Vignette: Sam is a 46-year-old man who is separated from his first wife to whom he was married for 16 years. Sam and his wife had one child and he adopted his wife's first child, a daughter. Sam remarks that he loves his children very much and that they are remarkable in many ways. He says that his daughter is the top of her class and his son is about to apply for police academy. Sam is active in his community, previously coaching his son's hockey team and attending church when his schedule permits. Sam chuckles and says that he loves to go to church because the "people are so nice and give me many compliments". It appears that Sam enjoys the praise, rather than the sermon. Sam comes to therapy because he is attempting to "better himself" and because he has experienced some "lows" recently after losing his job as a sales associate at his local Lexus dealership and finding a new position at a flooring company. Sam tells you that his schoolteachers praised him for being an excellent student and that he was naturally gifted at academics. However, he only attended two years of university, mostly taking electives, and that he preferred to "party" and have "relationships" during his university experience. Sam believes that if he hadn't been employed as "the best limousine driver in town" and "public relations expert", he might have had less money to spend on drugs and alcohol and more time to spend on his academics. Sam remarked that he was the "life of the party" no matter where he was and that he used to have a lot of "high rolling" friends before he married his wife and settled down. You ask Sam about his current place of employment and how he likes his job. Sam tells you that he has only been working there for about 5 months but that he is basically running the place because the owner of the company has no sales experience, nor does he know how to "interact with customers" to get the job done. Sam tells you that this amount of new responsibility is overwhelming, but the company better appreciate him for his vast expertise in sales and business knowledge. Sam goes on to tell you that previously interned at a small credit union bank where he "climbed the corporate ladder" but quit when his manager refused to give him a raise, citing that Sam did not have commensurate education or experience to request or be eligible for a $20k salary raise. Sam found this to be disgusting as he didn't believe his education should matter, but rather, the number of new customers and investments he arranged should. Sam told his manager that they would never find another employee like him every again and recalls slamming the door and giving his manager the middle finger as he walked out. Unfortunately, Sam tells you a similar story about two previous employers which, in his mind, has made it difficult to find a career he enjoys when his hard work and aptitude are often taken advantage of. Sam discussed that he may be happier if he changed careers and moved into the mental health field. He tells you that a previous supervisor told him that he was the "best listener" he'd ever met. Sam reports that he took a few undergrad psychology courses and that he thinks he would do well in a public mental health system where he could manage a group of psychologists or social workers. Eventually, Sam noted that he might like to work in upper administration or in a government role where he would be able to make decisions instead of "the idiots who are in power now". Sam remarks that he feels he has always been destined for "big things" but often times, other people get in his way. You ask Sam about the dissolution of his marriage, and he remarks that he loved his wife, but she "changed" over the course of their relationship. He noted that she no longer made him his favorite meals, that she started standing up to him about child-rearing, and that he thought she might be having an affair. Sam tells you that he could no longer associate with or be married to someone who didn't understand his inherent worth and devotion to their marriage. If she was cheating, Sam believed she was "the scum of the earth" and that it would only be a matter of time before he found a "new and improved" wife who would understand how significant he was in the community and within his larger family. You notice Sam gets visibly angered when you ask if his wife has remarried. He states that she married "some pretty boy who has a cabin on the lake and a 6-pack - as if that won't get old!" Questions 1. What is the presenting problem? 2. What are the predisposing factors (if any) that are present? 3. What precipitated the problem? 4. What is perpetuating the problem and distress? 5. What protective factors does this person have? 6. What is the most appropriate diagnosis and why do you think this diagnosis fits for this person best? (e.g., what symptoms do they satisfy) 7. What disorders did you think about and rule out (decide against)? 8. What is the suggested treatment? (e.g., type of therapy, length of therapy, combination treatment)