Read a transcript of a diagnostic interview. Then you will write a 1.5-2 page paper (1 inch margins, size 12 font, Times New Roman, double spaced) assigning diagnoses based upon what you read.
Michael is an 18-year-old Caucasian man of average height, and he is moderately overweight. He is a freshman at Temple University studying psychology. Michael was referred to the Temple Psychological Services Center by his girlfriend Jackie. He reported that he was ambivalent about coming in for an assessment, but his girlfriend convinced him to. The following is a partial transcript of the assessment:
Therapist: So Michael, tell me what’s been bothering you recently.
Michael: Well, I’m having a lot of trouble with my schoolwork. It’s hard for me to concentrate on anything. I’ll open up a textbook and then within minutes I’ve forgotten what I’ve read. I feel like I have always had issues like this, but I guess in high school I was able to get by without doing the work.
Therapist: What do you mean by, “always had issues like this?”
Michael: Maybe not always. I was a happy kid and had a decent childhood. However, around the beginning of high school I started to feel down most of the time. I would get distracted during school and failed a couple classes, but I somehow managed to graduate and get into Temple.
Therapist: Tell me what it is like to feel down all the time. Have you ever had a period where the down mood goes away?
Michael: I just feel like when I started high school, I became a sad and dreary person. I would feel blue basically all the time. Maybe for a week or two during summer, when the weather was nice, my down feeling would lift. But, I feel like I have generally been feeling low for years.
Therapist: What else is bothering you when you feel down? How are you sleeping?
Michael: Well, I feel like I’m generally tired all the time and pretty fatigued. I usually go to bed at 10 because I know I won’t fall asleep immediately.
Therapist: Is that because of a loud roommate, or noise?
Michael: Neither. I mean my girlfriend almost always sleeps over but she’s not the problem.
Therapist: Then what is?
Michael: I’m not really sure. I sometimes just lay there for hours tossing and turning. Then the next day, I’m really tired and have low energy. I’m sure feeling tired is also contributing to my bad grades.
Therapist: And these symptoms have been going on since high school?
Michael: Yes, I’ve felt down and tired for a long time, probably since freshman year of high school.
Therapist: Have you had thoughts of harming or killing yourself?
Michael: No, I would never do anything like that. I just feel generally crappy.
Therapist: Have you had any other negative thoughts, such as feeling worthless, guilty, or hopeless?
Michael: No, not really. Just feeling pretty low and tired, but it is definitely getting in the way of my schoolwork and my relationship with my girlfriend.
Therapist: How is your down mood impacting your relationship?
Michael: Well, sometimes I drink or eat a lot to feel better. I think Jackie is getting tired of me being drunk and gaining weight.
Therapist: Tell me more about that. How much do you usually drink?
Michael: I’m not really sure. Since I started college, on the weekends I’ll probably have about 10 beers a night. I sometimes get drunk during the week too.
Therapist: Was the transition to college particularly difficult for you?
Michael: Yea, I mean it was weird for me to live away from home since I’ve never done that before. Honestly, I was scared and pretty anxious. I’m glad that I met Jackie at the beginning of freshman year, because she makes me feel better when I’m in a bad mood.
Therapist: I see. How much time do you typically spend with Jackie?
Michael: Probably five hours a day, usually after class. I feel pretty lonely when she’s not around.
Therapist: What is it like for you to be without Jackie? Do you feel like you need her to take care of you or help you make decisions?
Michael: I mean, I like her input when I am making decisions, but I can usually figure things out for myself. I think I can take care of myself…but sometimes she doesn’t think so! That’s one of the reasons why I came in today. She wants me to get help.
Therapist: Ok I see what you mean. Back to your drinking habits—has your drinking ever caused problems for you?
Michael: Well as I said, it really bothers Jackie. She has told me several times that I need to stop drinking so much. But I’m in college, and so many other people drink! But I guess sometimes I drink more than I originally plan to, and I drink more than most of my friends. Jackie and I decided that I should try to max it out at 5 beers, but I usually drink more anyway. I also missed a bunch of classes because I was hungover, but I didn’t really care about that.
Therapist: Do you use any drugs?
Michael: I smoke pot once in a while. I think it helps me feel better when I’m down. Although, last week for the first time I had some sort of panic attack while I was smoking. It was really strange, my heart started beating really fast and I was sweaty and shaking. So after that, I think I am going to stop smoking for a little while.
Therapist: That must have been really distressing. Have you ever had a panic attack before?
Michael: Maybe once when I was a kid and I had to get a shot, but otherwise, that was the first one.
Therapist: Are you generally afraid of getting shots?
Michael: I mean, I don’t like getting shots but I’ll force myself to get them when I have to.
Therapist: Does getting shots make you anxious?
Michael: Yes definitely. But who likes getting shots? I manage and just try to man up and not pay attention to the doctor when I get shots. I’ve learned to deal with the anxiety and try not to let it get in my way. I had to get a couple shots before college and that went ok.
Therapist: Gotcha. So tell me more about your eating habits.
Michael: Well, I think I tend to eat more when I am drinking. But sometimes when I feel sad I just start eating and feel like I can’t stop.
Therapist: What is that feeling like for you? Describe a situation to me.
Michael: I keep a lot of snacks in my dorm room, like chips, leftover pizza, stuff like that. So sometimes when I get home from class I just start eating and don’t stop until all the food is gone. Sometimes I will three family-size bags of chips at once even though I don’t feel hungry. Then afterwards I just feel really full, sick and guilty about it all. I would never want Jackie to know about how much I eat, so I only do this when I’m alone. She would be disgusted.
Therapist: How often does this happen?
Michael: Now that I think about it, it usually happens a couple times a week, after my Abnormal Psychology class on Mondays and Wednesdays. It’s been happening all semester. I really feel like I can’t control my eating, and I hate that I’ve gained so much weight in the past few months since I’ve been eating like this.
Therapist: Tell me, do you try to get yourself to throw up or do you take laxatives to keep your weight down?
Michael: No, should I?
Therapist: No, I don’t think that’s a good idea. Is there anything else that is bothering you these days?
Michael: I really just want to snap out of this low mood and lose some weight, but sometimes I don’t think that’s possible…