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Gary is a 39-year-old male who comes into your office complaining of a variety of life stressors. To begin with, he lists the following:

  • weight gain of approximately twenty pounds
  • insomnia and interrupted sleep
  • decreased self-esteem
  • general fatigue
  • moodiness and irritability
  • anxiety
  • loss of appetite followed by increased eating
  • decreased libido
  • feelings of guilt stemming from loss of income due to economic troubles (business owner)

Gary has been married to his wife for twelve years. The marriage has had its ups and downs, but it is intact and relatively happy. Gary’s wife is a successful business owner with many irons in the fire and a healthy income (six figures). As is the case for Gary, his wife has to put the majority of her income back into her business ventures. The economy has taken a toll on the couple’s savings and investments, as well as on the way of life to which the two have been accustomed (doing and buying all they wanted—for an upper-middle income household).

Gary holds a master’s degree from Johns Hopkins University. He obtained his MBA and has ventured out in his own business. He has one full-time employee and a receptionist/data entry person who works hourly. He recently moved from a home office, which he shared with his wife, to a new office that has space for his employees. The office is large enough to be used as a meeting space for his clients. His list of clients has grown, yet the clients tend to pay later than Gary desires (60 days or more), and he often has to have his virtual accounting office prompt them for payment.

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Gary has to have a good cash flow in order to pay his employees, pay off his bills, and meet his family obligations. Due to a pre-existing health condition (his wife has a chronic illness), his health care premium is enormous (over $1K per month for his family plan alone). This does not include the premium Gary must pay for his full-time employee. Gary’s wife paid the family health care premium on her own plan for over two years. It cost her $1,600 per month to carry the entire family (which she did with no complaints).

Gary took over the premium, as he felt that his wife had carried that nearly $2K per year burden alone while he built his company. She had also covered all the expenses he was not able to pay during that time. Gary has stated that he could not have embarked on his private venture without his wife’s support (financial and otherwise). He feels that this has put a strain on his marriage in these stressful economic times.

Gary and his wife have two children, ages 6 and 9. Both are healthy, smart, obedient, fun, and well-behaved, per his report. Gary has no concerns regarding the children at the time of his visit. His wife works very hard to support the family and take care of the children. While Gary works most days from 8 a.m. to any and all hours of the evening, his wife does “double duty,” making nearly 200K and acting as a stay-at-home mother.

Gary feels that his wife’s deteriorating health stems from her attempts to do it all and be there for the children and him. While his wife does not complain, he feels and understands that she must resent him for her 24/7 work schedule that has been set to accommodate his business. As the economy has declined, Gary has felt his overall physical, emotional, professional, and personal state in decline.

Gary comes to your office asking you to help him regain control of his situation and make a plan to turn this cycle of decline around. Your assignment is to analyze Gary’s case and give this client a preliminary diagnosis using the International Classification of Diseases, Tenth Revision (ICD-10 link) provide a diagnosis.

Then, you will discuss your rationale for each decision using the knowledge you have gained in your studies. You will include homework assignments for this client in order to anchor his commitment to treatment and help him attain results.

Your paper will be around 6–8 pages.

Your directions for this case:

  • What is your diagnosis of Gary? This is your first session/intake, so your information is limited to the above. (20 points: rationale; proper use of diagnostic coding; one-page discussion)
  • What are the key symptoms that led you to your diagnosis or treatment concern? Explain and be specific. (15 points: rationale; one-page discussion)
  • What are your treatment goals for Gary? (20 points: rationale; one-page discussion)
  • What are Gary’s strengths as you see them (look for these to assist you in being a good helper for him)? (15 points: rationale; one-page discussion)
  • What are areas for improvement for Gary? (15 points: rationale; one-page discussion)
  • What two homework assignments will you give Gary to work on for his next appointment with you? (7.5 points: rationale; one-page discussion)
  • What are some areas you will explore next (e.g., Gary’s relationship with his wife; professional goals)? (7.5 points: rationale; one-page discussion of your reasons for wanting to find out this information)
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