Walk through a case to discover how the therapeutic process unfolds, some of the evidence-based strategies used, and how Cain transforms because of the work he puts in. Clearly, Cain isn’t a real person. I’ve never met anyone named Cain. Has anyone? For me, he’s an amalgam of cases I’ve worked over the years with no particular correlation to any specific patient.

Case presentation

Cain is a 35-year-old male. He is 6’2” and 220lbs with an athletic build. In 2021, he met diagnostic criteria for moderate alcohol use disorder, generalized anxiety disorder, and major depressive disorder by a clinical team at Panhandle Horizon, an inpatient treatment center. Cain didn’t follow up for aftercare and subsequently relapsed. He found his way into Alcoholics Anonymous and regained abstinence, which he’s maintained, but the depression/anxiety have persisted and worsened in recent weeks, prompting him to seek care at our office.

No other chronic health conditions are reported. He’s generally healthy.

Cain lives alone and is dating a woman he’s been seeing for 4 months. He was once divorced. Cain was married for 10 years before a betrayal resulted in the dissolution of their marriage in 2020. They had no children together. No other committed long-term relationships are reported.

Cain reports having a “rough childhood”, growing up with a father who was a drill sergeant and often verbally abusive. His mother died in a boating accident when he was young, and his father never remarried. He’s estranged from his father. Cain has two younger sisters, only one of whom he remains in contact with.

Cain states that he often “ran the streets” and experimented with drugs before enlisting.

Cain enlisted in the U.S. Army in 2010, served 5 years, and was twice deployed to combat zones. He served as an infantryman as a machine gunner, then a weapons-squad leader. Upon transitioning to civilian life, he enrolled at the local university, where he graduated with a bachelor’s in computer science in 2020. He took a full-time job as a software engineer at Blackwell in 2022, where he remains today.

In our initial encounter, he was somewhat guarded and uncomfortable, moving restlessly during moments of silence. Eye contact was intermittent. He often looked down and to the left. Cain became increasingly engaged as the interview progressed. Overall, his interpersonal presentation alternates between guardedness and apparent self-assurance.

Cain describes feeling “on edge” and occasionally re-experiencing internalized rage. No aggressive or acting-out behavior is reported. He states that he has days when he “falls into despair” and loses the will to live. It appears he’s intrinsically motivated to participate in therapy, as no other external force has referred him or required him to be here.

He wants to get better, and I look forward to showing you how this process unfolds.