General Issues in Psychotherapy

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Sample Case Studies

NOTE: All of the cases described below are entirely fictional. None of the names or other identifying information refer to an actual psychotherapy client. The primary purpose of these fictional cases is to challenge students to enhance student learning regarding concepts presented in the textbook. Some are rather straightforward clinical cases, whereas others incorporate unique challenges to the clinical psychologist.

Sample Case #1

(primarily regarding Chapter 11—General Issues in Psychotherapy, and Chapter 4—Cultural Issues in Clinical Psychology)

Zev is a 45-year-old man seeking therapy from Dr. Miller, a clinical psychologist. Zev is an Orthodox Jew. For many years, Zev has felt compelled to perform very specific, stereotyped rituals dozens of times each day. For example, any time Zev eats, he must tap his fork on the side of his plate five times before he takes a bite. As another example, when he gets undressed each evening, Zev must place his shoes exactly one inch apart other and precisely parallel to the wall near his bed. Zev feels that by doing such behaviors, he is preventing terrible things from happening. If he is prevented from doing these behaviors, he experiences extremely high levels of anxiety. In recent months, Zev has developed more of these ritualistic, anxiety-driven behaviors, and his behaviors have become more severe as well. His family has tried to be patient, but on numerous occasions his behaviors have gotten in the way of their lives, such as the time that he felt compelled to insert the key into the lock of their home “just right,” which required dozens of attempts and a delay of about 10 minutes while his family waited in the rain.

Dr. Miller has diagnosed Zev with obsessive compulsive disorder and he intends to use the most evidence-based treatment available.

Student Thought Questions:
• Do you agree with Dr. Miller’s diagnosis?
• According to the textbook (especially Chapter 11), what is the most evidence-based treatment for obsessive compulsive disorder? • To what extent is Zev’s cultural background (e.g., his status as an Orthodox Jew) relevant to the potential success of the treatment Dr. Miller may use (see Chapter 4, as well as Considering Culture Box 11.3)? Are any of his beliefs too sacred to dispute (see Considering Culture Box 15.2)? • In your opinion, how should Dr. Miller proceed?

Sample Case #2

(primarily regarding Chapter 12—Psychodynamic Psychotherapy)

Mallory is a 25-year-old woman seeking therapy from Dr. Santos, a clinical psychologist. When Mallory initially called Dr. Santos, she described mild depressive symptoms. At the first interview, Dr. Santos began with some open-ended questions intended to allow Mallory to explain the issues for which she sought treatment. Mallory began by describing her dissatisfaction with numerous aspects of her life. She had hoped to be married or seriously involved with a romantic partner, but she was not. Although her job paid her bills, she found it boring and somewhat unfulfilling. About 10 minutes into the interview, Mallory interrupted herself and said to Dr. Santos, “I’m sorry, I know I’m boring you. You’re probably thinking, ‘I have more important things to do, and other clients who need my help more than her—this is a waste of my time.’ I feel bad that I’m making you spend time listening to my stupid complaints. I’m just gonna leave.” Mallory stood up to go, but Dr. Santos urged her to stay and assured her that she was indeed very interested in what she was saying. Mallory stayed and continued, but again after about 10 minutes, she interrupted herself and insisted that Dr. Santos must be bored and frustrated with her. In all, the interview included four such self-interruptions by Mallory.

Dr. Santos was paying an appropriate amount of attention to Mallory, she was careful not to display any behavior (verbal or nonverbal) that would communicate...
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