Clinician: Clarisa T. Queen, PhD.

Patient: Malcolm Steadman

Date and Time: [redacted]

Location: Main Office

Participants: Client only

Purpose of Evaluation:

Evaluate effectiveness of Malcolm’s anti-depressants and to follow-up on prescribed treatment strategies and the effectiveness of him participating in Cognitive Reframing.

Clinician’s Notes:

Malcolm’s appearance was once again very hygienic and appropriate. His overall demeanor was relaxed and his motor activity at ease. This is a stark difference to the state of agitation he appeared to be in the last time we met. He eventually became jittery and anxious, but this was likely due to the quick consumption of his coffee.

If I am to be honest, I did not expect to see Malcolm again after our initial meeting. Although he assured me he would keep his next appointment, he has not kept appointments in the past. I assumed that Malcolm was paying lip service as he has a high need to please others and often fears confrontation. With that said, it was a pleasant surprise to see him, and his willingness to participate in today’s session was promising.

Malcolm showed up to the session with a full large cup of coffee. Before entering he consumed the beverage in a rush and apologized for bringing food to the session. I clarified that beverages were okay so long as they were non-alcoholic and did not become a distraction.

Malcolm has since obtained a job, and it appears that the structure that employment brings, on top of the relief of stress associated from unemployment, has greatly enhanced his mood. This is where our conversation took a turn into his philosophical obsessions. He is relieved to have a job, but the stress of incurring Debt has constantly been on his mind. This notion of debt has not expressed itself in the normal fashion that most of my clients stress about. It is not just the debt itself that worries Malcolm, it is the idea that debt can only be paid off with time. That is not to say that he is worried that it will take longer than he would like to pay off his debts, but rather that the transaction to clear those debts is his mortal time. Once again we see his fixation on mortality and death. Money, according to Malcolm (and not egregiously) is a unit of time. A representation of his finite mortality that can be exchanged for with goods. Owing debt is therefore a promise to exchange a portion of his life, to be paid off later, for goods now. Mr. Malcolm Steadman absolutely resents this.

Malcolm is not happy with the fact that the path of becoming healthy (both psychologically and physically) that is ahead of him is incurring a debt that he cannot pay off until he is healthy (Side note: Malcolm has yet to pay for his services). He is afraid that once he is healthy, further development and growth that he desires to become happy will “be held hostage” until he sacrifices a portion of his mortal time in exchange for that help.

Here we see a deep distrust in the society he wishes to be apart of, yet lacking an animosity to authority. This is coupled with his obsession of death and a deep anxiety of the existential. It appears that Malcolm wishes to rejoin what he considers to be “normal society” but resents the obstacles said “normal society” has placed in front of him to do so.

What was most interesting to me during this exchange was Malcolm’s mood. I did not observe any negative posturing or obvious expressions of anxiety while he expressed his woes (save for some restlessness, which I will attribute to the coffee). After some questioning Malcolm admitted that his initial exploration of this thought (something which occurred while he was walking to work, but after he received a notice from his landlord) did not result in his normal panic attack. In fact, Malcolm has not experienced any of his panic attacks since taking his new medication. This is a very positive improvement.

Malcolm has complained of an “overall dulling effect” of the drugs. He admitted that this was a minor complaint. Given his quick progress on his panic attacks, I would like to observe him taking his prescription on a longer term before deciding to change the dosage.

Malcolm has also made some large changes to his lifestyle, of which appear to be positive. Malcolm has taken in a roommate. I will admit that this news of a sudden change worried me, but after pressing Malcolm he assured me that this roommate was a longtime friend whom he met at his previous job and that this friend was a healthy influence. I asked if Malcolm felt comfortable with me meeting this roommate, which was something he agreed to with a visible nervousness (again, probably just the coffee). His roommate appears to be providing social interactions that he was terribly lacking in his isolation previous to being admitted to the psych ward. On top of this, Malcolm claims that he has not drank in a week. I made a point to celebrate this milestone with Malcolm, but encouraged him once more to seek out a support group.

Malcolm and I discussed further Cognitive Reframing concerning his obsession with death, this I believe is as necessary as his prescriptions.

Though I will reserve complete judgment before I meet Malcolm’s new roommate (something I only find necessary given the suddenness of the change) I will admit that I am optimistic. A healthy, and positive influence in Malcolm’s life that provides needed social interactions should greatly reduce his depression. Malcolm claims that this individual does not abuse any substances (something he was keen on pointing out twice, likely due to my concern about his alcoholism) and that said individual has a steady, and well-paying job. In Malcolm’s own words “he is a really normal guy that would not stand out ever”.

I think Malcolm has a lot of positive potential in improving.

–Clarisa T. Queen, PhD.

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