Who would study psychology if they didn't have some kind of problem?

There's a problem with the case study in Chapter 246.

The emotions conveyed through visuals are very direct.

For some more sensitive students, the heavily spliced ​​images displayed on the slides at this moment directly caused them to have extremely subtle physiological reactions.

Perhaps their breathing quickened slightly, or perhaps their throat tightened slightly.

Most sensitively, a heavy feeling has begun to appear in my chest.

Nan Zhuren continued:

"Compared to conventional depression, smiling depression presents many new challenges for psychological intervention."

"First, smiling depression is more difficult to detect in daily life. Many friends, colleagues, classmates, and even family members cannot tell the difference between a person diagnosed with smiling depression and someone who was previously diagnosed. This makes it even harder for them to accept the reality of the situation when they come to us, thus missing the best opportunity for intervention."

Nan Zhuren lowered his voice slightly.

"Secondly, the facial expressions of individuals with 'smiling depression' are difficult to use as a routine reference during counseling, thus interfering with the counseling process; in severe cases, they may even have stronger defensiveness in language than the average person, so interventionists need to have stronger insight and empathy than normal counselors."

"This also brings about the biggest challenge in treating 'smiling depression'—how to assess whether a person with 'smiling depression' has achieved 'recovery' in a psychological sense, or, to put it another way, how to assess whether a person with 'smiling depression' can live independently without counseling or supervision?"

"I will address these three questions one by one in the following case analysis."

Nan Zhuren took a deep breath: "And tried to answer them."

After the opening remarks, Nan Zhuren clicked the laser pointer to proceed to the next slide.

The disappearance of the crying-smiling image brought a sigh of relief to many students.

Now let's get to the main topic.

The first step is to introduce the visitor's background.

"The visitor, Xiao C, was a sophomore in college when she first came to us. She came from a well-off family and had always been a 'good student' and 'good child.' According to her parents, Xiao C had been at the top of her class since elementary school. Although she would occasionally fluctuate, she could immediately get back on track after being reminded. She was obedient and sensible in life and accepted almost all of her parents' advice. Her parents arranged everything for her in terms of hobbies, clothing, and life planning. She originally planned to study medicine in college, but chose Chinese Language and Literature at her parents' suggestion."

"According to classmates, the visitor is friendly and helpful. He rarely participates in class affairs or other group activities in his daily life, and his life is mainly focused on studying. However, he almost never refuses when invited by his roommates or friends."

It seems like a very standard background introduction.

However, those who previously noticed that "all information displayed had been obtained with the consent of the visitors' families" also noticed that what Nan Zhuren was displaying at this moment was from an observer's perspective.

There was no client complaint, nor was there a first impression from the counselor.

This is very abnormal, and could even be described as very unprofessional.

Some people started whispering among themselves.

……

These missing elements are things that Nan Zhuren cannot actually achieve even if she wanted to.

The case he shared was naturally Chen Jie, but Chen Jie's files had been almost completely destroyed by Lin Lilin.

The information that Nan Zhuren is presenting now is the result of the painstaking recollections of Dr. Chen, Cheng Hui, and others.

Fortunately, Nan Zhuren's purpose today is not "case sharing"—or rather, that is not the main purpose.

Nan Zhuren continued explaining: "During the initial visit, the Symptom Checklist-90 (SCL-90) and the Self-Rating Depression Scale (SDS) were used to assess the patient's psychology. The average score on the SCL-90 was 2.3, and the SDS score was 70."

"Based on the self-report, the client has symptoms of decreased interest and reduced energy, with additional symptoms including decreased self-esteem and self-confidence, and sleep disturbances. These symptoms have persisted for more than two months and have caused the client distress and adverse consequences. Based on the scale assessment results, the preliminary assessment is that the client may have moderate depression."

“After the initial visit, the counselor—who is also my mentor, Professor Lin,” Nan Zhuren smiled and specifically pointed out, “conducted a preliminary assessment of the client, established a counselor-client relationship, and set counseling goals. Ultimately, it was decided to use cognitive behavioral therapy and medication intervention simultaneously.”

"Initial drug intervention prescription: Escitalopram 5mg/day, Vortioxetine 10mg/day."

In this section, in addition to the typed description, Nan Zhuren also included screenshots of some handwritten prescriptions.

His presentation style sparked increasing discussion among the audience. "What's going on with this case sharing? Did he just finish explaining the scale scoring and then stop? Does that mean there was no intervention?"

"Why are you being treated like you're going to a psychiatric ward?"

“My colleague, I work in a hospital, so you can make your point much clearer.”

"Ah... I mean, the cognitive behavioral therapy intervention is indeed very standard, and the medication intervention is also reasonable. But, what about the specific plan?"

"At the very least, release a portion of the verbatim transcript of the conversation, right? What kind of case study is this?"

The professors in the front row also frowned slightly at this moment.

"Prescribing medicine on the very first meeting? Old Lin... I remember you have a clinic, right? Are you a shareholder?"

"I don't know whether to call him radical or conservative."

Even they started whispering among themselves.

"Judging from this handwriting, it is indeed Lao Lin's." These were the words of the dean of the School of Psychology.

He turned to the principal and explained, "Old Lin must have had a reason for doing this. Maybe he discovered through consultation that the client's situation was even more serious than the scale assessment suggested..."

……

The current reaction from everyone was exactly what Nan Zhuren wanted.

However, despite the plan going smoothly, he couldn't be happy.

This feeling began to spread as he narrated.

The counselors who were puzzled by the consultation process felt it, but they were unable to empathize for the time being, as their attention was mostly focused on the anomalies of the case itself.

Xia Tian, ​​standing in the last row, bit her lip and clenched her fists around the neckline of her shirt, slowly tightening them.

【Teacher Nan…】

On stage, Nan Zhuren continued, knowing that what followed was the key point.

"Consultation sessions are scheduled once a week."

"In the second and third weeks, the main focus is on helping clients learn the principles of cognitive behavioral therapy, helping them identify automatic thoughts, and becoming aware of their own emotions. At the same time, the dosage of medication is increased by 50% starting in the third week."

The slides flashed by quickly, and this part was mentioned only briefly.

The counselors began to murmur amongst themselves, while the professors in the front row frowned even more deeply.

"Starting in the fourth week, the consultation enters the next stage—cognitive reassessment, challenging automatic thinking."

"This phase takes a long time, spanning five, six, seven, or eight weeks."

"In the fifth week, the dosage was increased again, with escitalopram increased to 10 mg/day and vortioxetine increased to 20 mg/day."

This is considered normal. The initial dosage of prescription antidepressants is generally 50% of the standard dosage, which is gradually increased over the following two weeks.

However, Nan Zhuren's explanation was too brief, making it difficult for the consultants and doctors with medical backgrounds present to determine whether such drug intervention was necessary.

Since such incremental interventions are not always necessary, and it is possible that the interventions will be effective, the interventions may remain unchanged or even be gradually reduced.

At this time, their brains are very active.

Therefore, when Nan Zhuren showed the next picture...

Many people couldn't help but exclaim in shock or disbelief.

(End of this chapter)