Mr Sediki was referred to clinical psychology services following a crisis.
He is a 42-year-old married man and is the eldest in a family of 4 brothers. He presents as a polite and deferential man. Mr Sediki describes his relationship with his wife as good and they currently have no children, although they are currently trying. He told me that he likes children and thinks he would make a good father. In terms of social life, he reports that he doesn’t have close friends outside of work but sees his brothers occasionally. He described the social pattern as involving periods of intense contact with his brothers, followed by periods where he won’t contact them for a while until he feels the need to see them again.
He reported that his parents both died within the past 3-4 years; his father died suddenly following a stroke, and his mother died from cancer. He does not report distress in relation to the death of his parents and described it more as a period of confusion for him. He reported that he does not think their passing has affected him unduly. He reported that while it was sad, he has trouble remembering aspects of their deaths/funerals etc, so has come to the conclusion that it can’t have been a difficult time for him.
Mr Sediki described his childhood as difficult. He described his father as overbearing, ‘a bully’ and not really involved with the family: Mr Sediki thinks that his father did not care about his children and that they were in his way. His mother suffered from panic attacks and seemed to be constantly anxious and ill. He described her as ‘blessed’, and that she tried to be a good mother even though she was suffering, and that she would always try and help when he was unwell. One of his earliest memories was of his father staring at him like a statue while he was in pain from a stomach ache.
He could not recall where his mother was at this point but suspects that she must have helped him. He described himself as ‘maybe’ an anxious child, and sickly, with few friends at school. He did ok academically at school, but never felt good enough. He left school just prior to his leaving cert, and worked in a number of jobs before studying for his PSV licence. Intimately, he stated that he was never very successful with women, ‘never knew what they were thinking or wanted’ but nonetheless dated his wife for 6 years before marrying. He described that he wasn’t sure it was the right thing for him but that it was the right thing to do.
Mr Sediki has been a bus driver for Dublin bus for 16 years. He felt honoured to be entrusted with this role and responsibility for his passengers. He took great pride in his ability to navigate this large cumbersome machine through the narrow and often crowded streets of Dublin in a timely and safe manner. He has never had an accident and has received commendations from his employer for his courtesy and safety record.
4 weeks ago while on his regular route, a mother boarded his bus carrying an infant, who was screaming and inconsolable. As Mr Sediki guided his bus along the route he began to feel anxious, provoked by the crying infant. Perspiration flowed down his face and back and his respiration quickened. His anxiety grew with each street he travelled. He became so anxious, that he became worried that he would not be able to continue to drive the bus safely. Simultaneously he began to feel angry. The baby would not stop screaming. ‘If only the baby would just stop.’‘Why did the mother choose my bus.’‘Why couldn’t she quieten the child.’ What am I going to do? The incessant crying is making me crazy, something terrible is going to happen’’
His anxiety and anger grew to such proportions that he felt he had to pull the bus over to the kerb. He stopped the bus abruptly, and with a shaking voice, ordered the woman and the child off the bus. The woman shocked and confused stood and slowly began to gather her belongings. BY this time Mr Sediki was in an uncontrollable rage and state of acute anxiety. As the infant and mother passed to disembark, Mr Sediki raised his fist to strike out at the infant. At that instant, with his arm raised and poised to strike, Mr Sediki’s arm became paralysed in mid-air. He looked this arm in amazement and fear wondering if God himself had intervened and both protected the baby and punished him in one swift stroke.
The woman and infant quickly left the bus. With his arm frozen above his head, a shaken Mr Sediki called the bus company dispatcher and requested a supervisor and relief driver. By the time his supervisor had arrived Mr Sediki could lower his arm to his waist but both his arm and hand felt paralyzed. He was seen by his GP, placed on leave and was referred to psychological services. He reported thoughts of suicide, but reports being unsure of how he feels.
Write a clinical case formulation for Mr Sediki (copy of case distributed and available on Sulis), using the following format:
(1) Organise Mr Sediki’s presenting problems and underlying factors into an individualised explanatory model using one specific theoretical approach chosen from the following: psychodynamic, behavioural, cognitive, humanist or family systems school.
(2) Propose a plan for an assessment session to verify some of the hypotheses derived from the model you formulated in (1)
(3) Propose a treatment plan consistent with (1) and (2)
(4) Organise Mr Sediki’s presenting problems and underlying factors into an individualised explanatory method using a second specific theoretical approach different from the one you chose in (1), but again chosen from the following: psychodynamic, behavioural, cognitive, humanist or family systems school
(5) Propose a plan for an assessment session to verify some of the hypotheses derived from the model you formulated in (4)
(6) Propose a treatment plan consistent with (4) and (5)
(7) Critically discuss the advantages and disadvantages of using only the treatment plan described in (3)
(8) Critically discuss the advantages and disadvantages of using only the treatment plan described in (6)