Question:
What is the treatment plan
What the common treatment goals for the chosen diagnosis.
Why is the chosen diagnosis
What is the main important goals for treatment
Explain the diagnosis
Caroline called to make an appointment with a counselor. She asked the intake worker if there was anyone who specialized in “working with people with fears.” She stated that she has been having trouble driving her car lately due to “some fears I have.”
Caroline comes to the initial session the following day after her shift at the hospital
is over.
Caroline has been married for 15 years to her husband, Alex. She has two children, a girl named Josephine, age 14, and a boy, Carter, age 12. Caroline works a rotating shift at the hospital on the surgical floor. She switches between the 7 a.m.-3 p.m. shift and the 3-11 p.m. shift. She rarely has to work the 11 p.m.-7 a.m. shift unless they really need her to work. She has 15 years of experience as a registered nurse.
Caroline begins the session by explaining that she has trouble with certain fears, which have
been gradually increasing. She feels that the fears are beginning to interfere with her work
and the rest of her life, and she doesn’t know how to get control of them. She states that her
husband recommended she go to counseling and that she just needs to learn how to relax.
She states that her initial fear concerned driving. “I just began to feel very nervous about
driving the car by myself. I can drive the car to work, but it is difficult. I’m always so relieved
when I get into the hospital. My house is only about 2 miles from the hospital, so it’s not too
bad, but I begin to get nervous about an hour before I have to go every day. Driving around
town is a whole other story. I really don’t do it unless I absolutely have to.”
“During the week, I just pretty much stay at home except to go back and forth to work. I’ve noticed lately that it’s much worse when I get off at 11 p.m. and have to drive home in the dark.
I don’t like to be out when it’s dark.”
” I have a fear of being out at night . . . anywhere, anytime. I just don’t like to be out in the dark. It makes me very anxious,” Caroline tells you.”I really hate to stand in line at the grocery store. It scares me for some unknown reason. I begin to feel really uncomfortable, like I have to get out of there. So, I just refuse to do it. I make my husband or one of my children go to the grocery store with me and stand in line. I know they think I’m crazy, but I can’t help it. It just scares me to death.” Caroline looks distraught and anxious just talking about these issues.
“How long have you been having these fears?” you ask Caroline. “I guess it started about a year ago. I didn’t used to have any of these fears. I could go anywhere, and it didn’t bother me. It’s been a gradual thing that I’ve noticed lately is getting worse, so I thought I better try to do something about it before it gets really bad. I think my husband may be right. I just need to learn how to relax.”
Caroline was asked when she remembers her first anxiety attack. She responds “Well, yes, about a year and a half ago, I think it was. We were moving from California back to the East Coast, and I was traveling alone with my dogs and cats and a carload of stuff, and there were these long tunnels out West that I had to go through. I remember getting into this one tunnel and the traffic slowed down to a crawl because of an accident. All of a sudden, I thought I wasn’t going to get out of there alive. I remember feeling like I couldn’t catch my breath and like I was having a heart attack or something. It was one of the scariest experiences of my life.” “Okay. And this was before you had all these fears you described earlier, is that correct?” you ask.
“Yes, before I got scared to drive. But for a long time after that incident I was really scared
that would happen again. You know, that feeling like I’m having a heart attack. I was really
afraid I was going to die in that tunnel.”
You ask, “Prior to that incident, did you notice these fears?” Caroline responds that she didn’t remember these types of fears, she didn’t remember being afraid of anything in particular. She does remember having some increased feelings of anxiety whenever major changes were happening in life, but believed that was typical. She stated “Don’t most people feel anxious about starting a new job or moving to a new city”? You asked her to tell you more about that. She responded that new situations typically caused her to feel more anxious and she would have a hard time sleeping for a few nights before, and needed to stay busy just before starting a new job in order to keep her mind off things. She said that before moving to another city, she was busy anyway, but she had to stay focused on her packing, otherwise she’d begin to worry about whether people would like her in her new place, and if the neighborhood would be safe. She said she usually had similar questions about new jobs as well. She would wonder if she was going to do well, if co-workers would like her, and if she’d fit in with the company culture. She said that she didn’t ever have any real problems at work, or in the new cities where she moved, and people generally found her to be competent, personable, and friendly. She mentioned that she has lived in 3 different cities, due to her husband’s job relocations, and therefore she has had 3 times she has had to start new jobs. She kept her jobs until she had to move again. She also mentioned that in each new location, she got to know her neighbors within a few months of moving into the community, and she typically joined the school PTA so her children would feel connected to the school and she would know what was going on in their daily life there. It was important to her to feel a connection to her children’s teachers, other parents and the school administrators. She believed education for her children was very important and she made a point of being part of school activities and field trips.
Caroline disclosed that she was part of an “all American family” which she defined as Dad, Mom, big brother and herself. She stated “we had the 2 parents, 2 kids, 2 dogs, and the 2 story house with the white picket fence”. She remains close to her mother, especially after her father died a few years ago. She had a “good” relationship with her brother but really liked his wife, and keeps in contact with her on a weekly basis. She said she felt her family growing up was the model for the type of family she wanted to have as an adult.
You asked Caroline for more information about her husband and children. She stated that she and Alex met in high school but didn’t start dating until college. They married after both graduated and started their family shortly thereafter. She said that they have always been very much in love, and their roles have been “traditional”. Alex takes care of yard work, car maintenance, brings home the bigger paycheck and watches the kids when she is at work. She is responsible for inside the house, meals, most of the children’s activities, and her job is secondary. Up until her fears set in, she felt things were running very smoothly at their home, everyone had their routines and everyone seemed happy. She would like to get back to that and get over these fears that are hampering her daily ability to go do the things in life she has done in the past.
