According to A.D.A.M. (2010), "panic disorder with agoraphobia is an anxiety disorder in which there are repeated attacks of intense fear and anxiety, and a fear of being in places where escape might be difficult, or where help might not be available. Agoraphobia usually involves fear of crowds, bridges, or of being outside alone." (A.D.A.M., p. 1) The fear of the outside world has inclined the subject in this case to increasingly shut himself off from others and from opportunities to experience life. The result, A.D.A.M. (2010) reports, is a deepening sense of isolation and a further descent into the irrational response mechanisms that have come to control Mr. Wiley's life. Demographic Implications:

One major demographic concern for Mr. Wiley might be fear of the stigma connected to seeking therapy as an adult male. For one who fears constantly the loss of control in his own life, giving one's self over to the support of therapy may be challenged by certain cultural constructs.

Crisis Intervention:

That said, because Mr. Wiley has actively sought out the assistance of Dr. Leo Marvin, it is reasonable to assess that he is prepared to obtain the help needed to make improvements. Thus, it is first necessary to provide the subject with a number of coping mechanisms relating to the onset of panic. Here, cognitive behavioral therapy is recommended in the text by A.D.A.M. And implies the need to alter reflexive panic responses to triggers such as crowds, unfamiliar social situations or situations that disrupt routinized behavior. A.D.A.M. also indicates that pairing this with anti-depressant pharmacy treatment is...

Wiley's case though, it is also wholly apparent that some cognitive dissonance rests at the base of his depression and multiphobia. Likely some traumatic experience or sustained traumatic condition is at the root of Mr. Wiley's irrational behavior. It is incumbent upon the attending therapist to uncover this trauma and illuminate its connection to current phobias. Failure to do so, as occurred in Dr. Marvin's treatment program, can lead to an insecure dependency on the therapist's assistance due to a failure to identify the real roots of disorder. As the text by Malinckrodt et al. (2005) reports in one study, "secure attachment to therapist was significantly associated with greater session depth and smoothness. Insecure adult attachment was associated with insecure therapeutic attachment."
Conclusion:

This denotes the importance for the therapist of directing sessions not around the relationship between counselor and patient but around a mutually better understanding of the patient's needs. In Mr. Wiley's case, a failure to draw these boundaries can be shown to have deleterious effects on the client/therapist relationship.

Works Cited:

A.D.A.M. Medical Encyclopedia. (2010). Panic Disorder with Agoraphobia. PubMed Health.

DSM IV. (2010). DSM IV Obsessive Compulsive Disorder (OCD) Criteria. Biological Unhapiness.com.

Malinckrodt, B.; Porter, M.J. & Kivlighan, D.M. (2005). Client Attachment to Therepist: Depth of In-Session Exploration, and Object Relations in Brief Psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 42(1), 85-100.