Case Study Amy


Case Study Amy

Case Study Amy

New Assignment – PSY 300

INSTRUCTIONS: You will be required to read the assigned case study vignette and answer a series of multiple choice questions related to the case study. You will type the letter of the correct answer next to the question. Case Study Amy

Case Study Amy

Amy is a 27-year-old married Hispanic woman, who has been unemployed for the past 3 months. She lost her job as a server at Papa Antonio’s Italian Ristorante after a conflict with her boss, who insisted that she work during a weekend that she had planned to an anniversary weekend getaway to Cancun with her husband. The trip had been planned for several months and her boss was informed well in advance, but fired her anyway, after she refused to work during that weekend. She reported having conflictual relationships with some of her previous employers prior to this incident, but said that “it was never this bad before!” Amy has always struggled with sadness, even as a child, but especially after her mother abandoned her, leaving her with her grandmother, who raised her as her own daughter. She was initially relieved and energized after being fired, as her job was stressful, but over the past few weeks she has felt particularly hopeless almost constantly, and has not had any motivation to look for another job. Case Study Amy

Her husband was attempting to be helpful, but she began to get annoyed with him, as he kept insisting that she needed to quit sleeping so much and to get out of the house to look for a job. Amy began seeing a psychodynamic-oriented therapist about three weeks ago because she needed to talk to someone about the conflict with her husband, and because she has begun having more suicidal thoughts than she usually has had. However, Amy has been annoyed with the therapist, who she initially thought was “the most wonderful counselor she ever had.” But now she realizes that the therapist is the worst she’s ever had because she keeps asking questions about her mother, and Amy is there to talk about what’s wrong with her husband. She cannot understand how he can be so insensitive, and is beginning to think that she needs some space from him. After a few more weeks in therapy, Amy decided to begin filling out some applications for server positions at local restaurants, however, she became discouraged as she was continually distracted by the TV and social media, and was having trouble concentrating. She began ruminating on the thought, “I’m useless at doing these applications,” but she wondered if she was just completely useless altogether. Amy recalled some previous periods of her life that were similar to this, especially when she was 22 years old and had attempted suicide. After her attempt, she began seeing a therapist and taking Wellbutrin, which really helped to improve her mood. After about six months, she had begun to feel better, and to be more invigorated, finding the energy to land the job at Papa Antonio’s. Unfortunately, she noticed that her sex drive was significantly diminished last time she was on antidepressants, and wanting to avoid adding to the problems with her husband, she decides to avoid taking antidepressants again. Case Study Amy


In an attempt to improve her mood, her husband also asked a few of her good friends to reach out to her and try to take her out for dinner. After her best friend asks her to hang out, Amy is worried about her friends seeing her in her current state, and really has no desire to socialize, or to hang out with friends. In fact, she has missed her weekly get-together with friends, and quit going to the weekly bible study at her church. After several weeks of trying, Amy finally agreed to go out alone with her best friend, but when they arrived at the restaurant, she felt no desire to eat. Her best friend noticed that she seemed to have lost some weight, and attempting to make her feel better, complimented her on it, saying, “You look good! Have you lost some weight?” Amy was concerned that her friend might think she had an eating disorder if she didn’t order something, so she ordered a small salad, and ate about half of it. After returning home, Amy found herself again thinking about how useless she felt, and began contemplating what pills she had in her medicine cabinet. Before she was able to check the cabinet, her husband came home, and asked her how lunch went with her friend. She immediately became irritated by this line of questioning, and simply said “Fine,” leaving the house to go for a walk. Thinking it good that she was being active and getting out of the house, her husband gave her some space and did not ask about why she was leaving. She walked a few blocks to a high bridge near her house, and began thinking about jumping. She thought to herself that no one would really care if she were gone, least of all her mother, and that if she were gone her husband could remarry someone who would make him happier. She began to believe that she was useless and would be better off dead. She thought that she heard her mother’s voice telling her that she should go ahead and jump. As she approached the highest point of the bridge, a police officer stopped his car and asked if everything was okay. She said that it was, and that she was just out for a walk. He asked her to get into the car, and she agreed. After she left the house, Amy’s husband had found a spiral notebook where she had written about how useless and worthless she felt, and about recent phone calls from her mother telling her she should commit suicide. He had not heard about any phone calls with her mother, and believed that he would have heard about it, as it had been about 12 years since they last spoke. He immediately called the police, reporting that he thought she was going to attempt suicide, leading the police to check the bridge. Amy was taken to the psychiatric unit of the local hospital, and was assessed by the staff psychiatrist, who determined that she should stay for at least a few more days for observation. Amy agreed to stay at the hospital after talking with her husband, who told her that he was concerned about her returning home too quickly. Case Study Amy

Background History

Amy was the oldest of two children born to her mother, who was married to her father for less than two years, after which her father moved out and rarely spoke to her or her sister. After a few months, her mother remarried, and moved away with her new husband, leaving Amy with her grandmother. She always wondered why she was left and her sister was taken, but justified her mother’s decision by telling herself that her sister was just a baby when her mother left. In the beginning, her mother would come for a visit every few weeks or months, but these visits

gradually became less frequent, until years began to pass. The last time she saw her mother, Amy was 15 years old, and began screaming at her mother that it was not fair that she left her but not her sister. Amy often felt lonely and worried that she would never be successful in life. Growing up, she became more and more worried that other people would not want to stay with her, and began to feel more and more worthless, though she also became good at covering up this pain. She would often try to say things to get people to like her, and would even lie frequently in order to get her way. Amy’s grandmother was often scared that she would turn out just like her mother, and would frequently tell Amy about this concern. When she was 12 years old, she began “dating” boys, and as she aged, she would always be really into everything that her boyfriends were into. She thought of this as one of her best qualities, being like a chameleon and identifying with anyone that she was “dating” so that they would like her more and never leave her. Eventually, these relationships would always end with conflict, disappointment, and a break-up, which increased her sense of abandonment and loneliness. This pattern seemed to change when she was age 20 and met her husband. They were married within a year, and he seemed to be able to tolerate her changes in mood and especially her low periods. They did seem to have more conflict when she felt better, as she would frequently feel annoyed. Since her suicide attempt at age 22, their relationship had been stable, and she felt he had been doing better at tolerating her irritability, until recently, after she lost her job. Quiz Questions Put the letter of the correct answer in the line next to the question number. _____1. Amy’s case displays symptoms that meet criteria for which of the following disorders? Case Study Amy

A) Generalized Anxiety Disorder B) Schizophrenia C) Major Depressive Disorder D) Bipolar Disorder

_____2.Which of the following symptoms provides support for this diagnosis?

A) Amy’s suicidal ideation B) Amy’s difficulty with concentration C) Amy’s weight loss D) All of the above E) Only A & B

_____3.Which of the following psychotherapy modalities has been empirical supported as an effective for treating this disorder, and may be more helpful for improving Amy’s interpersonal problems?

A) Multicultural Psychotherapy B) Adlerian Therapy C) Emotion-Focused Therapy

D) Cognitive Behavioral Therapy _____4.Which of the following types of medications may be helpful to Amy, in light of her recent symptoms?

A) Benzodiazapines B) SSRI C) Xanax D) Valium E) All of the above

_____5.If Amy were to be given an additional diagnosis, which of the following would be most suitable?

A) Anorexia Nervosa B) Borderline Personality Disorder C) Dissociative Identity Disorder D) Bipolar Disorder

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