Case Formulations & Presentations Unpleasant Family Relationship Case Stuy

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timer Asked: Mar 29th, 2019
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Question Description

Attached you can find information about person I would like to use for paper. So your task would be to add this information according to outline plus add more info where necessary, while comparing to the sample paper. Let me know if you can work on it.

CASE FORMULATIONS AND PRESENTATIONS:

  1. Who this person is to you?-friend
  2. How you gonna get information?-interview
  3. What at this point you are formulating? There were a few main areas of concern for the client.These were a lack of support from his family, his inability to accept his experience of unpleasant and sad emotions, and his not understanding of broken family connections.He has a strong attachment to the family, and has an inability to let go of his past relationship.

Outline:

Presenting problem:

  • Describe in terms of behaviors, thoughts, and physiological response.-DETAILED
  • Exact number of incidences in day, amount of hair pulled, etc. Details in the behavior and put into objective terms Where, what, how (many), with who (not why!).
  • Also discuss current triggers context (environment), situational (create hierarchy), behavior cues, thought cues).

History of Presenting Problem:

Only information relevant to presenting problem. Onset and course of illness. When problem started, how , under what condition problem started.

Relevant factors to presenting problem (Development):

Information relevant to the development of the problem. Here you are answering HOW.

Here you are looking at learning theory.

Associated and Maintaining variables:

Here you are answering why does it continue.

How reinforced, etc.

Formulation of the chief complaint:

A summary of the above information describing how it developed, how it is experienced, how it is maintained in a succinct paragraph.

Strengths-resources:

What factors will enhance the efficacy of CBT.

Weaknesses-interferences with treatment:

What factors will interfere with the efficacy of CBT.

Eg, Compliance, physical factors, etc.

Treatment goals:

What you hope to accomplish in measurable factors.

Treatment procedures:

including why they are chosen. Be specific about how to proceed.

How monitored:

Be specific on how you plan to monitor the progress of the treatment and how the tools were chosen.

Sample:

Presenting problem: Pt is a 59 year-old Caucasian female hospitalized for bizarre and paranoid behavior. Specifically, she stopped eating, appeared to be responding to auditory hallucinations, and responded with rage to her family. Just prior to the hospitalization, she left her apartment and drove from Houston to New Orleans to see her son without telling any of her relatives, including her son. She was missing for three days and was found by local police of a small town in Texas after she abandoned her car. She denied any psychotic symptoms when asked directly, but she reported bizarre experiences. For example, she stated that she had died and was resurrected four times. In addition, she reported hearing voices “once in a while” giving her instructions, but believes that they are coming from external sources. It should be noted that during the interview, she frequently mumbled, as if responding to voices, and sometimes laughed during these mumbling episodes.

In addition to these difficulties, Pt has a history of being raped in a car while she was in Belgium 23 years earlier (when she was 36 years old). During the rape, she reported disassociating, and therefore, remembers much details immediately before and shortly after the rape, but little about the actual rape. Shortly after the rape, she developed intense fears. Currently, these fears are triggered by being alone with strange men, being in a car with a male, and being in a reclined position (e.g., in a dentist chair) when a male is near. In addition, about once a month, she hears voices commanding her to perform an action in order to avoid a rape like experience to which she responds with great fear. For example, a voice commanded her to get off the couch or “something gooey” would get in her hair. She reports being chronically on edge and easily startled by sudden noises and continues to have intrusive memories of the rape almost every day. These memories cause her to be agitated and fearful, and she experiences increased heart rate and nausea. She attempts to avoid these thoughts and avoids being alone with males. She experiences little connection with others and reports being irritable for most the day. She reported that the rape has changed her life and that she cannot feel normal feelings anymore. It is for these symptoms related to the rape that she requested therapy.

