During my clinical rotation I was able to have a therapeutic conversation with a 26-yearold male, A.L.

The patient suffers from major depressive disorder and has dealt with the
disease for 4 years. This is his third hospitalization and the clients chief complaint upon
voluntarily admitting himself onto the unit was due to his suicidal ideations. The patient
had a noose that he was prepared to hang himself with. He reached out to his mother
and she stopped him from hanging himself and helped him come into the facility. The
triggering even was him seeing an ex girlfriend with someone new. He has been on the
unit for 5 days and has a positive outlook on his treatment.
The patients id is strong as he mentioned getting into fights and losing his temper.
He further explained that he got into a lot of physical fights with his brother but he did
not wan to go into why he did these things. The ego is not as strong as his id but you can
tell that the ego tries to reason with the id and superego. We can see this when he
reached out to his mother when he tried to commit suicide. The superego needs more
development in a sense because the patient shows lack of concrete values or morals
that he goes by.
According to Erikson the patient has not yet completed the task of identity vs. role
confusion. We see that the patient was not able to figure out whom he was or what he
wanted to do with his life despite being a successful college graduate and pursuing a
career in accounting. According to Mahler he has completed the consolidation phase
because he does have a sense of the separate self while maintaining the idea that the
mother is a loving figure that will be there no matter what. According to Piaget the
patient seems to have mastered all he tasks and is able to think and reason abstractly.
According to Kohlberg he has not mastered the conventional level and behavior seems to
be motivated by respect for authority. He made it clear that he doesnt want to get near
the ex girlfriends new boyfriend because he doesnt want to get arrested. The patient
seemed to use the defense mechanisms of isolation because when talking about his
girlfriend that he states hurt him and he feels anger toward, he talks as if he has no
emotions or anger toward her. He also uses compensation in a sense because although
he had all the feelings of anger and sadness he was overly pleasant and communicative.
The patient plans on using medication as his primary treatment. He seems to be
reluctant to continue group therapy or DBT. He states that he has tried it but it does not
seem to help him. The patient is on Escitalopram also known as Lexapro, this is an SSRI
and is used as an antidepressant. I would teach the patient that he must take the meds
even if he is feeling better because the symptoms are likely to come back. Also I would
advise him of the increased risk of suicide while on the medication. Last I would advise
the patient that it may take up to 4 weeks before he can see a change in mood so it is
important to stick with the regimen even if he does not see a change right away. I would
teach the patient these tips by giving them handouts and verbally explaining it to him
and allowing him to ask questions and reiterate what he just learned about meds.
The patient does not seem to be having any cognitive distortions. His main
problem involves the separation from his ex girlfriend and he is well aware that his
depression is directly related to this. The only barriers that can be seen are the fact that
he uses defense mechanisms to mask true feelings and he does not adequately express
or communicate these feelings with anyone. This then makes the patient act out in a
violent manner especially with brother. Otherwise the patient has a good support system
outside of the hospital and uses them adequately. Overall I believe the patient has a
good prognosis. His depression is related to life stressors that he can learn to deal with in
a more effective manner. It is my belief that if the patient uses DBT and medications he
can have a very good outcome.