Vignette of Richard
Richard is a 47-year-old man who has been referred for counseling by his physician, Dr. Abrams. Dr. Abrams has been seeing Richard frequently over many years for a variety of physical complaints including joint pain, weakness in his fingers, dizziness, constipation, and headaches. Although Richard does have a medical diagnosis of ulcers and has been diagnosed with anemia in the past, Dr. Abrams has found no evidence of any illness or condition that would account for these symptoms over the years. Richard does not drink or use substances, and he is not currently taking any medications.
Richard also worries that he has a disease like AIDS or hepatitis, and every time he feels sick he believes it is a sign of a more serious illness. Dr. Abrams has repeatedly reassured him that he does not have these diseases, but Richard does not believe him and demands more tests be performed.
Richard is extremely distressed, has alienated most of his friends, and has lost three jobs in the past several years because of absences due to illness or medical appointments. Currently, Richard lives in the basement apartment of his parents’ house, and has not been able to find steady work. He spends most of his days on the Internet researching medical conditions or in chat rooms with others who have similar problems. He often feels anxious.
In the first counseling session, Richard describes his history of physical symptoms in great detail, presents files of medical procedures and tests, and starts to cry, saying he is probably going to die of a “horrible disease.” He resists any deeper exploration of his emotions or thoughts, saying, “This is not all in my head!”
- Describe what somatic symptom diagnosis you would consider giving to Richard. Consider also the possibility of a co-occurring substance use disorder impacting Richard’s physical and psychological symptoms. List the additional questions you would ask to obtain the information you would need to rule out a co-occurring disorder and be sure of your somatic symptom diagnosis.
- Describe some of the treatment goals, both long term and short term, you would have in working with this client.
- Describe the personal reactions you might have when working with a client who presents with a combination of physical and psychological symptoms. Include a discussion of your own assumptions and beliefs about the relationship between mental disorders and medical conditions.