Week 1: Mr. E

Mr. and Mrs. E are members of your church. Mr. E is seeking counseling but asking that his wife or children not be involved in any of the sessions as they are not aware of the difficulties he is experiencing.  Mr. E is a 27-year-old electrician and complains of dizziness, sweating palms, heart palpitations, and ringing of the ears.  He states that these symptoms have been occurring for at least the last 18 months.  He has also experienced dry mouth and throat, periods of extreme muscle tension, and a constant “edgy” and watchful feeling that has often interfered with his ability to concentrate.  These feelings have been present most of the time over the previous 2 years; they have not been limited to discrete periods.  Although these symptoms sometimes make him feel “discouraged,” he denies feeling depressed and continues to enjoy activities with his family.

He also has many worries.  He constantly worries about the health of his parents.  His father, in fact, had a myocardial infarction 2 years previously, but is now feeling well.  He also worries about whether he is “a good father,” whether his wife will ever leave him (there is no indication that she is dissatisfied with the marriage), and whether he is liked by co-workers on the job.  Although he recognizes that his worries are often unfounded, he can’t stop worrying.

For the past 2 years he has had few social contacts because of his nervous symptoms.  Although he has sometimes had to leave work when the symptoms became intolerable, he continues to work for the same company he joined for his apprenticeship following high-school graduation.  He tends to hide his symptoms from his wife and children, to whom he wants to appear “perfect,” and reports few problems with them as a result of his nervousness.

Please respond (short answer is fine) to all of the following questions:

In your diagnosis, please use DSM IV-TR diagnoses when appropriate (found in your powerpoint presentations)

1. What are the client’s most prominent ‘presenting issues’ (that is, what seems to take priority as being wrong)?

1. What else do you feel you need to know (or, what might be some areas you may ask about in order to determine what is going on and how severe the problem may be)?

1. What do you think may be your ‘initial diagnosis’ based on the information given in the case study? Why?

1. What, if any, psychospiritual factors might be present and maintaining the presenting issue?

1. What are possible methods of treatment or referral?