Case Study Report: Analyzing Aruni's Mental Health at the University

This case study report analyzes the mental health challenges of a 24-year-old woman named Aruni, who presented with suicidal ideation. The report begins with Aruni's background, detailing her family, work, and traumatic experiences, including her brother's suicide and subsequent relationship failures. The core of the analysis employs the 5P case formulation to identify presenting, predisposing, precipitating, perpetuating, and protective factors contributing to her anxiety and depression. The analysis reveals the impact of financial strain, societal pressures, and past trauma. The report then proposes recommendations based on psychological theories, focusing on cognitive behavioral therapy (CBT) as a primary intervention. It also discusses the involvement of family and community support, and the importance of evaluating outcomes to track Aruni’s progress and mental well-being.

Running head: CASE STUDY ANALYSIS
CASE STUDY ANALYSIS
Name of the student
Name of the university
Author note

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CASE STUDY ANALYSIS
Introduction
The assignment aims to analyze the case study involving a 24-year old woman named
Aruni. The analysis will involve a brief background of the case study person, analysis of the
problems faced by the person using the 5P case formulation and recommendations. The analysis
is done to identify the issues of mental health of the case study person using the various
theoretical concepts of clinical psychology. To be specific, the report will use three clinical
approaches to understand the mental health issue that the case study person faces. The
recommendation will include plan that will focus on bringing out positive outcomes. in addition,
it will also include the people that need to be involved in the plan and evaluation of outcomes.
Background of the case
Aruni was referred to a psychiatric clinic after expressing a desire to end her life to her
sister. She is just 24-years old and is the youngest member of her family. Aruni is yet to marry
and thus, lives with her parents. She has worked in different companies and in positions that
demanded greater responsibilities from her. her family depends on her income because they
come from a poor background. They worked as housekeepers and cleaners in a wealthy family,
their salary was not even half of what their daughter earned, and hence, they were proud of her.
Aruni had faced a traumatic event at the age of 12 years when she witnessed her older brother
take his own life by consuming poison. Although it traumatized the entire family but they moved
on and began to lead a normal life. Being exposed to a wealthy family from childhood, Aruni
found employment after completing her studies, the cost of which her parents bore. She wanted
to marry a wealthy man who could take care of her and her parents but was waiting for the right
time. aruni was constantly embarrassed by the status of her family with her friends saw her

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CASE STUDY ANALYSIS
simple house and lifestyle. Furthermore, she had to face several rejections in marriage because of
the status of her parents. She shared that she was about to marry a man but he refused after he
met with her parents. The same happened with another young man who worked at the same place
as Aruni did. He also broke up with her three months after the relationship when he found out
that her parents are poor, working as domestic servants. The disappointments kept knocking on
Aruni’s door as she found out that the house that she had renovated by spending her hard-earned
money was given to her elder sister.
Aruni also faced stress at work because of her boss. She explained that she did not like
her boss because she fears he does not have good intentions. Her boss asks her to work overnight
at the office and she could not deny it. The reason behind it is that she is burdened with loans
that she had taken to renovate the house and if she leaves her job, she could not repay the loans.
Apart from these issues, she had the added responsibility to take care of her elder sister’s drug-
addict and abusive husband. This was coupled with the responsibility of looking after the
treatment of her niece who had psoriasis. Aruni further explained that she found it hard
concentrating at work and hardly left her house after coming back from work. She had extremely
low self-confidence. She was sure that her life would never improve because her income was not
adequate to look after her and her family’s needs.
Analysis of the problem with the 5 P Case Formulation
Presenting factors
Aruni is just 24-years old and she has had to take up too many responsibilities at such a
young age. Apart from being young, Aruni belong to a poor family with financial and other
issues. She has faced refusals from wealthy men for marriage because of her parents’ status in

