Psychotherapy and Art Therapy Progress Note

Clinical Interview

Subjective

Presenting problem(s)

• Persistent depressive symptoms and generalized anxiety with onset 6 months ago following job loss; course has been fluctuating with moderate severity.
• Attended for scheduled follow-up psychotherapy and art therapy session; focused on emotional regulation, feelings of inadequacy, and anticipatory anxiety regarding upcoming job interviews.

History and Current Functioning

• Mood: Depressed and anxious; triggered by financial stressors and job applications; copes using deep breathing and journaling.
• Energy Levels: Low in the mornings, improving slightly by mid-afternoon; exacerbated by poor sleep; copes with short walks.
• Sleep: Initial insomnia (takes 2 hours to fall asleep), averaging 5 hours per night; triggered by racing thoughts; uses sleep hygiene techniques with partial efficacy.
• Employment/Education: Currently unemployed (formerly graphic designer); actively applying for roles, which triggers acute anxiety.
• Family: Lives with supportive partner; some guilt regarding unequal financial contribution; communicates openly to cope.
• Social: Withdrawn from broader friend group due to perceived stigma of unemployment; maintains weekly contact with one close friend.
• Exercise/Physical Activity: Walks dog 20 mins daily; previously attended gym 3x/week but stopped due to low motivation.
• Eating Regime/Appetite: Decreased appetite in mornings, mild stress-eating in evenings; no known allergies.
• Recreational/Interests: Sketching and reading; engagement has decreased over the past 3 months.
• Homework/Changes: Completed thought record from last session; noted reduced somatic chest tightness when challenging catastrophic thoughts about finances.
• Previous Assessments & Interventions: 8-week CBT group for anxiety in 2021.
• Psychiatric History: Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD), diagnosed in 2021.
• Physical Health: Mild tension headaches; otherwise healthy.
• Current Medications: escitalopram (Cipralex®) 10 mg PO daily.
• Supplements, Vitamins: colecalciferol (Vitamin D3) 1,000 IU PO daily, melatonin 3 mg PO QHS PRN.
• Substance Use: 1–2 standard alcoholic drinks per week; denies tobacco or recreational cannabis use.
• Relevant Cultural/Religious/Spiritual Issues: Identifies as secular; finds spiritual grounding in nature.

Risk Assessment

• Suicidal Ideation: Passive thoughts of wishing to "disappear" when overwhelmed; denies active ideation, intent, or plan. No prior attempts.
• Homicidal Ideation: Denies.
• Self-harm: Denies current or past NSSI.
• Addictive Behaviours: Denies illicit substance use or gambling.
• Risk-taking/Impulsivity: Denies.

Objective

Mental State Exam

• Appearance: Casually dressed, well-groomed, appears stated age.
• Behaviour: Cooperative, engaged, mild psychomotor agitation (fidgeting with hands) when discussing employment.
• Speech: Normal rate, rhythm, and volume.
• Mood: "Stressed and tired."
• Affect: Dysthymic and anxious, reactive, congruent with mood.
• Perception: No hallucinations or dissociative symptoms noted.
• Thought Process: Linear, logical, and goal-directed.
• Thought Form: Normal; no formal thought disorder.
• Orientation: Oriented to person, place, and time.
• Memory: Grossly intact for immediate, recent, and remote recall.
• Concentration: Mildly impaired during complex cognitive tasks, improved during art-making.
• Attention: Sustained throughout the 50-minute session.
• Judgement: Intact.
• Insight: Good; recognizes interplay between cognitive distortions and somatic anxiety.

Assessment

Assessment, Clinical Formulation, and Findings

• Worksheets, Assessments, Tests, Infosheets: PHQ-9: 14 (moderate depression, down from 16 last month); GAD-7: 12 (moderate anxiety).
• Art Therapy: Directive: "Bridge Drawing" (depicting transition from current state to future goal) using watercolour and charcoal on heavy paper. Chosen to explore themes of transition, uncertainty, and agency. Client depicted a narrow bridge over dark water, associating the water with fear of failure and the charcoal lines with rigid self-expectations. Observed decreased physical tension and increased verbal spontaneity while blending watercolours.
• Progress: Demonstrating improved awareness of cognitive distortions and willingness to engage with vulnerability through creative expression.
• Change or Addition of Goals: Added focus on tolerating ambiguity during the job search process.
• Modalities: Cognitive Behavioural Therapy (CBT), person-centred Art Therapy, mindfulness-based grounding.
• Predisposing Factors: Family history of mood disorders (maternal depression); perfectionistic personality traits.
• Precipitating Factors: Unexpected layoff 6 months ago.
• Perpetuating Factors: Ongoing financial strain, unstructured daily routine, avoidance of social activities.
• Protecting Factors: Supportive partner, strong therapeutic alliance, medication adherence, creative skills.

Plan

Treatment Plan

• Current Goals: Continue escitalopram 10 mg PO daily; reduce depressive and anxious symptoms via cognitive restructuring and expressive therapies.
• New Goals: Establish a structured daily routine incorporating scheduled job-search hours and dedicated leisure time.
• Homework: Complete 15 minutes of free-form watercolour journaling 3x this week when noticing somatic anxiety; limit job application work to 2 hours daily.
• Referrals or Letters: Provided contact info for local employment support services. Follow-up booked for 22/04/2026 at 14:00.