Case 1: Jack
Jack Krull is a 26-year-old white male presenting with a shy demeanor. He made only fleeting eye contact and did not smile as he told the therapist in his first session that he knew he was overdue for getting help, mentioning that one of his problems is procrastination. He identifies that he has a lot of anxiety, which has worsened lately.
Jack has a degree in engineering and has held a job as a government patent examiner for the past 3 years since finishing college. He said that he gets very little work done, frustrated by the fact that each patent is different in scope and to find out how to approach it, he has to get information from others. Jack described how difficult it is to call people to do this. He does not know what to say and is afraid of stumbling over his words and sounding “stupid.” He also thought he would be judged for not knowing more.
Jack said he could not concentrate at work, spending most of his time procrastinating. He has received a warning from his supervisor for not meeting his quota. His job is solitary, and he does not interact with others at work, although everyone else there are “nerds” like him. However, some of them go to lunch with each other. He wonders whether it would be nice to join them rather than eating alone at his desk, but he does not feel he can do this since he is always so behind.
Jack is the product of a dating relationship between his mother and father, who had just come out of a divorce. His father indicated that Jack was a “mistake,” and Jack has had very little contact with him throughout the years and no monetary support. From his mother’s previous marriage, Jack has a half-sister, who is 3 years older. From his father, he has a half-brother from the previous marriage, and another half-brother from a subsequent marriage.
Jack said that his mother remarried when he was about 7 to a critical stepfather to whom he did not feel close. His stepfather was physically abusive to Jack’s mother. During these sporadic abusive episodes, Jack would remain in his room, feeling guilty for being unable to help. His mother left this man when Jack was 12.
Jack described his mother as overprotective growing up, exhorting him to do well in school and disallowing his attending social events because she did not want him getting into trouble. They lived in an isolated, rural setting.
Currently, Jack speaks to his mother about once a month on the phone, and he says they are not close. He tends to avoid her as much as possible and dreads talking to her. He says that he does not feel connected to any of his half siblings either.
Jack was diagnosed with ADHD as a child but could not describe any behaviors that warranted the diagnosis. He took stimulants for years but could not tell whether they helped or not. He is currently not on any medication. He says that he does not remember much about his childhood, but that, in general, he has a terrible memory. He has one memory of speaking in front of the class for

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