THE CASE OF CRYSTAL SMITH_SAMANTHA ZAITZ
Assignment 5.1 The Case of Crystal Smith
Samantha Zaitz
Wake Forest University
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Diagnosis
I would diagnose Crystal with F32.0, Major Depressive Disorder, single episode, mild,
with anxious distress, severe.
Goal & Task
Crystal’s narrative is that she wants to relax and feel less anxious, and that this would
lead to her improvement and feeling better overall. As of now, Crystal is aware that she has a
problem, but does not have any insight into it or know about how to change it. Based on
Crystal’s narrative, her understanding of her problem and how she might improve, one goal
could be for Crystal to notice her negative emotions as they appear and dissolve throughout the
day (i.e., feelings of anxiety and frustration) (Johnson, 2022). Based off this goal, Crystal’s
narrative and understanding of the problem, one task could be to discuss and identify thoughts
and/or bodily sensations that are associated with Crystal’s negative emotions (together in
session) (Johnson, 2022). This task aligns with the goal in that it would help aid Crystal in
becoming more aware of the thoughts and/or feelings that lead up to and/or follow her negative
emotions and thus increase her ability to better notice these negative emotions on her own time
(Johnson, 2022).
DO A CLIENT MAP
Diagnosis
The diagnosis for Crystal is F32.0, Major Depressive Disorder, single episode, mild, with
anxious distress, severe.
Objectives
The objectives for Crystal’s treatment include noticing negative emotions as they appear
and dissolve, learning to accept feelings of depression and anxiety without becoming
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overstimulated and/or overwhelmed, managing feelings of stress and frustration and ultimately,
decreasing overall symptoms of depression and anxiety (Johnson, 2022; Reichenberg &
Seligman, 2016).
Assessment
Initially, I will conduct a routine, comprehensive clinical intake assessment to gain a
thorough client history and background (Reichenberg & Seligman, 2016). Given Crystal’s
diagnosis, I will then utilize the Hamilton Rating Scale, Hamilton Anxiety Scale and Beck
Depression Inventory to assess for presence and severity of both depressive and anxiety related
symptoms (Hamilton, 1960 as cited in Reichenberg & Seligman, 2016; Hamilton, 1959 as cited
in Reichenberg & Seligman, 2016; Beck et al., 1996 as cited in Reichenberg & Seligman, 2016).
Given that these assessments can provide a baseline for the client’s symptoms, they should be
administered again halfway through treatment to track progress and inform the duration of
treatment.
Counselor Characteristics
Clients with Major Depressive Disorder (MDD) respond well to counselors who are
supportive in their approach, but at the same time also deliberate and structured (Reichenberg &
Seligman, 2016). Furthermore, counselors treating MDD should hold a hopeful and judgement
free space, focus on the now/present, and skillfully and delicately be able to challenge
maladaptive thinking patterns and distorted cognitions (Reichenberg & Seligman, 2016).
Location of Treatment
The location of the treatment will be an outpatient, private practice setting.
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Interventions
One intervention that will be used when working with Crystal is discussing and
identifying thoughts and/or bodily sensations that are associated with Crystal’s negative
emotions, which is a component of mindfulness-based cognitive therapy aimed at stress
reduction (Reichenberg & Seligman, 2016). Another intervention that will be utilized is
cognitive-behavioral therapy, specifically, recognizing and challenging cognitive distortions (i.e.,
catastrophizing) and decreasing ruminations (Reichenberg & Seligman, 2016). Lastly, cognitive-
behavioral analysis system of psychotherapy will be used in order to bring awareness to the
consequences of Crystal’s depressive symptoms and how they impact her interpersonal
relationships (i.e., fighting with her husband) (Reichenberg & Seligman, 2016).
Emphasis of Treatment
The emphasis of the treatment will be present-oriented, supportive and fairly directive
(Johnson, 2022, Reichenberg & Seligman, 2016).
Number of People in Treatment
Crystal will attend individual therapy.
Timing
It is anticipated that Crystal will attend 8-10 weekly 50-minute, individual therapy
sessions for treatment. Midway through the number of sessions, the depression and anxiety
assessments utilized at the start of therapy should be administered again to track Crystal’s
progress and determine if additional sessions may be needed. Monthly sessions should be
continued for 6 months after the last weekly session to aid in treating problems as they arise in
order to address and prevent relapse and/or a major depressive episode (Reichenberg &
Seligman, 2016).
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Medication
Crystal will be referred to a relevant medical provider (psychiatrist) for a medication
recommendation and plan.
Adjunct Services
I recommend that Crystal also try exercise as an additional approach to help manage
symptoms of depression and anxiety (Reichenberg & Seligman, 2016). I will also refer Crystal to
the Mayo Clinic’s website and the National Alliance on Mental Illness’s website as these are
notable and esteemed mental health resources that can help provide her with further insight into
MDD (Reichenberg & Seligman, 2016).
Prognosis
In general, the prognosis for Major Depressive Disorder is exceptional, but it does
correspond to the severity of the case, outside support and willingness to change (Craighead et
al., 2007 as cited in Reichenberg & Seligman, 2016; Reichenberg & Seligman, 2016). Given that
Crystal’s case is mild, she has loving family and she sought out counseling on her own, Crystal’s
chances of recovery are favorable.
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References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental
disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
Johnson, D. (2022). Integrating Diagnosis, Stages of Change, and Working Alliance for
Treatment Planning [Lecture and VoiceThread Slides]. Integrating Diagnosis, Stages of
Change, and Working Alliance for Treatment Planning (Links to an external site).
Johnson, D. (2022). Stages of Change [Lecture and VoiceThread Slides]. Stages of Change
(Links to an external site).
Reichenberg, L.W & Seligman, L. (2016). Selecting effective treatments. A comprehensive,
systematic guide to treating mental disorders (5th ed.). Wiley & Sons, Inc.