History of Presenting Problem: Pt returned to the United States a month following the rape. It was upon her return that she remembered experiencing the intrusive memories that led to intense fear. Other symptoms soon developed and intensified. Pt soon began avoiding others, especially males, and refused to “go on dates.” In addition, after having an episode of intense anxiety after the dentist put the chair in a reclined position, she avoided all visits to the doctors. She reported having nightmares, of the rape, as well, which led to fear and avoidant behavior of sleep. It was around this time that she reported first hearing the voices speaking to her and giving her bizarre warnings. Her symptoms remained steady for several years, with some increasing in intensity, duration, and frequency. At this time, she began supportive psychotherapy with a female directed at alleviating these symptoms. She reported some symptoms reduction, such as an elimination of her nightmares and reduced tension, but she continued to avoid males, and experienced intrusive memories and subsequent intense anxiety. Her psychotic experiences apparently also increased and she was hospitalized for the first time at the age of 46. She was given antipsychotic medication, which reduced her anxiety as well as the disorganized behavior and hallucinations. Following this, she obtained a job caring for an elderly man. She worked on and off at various “care” positions. Due to the side effects of the medication she frequently discontinued them. After several months without the medication, her psychotic symptoms would worsen and she would be hospitalized and put back on the antipsychotic medications. Including her current hospitalization, she has been hospitalized four times. She reported that even while on the antipsychotic medication, her memories of the rape caused intense fear, but the memories were less frequent. She also continued to avoid being alone with most males, but could manage the fear when the males were people she knew. After 23 years, Pt still reports being bothered by intense fear and avoidant behavior related to the experience of being raped.

Relevant factors to presenting problem (Development): Little history of her family is known and she denies any family history of illness. According to the patient, she was raised in a “strict Christian” home. Her “relationship with God” was very important to her and she often “evangelized” to people who would listen prior to the rape. In fact, she stated that she entered the stranger’s (rapist’s) car in Belgium because she thought it would be “an opportunity to talk to him about God.” When it was discussed how being a Christian influenced her rape experience, she stated that she could not get angry with the rapist. Specifically, she reported more guilt about the consequence to the man after he was arrested. Clear self-blame was also apparent as she searched for her own behavior that led to the rape.

In addition to these cognitions, Pt also stated that her upbringing made “sex” a taboo topic to discuss. “Sex is only to be experienced with a husband.” The idea of “being violated” was hard for her to accept, and indeed, at times (and because she does not remember the actual rape), she questions whether she actually was penetrated.

A recent physical examination found her to have high blood pressure that was being treated with medication. Nothing else was remarkable in her past or current medical history.

Associated and Maintaining variables: Pt’s avoidance is the most outstanding maintaining variable. This avoidance presents itself in many forms. She avoids certain situations (e.g., taxi cabs, being with unfamiliar males) that maintains her fear, as well as subsequent avoidance of certain activities and places. Her avoidance of thinking about the rape and lack of memory of the rape inhibit her ability to process the experience and further reinforce her fear of the thoughts. Also, her response to the “voices” leads her to avoidant behavior. For example, when the voice warned her to get off the couch or “something gooey will get in (her) hair,” she immediately got up and left the room.

In addition, her subsequent beliefs that “the world is unsafe” and that she “cannot trust herself” further maintain the fear and hopelessness that she experiences. These overriding schemata influence her behavior and responses to the environment.

She is frequently tense and on edge. This keeps her sensitive to anxiety provoking thoughts and experiences. This physiological state maintains fear cognitions and behaviors.

No secondary gains are evident at this time. Pt is receiving assistance for her thought disorder; therefore these symptoms of trauma are not reinforced as a source of financial support. Her brother provides her with the same support regardless of these symptoms and no apparent benefits for these symptoms are evident. Pt, however, might prefer to be identified as someone suffering from a trauma rather than from a thought disorder. No exaggeration of trauma related symptoms are evident.

