Client ID/Case Number: 32667
Date of Session: February 20, 2013
Session Number: 42
Primary Reason for Therapy: David is undergoing therapy for severe depression, post-traumatic stress disorder, and substance abuse. His condition has deteriorated, with increased isolation and heightened paranoia. He continues to struggle with forming relationships and has trust issues. I am his fifth therapist. The trauma from his kidnapping at age 11 remains unresolved and appears to be deepening.
Note on margin: I sense a growing detachment in David. His stories don’t always align. Could there be something else under the surface?
Current Issues: David reported persistent paranoia, describing feeling as if he's being watched or followed. His nightmares have intensified, and he’s begun hearing fragments of conversations he can’t explain, leading to heightened fear and confusion. He also mentioned increasingly vivid flashbacks, often triggered by minor encounters.
Mood & Affect: Highly anxious, paranoid; flat affect with moments of agitation. Frequent dissociation during the session.
Client’s Progress: David has stopped using grounding techniques altogether, expressing a belief that “nothing helps anymore.” He has not adhered to his medication routine, reporting that he "doesn't trust it" anymore, fearing it makes him more vulnerable.
Interventions Applied: Cognitive-Behavioral Therapy was attempted to challenge his paranoia, but David remained resistant, questioning the reality of the situation. Grounding exercises were reintroduced but rejected by David, who claimed that he "can’t focus" when the anxiety hits. Discussion on medication’s side effects and changing everyday environment was brought up, but David remained skeptical.
Therapist’s Signature: Laura Miller
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