Finally, among immigrants to the United States, stress from acculturation can cause symptoms of depression (Hamamura & Laird, 2014; Lorenzo-Blanco et al., 2012). Stressors arising from migration can include a history of traumatic events, discrimination, and uncertainty about documentation status (Hamamura & Laird, 2014; Lorenzo-Blanco et al., 2012).
Psychological and social trauma among survivors of ethnic conflict, genocide, and mass violence add to that. Clients whose acculturation experiences have been difficult and stressful may be more vulnerable to developing depression (Hamamura & Laird, 2014; Lorenzo-Blanco et al., 2012).
ASSESSMENT AND DIAGNOSIS FOR ADULTS
At the beginning of the therapeutic relationship, a client may tell the clinician that he or she has been feeling down, not themself, or even lethargic. The client may cry and refer to a past childhood event that has come to mind lately. They may have somatic complaints, denying depressive symptoms. These first disclosures will be the initial step toward conducting a clinical assessment, which will help determine whether the client meets the diagnostic criteria for major depressive disorder under the DSM-5-TR and if so, which type of depression is being experienced. Diagnosis is an essential part of treatment plan development, intervention, and evaluation of outcomes. Before a diagnosis is made, a client should first be evaluated by a primary care physician or psychiatrist to identify or rule out any organic or medical causes. There are no
objective tests, such as a blood test, that diagnose MDD. Routine laboratory tests, however, including thyroid values, comprehensive metabolic panel, vitamin D, and urine drug screen, may identify underlying conditions or consequences in need of treatment. Differential diagnosis should assess for neurological causes, for example, cerebrovascular accident; Alzheimer's disease; endocrinopathies such as diabetes, thyroid, or adrenal disorders; metabolic issues; medications or substances used/abused; nutritional deficiencies, including vitamins D and B series, and iron; infectious diseases including HIV and syphilis; and malignancies (Bains & Abdijadid, 2023). Once medical reasons have been identified or ruled out, the clinician can further assess the client’s mental health status.
Clinical Assessment Box 1: Symptoms of Major Depressive Disorder DSM-5-TR-TR criteria: During the same two-week period, the person experiences five or more of the following symptoms, with at least one symptom being depressed mood or markedly diminished interest or pleasure. • Depressed mood. • Markedly diminished interest or pleasure in all, or almost all, activities. • Significant weight loss when not dieting or weight gain. • Difficulty sleeping (insomnia) or excessive sleeping (hypersomnia). • Psychomotor agitation or retardation. • Fatigue or loss of energy. • Feelings of worthlessness or excessive or inappropriate guilt. • Diminished ability to think or concentrate or indecisiveness. • Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, a specific suicide plan, or a suicide attempt. • Symptoms cause significant distress or impairment in functioning. • Symptoms not due to a substance or medical condition. Adapted from Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR-TR ed.), by the American Psychiatric Association, 2022, Washington, DC: American Psychiatric Association.
The first meeting with a client, a client’s family, or another significant person in the client’s life begins the clinical assessment. The exact approach a clinician uses to interview a client will vary, and the clinician should consider the client’s vocabulary, cultural background, illness severity, and ability to communicate when deciding the best approach to the initial meeting (Silverman et al., 2015). Although different approaches can be employed, one common approach is to start with empathetic, open- ended questions, such as, “What brings you here today?” (Silverman et al., 2015). Sometimes, simple questions may upset the client, especially if he or she is currently having a depressive episode. As the client tells his or her story, the clinician should pay attention not only to what is said but also to underlying messages about the client’s sense of hopelessness, irritability, or interpersonal effectiveness (Silverman et al., 2015). For example, during a pause in the conversation, a client may say, “I feel really tired. I haven’t been sleeping too well.” Keeping in mind that this may be a symptom of a depressive episode, the clinician can gather more relevant information about the onset of symptoms by asking questions such as, “How long have you had difficulty sleeping?” From there, the clinician can gain a greater understanding of the duration of the symptoms and other factors that may be related (e.g., substance or alcohol
use). Box 1 presents a list of symptoms of major depressive disorder as outlined in the DSM-5-TR . The clinician should then further investigate the client’s coping mechanisms to identify those strategies that are adaptive, such as talking with a friend or family member, and those mechanisms that are maladaptive, such as using alcohol or drugs (Silverman et al., 2015). It is important to frame such questions in a positive way that gives the client hope (Silverman et al., 2015). For example, the clinician can ask, “Tell me about a time in your life when you felt sad or upset. How did you work through the situation? What helped? What did not help?” The client may reveal ways he or she tends to approach difficulties. Again, it is important that the clinician pays attention to the nonverbal messages as well as the verbal messages. What didn’t the client mention as a coping strategy, and could this be identified as a possible source of support? By asking these types of questions and listening closely to what is and is not said, the clinician can begin to understand the client, which also helps to develop the therapeutic alliance that is so vital to treatment (Silverman et al., 2015). A thorough clinical assessment does not stop with identifying symptoms and coping mechanisms. Indeed, additional client information can be useful, especially when
EliteLearning.com/Counselor
Book Code: PCIL1525
Page 108
Powered by FlippingBook