Vignette for Case Conceptualization 1 Rich is a 30-year old male who presented t

Vignette for Case Conceptualization 1
Rich is a 30-year old male who presented to your office for an intake appointment. At the first visit, Rich appeared jittery and nervous. Upon greeting, Rich refused to shake your hand and awkwardly followed you back to your office from the waiting room. He reported that he is seeking treatment at this time because he is unable to function in many aspects of his life. He reported that his girlfriend recently broke up with him and that he was fired from his job because he stopped showing up to work. As such, he stated that he feels like he’s hit “rock bottom” and needs help.
He stated that over the last two years he began developing difficulties in his ability to function in “day to day stuff.” He stated that he often had fears of taking public transportation to work (he does not have a car) and that he had to “be creative in how he got to work.” He stated that he stopped taking public transportation all together and didn’t like being “out in crowds” at all. He reported that he “can’t remember” the last time he went out in public.
Rich reported that his home life has been very stressful. He reported that everything in his apartment has to be in a particular order or he would get “very upset.” He stated that he keeps his house clean but that it sometimes doesn’t feel “clean enough.” He reported that he is often worried about possibly getting sick or contaminated at home from dirt or bacteria. As such, he reported that he washes his hands multiple times throughout the day and will shower “a few” times before he leaves his house for the day. When asked specifically about how many showers he takes daily, he reported, “somewhere between 12-15 showers.” He stated he also feels the need to wash his hands “countless” times and that he also will do his laundry 2-3 times per day to “help make sure he isn’t contaminated.” Rich reported that these behaviors are “somewhat helpful” but that his fears are always in the back of his mind. He stated that because he has so many things to do to “stay clean” that his friends and family (and ex-girlfriend) no longer want to hang out with him and that he has very little time to do anything else.

* rubric is in attachments as well as directions