Reference no: EM133225019

Sam, a 22-year-old university student who lives at home with his mother, self refers to your private practice for help. Sam reported that the last four months have been extremely difficult for him, as he has felt an immense sense of loneliness. He said he felt like he was at "rock bottom" five weeks ago, when his mother was in Africa on holiday, and he was left at home by himself. Sam described an experience during this period where he had been at University at a late lecture and arrived home at about 7pm, and when he got home the house just felt "empty". He remembered at that point he felt extremely low, and recalled having thoughts such as, "nobody cares about me" and "I'm a failure."

Sam is an only child, and stated his mother is a huge source of support for him. Sam's father, who he rarely speaks to, now lives in Sydney with his new girlfriend. Sam's parents divorced several years ago due to their constant fighting and arguments, however, he reported still struggling with this change in the family structure. He noted that there was a lot of friction between mum and dad in the past, and believes it is not possible to talk to either of them about how he feels. He said, "every time I talk to them about how I feel they just blame each other, it's pointless, so I don't bother." 

Sam is currently enrolled in engineering in his first year. He reported that he finds lectures difficult. He said he struggles to concentrate during lectures at times and often lacks energy. Prior to University, Sam worked as an orderly in a hospital for 3 years, where his job was to escort patients to and from surgery. Sam reported enjoying the job, as it paid well, and he felt he was doing something important. Sam indicated that after finishing high school he wanted a break from study, and his girlfriend at the time, Sarah, was planning to become a nurse and encouraged Sam to apply for the orderly position at the hospital. Sam said he was "very uncomfortable" about applying for the position, but Sarah was a great source of support. Sarah was also working in administration at the same hospital, and Sam reported that those 3 years of his life after high school were "the best".

At the end of last year, Sam recalled that some "massive changes" happened. He reported that he and Sarah broke up. According to Sam, Sarah ended the relationship because she thought Sam wasn't exciting enough, and things had become boring. Sam says, he didn't realise Sarah was bored, and as a result the break-up was a shock to him. When the relationship ended Sam reported resigning from the hospital job straight away, as Sarah was still working there and he felt inadequate whenever he would see her. After the breakup, Sam reported being "quite lonely and had lost interest in things", however, his mother was very supportive. His mother encouraged him to hang out with his school friends again, but Sam indicated that he had lost contact with them after high school, as they all went to University and he hadn't. During this time Sam reported that he kept thinking about Sarah every day and wished he had done more exciting things with her so they didn't break up. Sam indicated that during the Christmas and the New Year period he felt that he didn't really have a clear purpose in life, and this made him feel "miserable".

Sam decided to start engineering this year, as he thought he better do something with his life. He said that he finds classes "difficult", as he has been feeling very tired and finding it hard to concentrate during lectures. He feels much older than the other students and has been keeping to himself whilst at University, thinking that the other students wouldn't want to be friends with him. He says, in order to cope with all his difficulties he would often have some drinks at home by himself on the weekends, typically 3-4 beers. He says he recently had an argument with his mother about the drinking, as apparently that was one of the main reasons she divorced his father. Sam says he doesn't feel like he has anyone to confide in and wants help.

After a full assessment, your diagnostic conclusion is that Sam has symptoms of a DSM-5 major depressive disorder. Sam's depression is the main target of your intervention.

PART A. Describe the presenting problems/symptoms, and the factors that may have caused and maintained the problems using either a Cognitive Behaviour Therapy (CBT) or Acceptance and Commitment Therapy (ACT) framework. 

Identifies and summarises main presenting problems/symptoms                             

Describes the factors that may have caused the problems according to the perspective of CBT or ACT

Describes the factors that may have maintained the problems according to the perspective of CBT or ACT, with detail on at least 3 factors