Case study on psychological assessment and treatment plan

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Johnson is a Chief Executive Officer (CEO) in a renowned international manufacturing company. Those who know him describe him as a quiet, hardworking, focused and no-nonsense man in his mid forties. It is true that his position is quite admirable and envious. But on close observation, one may wonder why he looks distressed. The daily hassles of present day life, tight schedules, frustrations and high goals are sources of stress in an individual. His daily activities include a busy schedule of meeting clients, making presentations, travelling, as well as making critical decisions involving the company, not forgetting his role as a husband and a father to his four children. These daily stressors and the increasing responsibilities emanating from his role have led to Johnson's suffering from psychological distress related to job burnout.

Johnson has been employed in his profession for five years and one month. He described to me an uneventful childhood which could lead to psychological problems. He did not suffer from any significant childhood illnesses or developmental delay by either his parents or on his own account. Johnson has had no previous contact history with either mental or physical health. Johnson described himself as having no time to spend with his family. He described his family as caring, understanding and very loving. Johnson informed that he sometimes drinks alcohol when he is not in a good mood. He denied any intake of illicit drugs, previously and now.

Johnson presented as a slim, neatly dressed and groomed Caucasian male. He spoke in a soft normal tone and volume. He maintained good eye contact with me throughout the duration of the interview. He had a pleasant personality and answered my questions openly and was polite throughout the interview. He was open in discussing personal intimate matters.

Nature of illness

As Bender (2005) asserts, 2005 National Survey on Drug Use and Health indicate that an estimated 24.6 million American adults, which translates to 11.3 percent of U.S. residents over 18 years were reported to experience "serious psychological distress" during the previous year. The report further suggested that approximately 30 million individuals undergo some major depression at least once in their lifetime. This is a serious condition resulting from stress and affects both the affluent and the poor. Research shows that women are more likely to suffer from psychological distress as compared to men. Similarly, it was clear that people who use drugs are more affected by psychological distress compared with those who don't. In spite of his respectable position and nature, Johnson has reported symptoms related to feeling of depression, anxiety, restlessness and hopelessness.

Effects of stress: psychological and physiological

Psychological distress is known to have a profound effect on man. In addition other illnesses that are closely related to stress have been known to affect human kind both psychologically and physiologically. To start with, severe psychological distress has been associated with causing a deficient immune system because of the body's response in dealing with this problem. The capabilities of the immune system are reduced after frequent activation of the autonomic nervous system in the case of psychological disorder which has been known to adversely affect the cardiovascular system. Under stress the heart rate is increased which increases the chances of experiencing a heart attack. In addition, the patients of psychological distress also complain of physiological tension and headaches, stomach problems and loss of sex drive.

Personal changes in Johnson's life due to psychological disorder

Psychological disorder causes a lot of changes in the peoples personal lives. For instance, Johnson mostly feels overwhelmed, loses confidence and becomes irritable and withdrawn. This behavior has made him less productive and effective which has made the company report less profits compared to the previous years. He has also developed sudden disinterest in his work, experiences sleeping problems, fatigue and has trouble concentrating. His personal nature has also resulted to more social withdrawal where rumors have it that he has turned to abusing alcohol and gambling as a way of coping with his condition. If the clear signs of psychological distress go unattended for a longer period, they can be more detrimental. Beyond interfering with job performance, and satisfaction, intense stress can lead to more serious problems including heart attack.

Johnson informed that at times he feels much stressed and would try to excuse himself from attending work, but from the encouragement of his wife he is able to make it to work. Johnson stated that often he loses interest at work and starts focusing on something else like playing computer games. He informed that sometimes he also gets confused on the tasks he has to complete. Johnson informed that due to the pressure at work he sometimes experiences major headaches and back pains, and sometimes he feels light headed and faint. Johnson also complained that he at times finds it difficult to communicate with clients and speak in front of his staff. Johnson informed that he starts feeling nervousness and is afraid of public speaking. When asked, why? Johnson informed that his quite nature interferes.

