title: Clinical case study: CBT for depression in a Puerto Rican adolescent: challenges and variability in treatment response.
abstract: BACKGROUND
  There is ample evidence of the efficacy of cognitive-behavioral therapy (CBT) for depression in adolescents, including Puerto Rican adolescents. However, there is still a high percentage of adolescents who do not respond to a standard "dose" of 12 sessions of CBT. This clinical case study explores the characteristics associated with treatment response in a Puerto Rican adolescent and illustrates the challenges and variability inherent in CBT treatment for major depressive disorder (MDD) in youth.
  
  
  METHODS
  The patient is a 15-year-old adolescent female who at pretreatment presented a diagnosis of MDD with severe depressive symptoms, high suicidal ideation, low self-concept, and highly dysfunctional attitudes. CBT treatment consisted of 12 standard individual therapy sessions plus four additional sessions, and one family intervention. A case study method was used. Both qualitative and quantitative data for the case are presented using self-report instruments, clinical case notes and recordings of therapy sessions.
  
  
  RESULTS
  Some of the characteristics she presented that have been associated with partial or no response to therapy were: increased severity of depressive symptoms, a prior MDD episode, co-morbidity with other mental disorders, and significant parental conflict. At termination the patient presented decreases in depressive symptoms, dysfunctional attitudes, and suicidal ideation, as well as improvements in self-concept. These improvements were maintained up to 1 year posttreatment.
  
  
  CONCLUSIONS
  Cultural issues are discussed in terms of the potential for parental conflict to perpetuate the patient's depressive symptoms.
authors.affiliation: Department of Psychology, University Center for Psychological Services and Research, University of Puerto Rico, Río Piedras, San Juan, Puerto Rico. mijimenez@uprrp.edu
authors.forename: María I
authors.initials: MI
authors.lastname: Jiménez Chafey
authors.forename: Guillermo
authors.initials: G
authors.lastname: Bernal
authors.forename: Jeannette
authors.initials: J
authors.lastname: Rosselló
mesh_terms: D000293:Adolescent; D015928:Cognitive Behavioral Therapy; D003431:Cross-Cultural Comparison; D003469:Culture; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000208:ethnology* / Q000523:psychology; D054541:Family Conflict / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D010552:Personality Assessment; D011647:Puerto Rico / Q000208:ethnology; D055502:Secondary Prevention