Case Study

Carl is a 37-year-old male who, during his intake visit, communicates he is experiencing a variety of life stressors. As you take notes, the following list is recorded:

• change in weight, an increase of 25 pounds
• trouble sleeping, primarily interrupted sleep and occasional sleeplessness
• low energy
• varied eating - periods of not feeling hungry followed by increased eating
• irritability and moodiness
• anxiety
• decreased sexual desire
• self-esteem - decreasing
• feelings of guilty - economic challenges have resulted in significant income losses
• Carl has been married to his partner for eleven years. The marriage has experienced challenges, but is relatively happy and intact. Carl's partner is an entrepreneur with many irons in the fire, and whose drive contributes to the business's success and a healthy income ($185,000). Like Carl, his partner must reinvest the majority of their income back into their business ventures. Recent economic shifts have put pressure on the couple's shrinking savings and investments, and on the upper-middle income lifestyle the two have become accustomed (buying and engaging in desired activities without much worry).

Carl holds a master's degree from University of Virginia, Darden School of Business. He pursued and obtained his MBA with the goal of establishing his own business. He has a receptionist who works remotely from home on an hourly basis, and one full-time employee. Carl recently made the move fromthe home office, shared with his partner, to a new office space that has room for his employees. The office is well sized, and includes a conference space where clients can meet. His client list has expanded, but Carl is experiencing difficulties getting clients to pay within the 45-day billing period specified when invoiced for services rendered. As a result, Carl is often forced to pay his contracted account a service fee to prompt clients for payment.

Carl pays the accountant's fee because he requires a steady cash flow to pay his employees, pay bills, and meet family responsibilities. The health insurance premium he pays for his family is high (over $1400 per month) due to a pre-existing health condition (his partner has a chronic condition). Additionally, he pays the health insurance premium for his full-time employee. Carl's partner willingly, and lovingly, paid the family healthcare premium on their plan for over two years at a monthly cost of $1,700.

Carl took over the healthcare premium four years ago, as he felt that his partner had carried that monthly burden alone while he built up his client base. His partner also covered expenses Carl was not able to pay while he attended graduate school and established his business. During the intake visit, Carl shares that he could not have pursued his business endeavors without his partner's support (financial and otherwise). He believes that this has created tension in his relationship with his partner, particularly during the current economic downturn.

Carl and his partner have three children, ages 2, 5, and 8. All are healthy, intelligent, fun-loving, and well-mannered, per his reporting. At the time of his visit, Carl has no concerns regarding the little ones. His partner works doggedly to contribute to the finances and to attend to the children. While Carl works most days from 7 a.m. to all hours of the evening, his partner "does it all," making $185,000 and being a stay-at-home parent.

Carl feels that his partner's deteriorating physical well-being is the result of this effort to do it all - being there for him and the children. While his partner does not express dissatisfaction, Carl feels (in his words, "understands") that his partner must feel resentment toward him for the non-stop, around the clock, work he must dedicate to his business. As the funds in their savings has shrunk, Carl feels his personal state has deteriorated, physically, emotionally, professionally, and personally.

Carl concludes his intake visit expressing he needs help. He needs help regaining control in his life. He wants your help to develop a strategy for reversing this downward spiral.

Questions

1. Based upon this intake visit, what diagnosis is most appropriate for Carl? This is your first session. Information is limited to the data collected in this first visit.
2. What are the principal symptoms contributing to the diagnosis proposed? Clearly explain, providing details.
3. Discuss Carl's strengths. These will facilitate constructive work with him.
4. Delineate Carl's opportunities for growth and/or improvement.
5. Looking to the next visit and beyond, what is the preliminary sketch of the treatment goals you have for Carl? Why do you identify these goals as appropriate for Carl?
6. What will be explored in future visits with Carl(e.g., interpersonal, aspirations)? Present rational explanation. Why do you want to know this information?