Relevant stressors arising from the illness

In the current difficult economy, most employees including managers find it harder to cope with challenges resulting from the job demands. For instance, the stressors resulting to the psychological distress in Johnson emanates from increased demands for overtime, pressure to perform to meet rising expectations, and increased pressure to work at optimum levels. In addition, more stressors may have originated from his relationships with his juniors and other employees and the pressure from decision makers.

Johnson informed that by the time he reaches home after work his mind is over pressured, which causes him to rage out in anger on his family. He says that his wife is very supportive and understanding. Hence, he informed that he hardly spends time with her, because of his busy work life. Johnson also complained that he often has no interest in sex, and if he does try to have intercourse with his wife he is either unable to maintain an erection or have an orgasm. Johnson informed that after work he likes to be left alone. Sometimes he has a loss in appetite and goes straight to bed without communicating with his family members. He tells that he lies silently on the bed thinking about work or nothing at all, not being able to sleep.

On Friday nights Johnson drinks excessively, he also goes to the casino and spends money. He believes that he does not have a drinking or gambling problem, but it is a way for him to relieve tension. Hence, Johnson says that his wife gets very upset on the fact that on Friday nights he is never home and his money spending at casinos can rather be used to pay the overdue bills, this causes him to get angry and he sometimes argues with his wife.

Interview with Belinda Xavier (Patients wife)

Johnson's wife Belinda tells me that Johnson is a very loving and caring man. Hence, since he has been employed in his position of CEO he has had a very busy life style. His routine is work at work, then work at home. Belinda noted that previously Johnson used to be a very outgoing person. Even though there were somewhat financial problems due to less income from his last job as a production manager, their life was much more romantic and happier and he used to spend weekend out with the family, because he had less work and stress on him. She also described Johnson as previously having a calm and patient personality, where as now he loses his temper easily. She noted that previously he never went to the casino, and only used to drink on special occasions. Hence, now this has become his every Friday night activity. Belinda was very supportive in discussing Johnson's situation, and informed that she has always been there to support him.

Recommended treatment

Since stress can cause more harm in our lives, the best way to deal with the stressors is to eliminate them. On the other hand, eliminating the stressors in this vast moving world and economy is impossible. The only discernible way is trying to manage stress by using stress management techniques. There are several stress management techniques which one can use. For our case, the stress management techniques that Johnson can use include: cognitive restructuring techniques, autogenic (self-produced) training and visual imagery, as well as coping skills training. The treatment plan also outlines effective relaxation techniques.

First, cognitive restructuring technique is a good way of understanding and changing our negative thinking and approach situations in a more positive way. It focuses on helping the patient understand the negative thought process that can cause problems and help in restructuring them to keep them fair and balanced. The first task in cognitive restructuring involves self-monitoring where the patient is supposed to evaluate himself. The main goals for this therapy involve identifying the specific cause of stress, challenging the stress-producing potential of this thought. In this case, a therapist can help the patient forget the irrational thoughts that provoke the stress and lastly, to covert the stress- provoking thought into something that induces relaxation instead. The strengths of this technique is that it teaches the patient that they have power to change the way they think about and perceive undesirable happenings. Another advantage of this therapy is that it is fast to administer.

For instance, it can be identified that Johnson drinks alcohol and spends money at the casino in order to relieve stress. However, this leads to financial and social stress for the family. In order to use cognitive restructuring he needs to make himself aware that the money being used on alcohol and casino does not relieve stress but causes more stress, and the money can be used to provide the needs of his family, which is more important. Cognitive restructuring also has an advantage in that it is a lifelong use therapy. Once learnt, it can be applied in any situation. This is a relevant therapy for Johnson who should learn that he is temporarily in the office and his health matters more. Although the company's progress has reduced, there is a chance of picking up without over involving himself. "Restructuring negative thought patterns can have a powerful effect on appraisal, emotions, arousal levels and resulting actions." (The Open Polytechnic of New Zealand, 2005: Cognitive techniques for stress management, p.5)

