Consider the following two scenarios:
Tim is a 6-year-old boy brought to the family medicine clinic for an initial visit. On entering the examination room, the physician observed Tim spinning in circles on the stool while his mother pled, “If I have to tell you one more time to sit down….” Tim was not permitted to begin first grade until his immunizations were updated. His mother explained that Tim had visited several physicians for immunization but was so disruptive that the physicians and nurses always gave up. She hoped that with a new physician, Tim might comply. The mother described a several-year history of aggressive and destructive behavior as well as four school suspensions during kindergarten. He often becomes “uncontrollable” at home and has broken dishes and furniture. Last year, Tim was playing with the gas stove and started a small fire. Tim frequently pulls the family dog around by its tail. Tim’s older sisters watched him in the past but have refused to do so since he threw a can of soup at one of them. Tim’s father is a long-haul truck driver who sees Tim every 3 to 4 weeks (Searight et al., 2001).
Wallace is a recently retired 55-year-old man and is the primary caregiver for his wife, who is currently undergoing chemotherapy for breast cancer. As his wife became weaker from the treatment, Wallace became increasingly anxious about his own ability to care for his wife and his sense of agency in the situation. After a serious infection led his wife to be hospitalized, Wallace’s symptoms grew worse. He stopped eating and lost 25 pounds during a matter of weeks. On a trip to the grocery store to purchase food for the household, Wallace had to stop and ask directions to get back to the house at which he had lived for 15 years. This further exacerbated his depression and anxiety and he grew fearful of leaving the home, often sitting in one chair for hours without moving.
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