​Application: Cognitive-Behavioral Orientation—Case Conceptualization

Psychotherapy Interventions II

Case Study: Kyle

Name: Kyle Gender: Male Age: 40 Ethnicity: Caucasian

Religion: Lutheran Relationship Status: Married

Description of Presenting Issue:

Kyle’s wife urged him to contact you because she was concerned about radical changes in his behavior. As a reservist in the U.S. Marines, Kyle has been deployed twice to serve in Iraq. During his first deployment, he was stationed in Kuwait and had an uneventful service. However, his second deployment was marked by a significant tragic event. During a weekend leave, Kyle was exploring a rural marketplace with several military colleagues. A bomb detonated at the market, killing several dozen local civilians, and one of Kyle’s colleagues. Kyle, who was not hurt in the blast, heroically assisted both his colleagues and many of the civilians who were critically wounded.

Since returning home 10 months ago, Kyle has been unusually withdrawn. He will not discuss his time in Iraq with his wife or family, and becomes quickly irritable when asked by friends about his deployment. Kyle’s wife reports that he frequently has nightmares in which he calls out or cries in his sleep. Kyle, himself, has not mentioned these nightmares. She has also noticed that Kyle seems unable to sit though a movie, a pastime that they both used to enjoy regularly.

Last month, a rash of nighttime burglaries occurred in Kyle’s neighborhood. Kyle became fixated on protecting his house and family, often staying up through the night and walking around the house repeatedly.

Kyle reports that although he cares about his family, he cannot seem to “connect” with them anymore. He can see that the change in his behavior is taking a toll on his marriage, but he does not believe that he can do anything about it.

Occupational History: Kyle is a software programmer. He has held various positions in the technology field, including management, but he prefers to write code.

Educational History: Kyle received his bachelor’s degree in computer science.

Medical History: Kyle is being treated for gastroesophageal reflux disease. His physician is treating the condition with Tagamet and dietary change.

Family History: Kyle is an only child. His parents adopted him when he was 9 months old; he has no contact or knowledge about his birth mother. He describes his father as “very caring, but very strict.” On the contrary, Kyle’s mother tended to spoil him and she refrained from disciplining him when he was growing up. Kyle’s father was an alcoholic and he would occasionally erupt in a drunken outburst. On rare occasions, he would lash out physically against Kyle or his mother.

Alcohol/Substance Use: Due to his father’s history, Kyle does not use alcohol. He occasionally takes prescription painkillers given to him by a friend to help him “chill out.”