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CASE STUDY ANALYSIS
the society as domestic servants. She has to look after the expenses of not only her immediate
family but also the family of her elder sister. She covers the expenses of her elder sister’s abusive
husband and treatment of her niece suffering from psoriasis. Her salary was not sufficient to
meet all these needs. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) notes
that 10% of people who commit suicide or think of committing suicide do not suffer from any
mental disorder. in case of Aruni, it could be stated that she has no serious mental disorder else
she would have committed suicide without informing anyone.
Predisposing factors
The case study person has a job with good salary but she still thinks of ending her life.
The main factors that caused her to think like that could be the over burden of her family on her.
Being a sole earner of her family, she always suffered from the stress of meeting everyone’s
needs including her own. she also might feel that despite doing so much for her parents, she has
not been given due importance and love as her parents included her elder sister’s name in the
will and not hers despite the fact that the house was renovated by her. She might have felt that
she should also commit suicide as her brother did and escape from all the problems. One of the
major issues that she has is that she never actually had the time to recover from the trauma of her
elder brother’s suicide. The suicide might have always been at the back of her mind and that is
why she gave it a thought. It is also important to remember that she is just 24-years old and
might not have that maturity to think about the affects her decision would have on the lives of
those who depended on her especially her parents and her niece.
Precipitating factors

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CASE STUDY ANALYSIS
While describing her current life situation, Aruni said that a man had proposed her for
marriage but withdrew the proposal because he found out about her parents’ poor lifestyle. She
received another marriage proposal from someone at her workplace but he too refused to marry
her when he found out that her parents are domestic servants. The refusals and especially the
reason for the refusals might have depressed Aruni and caused her to feel ashamed of herself.
This exacerbated her already stressed and depressed life and she wanted to end it.
Perpetuating factors
The poor status of her parents, her niece’s psoriasis and the financial dependence of her
elder’s sister husband are most likely to maintain the problem for Aruni. She would always be
under the pressure of working in a place she feels uncomfortable because of the loans she has
taken and the growing needs of her family. In addition, she has witnessed at a very young age,
the suicide of her elder brother that might prompt her to do the same.
Protective factors
Aruni has been a bright student and has worked in higher positions with good salaries.
She is quite young and has a long life ahead of her. Apart from that, she has a niece who is too
young to suffer from such an illness. She has a strong educational background with which, she
could find a better job. She is mentally strong, which is evident from her determination to study
hard to find a suitable partner for marriage and achieving her goal of academic success. In terms
of community support, it could be said that the only support she might have is the support of the
family that has employed her parents. Apart from that, she has no community support. When it
comes to social support, she has her two elder sisters and her parents but they too are financially
vulnerable and might not completely be able to support her.

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CASE STUDY ANALYSIS
Recommendations
After analyzing the presenting problems by using the 5 P case formulation, it could be
seen that Aruni suffers from anxiety and depression. Depression is a major mental health issue
that has become a global concern. In majority of cases, depression has led to suicides. In case of
Aruni too, the same has happened although she had only expressed about ending her life.
Psychological theories explaining depression
Several theories have been suggested by psychologists, which explain depression
amongst people and the reasons that cause it (Miu & Yeager, 2015). Behaviorist theory is one
such theory. According to this theory, depression results from an individual’s interaction with
her or his environment. The theory states that depression occurs from association some stimuli
with negative state of mind (Reynolds & Crea, 2015). The social learning theory is also a part of
the behaviorist theories according to which, people learn certain behaviors through observation,
reinforcement and imitation. This also constitutes the classical conditioning concept of the
behaviorist theory. In operant conditioning, it is stated that depressed people normally become
less active socially. To cite an example, the loss of a loved one causes the person to become
inactive and the person could only cope with the loss with support from the family and friends.
In Aruni’s case, she had lost her brother at a young age and that would have led her to depression
however; with her parents around, she was able to cope with it. Another important psychological
theory that explains depression is the psychodynamic theory. Sigmund Freud was one of the first
proponents of the psychodynamic theory. Freud stated that depression is the result of “inwardly
directed anger”; it is an internalization of the loss of a love object (Basham et al. 2016). Aruni

