Reference no: EM133404648
Patrick, age 35, self-referred for mental health help at a community service center. He came to know the service when he confided to a senior at his workplace who reprimanded him for poor performance, of his problem with her fault-finding mother. At the intake interview, he revealed several occasions of suicidal ideation lately. He was afraid that these suicidal thoughts might become irresistible down the line.
Patrick lived with his 70-year old widowed mother in a small rented apartment. At 30+ age, he was still single. Patrick volunteered to tell intake workers something about his family history in the context of explaining why/how he became "depressed with life".
Patrick was born in the late 1980's had two sisters, one 6 years older and the other 3 years older. In his early childhood years, he already had a vague sense that both parents cherished him more than the two sisters since he was the only son in the family.
His parents were natives of Fujien in Mainland China. They were neighbors in their childhood years. After completing secondary school education and later being trained as teachers, they married with their parents blessing and taught in the primary school of their childhood years.
Not long after Patrick was born, his father left home to find employment in Hong Kong to earn more money for the family. His ambition was to start a small business and then nurture it into a big one. It was an ambition that he soon realized to be a fantasy. He could only hold on to a waiter's job in a small restaurant.
When Patrick was ten years old, his mother brought the three children to Hong Kong for family reunion. As she did not speak Cantonese, she could only find low pay job, and there would be little usable income after paying for childcare. Hence, she stayed home as full-time a housewife.
Patrick found school life miserable after moving to Hong Kong. First, there was language barrier in the first few months. Second, he was a new-comer joining a P.5 class the middle of the school-term. Moreover, even though he did very well in his primary school in Mainland China, he had to repeat one year due to poor English. He was ashamed to be the 'oldest' and the "tallest" pupil in the class. He was also teased by his classmates for his 'Fujien' accented Cantonese.
Family reunion did not bring happiness to the family. His mother complained that the father, who was the sole breadwinner of the family, failed to find a better paid job. Consequently, his father took up a night-shift taxi-driver job besides being a waiter in daytime. Unfortunately, two years after the family reunion, the father died of lung cancer. After that, family life turned chaotic. Poverty aside, the mother became very depressed and addicted to gambling and alcohol.
Patrick had promised, when his father was very ill, that he would take good care of the family on his behalf as "the only man" in the family. He would work hard in his study to qualify for professional education in university as a doctor or a lawyer. In the next five or six years, the single-parent family survived on cash assistance from the government's Comprehensive Social Security Assistance Scheme. When she was sober, the mother kept reminding the children to work hard on their schoolwork, telling them that this was the only way to break away from poverty. In particular, she explicitly voiced her expectation that Patrick, as the only son, should work exceedingly hard to get a high paid job in future.
Patrick's two elder sisters had been very successful in schooling. The eldest sister got a MBA from the University of New South Wales. She married to a wealthy businessman. The elder sister obtained a law degree from the University of Hong Kong and worked as a solicitor in a large law firm. She lived away from the family after she had the means to keep a small apartment near her office in Central. Sibling relationship had been distant. The two sisters led a busy life. In the few festival occasions that all three siblings had family dinner together, they seldom talked about each other's life. Patrick tensed up whenever he had to "socialize" with the two sisters.
As he had promised his deceased father, Patrick did study very hard in P. 5 and P.6 years to rank top in his class. He got into a Band 1 secondary school. However, starting from F.2 onward, he could only manage to obtain average grade. Even worse, he failed to get any of the UGC-funded university places. Reluctantly, he enrolled in a two-year self-financed Associate Degree in business management in what he considered to be a 'low-ranking' local university. After completing the AD, he took up a 'top-up degree programme' to graduate with a first-class bachelor's degree in business management awarded by a 'low-ranking' British university two years later. Nonetheless, he was ashamed of his inferior academic attainment as compared with the two sisters. He felt that his place as the only son in the family was undermined.
At first, thinking that he graduated with first-class honor, he should be able to get a management job in the commercial or finance sector with a salary at over $25,000. It turned out that he could only find a job as an administrative assistant in a mid-size company earning a salary of $12,000 - after a six-month job-hunting process. Even as he expected to get a fast promotion, he quitted the job six month later. He felt that he was unfairly treated by his boss (being fault-finding), and that teammates looked down upon him because his was a top-up degree awarded by a little-known British university.
Back home, he found life also stressful. His mother often nagged at him for failing to get a 'decent' degree from a prestigious university and therefore was stuck with a low paid job. She was frustrated that Patrick could not earn a decent income after having spent so much money on university education. She considered it a shame to have relied on financial support from the two daughters. Patrick thought that his mother's non-stopped nagging could have affected his job performance, since "he often returned to workplace in bad mood". Had his mother been less a source of emotional strain, he could find more energy to "advance my career".
Patrick admitted that he was a loser among a handful of secondary school classmates whom he considered to be "his friends". They were all high achievers in high-status professions. He therefore avoided meeting them these days. He had had a very close 'girl-friend' who was his secondary school classmate. The relationship faltered because he failed to get a university place while she studied nursing at CUHK. Since then, he avoided any "unnecessary contact and communication" with opposite sex in the workplace. He did not want to risk "being dumped again".
Case analysis
Using the Rational-emotive Behavioural Therapy discuss the following questions by referring to the case materials:
Given the assessment or provisional understanding in presenting and underlying problems, formulate a provisional plan for guiding counselling work with the client.