Clinical Vignette

Maria,who is a wife/mother, her husband “Javier” in process of divorce and their five children; She is a 34 year old woman of Latina descent. This is neither a blended family from past marriages nor extended family. This is a normal family that come together to marry and started a new family. Maria’s parents were born in Mexico, their religion is Catholic. Maria’s mother’s age is forty-nine years old, and her father’s age is fifty. Her father has diabetes and her mother has benign tumors in her breast.
Maria is the oldest of five children. She has two brothers and two sisters. Maria’s childhood was not close with two of the younger sisters (parents’ favorite’s children) because her sisters took advantage of her. Maria has ambivalent feelings about most of her siblings and describes her relationship with them as neither good nor bad. However, Maria’s relationship with the youngest brother was very close. She states that her brother was very mature for his age (fifteen years old), so she could have with him all kinds of conversations. He gave her advice about how she needed to stand up for her rights. Maria loved and admired her youngest brother, and for that reason, it has been painful to accept his death. At the present time, Maria states that she is in constant communication with all siblings, except the youngest sister. Maria expresses her bitterness and anger toward her youngest sister. In family meetings, Martha speaks with her youngest sister only about the basic things. Each of those individuals comes with a history from their original family. However, with the rest of the family, she speaks and enjoys their company.
She considers her parents hardworking and respectful persons. She sees her father as a strong and strict man, parenting style is authoritative and directive and her mother is abnegated and melancholy woman. Her mother cries most of the time because two years ago her youngest son passed away due to cancer. The family practices high conservative values of culture and traditions. She describes her relationship with her parents difficult because she never had good communication with them. Maria states that when she was a child, she was afraid of her parents because they punished her for anything. She states that she could not confide in her mother because Maria’s mother would take it the wrong way and tell her father. As a result, her father bickered and sometimes he hit her. Maria expresses that her childhood was sad because her parents were very strict and unfair with her. For example, her parents let the youngest children go out wherever they wanted and do whatever they wanted. Moreover, she declares that one of her bad experiences was when her father did not let her participate in sports because he considered that the coach (male) was trying to grab her. Nowadays, the relationship with her parents is close, but she still has problems with having good communication with them. This dysfunctional family is characterized by closed communication, poor self-esteem of the mother, and rigid patterns. This family exhibits dysfunctional patterns because the members are incapable of autonomy or genuine intimacy. Rules serve the function of masking fears over differences. The parent’s rules are rigid and inappropriate in meeting given situations. The members are expected to think, feel, and act in the same way. Her father attempt to control the family by using fear, punishment, guilt, or dominance; her father is inclined to maintain traditional gender roles. The family system breaks down because the rules are no longer able to keep the family structure intact. There is no doubt that client’s demographic has great impact in in her treatment and diagnosis.
Maria describes her childhood as stressful and depressing because her parents never trusted her. She states that she feels resented by her parents because they were very strict with her and she did not understand why her parents let her siblings have whatever they wanted. ”It was not fair,” Maria says. She told me that her father gave her only duties and not rights. She states that she could never talk with her parents about her feelings. Maria says that she was afraid of hurting her parents’ feelings. Many times Maria told her secrets or problems to her mother, but her mother misunderstood the message. For that reason, Maria decided not to tell her mother her problems. She says that her parents treated her as a child; even when she was eighteen years old. When she did not follow her father’s instructions, he hit her with the belt. Maria considers that her father was overprotective because he saw her as a child. Thus, Maria declares thatshe can now understand her parents’ attitude. Her parents raised their children in the way that their parents had raised them, treated them when they were children. However, Maria says that it was difficult to understand and accept her parents’ discipline because she felt too much emotional pain.
Maria is in the process of her possible divorce and she is complaining about her economic, emotional, and health problems. She has expressed sadness and pain for the last few months, and she blames her husband for all her problems. Maria is going to see her medical doctor because she has sleeping problems, headaches, and depression. Thus, Maria is going to see her doctor twice a week. She currently is not taking medication. Maria states that she has no history of psychiatric illness. She expresses that she wants to see apsychotherapist because it is difficult to confront, solve and adjust to her new problems they are having and at the end to accept her possible divorce.
DSM-IV-TR (5 Axial framework)
Axis I 300.4 Dysthymic Disorder
R/O R/O Major Depression

Axis II V71.09 No diagnosis

Axis III 540.9 Appendicitis, acute
617.9 Endometriosis
309.42 Primary insomnia
463 Tonsillitis, acute

Axis IV A. Problems related to primary support, Economic problems, and Educational problems

Axis V GAF= 70 (Current)
Dysthymia is characterized as low-grade chronic depression. This means, diagnostically , that a child or teenager has felt a general sense of depression for at least 1 year, in adults, the representative period is a minimum 2 years. What is pivotal to a diagnosis of dysthymia is that the depression is not major or acute, and for prolonged periods of time. Also known as “neurological depression” dysthymia is, like most forms of depression, more common in female than males. The exact cause of dysthymia is not known. Studies conducted on the brains of women with dysthymia versus so-called normal brains have shown a difference in psychological components, especially in the frontal lobes. This cannot be dismissed as a flawed personality trait. Dysthymia may have causes similar to major depression, including: genetic predisposition, environmental factors such as growing up in a household with depressed or dysthymic parents and or sibling; enduring significant stress on an on-going basis, continual loss, such as frequents deaths of family and close friends; social isolation, this tends to make people laconic an distanced, ensuring no effort to be “up” is required
The fundamental clinical manifestations of dysthymia consist of gloominess, anhedonia, low drive and energy, low self-confidence and pessimism. As such, dysthymia differs from melancholia characterized by profound disturbances in psychomotor and vegetative functions. This is a familiar classical dichotomy in depression contrasting endogenous and neurotic depress.




Clinical Vignette