Introduction: The Four Case Examples

Abstract

This book addresses the application of cognitive behavioral therapy to persons with chronic illness and/or impairment. Rather than emphasizing diagnostic categories , it focuses on cross-cutting symptom categories of fatigue, pain, sleep dysfunction, and gastrointestinal problems. Individually or in combination, these symptom categories most frequently characterize chronic conditions. While each of these categories of symptoms requires some special considerations, the book will illustrate how the major therapeutic strategies of cognitive behavioral therapy can be applied across them. In this chapter, four case examples are introduced, each presenting with one of the four major symptom categories. The first case example focuses on fatigue as the primary symptom and describes the experiences of Nina, a 35-year-old woman with chronic fatigue syndrome. The second focuses on pain as the primary symptom and describes the experience of Paulette, a 42-year-old woman with rheumatoid arthritis. The third case example highlights the role of sleep disorder in chronic illness and describes Curtis, a 60-year-old man with advanced prostate cancer. The fourth case example focuses on gastrointestinal difficulties as the primary symptom and describes Alex, a 23 year-old man with Crohn's Disease. These case examples are composite representations of actual cases seen by the author. Significant sociodemographic details, diagnostic information, aspects of the medical history, and background information have been altered so that it is impossible to trace any of the case examples to the individuals that were actually treated. These case examples reappear throughout the book and serve as bases for illustrating the application of key concepts of cognitive behavioral therapy. They each vary in terms of the degree to which Axis I and II psychiatric overlay is also present to illustrate nuances involving therapy pacing, differing approaches to the integration of related knowledge, and to reveal the real-world complexities that can arise when conducting cognitive behavioral therapy with individuals with chronic illness. The choice to present some of the case examples as having psychiatric overlay was made in an effort to best reflect variation in the types of clients with chronic conditions that would most likely be referred for psychotherapy.