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一例晋升抑郁症的案例分析报告-给力心理
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一例晋升抑郁症的案例分析报告

一例晋升抑郁症的案例分析报告
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发表时间:2015-02-10 13:45:40 396 0 0

某女,37岁,某大学教师。去年晋升副教授职称受挫,而同期教师大部分都晋升为副教授,因此精神压力很大。去年晋升结束后,出现了不愿意见人,尤其不愿意见去年晋升为副教授的同事,精神疲乏无力,整天唉声叹气,自觉不如人。但看到活泼的女儿,觉得不应该这样下去,于是在家人的帮助下,调整二个月(出去旅游,去百林禅寺打坐等)后,情况好转,能够正常上课,和同事偶尔也有说有笑,只是早晨起床前有不想活的念头,活动后好转。今年的晋升材料已经报上去,评审结果要等一个月后知晓。自材料报上去后,患者出现了头晕、头胀、记忆力下降、注意力不集中、心烦、失眠,主要为入睡困难、早醒,每天最多有5小时睡眠。整日唉声叹气,呆坐,兴趣索然疲乏无力,自觉能力减退,上课无精打采,学生对她有意见,自认为今后无法上课了。不愿出门见人,既往的“不如意”纷纷涌上心头。自信心降低,感觉人人都比自己强,走到哪里都感到低人一等,认为自己是个失败者,尤其是晨起曾多次萌生自杀念,家人怎样劝说也无济于事。

过去无明显躯体疾病史。

    生长于河北某小城镇,父母均为教师,对子女要求过分严格。患者性格内向、孤僻少语、胆小怕事、多愁善感。业余时间喜欢看诗歌、小说,7岁上学,成绩优秀,本科毕业后又考取本校研究生,然后留校任教。教学中一直兢兢业业,得到学生的一致好评,人际交往较少。

诊断:抑郁性神经症。

诊断依据:根据神经症评分标准此案例可评7分。测抑郁自评量表(SDS)为63分。

鉴别诊断:

与精神病区别:精神病与神经症是轻重完全不同的两组病。轻重由三方面加以衡量:1、症状自知力。精神病无自知力,神经症对自己的疾病相当了解,并主动求医。2、社会功能的损害程度不同。精神病有严重的社会功能损害,而神经症则较轻。3、精神病对现实严重歪曲,存在幻觉,妄想。

咨询方案:

一、     咨询目标

1、长远目标:促进求助者心理健康和发展,充分实现人的潜能,达到人格完善。

2、具体目标:通过咨询师和患者的共同努力,使患者打消自杀念头,自信心增强,与别人相处时说话流畅,不再贬低自己,不怕出门见人,更多的微笑,睡眠改善,入睡容易,并且由以前的每天5小时睡眠增至6.5个小时。

二、     双方各自的特定责任、权利和义务

求助者的责任、权利和义务:

责任

1、          向咨询师提供与心理问题有关的真实资料;

2、          积极主动的与咨询师一起探索解决问题的方法;

3、          完成双方商定的作业。

权利

1、          有权利了解咨询师的背景和执业资格;

2、          有权利了解咨询的具体方法、过程和原理;

3、          有权利选择和更换合适的咨询师;

4、          有权利提出转介或终止咨询;

5、          对咨询方案的内容有知情权、协商权和选择权。

义务

1、          遵守咨询机构的相关规定;

2、          遵守和执行商定好的咨询方案各方面内容;

3、          尊重咨询师,遵守预约时间,如有特殊情况提前告知咨询师。

咨询师的责任、权利和义务

责任

1、          遵守职业道德,遵守国家有关的法律法规;

2、          帮助求助者解决心理问题;

3、          严格遵守保密原则,并说明保密例外。

权利

1、          有权利了解与求助者心理问题有关的个人资料;

2、          有权利选择合适的求助者;

3、          本着对求助者负责的态度,有权利提出转介或终止咨询。

义务

1、          向求助者介绍自己的受训背景,出示营业执照和执业资格等相关证件;

