Chapter 1. Zach

1.1 Introduction

Missouri State University

1.2 Presenting Complaint

Zach is a 21 year-old college student who recently moved back in with his parents. He is a junior in college and had been living with roommates in a house just off campus. Zach had always been an easygoing guy. He rarely experienced any conflict with family or friends. But over the past few months he has been having problems with a number of people. He doesn’t understand why everyone seems to be “out to get him.

Zach’s first 2 years of college went very well. He attended college in the town where he grew up so he didn’t have the typical challenges many of his friends had, such as being far away from family and friends. He chose to live in the dorms so he did experience some adjustment to being on his own for the first time. He liked his roommates and they became such good friends that after their sophomore year they all decided to move off campus into a nearby house. Zach was looking forward to the move and excited to spend the summer with his girlfriend, Julie. This was the first summer that he wasn’t going to have to work since he was 16 years old. He managed to save enough money throughout the year and since Julie did not have a job, he decided he would take one summer class and hang out with her.

The first 2 weeks of the summer were great. He slept in every day, went to class, worked out, and spent time with Julie. Since all of his roommates had full-time jobs, he often had the whole house to himself. Julie began babysitting more in the evenings so he started spending more time alone. One night, he went to study at a local coffee shop and saw Julie there with another guy. He was shocked but told himself not to overreact, that he was probably just someone from one of her classes and they were probably just studying. Later that evening, Julie stopped by Zach’s house and broke up with him saying that she had fallen in love with someone else. After she left that night, she refused to return Zach’s texts, leaving him wondering, “What did I do wrong?”

After the breakup, Zach found it difficult to go to class for fear of bumping into Julie and her new boyfriend. He told himself that he would just keep up with the work on his own since he had so much time during the day. The problem was, he couldn’t concentrate and would spend hours staring at the same page. Eventually, he would just give up and go take a nap. He was surprised how tired he felt since he would sleep late every morning. As a result, he started having a difficult time falling asleep at night. He would lie awake and replay the breakup over and over again in his mind. Julie was his first serious girlfriend and now he didn’t think he would ever be able to find someone he could trust ever again. He would think to himself, “I’m such a loser,” “How could I not know she was cheating on me,” “I’m never going to go through that again,” “I’ll probably be alone forever.” Eventually, Zach would fall asleep only to awaken again around 4:30 am and not be able to fall back asleep for hours. He would force himself to stay in bed because he knew he didn’t have anything else to do.

A few weeks passed and Zach dropped his summer class because he knew there was no way he could catch up and pass. He had stopped working out and sometimes days passed where he wouldn’t leave the house. Some days, he couldn’t remember when he last took a shower. He knew his roommates were concerned about him because they would try to get him to come out with them, but he would always come up with an excuse to stay home. Everyone asked him if he was just sad because of what Julie did, but he didn’t even know if he felt sad --- he just felt nothing. It seemed as though, all of the sudden, he didn’t care about anything anymore.

Despite being home all the time, Zach found it extremely difficult to complete his assigned jobs in the house. At first, his roommates just let it go and would pick up the slack but by last week they had hit their limit. They told him that he was going to have to contribute more or they would have to ask him to move out. Rather than start pitching in, Zach got really mad feeling that once again “no one gets it.” All he wanted to do was sleep and he became exceedingly frustrated when he could not fall asleep. At 3:00 am, one of Zach’s roommates found him in the bathroom emptying out the medicine cabinet mumbling “I just want to go to sleep and never wake up.”

Zach’s roommate immediately called his parents and told them what was going on. His mother, while upset, said she knew something was wrong because Zach had stopped calling to check in and returned her voicemails only occasionally. Within the hour, both of Zach’s parents showed up at the house insisting that he come back to their house with them. Zach thought they were overreacting but he didn’t have the energy to fight them, so he agreed. The next day, his mother made an appointment with a doctor and informed him that he would be living with them until they figured out what was wrong and how to help him.

1.3 Social/Family History

Zach grew up in a loving family consisting of his mother, father, and older sister. His parents have been married for 25 years, although there was a time when Zach was sure they were going to get a divorce. When Zach was 8 years old, he found out that he had a half-brother who lived in a different state. Apparently, Zach’s father’s high school girlfriend contacted Zach’s mother through Facebook and told her that they had a son just after high school. Zach’s father had never disclosed this secret to anyone, including Zach’s mother. This news caused significant tension in their marriage and Zach remembers a period of time where his father moved out of the house. He remembers his mom crying “all the time” and eventually having to go to her doctor to get some kind of anxiety medicine. After about a year of conflict, Zach’s parents decided to work on their relationship and find a way to move forward. They have rarely spoken about the event and Zach has never met his half-brother.

Zach grew up in the same town his entire life and often spent weekends at the lake with his extended family. Both sets of grandparents, and numerous aunts, uncles, and cousins lived nearby. Everyone got along very well and they enjoyed spending time together. His maternal grandfather was the funniest, but also the most unpredictable one of the bunch. All his life Zach remembers never knowing what to expect from Grandpa. He was usually the life of the party and loved to buy all the grandkids presents for when they would come up to the lake. There were times though, when Grandpa would stay locked in his room for days. After these episodes, the family wouldn’t see much of Grandpa for some time, and when he eventually rejoined the family gatherings, he seemed to be on the top of the world.

Zach was born a healthy baby, although his mother did suffer from a brief postpartum depression. She had experienced a similar episode after Zach’s sister was born, but she was prepared this time, and much better able to manage her symptoms. As a child Zach was easy going and eager-to-please. His mom stayed home with him until kindergarten so she wasn’t aware of how shy Zach was until he started school. For his first few years of school, Zach would not want to talk to the teacher or any other kids he called his “friends.” He would make up excuses not have to go to school, often claiming an upset stomach. At first his mother would allow him to stay home, but she recognized that his anxious behavior only worsened when he had to go back. By 3^rd grade, Zach seemed to be much more comfortable at school and he had made a couple of good friends who were always in the same class. Zach’s mother was surprised at how well he seemed to “grow out of his shyness.” The only area where he still seemed to have some difficulty was talking with girls he liked. He managed to ask a girl to his senior prom, which lead to his first date. He was relieved to have a date and had a great time at the prom, which gave him a boost of confidence going into college.

Zach first met Julie in his chemistry class. It took him almost the entire semester to talk to her, but when he finally did, he was surprised at how easy she was to talk to and that she seemed interested in what he had to say. They agreed to start studying together and after a couple weeks, Zach managed to ask her out on an official date. After that date, they were together all the time until their recent break up.

1.4 Multiple-Choice Questions

1.5 Treatment