Generalist Paper

Running head: GENERALIST PAPER

Generalist Paper

sara show

Practice I

bob dole

8/2/2011

Presenting Problem

Following several episodes of reported emotional frustration and relational problems, Steve presented to the therapy office where he had once received marital therapy in order to pursue clarification regarding his own thoughts, feelings, and struggles. He reported that he felt as though his family was plotting against him, and that he just wanted to "figure things out for myself." He also stated, "If they don't want help, then I'm going to try and help myself. It's my turn." He further indicated that he had recently learned of a history of severe mental illness in his family and that he was concerned that he might be the reason why his son was diagnosed with Bipolar Disorder. When discussing his reasons to be evaluated further, Steve indicated that he wasn't sure if he had a diagnosable attention deficit. He reported that he becomes confused easily, has a high amount of energy, and struggles with maintaining focus for more than a short period of time.

Steve disclosed that he is currently experiencing an intense level of frustration within his marriage. Furthermore, he reported that he has become paranoid that members of his family, including his wife and children, are plotting against him. Specifically, he said that holidays, his marriage, his mother's house, and a structured work atmosphere trigger his presenting problems. As a result, Steve was self-referred for psychological testing in order to gain insight on his current frustration and relationship difficulties. Testing was also requested to rule-out Attention-Deficit/Hyperactivity Disorder versus a mood disorder (i.e., Bipolar Disorder), as well as assess his cognitive functioning and provide treatment recommendations.

Background Information

Steve was born in Cuba and moved to the United States in his early childhood. He is the youngest of four children. He indicated that his mother was 13 and his father was 17 when they got married. He reported that his mother and father both worked at a hotel in Chicago. Steve indicated that the quality of family relationships "sucked." He explained that his family was always fighting and that is how they resolved most conflicts. Steve indicated negative memories of his parent-child relationships from youth. For example, Steve recalled that he was punished by being hit with an extension cord. Also, he mentioned that his parents would slap him and pull his hair. With regards to significant family deaths, Steve reported that his father died from lung cancer when he was nine years-old. He indicated that his sister died when she was 20-years-old from a cocaine/suicide overdose and his middle brother died from complications related to AIDS when he was thirty-four years-old.

Steve has been married for the last 22 years. He and his wife, Rosemary, have two sons named Steve, who is 22-years-old, and Anthony, who is 19-years-old. Steve expressed significant dissatisfaction regarding his marital relationship, revealing that they are not sexually intimate. He further stated that Rosemary and he have not been communicating and when they do, they disagree on all matters. Steve revealed that he has been unfaithful and has been having an affair for some time. Currently, he and his son, Steve Jr., are living in a condo while his wife and Anthony are still residing in the home. Steve further indicated that his wife has verbalized her desire for a divorce. In terms of significant friendships, Steve stated, "I am building my army of friends who will go to bat for me." In terms of hobbies/interests, Steve explained that in the last eight months, he has found art extremely interesting.

Steve indicated that he recently started feeling and having thoughts that he cannot get rid of that his immediate and biological family are plotting against and talking behind his back. For example, he reported that, "someone is going to get the best of me and my mother and brother are lying to me." As a result, Steve explained that he has urges to get in his car and drive to Florida and leave this town behind. Steve also reported that he has been having unwanted memories about the sexual and physical abuse he endured as a child. Steve divulged that his first sexual experience was with his sister and her friends, although he indicated that he forgave his sister later in life. He further stated that he was forced to perform oral sex on eighth grade males when he was in the sixth grade. He also indicated that he believes his mother and oldest brother are withholding information from him regarding past events in his life.

Steve is currently not working and has been collecting unemployment for the last six months. Steve reported that he has been in the car industry since he was 18-years-old. He explained that the best thing about the car industry is meeting people and learning from them. According to his report, his longest stable period of employment was eight years at a car dealership. He stated that he received promotions and was successful because he was drinking at least ten cups of coffee a day and "kissing up" to the right people. However, he revealed that he has encountered many problems at other dealerships because of his defiant attitude and the fact that he wants to do things "my way" because it is the right way. When asked about future occupational goals and his ideal job, he replied that he would like to run a car dealership.

When asked how he manages his presenting problems, Steve admitted to self-medication. He revealed that he has been abusing stimulants and drugs since his teenage years. For example, Steve explained that having at least ten cups of coffee and smoking marijuana allows him to concentrate and become motivated. Steve admits to using marijuana daily and has been using marijuana since his teenage years. He revealed that when he is drinking 10 to 12 cups of coffee a day, he does not smoke marijuana. He commented that his wife and sons tell him that he has a problem with marijuana and as a result, he feels guilt when his marijuana use is provoked by his family.