For

numbers, Crystal will primarily be in the individual treatment setting, but couples therapy is also

an option if it is determined it would be beneficial for Crystal and her husband.

Numbers

Crystal’s timing of treatment will have a moderate duration lasting six months and will

occur once a week. At the six-month mark, Crystal’s needs will be reevaluated to see where she

is at in meeting her counseling goals.

Medications Needed

Crystal will be educated on her options for treatment other than just therapy. Sometimes,

depression and anxiety are helped best when both therapy and medication are used for treatment.

If Crystal begins medication, then the medication and symptoms will be monitored and Crystal

should have the opportunity to ask any questions or discuss any concerns with the therapist.
Adjunct Services

Adjunct services for Crystal could include her finding a relaxing activity such as yoga. If Crystal

decides to utilize both therapy and medication to treat her symptoms, then an adjunct service

would be a psychiatrist or medication management provider.

Prognosis

The prognosis for Crystal is good as long as she remains on the path of treatment. She has

a mild form of the disorder and is not experiencing any psychotic symptoms which usually has a

positive outlook on remission of symptoms.

References
American Psychiatric Association Publishing. (2022). Diagnostic and statistical manual of

mental disorders: Dsm-5-Tr. American Psychiatric Publishing, Arlington, VA. ISBN-13:

978-0890425763 ISBN-10: 0890425760

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental

disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Reichenberg, L. W., & Seligman, L. (2016). Selecting effective treatments – A comprehensive,

systematic guide to treating mental disorders (5th ed.). John Wiley & Sons, Inc. Referred

to as “SET” for reading assignments. ISBN: 978-1-118-79135-6