For the purposes of the case study the client will be called Jane.
Jane is a 22 year old single white British female who lives with her parents in a house outside the city. She is heterosexual and has had a boyfriend for seven years. She feels unable to discuss her issues with her boyfriend. Her parents both have mental health issues and Jane does not feel able to talk to her mother about her problems. She has an older brother she has a good relationship who lives with his girlfriend, a four hour drive away.
Jane is educated to degree level, having studied Criminology and is currently working part-time for her father managing his client accounts for a business he runs from home. A typical day involves organising all receipts and creating spreadsheets for each client’s accounts. Jane states she would like to get a full time job and be normal like her friends. Jane has a small circle of friends from university who she states have all gone onto full time employment. Jane also has a puppy she spends time looking after and taking for regular walks.
Jane was referred following a health check at her GP surgery. She had been prescribed Citalopram 20mg by her GP for anxiety symptoms and panic attacks she had been having for two years. Jane has no previous contact with mental health services. Jane’s father had a diagnosis of Bi-Polar Disorder, her brother has Depression and her boyfriend has a diagnosis of Obsessive Compulsive Disorder which he is continuing treatment for. Jane’s anxiety/panic has increased over the past two years. She had read about Cognitive Behavioural Therapy on the Internet and was willing to see if it was help ease her anxiety symptoms.
Jane stated that the problem started due to family issues in 2007.Her brother and father were estranged due to a financial disagreement and this resulted in Jane’s brother leaving the country with his girlfriend, causing Jane to become very distressed. Also during this time she was taking her final exams at University, Jane states this was when she experienced her first panic attack. She had spent the evening before her brother left the country, drinking alcohol with friends, she remembers feeling ‘hung-over’ the next day. While travelling in the car to the airport, with her brother and his girlfriend, Jane states she started to feel unwell, she found it difficult to breathe, felt hot, trapped and felt like she was going to faint.
Jane stated she felt “embarrassed” and “stupid” and had since experienced other panic attacks and increased anxiety, anticipating panic attacks in social situations. Jane had reduced where she went to, finding herself unable to go anywhere she may have to meet new people. Her last panic attack happened when Jane visited her GP for a health check and fainted during the appointment, Jane has blood phobia and she stated she had not eaten since the day before and was extremely anxious about the any medical interventions. Jane believes it was a panic attack that caused her to faint. The GP prescribed her 20mg of Citalopram, a few weeks prior to her initial assessment with the therapist.
When Jane and the therapist met for the initial session Jane described herself as feeling inadequate and as if she was trapped in a cycle of panic. Although Jane felt unhappy she had no suicidal ideation and she presented no risk to others. Jane stated she had become more anxious and that she had panic attacks at least twice a week.
Prior to and during therapy, Jane was assessed using various measures. These enabled the therapist to formulate a hypothesis regarding the severity of the problem, also acting as a baseline, enabling the therapist and Jane to monitor progress throughout treatment. (Wells, 1997). The measures utilised in the initial assessment were a daily panic diary, Wells (1997) and a diary of obsessive- compulsive rituals, Wells (1997) a self rating scale completed by the...