Interpersonal Psychotherapy

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Interpersonal Psychotherapy Case Study
The case is about Lot, a 55-year-old female who is a housewife with two children. She used to have her own clothing boutique, but it is now closed due to the effects of the pandemic. She decided to undergo psychotherapy because of her daughter's suggestion, in hopes of psychotherapy addressing her chronic pain that has already been recurrent for the past eight years. She also reports fatigue, difficulty falling asleep, and feelings of anxiety.
        Lot was raised in a Catholic and Asian household with four siblings. She is the middle child and has one older brother, one older sister, and two younger brothers. She recalls her childhood to be beautiful with many happy memories, especially with her siblings. However, she also has memories of other people being in their home due to the business transactions of her parents at the time when she was a child, and this resulted in feelings of lack of privacy, the need to be accommodating, and to adjust to the needs and wants of other people. She had many friends at school and even had many suitors as she was growing up. After she focused on her marriage, she lost contact with most of her friends, only maintaining two girlfriends she occasionally talks to. Due to her conservative and traditional upbringing, she only had one exclusive romantic relationship in her twenties, which lasted for two years until she broke it off because she "cannot see building a future with the guy even though he was loving and faithful to me." When this relationship ended, she reports being courted by her now-husband for two months then getting married immediately, which she explained as "it just felt right and he was caring, similar to how my father was with my mother." She describes her marriage as "at times heavy and hurtful, but it is okay because it is normal for couples to go through challenges" however, she mentions that it is pretty challenging to have a husband who works in another state or country where the job requires. Due to this, Lot is the one who is primarily in charge and hands-on with her children as they were growing up. After getting married, she prioritized being a homemaker and a mother of two children, whom she described as her "happiness" and "God's greatest blessings."
Patient History
Lot is now married for twenty-six years, and as previously mentioned, she is a housewife still living with her two children. Her daughter is now 23 years old, while her son is 20 years old. She reports being stressed by the current situation with her husband, whom she believes is already emotionally abusive towards her. Now that her husband is away, she feels relieved but experiences anxiety when her phone rings and the call is from her husband. There are also days that she feels "extreme sadness" and is not interested in doing anything, even her basic self-care routine. These days, it is usually with physical pain that starts from her chest or neck then spreads all over her limbs until she cannot do any activity due to pain. These are not associated with conditions such as hypertension because her blood pressure readings are often normal or slightly elevated due to pain during these moments. She describes her husband as very frank and sharp-tongued when talking to her up to the point of her asking herself if her husband still loves her. The usual topics of their discussions are about finances and regrets. According to Lot, she feels like her husband is blaming her for the challenges they had faced and the ones they are still experiencing. She attributes her husband's poor behavior/demeanor due to his unhappy childhood and poor parenting skills received when he was still young. She does not fight or answer back to her husband and still treats him with love, care, and faithfulness.
Lot's most stressful memory is also related to her issues with her husband. She recalls the memory of actually answering back to her husband and having a full-blown discussion with him. Then there were a lot of hurtful words that were said to her. This led her to question her worth and all the decisions she has made throughout their marriage. Some of the issues raised during the discussion were her husband blaming her for things such as failed business ventures, the lack of a large amount of savings, etc., and her husband prioritizing other people over her and their family. These people include her in-laws and workmates. It was even more unforgettable to her because she was almost sent to the hospital because of her hypertension at the time, but the primary concern of Lot is that her children saw the whole discussion. She described seeing fear and hurt in the eyes of her daughter at such a young age. She also felt anger, palpitations, nausea, and tremors during and shortly after the event. She reports getting a similar reaction when she recalls this or during heated conversations with her husband.
She describes stress as a part of her daily life and is something that she has already accepted, but lately, she feels that it is too overwhelming and sometimes thinks about "how to make it all stop." The strained relationship and issues with her husband are the ones she identifies as giving her stress and anxiety. She mentions that her husband had emotionally abusive episodes in the past that somehow worsened as years went by in their marriage. Aside from these encounters, she is also stressed that her husband is always asking her to do a lot of extra errands. These errands come in the forms of secretarial duties that add up to the stress that she is already feeling from being a homemaker. In addition to this, she also questions what she did right in her life and whether she made the right decision to prioritize being a devoted wife and full-time mother, which meant sacrificing her career and huge potential when she was a lot younger.
During the childhood years of Lot, she remembers always being left at home with her siblings. This meant that their much older cousin, Blesilda, will be their babysitter. Most of the time, other strangers also come in and out of their homes because their parents are busy entrepreneurs with a lot of connections. She describes that she was always fearful that her parents may meet an accident and that they might be left with Blesilda or other people they are uncomfortable with. Lot recalls that this fear started when she and her siblings were playing and got a bit rowdy and noisy, then suddenly, Blesilda shouted and even spanked her backside and legs with a belt that has a metal part on the end she was hit with. The pain was shocking and unforgettable for her, primarily because her parents never used these kinds of disciplinary actions. Aside from the shock, she also felt confused because she was not sure about what she did wrong, but she just went on being anxious, careful, and well-behaved since then.
Early this year, Lot also shares that her mother passed away. She claims that she has already accepted it because "death is a part of life" and that she was ready since her mother is already old and had been ill for a long time. However, she says that she genuinely feels the loss and even feels anxious about growing old. She also mentions that her kids are now adults, and she is already feeling the changes compared to when they relied on her in many aspects of their lives. She is unable to point out the exact feeling but describes it as "odd." Last but not least is the issue with her chronic pain, which she had been feeling for years already. She feels really sad about it because there are many activities that she cannot do when episodes of intense pain are felt all over her body. However, when she can function normally, she "does not feel like doing anything at all." This also includes a lack of interest in her usual hobbies like cooking and gardening. She associates these circumstances with feelings of worthlessness and helplessness.
Assessment
Lot was administered tests for post-traumatic stress disorder, depression, and anxiety. These are the clinician-administered PTSD Scale for DSM-5 (CAPS-5), the Patient Health Questionnaire – 9 (PHQ-9), and the Anxiety Symptoms Q...