Lonely Client who Recently Experienced Loss
Instructions:
Lonely Client who Recently Experienced Loss
You are seeing a current client for a follow-up session with new developments after a recent loss. This is not an initial interview. For this session, focus on the interpersonal therapy modality to engage with the client
Interpersonal therapy—This type of therapy focuses on relationships with other people and life transitions. It is based on the foundation that relationships are at the center of psychological problems.
Case Study: An isolated 70-year-old Asian man, Raymond, lost his wife six months ago. Though he has long disliked people, he now finds himself suffering “unbearable” loneliness. He states he hasn’t considered suicide but has increased his alcohol consumption. He notes typically drinking “a six-pack every evening in order to stop thinking so that I can fall asleep.” Before his wife passed, he had been sober for 20 years. He states he just feels like he is withering away and that he feels like he is almost dead.
Mr. Zing also remarks that, independent of his dizziness symptoms, he feels unsteady on his feet when walking. He has started using a cane but doesn’t like to use it inside. When asked about previous falls, he says he hasn’t fallen. However, he says his elderly neighbor recently fell and is now in a nursing home. Now he’s fearful about falling and becoming a burden to his family. Although Mr. Zing has spinal stenosis, a recent steroid injection has relieved severe low back pain. Now he suffers only from lower back stiffness for several hours in the morning. He denies any specific weakness in his legs.
Medical Problem list
Hypertension
L3-5 spinal stenosis and chronic low back pain and leg numbness/paresthesias
Depression
Benign prostatic hypertrophy, with 3-4x/night nocturia and occasional incontinence
Hyperlipidemia
Gastroesophageal reflux disease
B12 deficiency
Allergic rhinitis
Glaucoma
Nummular eczema
Medications
Valsartan 80 mg daily
Citalopram 40 mg daily
Flomax 0.8 mg at bedtime
Finasteride 5 mg daily
Lipitor 40 mg at bedtime
Omeprazole 20 mg daily
Cyanocobalamin 1 mg daily
Claritin 10 mg daily
Flonase nasal spray two puffs to each nostril daily
Gabapentin 300 mg tabs 2 tabs three times daily
Tylenol 500 mg one to two four times daily prn
Brimonidine tartrate 0.15% ophth 1 drop OU twice daily
Cosopt 2%-0.5% 1 drop OU at hs
Latanoprost 0.005% 2 drops OU at hs
Trazodone 25 mg at hs
Calcium carbonate 500 mg 1-2 tabs three times daily
Review of Systems
Positive for fatigue, poor vision in his left eye, constipation, nocturia three to four times a night, frequent urinary incontinence, low back stiffness, difficulty concentrating, depression, dry skin, hoarseness, and nasal congestion.
Vitals:
Supine – 135/76, 69; Sitting – 112/75, 76; Standing – 116/76, 74
R 20
T 96.8
O2 98%
Pain 3 on 0-10 scale
BMI: 19
Physical Exam Constitutional: This is a thin, alert, older Asian male in no apparent distress, pleasant and cooperative, but with a notably flat affect.
Head: Normocephalic / atraumatic.
ENMT: Wearing glasses.
Acuity 20/30 R, 20/70 L.
CV: Regular rate and rhythm normal S1/S2 without murmurs, rubs, or gallops.
Respiratory: Clear to auscultation bilaterally.
GI: Normal bowel tones, soft, non-tender, non-distended.
Musculoskeletal: Strength: UE strength 5/5 B biceps, triceps, deltoids; LE strength 4+/5 bilateral hip flexors and abductors; 4+/5 bilateral knee flexors/extensors; 5/5 bilateral AF/AE; 5/5 bilateral DF and PF. No knee joint laxity. Foot exam shows no calluses, ulcerations, or deformities.
Neurology: Cognitive screen: recalled 3/3 items. Whisper test for hearing: Intact. Tone/abnormal movements: Tone is mildly increased in both legs; normal tone in both arms. Sensation is intact to light touch and pain throughout. Reflexes are normal and symmetric.
