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Christian Counseling Scenario
What are the client's most prominent presenting issues (that is, what seems to take priority as being wrong)?
In the case of Leon, a 52-year-old man with a dysfunctional childhood who has been unable to experience life in typical fashion, the most prominent presenting issue is definitely the individual's lack of emotional capacity and general apathy, both of which are obviously symptoms of a deeply repressed psychological trauma. The circumstances described in the introduction to Leon's case, wherein his eventually divorced parents both suffered from chemical dependency and addiction, while the father inflicted sever emotional and physical abuse, is extremely typical in terms of being connected to later symptoms of Post-Traumatic Stress Disorder (PTSD). According to the Diagnostic and Statistical Manual of Mental Disorders IV Text Revision (DSM-IV TR), "diagnostic criteria for PTSD include a history of exposure to a traumatic event that meets specific stipulations and symptoms from each of four symptom clusters: intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity," (DSM -- IV, 1994, 4th ed.) and Leon's current symptoms are closely aligned with this diagnostic template. Intrusion comes in the form of...
Avoidance is evidenced in Leon's apathy and social withdrawal, as well as his fear of commitment and inability to develop intimate emotional bonds with his own family. Negative alterations in cognition and mood, as well as alterations in arousal and reactivity, can be linked to Leon's insomnia, anxiety, and lack of energy.
2.) What else do you feel you need to know (or, what might be some areas you may ask about in order to determine what is going on and how severe the problem may be)?
I would like to know whether or not Leon ever reached a sense of resolution with either of his parents after their estrangement when he moved out at the age of seventeen. The presence of such intense emotional trauma would suggest that no attempts at therapeutic closure have ever been made, and I would ask Leon directly why he has avoided this crucial confrontation. By refusing to accept that the trauma he experienced during childhood is affecting his adult life, Leon has shut himself off from any realistic route to genuine healing, allowing his state of apathetic withdrawal to become normalized behavior.
3.) What do you think may be your…
References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, D.C.
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