The following essay is a case study of a client named John who is suffering from major depression and was sent to see me for treatment by his concerned wife. I will provide brief background information about John then further discuss interventions and strategies I believe can be applied in each session with my client in order to make John's life more manageable. In the essay, I will be writing as the therapist, and the sessions are based on a ten week period.
BACKGROUND INFORMATION (Case History)
A 27-year-old man named John came to see me with the following litany of complaints, "I've reached a point where I can't go on....Got no fight left in me. And not enough guts to end it here. Best damn job I ever had almost can see my way out of the debt. Now, it's all going to hell...and now I really don't care about anything, except not going back to work. I can't kid myself. I just can't take it anymore. And I have to confess I have no faith left in anything including your profession. I came here on my wife's insistence but I don't think you can help me either....But, maybe I can tell someone how I feel, how balled up I am...I can't find any work...I can't afford to relax a couple of weeks on some warm beach, or forget my troubles with some floozy blonde. Hell that's for the books on the best seller's list. I've just got to go about acting like my normal stupid self and something's got to blow. It goes in waves. Sometimes, I am alright and then I get anxiety feelings, and my heart pounds. I shake all over, and think I am going to die. God, it's awful!"
PRESENTATION OF THE PROBLEM
Since the client appeared to be an intelligent, executive type with a graduate degree, who reported no other major problem, except for the fact that he couldn't stick to a regular job and this is what appeared to be triggering acute anxiety attacks in him, I decided to use Cognitive Behavior Therapy (CBT) with him. In the course of the preliminary investigation it turned out that the client was married; that the wife was very understanding and supportive and that there was no major area of marital discord between the couple, except for the fact that the client appeared unable to hold a job for too long, so he did not have a regular income. In fact, this is what had begun to threaten the stability of their marriage, so on his wife's insistence he had come to see the therapist.
Some years ago, the patient had even tried to launch his own business venture by renting a small store near the entrance to a large building and stocking it exclusively with neckties. For a while, he managed to make ends meet, but soon it became obvious to the wife that his business venture was doomed for failure. This was because around this time, the patient had begun to complain that the shop was "too stuffy," that he didn't have any "elbow room," that the walls appeared to be closing in on him and that at times he feels compelled to go outside and get his "lungs full of fresh air." Soon enough the frequency of these complaints intensified and eventually the couple had to shut shop.
THE CLIENT`S REACTION TO THE PROBLEMS AND SYMPTOMS
I had worked with many clinically depressed patients before, but this one, despite the severity of his symptoms appeared very motivated for change and prima facie also appeared an intelligent, reasonable patient to deal with.
CONCEPTULALISATION OF THE PROBLEM
As is clear from the patient's description of his problems, most of the symptoms that he has described --- sleeplessness, weight loss, loss of appetite, loss in interest in major activities --- fit in very well with the American Psychiatric Association (APA's) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. (DSM-IV criteria). So my diagnosis was that this patient suffered from major, clinical depression.
Further I realized that since, personal reactions, thoughts, and expectations play a significant role in the etiology and...