Formulation of the chief complaint: Pt is a 59 year-old Caucasian female entering therapy for her symptoms related to a traumatic event. She experiences intrusive memories of a rape that trigger intense anxiety, in addition to several other trauma related symptoms. Her religious upbringing and prior experiences helped establish schemas about the world and her safety. Specifically, prior schemas were: “bad things happen to bad people,” “women are at least partially to blame when they are raped,” “someone who is raped is a ‘dirty person,’” and “the world is a safe place”. The traumatic experience of a rape challenged these beliefs. In turn, these beliefs were activated and applied to her, causing a strong sense of anxiety (The world is unsafe, people are unpredictable and can harm you, I cannot control what can happen to me) and depression (I must be a bad person to be raped). These thoughts are maintained by her selective attention and sensitivity to evidence that supports these thoughts. Her psychotic symptoms also reinforce her belief that she cannot take care of herself and that she cannot even trust her own judgment.In addition to these cognitions, her avoidance maintains her anxiety. She avoids thinking about the rape so that when she is reminded of it, the intense anxiety occurs. Her avoidance of situations also maintains the current level of anxiety.

Strengths-resources: Recent assessment revealed that Pt’s cognitive functioning is higher than average, which is especially unique for an inpatient population. Specifically, her Verbal IQ was measured to be 119 (as measured by the WASI) and her immediate and delayed recall of context-relevant verbal (Logic Memory) and non-verbal (Family Pictures) information, as well as her mental manipulation of verbal information (Letter-Number Sequencing) ranged from scaled score of 12 to 15. In addition she is oriented to time and place. This strength in cognitive functioning will assist her in understanding and remembering the CBT formulation and techniques.

In addition, Pt is motivated for treatment and has the support of her group home. The home will provide her transportation to the sessions and provide other support in her therapeutic efforts. In addition, the patient believes that she will benefit from therapy, and has shown behavior that indicates a potential for good compliance (e.g., completing assessment procedures on time and with much thought, arranging her own transportation to the sessions). She reports being enthusiastic and eager to begin therapy.

Despite having somewhat blunted affect, Pt still remains connected with others. She reported being comfortable with the therapist (who is male). This rapport will be essential as treatment begins and details of the rape are elicited.

Pt is enrolled in a socialization program that will focus on improving her job skills. She will be trained on the computer and on greeting guests. This program will also provide opportunities to challenge her cognitions and behaviors (e.g., being alone with unfamiliar males, experiencing competency).

Weaknesses-interferences with treatment: The primary concern is the psychotic experiences in which she reports little insight. These symptoms may interfere with her understanding of the formulation, ability to retain prior knowledge, and engage in the therapy (e.g., challenge her belief). Therapy may be especially difficult during active psychotic phases. This also may make exposure techniques difficult as the intense emotion may trigger a psychotic episode or the habituation to the feared stimuli may be stalled.

As is common with long lasting PTSD symptoms, Pt also is experiencing a high level of depression (33 on the BDI). The depression may also interfere with exposure techniques and cause additional distress.

Treatment goals: The primary goal is to reduce the trauma-related symptoms. Specifically, we aim to increase the time free from intrusive memories of the rape and limit the impact these memories have on Pt. Also, we hope to reduce the level of tension and agitation experienced, and cease the avoidant behavior and increase adaptive behavior. It is expected that, as the trauma related symptoms decrease, her depressive experiences will also decrease as they are highly related to each other. It is also expected that her psychotic symptoms will be less intense and less frequent due to the reduction in the stress caused by the trauma symptoms. This will reduce the amount of stress that can trigger the onset of psychotic symptoms.

Treatment procedures: Pt has strong verbal and memory skills that will likely respond well with efforts to identify her negative schemas and subsequent automatic thoughts. Therefore, efforts to challenge cognitions are highly recommended. She can receive interventions to educate her about the effects of her negative automatic thoughts, how to identify them, and subsequently how to challenge them.

