I am reminded of the Mad comic book and the refrain it always asked.... "why me worry?" Gary has a successful life as a practicing physician yet he is very unhappy. I wonder what is the function of his anxiety ? It does not seem to be based on any realistic appraisal of his abilities so I would look to his history to see if there is any information that could help us understand what is going on. His parents are described as problematic people. He told us that "my parents always did things for me and tore down what I did". He also reported that his sisters "always wrote his school papers for him and then told him that he was dumb. His mother is described as being down on men, as always tearing him down, and as never letting him invite friends over because the house was too messy. His father was a "workaholic who never believed in me". The theme is an extremely negative, critical and an unhappy, lonely, existence. This young man was never allowed to develop his own non critical productive voice. It appears that he is continuing to treat himself in the same manner as he was treated by his family. I think that Gary has complied with their view of him. We see this in his continual doubt, worry and unhappiness. He must not feel comfortable thinking for himself. He might have inferred that his parents enjoyed having the opportunity to put him down in order to make themselves look and feel better. His worry of constantly making mistakes or losing control suggests that he had a family member that was out of control that he was identifying with. I would look into the side effects of his sudden withdrawal from Valium, and rule out alcohol abuse.
I wonder if the exacerbation of his symptoms occurred at this time because of his return to school. He is getting additional training in order to switch jobs, perhaps into a field that he might enjoy more. This could increase his anxiety as he might feel as though he was defying what his parents wanted for him by trying to enjoy his life more not just be a workaholic as he describes his father.
Gary seems as though he is someone who has tired to be a good boy all his life and it has left him feeling alone and unseen or cared for. We might see him attempt to disconfirm his beliefs (or alter his scrip) by testing Jim in treatment. He might act very critical of Jim's assignments. He might act like they are silly, or useless, and try not doing them (as a test) to see if Jim will get upset. He might wonder if Jim would throw him out, tell him he is no good or enjoy showing him how to do the assignments which would replicate his family experience. I was very struck by the idea that his family members did his homework for him when it appeared that he was capable of doing it for himself. Although his family may have meant no harm and had wanted to help, this might have led Gary to develop the idea and pathogenic belief that others would not like him to have independent success.
As we learn how Gary responded to Jim's assignment we will understand more about how Gary plans to work in treatment. Jim has taken Gary seriously and offered him realistic, reasonable help in overcoming his problems. Gary is likely to assume that he is always doing something wrong and that he will be criticized. I am interested in learning how he responded to the assignments and how it felt to be in the room with him. Did he enter treatment with a contract for a particular number of sessions? or was he free to stay in treatment as long as he would like?