Secondly, autogenic (self-produced) training and visual imagery is another technique used to manage stress and psychological distress illnesses. It involves the process of relaxing muscles for the sake of stabilizing the emotions. This is with an aim of helping the patient to be able to regulate autonomous organic functions by exercising his muscles and usually involves external or remote stimuli to create a withdrawal condition. In this case, the therapist should provide a sleep-like condition which should later be adopted by the patient. This technique is very helpful in the psychological distress. When well applied, autogenic training decreases anxiety, depression, and a number of symptoms as well as intensity symptoms of psychological distress. This technique is useful for Johnson's case as it would help him relax his mind and be able to focus on his job. A stable mind will increase productivity which reduces the effects of problems that may result to more stress. When visual imagery is used appropriately, the patient's imagination is used to avert thoughts relieving stress and bringing the patient to a normal condition. For instance, during intercourse with his wife, Johnson can abandon himself from all work related thoughts by imagining himself and his wife in a special place like the beach or meadow.

It would be good if the following three steps are used in Johnson's treatment plan, this can help him effectively deal with stress in most situations.

"Muscle relaxation

Controlled breathing

Special place imagery"

(The Open Polytechnic of New Zealand, 2005: Cognitive techniques for stress management, p.4)

The third stress management technique which can be used to deal with stress and psychological disorder is that of coping skills training. Coping skills training helps the patient reduce the intensity of the emotional distress, reduce the likeliness of doing something harmful due to stress, improve the ability to be able to continue to function well even when in stressful circumstances, build confidence in one's ability to handle difficult situations and reduces overall experience of emotion deregulation. Some of the common coping skills that the patient may use include; social support, behavioral activation, relaxation exercises, mindfulness meditation, and active problem solving.

"Coping skills training provides rehearsal in imagination for the real life events the patient finds distressing. The patient will learn to relax in the imagined scenes and will thereafter be prepared to relax away tension." (Davis, Eshelman, and McKay, 1995, p.15) This therapy is relevant and very useful for Johnson in trying to bring him back to his senses and regain confidence in the performance of the company and from his colleagues. Since it may not be possible to live without some work stressors, the therapy is ideal in ensuring that his performance is not affected even in stressful circumstances. Johnson can use the relaxation technique to overcome his anxiety of communication with clients and staff. For this he can use his imagination and think about speaking in a meeting or interview, and then relax away any stress he is confronting. By doing this he will be sending a message to his mind that he can communicate effectively with anyone.

I strongly recommend Johnson to imply relaxation techniques to reduce stress. There are several relaxation methods. This includes breathing techniques, mediation or even praying. During his working hours Johnson can take a one minute break every one hour, during the one minute he can close his eyes and breathe in and out slowly, he can either clear his mind from all thoughts, or think about something positive. This will relax his muscles and calm his entire body. This can be done at his own desk.

It is very important for Johnson to think outside of work. In the weekends he needs to spend time with his wife and children. I recommend that he goes out dining with the family or even a short drive for sightseeing. Socialization is very important in our daily lives. Social withdrawal can lead to insanity or chronic depression. I have found that Johnson's family is quite supportive to his situation, specifically his wife. In order to reduce his stress symptoms Johnson's contribution is needed.


"The point of managing stress effectively, then, is not only to prevent harmful distress - emotional upset, headaches, or heart attacks - but also for the higher purpose of promoting wellness - well-being and fulfillment." (Schafer, 2000, p.61)

In spite of the social roles one plays in the society, stress is unavoidable. Stress may have an impact on the overall health of an individual which may affect daily expected performance and productivity. Luckily, our bodies are designed with a set of automatic responses to deal with stress while trained therapists may come in to assist with the healing process. On the other hand, our bodies deal with all types of stress in the same way, as such that experiencing stress for long periods of time like constant stressors at work places may have negative impact on our lives causing psychological disorders. To be able to cope with stress emanating from work, employees should develop self coping mechanisms so as to keep up with the expected productivity.

According to the discussion I have had with Johnson, we have understood that he is suffering from stress related illness. I have provided stress management techniques including: cognitive restructuring techniques, autogenic (self-produced) training and visual imagery, as well as coping skills training as part of his treatment plan. The treatment techniques outlined can be very effective for his job performance and social life if undertaken.