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Jimena is a 13-year old teen who during the last three months has been experiencing depression. She isolates herself from everyone and therefore, “she reports feeling down.” She may feel happy but that only lasts a few moments and immediately goes back to feeling depressed. She no longer engages in her favorite hobbies, such as “playing piano, spending time with her dog, and going to the movies with her mother.” Jimena’s depression has been causing her academics to go downhill. Although Jimena gets her good night sleep, every morning she feels “really tired.” Jimena’s fatigue is affecting her everyday duties. She tends to think and feel negatively about herself, “feelings of worthlessness and hopelessness.” Someone who has depression, tends to have suicidal thoughts and Jimena states “she has bad thoughts.” Jimena has also experienced social anxiety. Jimena will only speak to certain individuals, such as her family members. If her mother makes her speak to an unfamiliar person, “Jimena will cry, or become very angry, refusing.” In school Jimena will try to avoid eating at the cafeteria, she states “she doesn’t fit anywhere.” She is afraid to make friendships with peers at her school, she states “they are all mean.” When in unfamiliar situations, where Jimena feels she is being stared at, she reports “feeling sick.” Jimena’s mother states these problems have been on going “for about three to four months.” Someone with social anxiety disorder according to the DSM-5 must have approximately six months.
1. Major Depressive Disorder
Relevant Developmental Concerns:
Jimena has just about entered the teen years, therefore some of her behaviors can be quite normal during her stage. When a young person becomes a teenager, they tend to become more independent. Most teenagers become a little rebellious towards their parents because they want more freedom. Teenagers tend to want their own privacy and begin to detach from their parents. Therefore, in therapy it will be essential to speak to the parents that it is normal for a teenager to have these behaviors. I should keep in mind that teenagers can be moody and might not want to speak, therefore it will be important to establish rapport. During the adolescent stage many of them are now experiencing new things at school, such as drama and breakups. Therefore, in therapy it will be worthy to underline the importance on how to cope with those problems.
1. Learn to express feelings to increase positivity on self-worth and to lessen the habit of isolating herself in a room.
2. Meditate for a few moments each session, to relax and clear mind.
3. Begin doing one activity at a time, such as her favorite hobbies and talking to friends.
4. Create a plan to build up her school grades for academic success in the future.
Course of Treatment:
The first time Jimena came in with her mother I tried to establish rapport. We spoke about what she likes to do, her favorite movies and hobbies. After I established a good rapport with Jimena, I decided to speak to her mother about the importance of understanding teenage behaviors. In addition, I addressed what Major Depressive Disorder is and how to be there for her daughter. This included how to give her space, but at the same time to let her know that she will always be there for her. During the first few sessions I taught Jimena how to meditate. Before starting each session, she would meditate for a few moments to relax.
The next step was to give Jimena a book in which she would write down her feelings. In the beginning Jimena thought this was not going to help her and that it was a waste of time. I let her know that we would try this routine. If she felt it did not work after a few sessions, then I would help her a different way. I began by asking her questions such as, “What is it that you are feeling right now?” “When you feel sad, what do you do? Or what do you think of when you are sad?” Jimena’s feelings were quite negative, (e.g., “no one likes me,” “I’m never going to succeed,” and “I should just give up, I’m a failure.”) To change her negative judgements, Jimena and I came up with positive thoughts to replace them. For instance, whenever she felt that no one likes her, she will say, “I have a mother and a family who loves and cares about me.” When she thinks she will not be able to succeed, she will say “I am smart, and I can do anything I put my mind to.” Jimena felt that her way of thinking was normal, for that reason it was challenging for her. After a few more sessions, Jimena was making some progress on replacing her negative thoughts to more optimistic.
Taking a day at a time, Jimena and I would engage in some of her favorite hobbies. First, we played Piano. Since I was unable to attend the movies, I assigned her homework in which she would attend the movies with her mother. It was in Jimena’s and her mothers’ interest to raise her school grades. Jimena and I came up with a planner to help her get back on track. Jimena states “meditations have truly helped me when I want to relax and clear my mind.” Most of the sessions were done alone with Jimena, but it was important that her mother would be involved. It was important for her mother to be involved because it would show Jimena that she cares and wants to help. Also, her mother would see the type of activities Jimena and I would engage in, so at home she could continue therapy. Jimena is slowly recovering and they both agree to continue coming to therapy.
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