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CASE STUDY ANALYSIS
faced rejection from the men she thought she would marry thus causing her to go further into
depression.
Psychological theories for the treatment of depression
Depression arising from stress and hopelessness does not have a set medical treatment.
One of the best and most effective ways to treat and prevent depression is to make use of
psychotherapy. Several approaches are there that are used to treat depression. The three most
common approaches could be suggested for the present case study person.
Cognitive behavioral therapy or CBT
This psychotherapy modifies the thought patterns of the person suffering from
depression. The CBT helps the person change her behaviors and moods (Cunningham &
Shapiro, 2018). From the analysis of Aruni, it is evident that she suffers from Major Depression
that is, suffering from depression for one or two weeks (Koukopoulos & Sani, 2014). Aruni has
been feeling low and hopeless especially after the rejection of two marriage proposals and has
been wanting to end her life. The CBT could help Aruni come out of this phase of her life and
feel good about her again. This type of therapy is a blend of therapies wherein the therapist
would help Aruni to identify a specific negative though pattern as well as her behavioral
responses to challenging and stressful situations. The therapy is a way of contemplating about
the way the person’s action affects her thoughts and feelings and the way she perceives herself
and others around her. The treatment through CBT involves guiding the person to develop more
positive and reasonable ways of dealing with stressors (Cunningham & Shapiro, 2018).. This
would help the case study person minimize or eliminate her disorder altogether. CBT lays

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CASE STUDY ANALYSIS
emphasis on improving the state of the person’s state of mind at present rather than going back in
the past and asking about the depressive things.
The therapy involves meeting with the therapist for five to twenty sessions depending on
the need of the person. Each session lasts from 30 minutes to one hour. In the first four to five
sessions, the therapist ascertains whether the person is right to be treated using CBT and whether
she feels comfortable with it. The therapist might ask her about her background and her past to
understand her current situation. Aruni would make the decision on what she needs and wants to
deal with.
Interpersonal therapy
This psychotherapy is a short-term therapy that is used to treat depression. It has been
found in studies that interpersonal therapy or IPT could be quite effective in treating clinical
depression despite being a short-term therapy (Hetrick et al., 2016). The therapy addresses
interpersonal issues that affect the person. By doing so, the therapy lays stress on the way the
symptoms are associated with the individual’s relationships that include her family and friends
(Weitz et al., 2014). The immediate target of the therapy is to treat rapid symptoms and better the
social adjustment. Aruni’s immediate symptom is the feeling of hopelessness and committing
suicide, which would be the focus on the interpersonal therapy. After addressing the short-term
goals, the therapy then focuses on the long-term goals. The long-term goals include enabling
Aruni to make her own needed adjustments. When she would be able to do that, she could reduce
and cope with the depressive symptoms on her own. Interpersonal therapy is based on manual
treatment, which is, the therapist relies strictly on treatments that is effectiveness has been
supported by empirical evidence.

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CASE STUDY ANALYSIS
The therapy, as stated above, is a short-term treatment and hence, its sessions last to 12 to
16 one hourly sessions only. The therapist would focus on Aruni’s identifiable problems and the
way she interacts with or does not interact with others. Once these problems are identified and
addressed, Aruni would find that her experience has improved and her symptoms have reduced.
In IPT, the therapist does not intend to check on the symptoms of the illness except checking on
the severity of the illness and the effect of different treatments. The therapist instead works in
collaboration with the person, in this case, Aruni, to identify and address one to two persisting
and crucial problems in her interactions.
Psychodynamic therapy
Known also as talk therapy, the psychodynamic therapy allows patients to discover the
full variety of their emotions that also include feelings of which they might not be aware.
Psychodynamic therapy treats depression by bringing out the unconscious elements of the
person’s life and making it a part of her present experience (Leichsenring & Schauenburg, 2014).
The therapy helps the person understand the way her behavior and mood is influenced by the
unresolved issues and the unconscious feelings. The therapy is different from CBT and IPT in
that it psychoanalyzes the person. While in CBT, the emphasis is on the way the person thinks, in
IPT, the focus is on improving the interpersonal bonds by identifying the problems. In
psychodynamic therapy however, the stress is laid on exploring the unconscious feelings of the
person that are not generally understood from the present situation. In psychodynamic therapy,
Aruni would be asked to explore all the feelings that she is aware of and those that she is not
aware.

