Analyze therapeutic approaches for treating clients presenting with depression

Analyze therapeutic approaches for treating clients presenting with depression

Psychotherapy With Older Adults

According to the Institute of Medicine, more than 20% of the growing older adult population has a mental health disorder (IOM, 2012). In the past, many older adults avoided psychotherapy because of the associated social stigma, but with the growing acceptance of therapy and awareness of mental health issues, more of this population is seeking the help they need. In your role, as the psychiatric mental health nurse practitioner, you have the opportunity to help these older adult clients overcome challenges that may have plagued them for a lifetime. Psychotherapy Essay Example

This week, as you explore psychotherapy with older adults, you assess clients and consider the appropriateness of various therapeutic approaches.

Learning Resources

Required Readings

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.

Chapter 18, “Psychotherapy With Older Adults” (pp. 625–660)
Chapter 20, “Termination and Outcome Evaluation” (pp. 693–712). Psychotherapy Essay Example
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

McGuire, J. (2009). Ethical considerations when working with older adults in psychology. Ethics & Behavior, 19(2), 112–128. doi:10.1080/10508420902772702

Swift, J. K., & Greenberg, R. P. (2015). What is premature termination, and why does it occur? In Premature termination in psychotherapy: Strategies for engaging clients and improving outcomes (pp. 11–31). Washington, DC: American Psychological Association. doi:10.1037/14469-002

Discussion: Therapy with Older Adults

Clients who are older have often times been dealing with their mental health disorder their entire lives, whiles other disorders may be brought on through the aging process or the trauma of losing a lifelong partner. Treatment can be challenging for both the client and the therapist. For this Discussion, you will focus on therapeutic approaches for an older adult presented in a case study.

Learning Objectives

Students will:

Assess clients presenting with depression
Analyze therapeutic approaches for treating clients presenting with depression
Evaluate outcomes for clients presenting with depression
To prepare:·

Review this week’s Learning Resources and reflect on the insights they provide.
Review the Week 10: Case Study from this week’s Learning Resources Below: Psychotherapy Essay Example
NURS 6640: Psychotherapy with Individuals

Week 10: Case Study

IDENTIFICATION: The patient is a 69-year-old, widowed African American male who is the father of one adult child and grandfather of six grandchildren. The patient is self-referred to a psychiatric outpatient clinic.

CHIEF COMPLAINT: “I need help with depression and anxiety.

HISTORY OF CHIEF COMPLAINT: The patient reports thathis father is dying, and he has been experiencing worsening ofdepression and anxiety symptoms over the past few months. Heis seeking a psychiatric evaluation at his son’s advice. Thepatient does not enjoy being with his family.


He has difficulty falling asleep, but then spendsthe day lying on the couch and reports feeling like he is “movingin slow motion.” He reports feeling tired all the time. He hasalso stopped going to his volunteer job at the nursing home.

He responded to the practitioner’s question of “whydepressed now?” by saying that with the imminent death of hisfather, he is losing his main support.In addition to his father’s illness, the patient was diagnosedand treated for prostate cancer this year. He receivedpsychotherapy at that time which focused on his anxiety aboutthe diagnosis, his denial of its severity, his wish to “not knowwhat he knew,” and, ultimately, end-of-life issues.

PAST PSYCHIATRIC HISTORY: The patient was neverhospitalized for psychiatric reasons. He has no history ofsuicidal thoughts, gestures, or attempts.The patient described either a partial or negative responsefrom several medications he had been prescribed from his primary care provider (PCP) over the course of a several years,including Effexor, Prozac, Zoloft Lexapro and Duloxetine. Psychotherapy Essay Example

He is currently prescribed Lorazeapm 1 mg BID by hisPCP which he has been taking for several years.

MEDICAL HISTORY: GERD, HTN and hyperlipidemia. History of prostate cancer.

HISTORY OF DRUG OR ALCOHOL ABUSE: The patientdenies history of drug and alcohol abuse.

FAMILY PSYCHIATRIC HISTORY: Patient reports that hismother had depression. He is an only child and does not recall anyemotional difficulties in grandparents or other relatives.

Personal History

Perinatal: No known perinatal complications.


Mental Status Examination

Appearance: Well-groomed, appropriately dressed, olderGentleman who is obese

Behavior and psychomotor activity: Good eye contact,pleasant, cooperative. Slightly unsteady gait uses walker.

Consciousness:Alert and able to answerall questionsappropriately.

Orientation:Oriented to person,place, time, andsituation.

Memory: Intact. Good recent andremote memory.

Concentration and attention:Appears to have goodconcentration during theinterview but reportsthat he has recently hadtrouble concentratingwhile reading. Psychotherapy Essay Example

Visuospatial ability: Not formally assessed.

Abstract thought:Within normal limits,appropriate use ofmetaphors.

Intellectual functioning:Patient has Masters degree

Speech and language: Normal rate and rhythm.

Perceptions: No abnormalitiespresent.

Thought processes:Goal directed, butevidence of guilt andrumination consistentwith depressivesymptomatology.

