diagnose the client explain what led you to this diagnosis, and identify a treatment plan for this client (1-2 therapeutic models). Use this thread to share with your classmates how/why you came to the conclusion of this diagnosis and treatment plan. If you have similar and/or different diagnoses than your classmates, you can respond to threads to create discussions with classmates. next I'm sharing the probelm.....

The client is a 39-year-old woman who is referred for evaluation by her physician. The client states she made an appointment with his doctor after a trip to the emergency room, however she says his doctor has told her she is in great health and suggested this may be psychological. The doctor referred her to a psychologist/counselor (you) to discuss more and seek therapeutic treatment.

The client reports that about a year and a half ago she was at home working (client works both from home and from office) one afternoon when she began to feel tense and anxious for no reason. She says she became short of breath, began to feel faint, and that her mind began to race.These symptoms only lasted a few minutes and then went away, however she says she had a few more experiences just like this one over the next few weeks and months (each one "out of the blue").

However, these symptoms began to get worse about five months ago. The client says she woke up one night with the feeling that she was choking or being strangled and she couldn't catch her breath. She also said she felt very panicked, and thought she was having a heart attack and was about to die. She called 911 and was brought to the hospital in an ambulance. She was sent home after test results showed her heart was fine. Two days later, she had another attack while driving to work.

This attack was so severe the client had to pull over to the side of the road, and again explained feeling anxious, was short of breath, was sweating, and was nauseous and sick to her stomach. She says this attack was totally unexpected, and that after 20 minutes or so it gradually went away. She ended up calling out sick and staying at home, in bed for the rest of the day.

Since that time these "episodes" have become pretty regular, although the client can't tell when the next one is going to happen. In the past month, for example, the client has had at least two severe attacks per week, occurring at various times (some at night, others during the day, etc.).The client also says the episodes appear to be increasing in intensity as time progresses. For example, she reports, "When they first started, these attacks were terrifying. I felt like I had gotten them under control but now they happen so often I feel like this is unmanageable. I honestly thought I was going to die when I had the last one a couple of days ago - I couldn't breathe, I was feeling crazy, and my mind was running 1000 miles an hour".

As a result of these attacks, the client reports she has changed her lifestyle a great deal. For example, the client says that for the past three weeks or so she has essentially been home-bound, not wanting to leave her house for fear of when another attack might happen. She has left home recently to visit her doctor for an evaluation, however the client shares that while waiting in the doctor's office that she found herself becoming nervous because of how crowded the office was, wondering how she would escape or get to her car if she were to have another attack. The client says that this nervousness about public and crowded spaces has never been a problem for her, although it's something she struggles with today each time she leaves home.