Introduction Rahul is 24 years old and is employed as a partner in his motherâ€™s business. He is the middle child with an older sister and younger brother. His mother runs the family business and his father has problems in drinking. He was brought by his wife for problems with gambling and excessive lying. Presenting Problem Rahul has problems with betting and gambling. He also has problems with excessive lying and hiding. History of the Presenting Complaint Rahul lives with his family who is located in Chennai. He is addicted to gambling and tends to lie about it and hides it from his wife and family. His routine is disrupted during the cricket and football season. He sleeps late and wakes up late. Watching the games have triggered his betting tendencies. He also plays poker online or on the phone. He has lost a lot of money by gambling. His interaction with his family has decreased and his wife is getting frustrated with him because of the lying and also because he does not stand up to his parents or explain her issues to his parents. He is not able to be assertive in his communication to anybody including his subordinates (like driver). He feels like running away or disappearing because he feels he cannot do anything right and he does not know himself anymore. Past Psychiatric History Nil Past Medical History High sugar level Family History
Rahul’s father had a history of abusing alcohol. He was addicted. His father has had a second wife which the family knows about. His parents question his wife a lot and this upsets her. The family environment is stressed. His father has encouraged him to ask him for money in secret so that he can gamble. Personal History Rahul grew up in a dysfunctional home. His current relationships with his parents and siblings are strained. He is recently married. He has had a history of engaging in gambling since his studies abroad. Since then he has been betting and gambling and losing lots of money via online gambling. During the cricket and football season, he meets his friends and gambles. Has lost big amounts of money and lied saying it was to buy gifts for his wife. The couple does not have any savings of their own; they live with his parents and look to them for support. He is not assertive in his communication and is losing confidence. Follow up Session2 His addictive habit was making him lose structure in his daily life. He was having problems with his parents. Rahul was continuing to play poker on the internet and mobile. His interaction with his family was decreasing. He recognized that his behavior was wrong but claimed that he could not help it. Counselor’s Intervention •
Rahul was asked to maintain a structured daily routine
He was asked to engage in affirmative self talk to cut down his impulsive behavior.
Alternative entertainment to divert his mind was suggested (to attend dance classes with his wife).
Session3 Rahul’s sugar level had gone up. He was put on insulin. He has refrained from getting into playing poker online. During his vacation in May he planned to go to Shimla. The couple had not started dance classes yet, but Rahul was going to the gym regularly. His sleep routine, diet routine and daily structure has improved. Counselor’s Intervention •
Was referred to a psychiatrist for medication to manage his impulsive behavior.
Session4 Rahul visited the psychiatrist who conducted some tests and put him on Depakote 250 and Xet ck12.5 Rahul played poker with money and lost 3 lacs in the process. He lied to his family saying he bought his wife a bag and a watch with that money. His credit cards kept getting swiped for big amounts of money. His wife was worried that there will be left with no money. He was fidgeting with a rubber band throughout the duration of a session and did not maintain continuous eye contact. He was unable to be assertive to his driver to give him instructions to come to work early. Rahul took everything as a personal attack and felt like he couldn’t share anything with anyone. Counselor’s Intervention •
Explained what addiction is, helped him understand the process of his behavior.
Rahul was asked to write self defeating thoughts and positive thoughts. This was given as homework.
Relaxation music was suggested before going to bed.
Rahul had been exercising and his sugar levels were back to normal. He felt like running away from life. His wife verbalizes when she is unhappy and this affected him. Rahul met an instructor about confidence building classes and had been listening to music for relaxation. He joined a cricket league and is enjoying it. He told himself that he cannot give up so easily. Counselor’s Intervention •
Explained and helped Rahul write self defeating and counter thoughts pertaining to specific situations.
He was asked to try keeping away from food he found tempting for to days so that he could practice self control.