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CASE STUDY ANALYSIS
The psychodynamic therapy session takes place once in a week with 50 minutes for each
session. Aruni would be asked to sit up in a chair and the therapist would not be around.
However, unlike CBT and IPT, the psychodynamic session would be open-ended, which is, it
would not follow any structured or formal set of questions. The therapy is based on the free
association process (Leichsenring & Schauenburg, 2014).
After analyzing the three psychotherapies suitable for the treatment of Aruni, it is evident
that she needs both interpersonal therapy and psychodynamic therapy. It should be recommended
that Aruni be given separate sessions of interpersonal therapy and psychodynamic therapy in
order for her to improve quickly and effectively. In the IPT sessions, she would be able to talk
about her present situations and the relationships that have caused her problems. The therapist
would be able to guide the way to deal with her interpersonal relationships. In psychodynamic
therapy sessions, Aruni would be able to explore her unexplored emotions, probably the suicide
of her older brother and the uncomfortable situation she faces at her workplace.
Conclusion
In the end, it needs to be stated that the treatment that is best suited for the case study
person is the interpersonal therapy and the psychodynamic therapy. In the paper, the case study
person has been analyzed thoroughly and it was found that she suffers from major depression
involving hopelessness and the desire to commit suicide. The analysis was done using the 5 P
case formulation that involved presenting factors, perpetuating factors, predisposing factors,
precipitating factors, and protective factors. It was found that Aruni has several factors that led to
her depression and the feeling to commit suicide. The analysis then used psychological theories
to understand Aruni’s problems. Behaviorist theory and psychodynamic theory was used to

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CASE STUDY ANALYSIS
understand the problem that Aruni was facing. The analysis then provided recommendations for
the treatment of Aruni’s depression. The three therapies were recommended that included
Cognitive Behavioral Therapy (CBT), Interpersonal therapy (IPT) and psychodynamic therapy.
It was lastly recommended that Aruni be treated with IPT and psychodynamic therapy to ensure
quick and effective treatment.

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CASE STUDY ANALYSIS
References:
Basham, K., Byers, D. S., Heller, N. R., Hertz, M., Kumaria, S., Mattei, L., ... & Shilkret, C. J.
(2016). Inside out and outside in: Psychodynamic clinical theory and psychopathology in
contemporary multicultural contexts. Rowman & Littlefield.
Cunningham, J. E., & Shapiro, C. M. (2018). Cognitive Behavioural Therapy for Insomnia
(CBT-I) to treat depression: A systematic review. Journal of psychosomatic
research, 106, 1-12.
Hetrick, S. E., Cox, G. R., Witt, K. G., Bir, J. J., & Merry, S. N. (2016). Cognitive behavioural
therapy (CBT), third‐wave CBT and interpersonal therapy (IPT) based interventions for
preventing depression in children and adolescents. Cochrane database of systematic
reviews, (8).
Koukopoulos, A., & Sani, G. (2014). DSM‐5 criteria for depression with mixed features: a
farewell to mixed depression. Acta Psychiatrica Scandinavica, 129(1), 4-16.
Leichsenring, F., & Schauenburg, H. (2014). Empirically supported methods of short-term
psychodynamic therapy in depression–towards an evidence-based unified
protocol. Journal of Affective Disorders, 169, 128-143.
Miu, A. S., & Yeager, D. S. (2015). Preventing symptoms of depression by teaching adolescents
that people can change: Effects of a brief incremental theory of personality intervention
at 9-month follow-up. Clinical Psychological Science, 3(5), 726-743.
Reynolds, A. D., & Crea, T. M. (2015). Peer influence processes for youth delinquency and
depression. Journal of adolescence, 43, 83-95.

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Weitz, E., Hollon, S. D., Kerkhof, A., & Cuijpers, P. (2014). Do depression treatments reduce
suicidal ideation? The effects of CBT, IPT, pharmacotherapy, and placebo on
suicidality. Journal of affective disorders, 167, 98-103.