ASD Case Kyle Is a 40-Year-Old Male

ASD Case Kyle is a 40-year-old male of Greek-American descent. He reports that his religion is Eastern-Orthodox and he attends weekly services. Kyle's wife urged him to contact a therapist because she was concerned about some recent and radical changes in his behavior. As a reservist in the U.S. Marines, Kyle has been deployed twice to serve in Iraq. During his first deployment, he was stationed in Kuwait and had an uneventful service. However, his second deployment was marked by a significant tragic event.

During a weekend leave just before he was sent back to the United States Kyle was exploring a rural marketplace with several military colleagues. A bomb detonated at the market, killing several dozen local civilians, and one of Kyle's colleagues. Kyle, who was not hurt in the blast, heroically assisted both his colleagues and many of the civilians who were critically wounded. Since returning home two weeks after this event Kyle has been unusually withdrawn.

He will not discuss his time in Iraq with his wife or family, and becomes quickly irritable when asked by friends about his deployment. Kyle's wife reports that he has been having nightmares in which he calls out or cries in his sleep. Kyle, himself, has not mentioned these nightmares. She has also noticed that Kyle seems unable to sit though a movie, a pastime that they both used to enjoy regularly. This is especially true of action movies.

A few days ago the local news reported a rash of nighttime burglaries that occurred in Kyle's neighborhood. Kyle became fixated on protecting his house and family, often staying up through the night and walking around the house repeatedly. Kyle reports that although he cares about his family, he cannot seem to "connect" with them anymore. He can see that the change in his behavior is taking a toll on his marriage, but he does not believe that he can do anything about it.

Kyle complains that he feels "empty and bored" lately. He is considering making a career change but is not certain what he would like to do next. Recently, he was involved in a physical fight with another man at a restaurant when the man "gave me a sarcastic look." Occupational History: Kyle is a software programmer. He has held various positions in the technology field, including management, but he prefers to write code. Educational History: Kyle received his bachelor's degree in computer science.

Medical History: Kyle is being treated for gastroesophageal reflux disease. His physician is treating the condition with Tagamet and dietary change. Family History: Kyle is an only child. His parents are both of Greek origin and his Grandparents immigrated to the United States in the 1900s. Kyle describes his father as "very caring, but very strict." On the contrary, Kyle's mother tended to spoil him and she refrained from disciplining him when he was growing up. Kyle's father was an alcoholic and he would occasionally erupt in a drunken outburst.

On rare occasions, he would lash out physically against Kyle or his mother. Alcohol/Substance Use: Due to his father's history, Kyle does not use alcohol. He occasionally takes prescription painkillers given to him by a friend to help him "chill out." Social-Cultural Factors: There was a large influx of Greek families that immigrated to the United States at the end of the 19th century or at the beginning of the 20th century before the First World War. The reason for this mass immigration was the failing Greek economy.

Most of these families were Orthodox (Cashwell, Looby, & Housley, 1997). Individuals with a Greek heritage have a rich cultural and historic legacy due to the status of the ancient Greek Empire. They are very proud of this. Family relations are very important to Greek Americans. Their culture is inclined to be patriarchal as well as male individualistic, so these families will often have strictly defined gender roles. Relationships between couples are fairly formal in this sense and extramarital affairs by the males are often accepted.

As a male dominated culture Greeks tend not to be very tolerant of issues like homosexuality, or male weakness, but they are open to cross-cultural marriages (except for people of Turkish descent because many centuries ago the Turks destroyed the Greek Empire; Cashwell, Looby, & Housley, 1997). The male "macho" attitude that Greek Americans adhere to can offer explanatory information regarding Kyle's reaction to his feelings as well as present a barrier to having him open up in therapy.

A male therapist would most likely have greater success with Kyle, but a good female therapist can establish rapport by emphasizing how brave he was in Iraq, etc. Moreover, there will be the need for the therapist to direct Kyle a bit more and offer practical and direct treatments. Greek Americans prefer auditory modes of communication when learning and using a more cognitive behavioral approach with relaxation and exposure as opposed to a psychodynamic approach would appear to be very effective with this patient (Cashwell, Looby, & Housley, 1997).

This allows for a practical approach to Kyle's issues. As Americans we tend to expect more openness and less of a "macho" approach in instances like this. It is very important to respect the client's unique reaction to his situation. Likewise, the DSM-IV does not define such behaviors as aggression and acting out (for lack of a better term) as symptomatic in conjunction with Kyle's current situation (American Psychiatric Association, 2000), whereas given the cultural variables involved they make perfect sense.

Kyle's family history will also be important to discuss as early childhood abuse or family instability appears to be a risk factor for Kyle's suspected problem (Nugent, Tyrka, Carpenter, & Price, 2011). Applicable Ethical Issues: The first issue of course is Kyle's response to his diagnosis given his cultural background. We would expect that Kyle may view a diagnosis as a sign of weakness; however, one way to address this would be to get Kyle involved in a PTSD support group at a local VA hospital.

Most of the members of such groups are male and Kyle can learn from others who have experienced similar issues (Cloitre, 2009). This will allow the therapist to discuss these issues with Kyle,.