Thought content:Patient is highly anxiousand expresses thoughtsof sadness, frustration.He is preoccupied withthoughts about theanticipated loss of his father.

Mood: Depressed and anxious.

Affect: Congruent with mood.

Impulse control: Good.

Judgment/insight/reliability: Good.

Post a treatment plan for the older adult client in the Week 10: Case Study found in this week’s Learning Resources. Be sure to address the following in your post:

Which diagnosis should be considered?
What is the DSM-V Coding for the diagnosis you are considering?
What is your rationale for the diagnosis? Be sure and link the client’s signs and symptoms to the DSM-V diagnostic criteria to support your diagnosis.
What tests or tools should be considered to help identify the correct diagnosis?
What differential diagnosis should be considered?
What Treatment Strategy would you recommend?
What treatment would you prescribe and what is the rationale?Psychotherapy Essay Example
Diagnostic Tests
What standard guidelines would you use to treat or assess this patient?
Clinical Note: Is depression a normal part of aging?
Support your approach with evidence-based literature.


The likely diagnosis for this older adult is mixedanxiety-depressive and the DSM-V Coding for the disorder is DSM-5 296.20-296.36. According to the DSM-5 criteria, depressive disorder is characterized by symptoms such as sad mood, hopelessness, anhedonia, weight changes, appetite changes, sleep problems, social withdrawal, restlessness, fatigue/lack of energy, concentration problems. excessive guilt, worthlessness, and preoccupation with death. The symptoms result in clinically significant distress or impair individual functioning (Tolentino & Schmidt, 2018). The client in this case study manifests symptoms such as sad mood, anhedonia (lack of interest in pleasurable things), social withdrawal, fatigue, sleep problems, guilt feelings, and concentration problems. These symptoms have impaired his normal functioning (occupation), as he is unable to go to his volunteer job at the nursing home. Another possible diagnosis for this client is anxiety disorder as characterized by the patient being highly anxious and expressing thoughts of frustration and sadness and preoccupation with the thoughts of losing his father (Zimmerman et al., 2019).
The assessment tools appropriate in assessing the client include the Geriatric Depression Scale (GDS) to assess the severity of depression for this client and the Geriatric Anxiety Inventory to assess anxiety. The differential diagnoses for this client include generalized anxiety disorder (GAD), side effects of medications, and medical comorbidities (Subramanyam et al., 2018).Psychotherapy Essay Example
The treatment approach for this client includes both psychotherapy and pharmacotherapy. Psychotherapy treatment choice is cognitive-behavioral therapy (CBT). Using CBT, the patient will be taught that his interpretation of situations influences his feelings, moods, and behavior (Blackburn et al., 2017). Therefore, the client will be able to identify maladaptive thoughts and learn to replace them with more positive thoughts. This will reduce negative emotions and problematic behavior.
The appropriate pharmacotherapy treatment choice for the client is venlafaxine. SSRIs such as venlafaxine are the first-line medications for older adults with depression as they are well tolerated and have minimal side effects. The 2006 Canadian Coalition for Seniors’ Mental Health guideline provides that factors that should be taken into consideration when choosing antidepressants for the older adults include earlier response to treatment, type of depression, other comorbidities, other drugs being used, the safety and potential of overdose risk(Blackburn et al., 2017). Antidepressants for older adults are supposed to be initiated at half the usual adult dose, and if the older adult tolerates the dose, it should be elevated within one week. The dose is supposed to be titrated upwards until the person shows adequate clinical response, side effects restrict further dose increase, or when the maximum dose is reached (Blackburn et al., 2017).
Depression is not a normal aspect of aging, but a common mental health issue among older adults. However, older adults are at a higher risk of developing depression due to concern about chronic diseases (Avasthi& Grover, 2018). The patient in this case study had prostate cancer, which could be a risk factor for the patient becoming depressed. Depression in an older adult can be challenging to diagnose became sadness may not be the key symptom or the older adults may not be willing to talk. Sleep difficulties and feeling tired are common symptoms of depression among the elderly. Psychotherapy Essay Example
Avasthi, A., & Grover, S. (2018). Clinical Practice Guidelines for Management of Depression in the Elderly. Indian journal of psychiatry, 60(Suppl 3), S341–S362.

Blackburn, P., Wilkins-Ho, M., & Wiese, B. S. (2017). Depression in older adults: Diagnosis and management. British Columbia Medical Journal, 59(3).

Subramanyam, A. A., Kedare, J., Singh, O. P., & Pinto, C. (2018). Clinical practice guidelines for Geriatric Anxiety Disorders. Indian journal of psychiatry, 60(Suppl 3), S371–S382.Psychotherapy Essay Example .

Tolentino, J. C., & Schmidt, S. L. (2018). DSM-5 Criteria and Depression Severity: Implications for Clinical Practice. Frontiers in psychiatry, 9, 450.

Zimmerman, M., Martin, J., McGonigal, P., Harris, L., Kerr, S., Balling, C., … & Dalrymple, K. (2019). The validity of the DSM‐5 anxious distress specifier for major depressive disorder. Depression and anxiety, 36(1), 31-38.Psychotherapy Essay Example

Scroll to Top