Behavioral intervention can include engaging in positive behaviors to increase positive experiences and teach her the behavioral-feeling connection. Also, engaging in behaviors that challenge her irrational beliefs may be necessary. Exposure should be performed with caution due to her psychotic experiences, as well as depression. However, exposure in the session can include repeated descriptions (written or spoken into a tape recorder) of the rape to access the memory of the rape. The goal here is to help her process the experience emotionally rather than to habituation (due to the psychotic and depressive symptoms). The exposure in the session can monitor Pt’s reaction to the description in order to assist her if the exposure is difficult to manage.

Because of the tension Pt experiences, she might benefit from relaxation training. Efforts can be made to identify a method in which she responds well. Different techniques should be explored during sessions.

How monitored: Every four sessions, Pt can complete the IES, a measure of PTSD symptoms, BDI, a measure of depression, and the PTCI, a measure of distorted cognitions associated with traumatic experiences. This will monitor progress toward the goals of therapy. Every session, Pt can provide a general rating of tension, anxiety related to intrusive memories, and depression to show the progress of subjective experiences. These ratings can be graphed to provide Pt with a picture of her progress in therapy.

As each assignment is assigned, an additional assignment will be to monitor reactions and changes associated with the assignment. For example, Pt can be asked to rate level of depression and happiness before and after engaging in a positive behavior.

