CASE STUDY 1

Client A is a young white man, 18 years of age, who grew up in a middle-class section of an affluent community. He presents for treatment because he is struggling with several identity and lifestyle issues, specifically how to attain a fulfilling romantic relationship. Client A recognizes that he struggles with having a "big ego," but he admits to disliking many things about himself, such as his "gut." (He is slightly overweight at the time of presentation.) The client has recently graduated from high school, where he had been successful in many activities, but he has always believed he was capable of performing better. He found himself in a deep depression after a girl in whom he was interested gave him mixed messages and, ultimately, rejected him. Client A has wanted to examine his issues for some time but grew especially concerned when, following the girl's rejection, he punched a wall and almost broke his hand.

Client A identifies that the main negative message he heard when the girl rejected him was, "I am worthless." Interestingly, some of the reasons the girl rejected the client existed long before she met him, including the fact that her conservative family pressures her not to date. However, Client A is unable to see this evidence. Using a series of questions, he and his therapist trace the negative message ("I am worthless") back to two instances that occurred roughly around the same time. The first was when he was in elementary school and did not have many friends, and the second was when his parents made fun of him for being unpopular. When he was about 8 years of age, he overheard his parents talking in the kitchen one night when they thought he was in bed, mocking him for his "big ears" and for being an awkward kid. This absolutely devastated Client A and served as the small-t trauma that resulted in his pervasive, depression-provoking belief in his own worthlessness.