Ms. S, a 19-year-old girl, failed in SSLC, presented with pervasive sad mood, decreased interest in studies, poor academic performance, irritable over trivial issues, anger outbursts, crying spells, guilt feelings, feeling of worthlessness, disturbed sleep, reduced appetite, difficulty in attention and concentration.
In year 2007, Ms. S started complaining that she is unable to remember what was taught in class room as well as whatever she was reading. Gradually, her academic performance had come down significantly by 2008. Since 2008, mother reported that Ms. S gets irritable over trivial issues, anger out bursts and occasionally beats her sister. Subsequently, Ms. S became dull and lethargic later. In spite of these, there was a pressure from mother to perform better studies as she was performing very poor in her academics. So, the client started to think that she is a failure, she cannot clear her exams, better to die rather than living. However, client did not attempt for suicide. She also felt guilty that she was unable to fulfill the dreams of her parents with respect to academics.
Ms. S was not attending Bharatanatyam classes and meditation classes, which she used to before the onset of the symptoms. Client's sleep and food intake had come down gradually. Ms. S was given anti-depressant medication by the consultant psychiatrist for 2 months, and there was no adequate improvement in her depressive symptoms except her sleep.
The therapist followed single subject research design A-B outcome design with baseline and treatment phase to test the treatment gains. Hamilton Depression Rating Scale (HAM-D) was used to assess the severity of the depression. The scale has 21 items, and the total score 0-7 shows normal, 8-13 mild, 14-18 moderate, 19-22 severe, above 23 very severe. HAM - D demonstrated high levels of reliability (ra = .91 to .94, ra = .95 to .96). Extensive validity evidence was presented, including content, criterion related, construct, and clinical efficacy of the HDI cutoff score. The client had scored 21 on HAM - D (moderate depression) at baseline, and it had come down to 6 (normal) after providing solution-focused therapy [Figure 1].
The case worker had listened to the client attentively and empathetically about her concerns. The client was anxious and worried about her academic difficulties and parents pressure to perform better in the academics. The detailed information was elicited from the client about her problems and experiences. This has increased client's understanding about her problem. The case worker has validated her feelings and concerns. This has brought some amount of positive change in the client as she felt that the case worker has understood her problem. The case worker and the client sat together and discussed about future goals. The goals were clear, simple, and attainable. Though the client felt hopeful, she did not have clarity about how to achieve her goals.
Identified goals were: 1. Managing academic stress, 2. Enhancing attention and concentration, and 3. Planned preparation for exams.
The miracle question devised by Steve de Shazer (1988) was asked to the client in each session.
Imagine when you go to sleep one night a miracle happens and the problems you have been talking about disappear. As you were asleep, you did not know that a miracle happened. When you woke up, what would be the first signs for you that a miracle had happened?
On a 0 to 10 scale with 10 representing the best it could be and 0 as worst it has been. The aim of scaling was to measure the progress as sessions goes on. The client has mentioned her score as 2. As the sessions progressed, the scores have increased, which means Ms. S has improved significantly.
The case worker has discussed about the clients problems in the past and how they were managed. The case worker found that: The client was practicing Bharatanatyam and going for evening walk with friends. She also used to practice western dance with her sister. According to client, these activities were her main source of coping. Client reported that she used to feel free and active after doing Bharata Natyam. While she was in SSLC, the client stopped doing all these things due to academic pressure. The case worker has discussed about possibility to start doing these activities. The case worker also discussed with mother about the need for sending client for Bharata Natyam. The client started going to Bharata Natyam classes and evening walk with her friends. Gradually, her score on scaling has increased. The case worker has given positive feedback at the end of each session. Client efforts to change, regularity to sessions, honesty, and commitment were identified and reflected on her.