Unformatted Attachment Preview

Case Presentation Outline Demographics P.K. is a 63-year-old single white male, with a Eastern-European last name, firstgeneration Slovak-Canadian-American who came to counseling (voluntarily) because he was experiencing an unpleasant family relationship related to two of his cousins form Canada. P.K. is a successful attorney practicing law for over forty years. He has never been married. He is very religious and attends Church services regularly. P.K. was born in Canada and moved to Hammond, Indiana when he was 9 years old. He speaks English and Slovak. Key findings The client expressed his sadness over his family issue. He described his sadness as very extreme during his recent visit to Canada. He expressed anxiety upon the thought of his next visit. He described his cousins as manipulative and verbally abusive and expecting him to take sides in a family dispute. In the beginning, this had an effect on his ability to work. Now, he best copes with his sadness by trying to stay busy with other activities and “not think about it”. He claims there are no particular triggers to his situations, and it currently has no other effect on his physical health. Background The client was very close to his deceased parents and his two sisters. P.K. had a “big” problem with the alcohol in the past, and he has been sober for the past 10 years. He enjoys attending AA meetings and works with newcomers in recovery. During his addiction to alcohol, he experienced a few arrests for alcohol-related offenses. His past relationship with his extended family was very strong. P.K. feels that the main problem in his relationship with his cousins is their long-time feud related to their mother. Formulation There were a few main areas of concern for the client. These were a lack of support from his family, his inability to accept his experience of unpleasant and sad emotions, and his not understanding of broken family connections. He has a strong attachment to the family, and has an inability to let go of his past relationship. Interventions and Plans I used nondirective listening skills such as eye contact, proper body posture and verbal tracking in an attempt to identify the reasons why he is sad. I also explained that counseling is not about moralizing or laying blame, but rather it is about empowerment to cope with, move on, and grow through situations. I was able to develop a relationship with the client and gain a significant amount of information and trust in the relationship. Once good rapport was established, I turned to address the client’s issues relating to negative emotions and letting go. In future sessions, I would use a visual strategy, which would help the client to express his emotions and feelings, and to make that feeling a concrete thing to his issues. The second approach would be paralleling in order to enable him to highlight his strengths and to show him that he already has the tools to resolve his issues. Reason for Presentation I believe this case is ordinary but it gave me an opportunity to work with a very unique client. I also believe that technique that will be applied will be beneficial for the client. I do not think I need help with the case, and it could be beneficial for others to learn from my experience. Interviewer: And let me start with asking you some questions. First, so what prompted you to come seek treatment today? Client: I am disturbed regarding two cousins who are feuding with each other. Their sisters are feuding over the deceased father and living mother and they take sides and when I am visit them it is difficult to visit them and discussed the other family and cousins because they are not getting along. So, recently when I visited them I went to a funeral and their and family and I was sitting with other cousin, I stay overnight with first cousin and I set with other cousin at funeral luncheon and the son of the first cousin was angry with me that I spent all my time at funeral lunch sitting with cousin that is feuding with his mother. Then when I drove back to the first cousins home with them in their vehicle than he land basted me for spending all of my time at the sitting arrangement with the second cousin, his aunt and he complained that it was the optics looked bad. And I was appalled that he was concerned about the optics. He is new medical doctor and he was concerned about the optics, basically how it came off to the other people that we were sitting at the luncheon that it may looked I am taking sides. I am siding with second cousin his aunt and not with first cousin who hosted me the night before for overnight stay. We went to funeral home night before together and all of that so I want to share my time with each cousin and try to find out from second cousin at first cousin request what is going on with finances of the home that was sold from the mother and what is going on with that because it seems to be inequities. So they are having a long standing sister feud and I am trying to remain neutral as the oldest cousin in the family and I got criticized by the son of the older sister for because it looked like I was taking sides. And I said I do not want to get involved and not being in middle of it. I wanted to be OK and good with everyone. I feel it is my, that is normal thing to do and I feel it is my duty and responsibility as the oldest of 14 grandchildren that one of these days when their mother who is last sibling of my mother, one of these days when she dies that I am going to be patriarch of that side of family and I think as being the oldest, the oldest grandchild of the oldest living cousin I have a duty to not participate in divisiveness and division and try to be a get along with everyone equally and be a peacemaker and a I was criticized for, for saying that I love all my cousins equally because that the family of the older sister hates the family of the younger sister and therefore they do not want to hear me say that I love all my cousins equally and I was criticized for that. And that disturbed me because it is first time in my mother side of the family that we had that I was attacked verbally and such a negative way by great grandson who is now medical doctor. He is the most educated amongst all of them in the family and I was verbally attacked for not wanting to take side and they were, they thought it was my duty to become an investigator with second cousin regarding where the moneys are at from the proceeds for the sale of their mother house and I did not think that was my place, nor my duty and I was criticized for that and I did not appreciated that at all. Then afterword I went down the road to visit my other aunt who lives two hours away and met with cousins from that family and I was heartbroken and shared with them all of my hurt feelings that I just experienced earlier in a day and how it was very bad day in my life on my mother side family for the first time ever and that I am experiencing disunity and what I think was a unjustified criticism. Interviewer: Alright, OK, I appreciate your input and explanation. I understand completely, but before we go back to that topic that clearly bothers you and give you stress let me ask you some personal questions first and then we can go back. Is there any other stressor in your life that you are experiencing right now? Client: Nothing that is really disturbing me greatly as much as what I just shared with you. Interviewer: And I would like to know you little bit more personally better so is there anything important about you that I should know particularly? Client: I am an attorney and I have several jobs and positions within that line of work that keep me busy and active. I am also very active in 12 step programming, spend great deal of time going to AA meetings and participating in meetings and helping new comers into recovery to get well and speak at hospital as well. I spend good amount of my evening time attending such meetings and dealing with and discussing with new comers along with socializing with friends that I met in last 10 years in a program and I get some gratification for being of service to people who need help at a difficult time in their life. Interviewer: Did you have any treatment or any difficulties in the past? Client: No, I've not had any mental health treatment unless you want to consider the intensive outpatient program when I had some