Jane 's Developmental Level ( Separate Behavioral Therapy Sessions
Given Jane’s developmental level (58 I.Q.), it is not surprising that she could not fully understand everything that was happening to her. Jane is actually a very sweet young woman, but she can be a handful when her environment is not well structured. Jane’s mother and I agreed that Jane would benefit from separate behavioral therapy sessions. I discussed the linkage of psychosocial stress and the onset of psychotic symptoms (Zubin & Spring, 1977, as cited in Castonguay & Oltmanns, 2013). We both agreed that reducing the stress in Jane’s environment is wise for many reasons. This will also help to prevent the return of Jane’s depressive symptoms.
Periodic sessions with Jane and her mother would also be helpful to ensure Jane’s continued buy-in to her medication treatment, and as an opportunity to monitor symptoms and provide additional psychoeducation.
In addition to antidepressant medication, I would use Cognitive Behavior Therapy with a psychoeducational component, perhaps woven in with Jane’s behavioral therapy. Low self-esteem is also a predictor of higher levels of depression as time passes (Johnson & Fingerhut, 2004, as cited in Castenguay & Oltmanns, 2013), suggesting that Jane’s self-esteem should be an additional focus of therapy.
It will also be important to understand and monitor Jane’s prodromal symptoms (both psychotic and depressive). This will allow an early alert if psychotic symptoms start to reappear, and provide an…