2、          遵守咨询机构的有关规定;

3、          遵守和执行商定好的咨询方案个方面内容;

4、          尊重求助者,遵守预约时间,如有特殊情况提前告知求助者。

三、咨询次数与时间安排

每周1次,每次50分钟左右。

四、咨询方法、原理:采用认知治疗。此治疗方法的基本理论是ABC理论,该理论基本要点是,情绪不是由某一诱发事件本身所直接引起,而是由经历这一事件的个体对这一事件的解释和评价所引起的。A指诱发事件;B是个体对这一事件的想法、解释和评价,是指个体在遇到诱发事件之后相应的信念;C是在特定的情景下,个体的情绪和行为结果。该理论认为,诱发事件A是引起情绪和行为反应的间接因素,而B才是引起情绪和行为反应的更直接因素。

五、咨询阶段:

1、处理自杀危机。采取积极关注、尊重、共情等咨询技能,设身处地的理解和真诚帮助的态度,倾听和鼓励患者倾诉。建立良好咨询关系。在这种氛围中讨论患者问题的性质,消除误解,激起患者求生欲望。干预自杀危机,用认知治疗原理和治疗过程说明。自杀危机干预方法:(1)询问想自杀的理由和没有采取行动的原因。对阻止自杀的积极因素加以强化和肯定。(2)询问患者是否考虑过其他解决问题的方法。抑郁症患者的负性自动式思维常使其忽略积极的、现实的应对方法,这种方式的询问有助于患者对自己的想法进行思考。(3)告诉患者问题的性质是对晋升的一种心理反应,只要患者愿意接受帮助,采取行动自助都能治好。(4)告诉患者认知治疗是治疗抑郁的一种心理治疗方法,要求她配合,大约需要10——20次,要在医生指导下反复练习,不要急于。(5)向患者表明咨询师真诚地帮助她,并且能够帮助她。教会患者做“进行性肌肉放松训练”以促进睡眠。此为家庭作业,每日练习半小时。

   2、第二次、第三次重点在于帮助患者认识:想法和情感、行为之间的相互关系。检查作业完成情况,患者一直在坚持放松训练,睡眠有改善,问消极观念时,述:有时有,但少了。给予鼓励,要认真配合,您的无能感是一种情绪反应,并不是你的真实情况。以往的成绩就证明你很有能力。脑子里的“失败者”想法加重了抑郁情绪,一旦情绪改善,您就有另外一种感觉。这种感觉歪曲了真实情况。要采取积极行动打破这种恶性循环。

   3、最后转移到帮助患者识别、检验负性自动式思维。经过一段时间治疗后,患者抑郁症状减轻,消极观念消除,对情绪影响认知和行为有了一定认识,为识别干预负性自动式思维提供条件。

六、咨询效果及评价手段:

1、评分:按神经症评分标准此案例咨询结束后评3分。抑郁自评量表(SDS)50分。

2、求助者自我感觉又重新找回了自信;打消了自杀念头;每天睡眠6——7个小时;笑容多了,讲课有精神,得到了学生的重新赞许。

3、陪同她来咨询室的丈夫紧锁的眉头舒展开了,因为她再也不怕见人了,并且更关心、体贴家人。最近还参加了学校组织的旅游。

4、求助者述:大家都对我挺好,他们并没有因为晋升的事看不起我。

5、据观察,患者面色红润,目光有神,说话声音提高了,语速也加快了,衣着比从前得体、靓丽。

七、咨询费用:每次100元。

八、双方商定详细咨询方案,做到双方心中有数。

参考文献:1.中国就业培训技术指导中心、中国心理卫生协会组织编写  心理咨询师   国家资格培训教程(三级)   民族出版社

          2.王长虹 丛中主编  临床心理治疗学  人民军医出版社

                                                                                                               

                                                                                                           河北医科大学第三医院   田国才

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本文作者

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