troubles with alcohol 10 years ago where I have to then attend intensive outpatient program for 3 weeks followed by after care in order to get an order to continue with recovery from problems in life that created by alcohol abuse other than that I didn't have any kind of mental health treatment or anything. Interviewer: OK, Let me ask you now if you are comfortable with some social history some social questions like, how would you consider your life and your friends and your life and do you belong to any organization. What do you value a lot? Client: I consider myself very lucky to have lots of friends and acquaintances that I can always work with and be comfortable with socially starting with my church and ethnic community with our Slovak people and church and social functions along with the legal community fellow lawyers that I've known for many years, this is 40 years now that I am practicing law. So I have a lot of good lawyer friends and friends of judiciary as well as lawyers that are part of professional socialization and also social life activities with fellow lawyers. The AA program that I go to is big part socialization as well as substance of discussion that we had in meetings and socializing that goes after meeting and all of other activities that goes with that. So, there than I am always active in politics I have held public office in the past and I always attend regularly fundraisers for friends who have supported me and in the past who I supported so as far friends acquaints and all there is a lot of people that I have a come across, became acquainted with in adult life that I am in always in contact with there is a feeling of never being alone. I am always busy doing something or with people like a people person, always with people, day in and day out and all of those different communities that I am active in. Interviewer: So what would you say what your major strengths are? Client: My major strength I think is of being of service to others both in my line work and in my church life and in the part of recovery with 12 step programming. It is serving others and helping others. That is also part of 12 step in recovery of whatever is for alcoholism or people with narcotics troubles or any other stuff that of the 12 step is service so I spend a lot of my time in service paid or unpaid or volunteer weather is in my law practice in my church life or in recovery mode or anything like that it is helping others. Because it was said by Cardinal Francis George at his eulogy the Archbishop of Seattle eulogized Cardinal Francis George and said that he said that when we died the only thing that we can take with us what we gave away. And that was a profound part of eulogy that was video typed and shown on a top of network news on all three local Chicago stations and it is very profound and it is true only thing that we can take with us what we gave away, so I try my best on a daily basis to be of service and help others as best as I can and that is very rewarding and gratifying. Interviewer: And if may I would like to go back to the first thing that we talked about some issue with your cousins and I would like to ask you questions like what changes do you hope this if you can call therapy or I should say interview or this conversation will lead to? Do you have any expectations? What would you like to accomplish? Client: No I do not have expectations because other than just it feels better to share with someone else to talk it out and talk it over to get things of our chest as we say, as far as son of my cousin that was upset on a day of this family funeral that we went to with seating arrangement he is 30 years younger than me he is new professional we were bonding together because I was a first professional in the family of my generation and he is a first professional in a family of his generation so we bonded well together for all of his life. He is 33 years old now so it was sad that stress came from him and I tried to, I tried to hold withdraw and hold myself back and not do anything that would be aggressive or add fuel to any fire and just withdraw and hold back and let him think things through and maybe with passage of time he will realize that I am not a part of what caused the division between his mother and his aunt and hopefully with passage of time since we are in long distance relationship they live in Windsor I live in Chicago area that maybe passage of time will have him cool of and if he does not cool off than I can just attributed to immaturity of that station in life regardless of how professional he may be as a medical doctor there is still, he is protecting his mother integrity which I told him that I respect him for protecting his mother integrity but that does not mean that I need to take a side. And so he is involved as a medical doctor with people physical health and I think that he will learn with passage of time that longer he would carry this resentment or grudge that also would affect his own mental health and his professional enough that he should be able to see mental health and physical health often time go hand in hand and we need to have harmony with physical health and mental health and hopefully he will come to realize that maybe one particularly luncheon was just of base and hopefully let it go and move on as a family where I get along with his family and I get along with other cousin and her family and just because of they do not get along with each other does not mean I can get along with both of them. Interviewer: Sure, what do you think and how do you feel if this situation does not improve with them? How would you feel? Client: I gave that a lot thought and it is hurtful and painful and if he wants to continue holding the grudge I am just going to have to accept something that I do not like having to accept but just have to accept as is that is the way is and wish him best and move on in my own way and if they extend their hospitality on my visit to my hometown I will receive it and if they do not than that is their situation and not mine and just continue in my family life with rest of cousins without them. I am not kicking them out of my life and if they want to so to speak disassociate themselves with me than I just have to live with something that is difficult to live with because everybody likes to be harmonious with as many in a family and if that is way it is I will just have to sadly accept it and move forward with rest of the family. Interviewer: So, correct me if I am wrong the way I understood you now that what are you saying is in one sentence that you basically realized that you can not changed them but you can only change yourself of course and then since you can not change them and you are trying your best and you gave all the effort that you will be at peace at the end because of situation? Client: Yes, Interviewer: Unfortunately, not Client: Unfortunately, correct that is where we always practice serenity prayer of accepting the things that we can not change encourage to change we can and with wisdom to know the difference and that prayer applies directly in that situation if I have to accept things that I can not change about of son of my cousin than I have to accept that I do not know what courageousness of my heart I can take to change anything because I think that we are not supposed to be involved and controlling and repairing and fixing and managing the other people because of that is, that does not work and so older we get that is where wisdom comes play to know that difference in that so not add fuel to any fire if that is choice that he wants to go than I unfortunately have to accept and just tried to be at peace with myself without him. Interviewer: And I would assume that you gave thought about why he felt comfortable of talking to you in this manner? Client: He told me so, he said that he is protecting his mother and I responded that I am not doing anything that it is threatening your mother. I love your mother and I love your aunt and I love your grandmother and it is appropriated for me to love all three and if you are having problem with your aunt and your grandmother who I love dearly that is not my situation and is not for me to break off relationships with family members that you feel have hurt and offended and crossed you. ...
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henryprofessor
School: Rice University

