Case Study

Case Study: Harold

Harold is a 22 year old single man who comes to therapy at this time because he just obtained health insurance. He has never been in therapy before. He complains of feeling depressed, irritable and angry. He also reports that he thinks too much about the past (when he was a child) and remains angry with his mother and father who both drank heavily. On a typical night, Harold himself will drink three shots and a few beers.

Harold reports having no friends and states that he doesn’t “know how to make friends.” He has never had a friend. He spends what leisure time he has with his aunt, helping her out whenever she asks, even though his aunt has her own son who could also meet her needs. This aunt has one son, the age of Harold and the two “hang out” at his aunt’s house. They do not go out because his aunt’s son “never has money” leaving the client to pay for everything. The only other contact with someone his own age is his mother’s previous drinking partner’s daughter. He believes however, that she gossips about him and he can’t trust her.

Harold works close to 60 hours per week at a job that pays $10.50 per hour. He has recently purchased a car and reports that he needs to take on overtime hours to meet his expenses. The only expense he reported however was his car. He lives with his father and step-mother. His mother died when Harold was 18.

Harold recently joined a gym but has not yet gone to work out. He is overweight with poor posture and a weak handshake. He wears stylish thick glasses which he reports just purchasing. When asked what he likes most about himself, he at first could not find anything he liked about himself. With encouragement, he did report that he liked the color of his eyes. He reports that he thinks negatively about himself countless times during the day.

Harold reports being bi-sexual and has had a one-time fling with a man. He has never had a girlfriend or had sexual intercourse with a woman but he would like to meet one. During the session, Harold expressed embarrassment when speaking of his sexual history. He stated that he is afraid of women and blushes and stutters in their presence. He has attempted to meet women at bars but again, becomes so self-conscious that he needs to excuse himself and throw up from his high level of anxiety.

Your mission:

1. Conduct a behavioral assessment (chapter 5)
Clarify the problem
Set initial goals
Select and define target behaviors precisely

2. Recall that there are eight most frequently used assessment methods but the only one available to you is an interview. What five questions might you ask Harold?

3. Design a treatment plan: From the chapter that speaks to modeling, imitation and skills training, what interventions might you implement? What design would you use?

4. Monitor the client’s progress: What type of data collection would you use?

5. If you were to use exposure therapy, which would you choose – brief and graduated or prolonged and intense?

6. If you were to use modeling, describe what and how you would use this type of intervention.