Client: Bob
Bob is a 45-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
Bob has been married to his partner for eleven years. The marriage has experienced challenges, but is relatively happy and intact. Bob'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 Bob 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).
Bob holds a master's degree in 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. Bob recently made the move from the 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 Bob is experiencing difficulties getting clients to pay within the 45-day billing period specified when invoiced for services rendered. As a result, Bob is often forced to pay his contracted account a service fee to prompt clients for payment.
Bob 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. Bob's partner willingly, and lovingly, paid the family healthcare premium on their plan for over two years at a monthly cost of $1,700.
Bob 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 Bob was not able to pay while he attended graduate school and established his business. During the intake visit, Bob 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.
Bob 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, Bob has no concerns regarding the little ones. His partner works doggedly to contribute to the finances and to attend to the children. While Bob 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.
Bob 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, Bob 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.
Bob 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.
Your Task:
Review Bob's case and give a preliminary diagnosis using the knowledge gained in this course. Relevant diagnostic criteria can be found in the International Classification of Diseases, Tenth Revision (ICD-10 link), and the Study Guide to DSM-5. You may find useful, as a supplement, the sequential presentation of disorders found in Lumen Learning Abnormal Psychology, https://courses.lumenlearning.com/abnormalpsychology/ . Answering the following six items, provide evidence of your logic for each decision. Reinforce responses with scholarly resources and appropriate detailing. Discuss how and why your arrived at conclusions drawn.
Develop your analysis in an organized, well-developed 5 to 7-page paper not including cover and reference page.
Required Items to be Addressed (scored):
Based upon this intake visit, what diagnosis do you think is most appropriate for Bob? Be mindful, this is your first session. Information is limited to the data collected in this first visit. What assessment tools would you want to administer if any?
What are the principal symptoms contributing to the diagnosis proposed? Clearly explain, providing details. What does the criteria in the DSM states and how does this compare to his symptoms? Does this disorder overlap with another or can you rule out other disorders?
Discuss Bob's strengths. These will facilitate constructive work with him.
Delineate Bob’s opportunities for growth and/or improvement.
Looking to the next visit and beyond, what is your preliminary sketch of the treatment goals you have for Bob? Why do you identify these goals as appropriate for Bob?
What will you explore with Bob in future visits (e.g., interpersonal, aspirations)? Present rational. Why do you want to this information? (