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Running head: CASE FORMULATIONS

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Case Formulations
Name
Institution

CASE FORMULATIONS

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Case Formulations
Presenting problem: P.K is a sad 63-year-old unmarried Eastern-European white male
individual whose first generation is Slovak-Canadian-American. It is critical to highlight that P.K
has voluntarily come to seek counseling services in a bid to cope with his unpleasant family
relationship with his two Canadian cousins. Despite the current problem (sadness), it is important
to point out that the client is a prominent attorney whose legal practice exceeds forty years. P.K
is extremely saddened by the current wrangles among his family members. He is also saddened
by the fact that his recent visit to Canada earned him substantial humiliation and abuse;
especially after refusing to take sides in the conflict between his younger cousins. Their conduct
has been the primary cause of his sadness. Specifically, P.K is significantly troubled by high
levels of sadness as a result of the current family issue; whereby he complains of the aggravation
of the condition during his last visit to his Canadian cousins. P.K’s problem is deeply rooted in
the manipulative and abusive nature of his cousins who also expect him to take sides whenever
there are disagreements in the family. Initially, the problem significantly crippled his ability to
work as a result of the sadness triggered by the conduct of his cousins. Despite that he currently
tries to cope with the situation by keeping himself busy with other activities, he argues that the
situation is no longer a threat to his physical health. In his background, P.K has previously
experienced chronic alcoholism problem; however, he has refrained from alcohol for the last
decade. He reports that his sadness can also be attributed to the demise of his parents and two
sisters to whom he was very close. P.K, during his alcoholic days, also underwent several arrests
as a result of different alcohol-related offenses. It is also evident that P.K had maintained a solid
relationship with his extended family during the early days. As such, he attributes the strained

CASE FORMULATIONS

3

relationship with his cousins to the historically extended feud associated with their mother. As a
result of these historical and current experiences, P.K reports that has been adversely affected by
increased levels of sadness which is detrimental to his mental and physical health. He is
saddened explicitly by the increasing disintegration of his extended family ties which were
previously very strong, and probably he never thought it would break. Also, he is saddened by
the fact that his nuclear family is no longer existent since his parents already passed on as well as
his sisters. His only remaining family is his Canadian cousins who have turned abusive and
manipulative; thus, making him sad. Therefore, he has decided to seek counseling as a way to
develop succinct coping mechanisms to avoid further adverse effects of the problem.
History of Presenting Problem: P.K’s sadness has evolved over the years since he moved to
Hammond, Indiana at a young age following the demise of his parents. He had had maintained
solid relationships with his nuclear and extend...

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Anonymous
Good stuff. Would use again.

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