CASE EXAMPLE

Allen is a 65-year-old who retired as a history teacher 10 years ago. He is coming to counseling at the insistence of his wife and adult children, although he states that he doesn’t think counseling can help him. He reports that his wife says he repeats things “constantly” and although he shares that he may say things “a few times” because she didn’t hear him, he does not believe that he does this “constantly” and does not really think it is a big problem. He also shares that his wife tells him he is very impatient, although he is dismissive of this concern, again saying he thinks he is “not that bad.” He does admit that he has been depressed in the past and that he has been having a difficult time more recently feeling any motivation or interest to do anything.

He expresses unhappiness because his wife recently retired from her full-time corporate position, but she continues to be very busy, continuing to work as a consultant and engaging in many activities with her friends. Allen, by comparison, reports that “all my friends are gone” and shares that although they are not deceased, they are spread out across the country where he does not have contact with any of them. Allen had looked forward to the time when his wife would retire, as he had expected that the two of them would spend more time together, travel, and enjoy retirement together.

Allen has been spending his time busying himself with household jobs, working on his own art, assisting his wife with her work projects, and planning their vacations. He enjoys a glass or two of wine with dinner and states that he is just a “social drinker.” He has experienced some times with sadness in the period of time since he retired but got through those times by focusing on his future hope about his wife retiring. At several points in the interview, Allen sighs and states, “I just feel like a total nothing.” He reports increasing disinterest in his previous interests and hobbies and that “I just can’t get interested in anything anymore.”

He admits that he has had some thoughts of suicide but then feels both ashamed and horribly guilty for how that would affect his family, which then serves to make him feel very sad. Allen says he is coming to counseling to see if the mental health provider can figure out what is wrong with him and admits that he is afraid he is “crazy.” On collateral consultation with Allen’s wife, it is apparent that Allen has minimized the intensity of his angry outbursts, and she admits that she has felt frightened by Allen’s outbursts.

DISCUSSION QUESTIONS

1. What are the prominent clinical issues?
2. What provisional diagnoses would be important to consider?
3. What models discussed in the text would be useful?
4. What other professional, medical, and/or social services may be important in this case?