1. FAMILY My 57 year old mother died after a short illness last June. She was a wonderful mother and my 66 year old father adored her. They had been married for 38 years. He is finding it extremely difficult to cope without her. To make matters worse, he retired just two months before she died and is at a loss to fill his days. He is disorganized and has not established any pattern in his life. I invite him for meals and outings, but he is detached and depressed. He doesn’t seem to be part of the world any more. I am terribly worried about him. How long will he be like this? I am 34 and have small children. I thought being with the children would help him, but it’s as though he doesn’t see or know them. He just sits and stares into space for much of the day. He seems locked into his grief. 2. FAMILY One of our 17 year old son’s best friends took his life several months ago. Our son didn’t say much at the time, but he was very shaken. Since then he has gradually “retired” into himself. He stays in his room most of the time listening to rock music. He is unemployed and no longer sees his former schoolmates. We are very worried about him. How do we get him out of himself? He has always been a quiet guy but his present behavior is beyond “quiet.” We have two other children, girls aged 13 and 10, but our son now just ignores them. 3. FAMILY - rural Ken is a 67 year old farmer who lives with his wife Margaret. Ken and Margaret had hoped to retire late in their 60s and move to the west coast to be closer to their children, reluctantly selling the family property that has been struggling financially. They have limited investment funds set aside to support their retirement and have been told it is unlikely that they would be successful in selling their farm. Ken also suffers chronic back pain from a previous farm injury. A neighbor has become concerned about Ken’s ability to cope with his property, and has visited Ken and Margaret a number of times due to problems with his stock and pasture management. Margaret believes the farm is “too much for them now,” but feels she can’t talk to Ken about this. Ken has become withdrawn and refuses to discuss the issue. He talks about there being “no way out of this,” and that it “might as well be over.” He sees his physician infrequently, having difficulty traveling the 60 miles to the nearby town. 4. FAMILY - rural Jason is 34 years old and lives with his wife Jenny and their two children (8 and 3 years old). After completing a mechanical trade apprenticeship in Boston, he has returned home with plans to build his future as a farmer. He has become increasingly irritable and frustrated with what he believes is his failure to “get on top of things” on the farm, and they are struggling to manage financially. Jason is drinking heavily, mostly at home, but still drives his car into town. Jenny is angry and worried about this. She is feeling isolated, having few friends in the area, and relying on Jas ...

1. 1. FAMILY
My 57 year old mother died after a short illness last June. She
was a wonderful mother and my 66 year old father
adored her. They had been married for 38 years. He is finding it
extremely difficult to cope without her. To make
matters worse, he retired just two months before she died and is
at a loss to fill his days.
He is disorganized and has not established any pattern in his
life. I invite him for meals and outings, but he is
detached and depressed. He doesn’t seem to be part of the world
any more. I am terribly worried about him. How
long will he be like this? I am 34 and have small children. I
thought being with the children would help him, but it’s
as though he doesn’t see or know them. He just sits and stares
into space for much of the day. He seems locked
into his grief.
2. FAMILY
One of our 17 year old son’s best friends took his life several
months ago. Our son didn’t say much at the time, but
he was very shaken. Since then he has gradually “retired” into
himself. He stays in his room most of the time
listening to rock music.
He is unemployed and no longer sees his former schoolmates.
We are very worried about him. How do we get him
out of himself? He has always been a quiet guy but his present
behavior is beyond “quiet.” We have two other
children, girls aged 13 and 10, but our son now just ignores
them.

2. 3. FAMILY - rural
Ken is a 67 year old farmer who lives with his wife Margaret.
Ken and Margaret had hoped to retire late in their 60s
and move to the west coast to be closer to their children,
reluctantly selling the family property that has been
struggling financially. They have limited investment funds set
aside to support their retirement and have been told
it is unlikely that they would be successful in selling their farm.
Ken also suffers chronic back pain from a previous
farm injury. A neighbor has become concerned about Ken’s
ability to cope with his property, and has visited Ken
and Margaret a number of times due to problems with his stock
and pasture management. Margaret believes the
farm is “too much for them now,” but feels she can’t talk to Ken
about this. Ken has become withdrawn and
refuses to discuss the issue. He talks about there being “no way
out of this,” and that it “might as well be over.” He
sees his physician infrequently, having difficulty traveling the
60 miles to the nearby town.
4. FAMILY - rural
Jason is 34 years old and lives with his wife Jenny and their two
children (8 and 3 years old). After completing a
mechanical trade apprenticeship in Boston, he has returned
home with plans to build his future as a farmer. He has
become increasingly irritable and frustrated with what he
believes is his failure to “get on top of things” on the
farm, and they are struggling to manage financially.
Jason is drinking heavily, mostly at home, but still drives his
car into town. Jenny is angry and worried about this.
She is feeling isolated, having few friends in the area, and
relying on Jason’s parents who live nearby, who are
eager for Jason to remain in the area and take over the family
farm. Jenny has taken Jason to the primary care

3. physician a number of times now for these problems, but is
concerned he is getting worse.
SCENARIO 1
You have been asked to see Sue, a high achieving student,
because her home room teacher has noticed
that she has lost a significant amount of weight in the last few
months. Her clothes are baggy. She also
seems to have withdrawn from her friends and is often seen
running around the track at lunch time or
recess. She has been spending more time in the school nurse’s
office, often complaining of a stomachache
and nausea. Last week she fainted in an afternoon class. Her

4. teachers comment that she seems distant in
class and that the quality of her homework assignments has
begun to deteriorate. When asked, she
constantly denies there is anything wrong and promises that she
will work harder to make up for her falling
grades.
The school has told Sue’s parents they are concerned that she
may be developing an eating disorder. When
her parents confronted her, Sue merely told them that
everything was fine. They thought you might have
better luck getting her to open up.
SCENARIO 2
A student has been absent from classes a lot over the past few
months. Her appearance has deteriorated:
her hair is limp; her skin is pale; her teeth are stained and she
has dark circles under her eyes. You have
noticed that her weight has fluctuated a lot recently and she
often appears “puffy” around her face and
neck. Her teachers report that she has dismissed herself several
times during class to go to the bathroom
and sometimes returns with a flushed face and watery eyes. Her
friends tell you that she talks obsessively
about weight, food, calories, and celebrities’ bodies. She has
rejected her homeroom teacher’s attempts to
speak with her about any problems she might be having and
denies that there is anything wrong.
You are concerned that she may be developing an eating
disorder.
SCENARIO 3
A male student in 10th grade has gained a significant amount of
weight, withdrawn from his social group
and no longer plays sports. He often disappears at lunchtime but

5. is rarely seen eating at school. When he
does eat, it seems that he is generally eating junk food. His
teachers comment that he is often late to class,
his academic performance has fallen, and his mood swings are
quite noticeable during the day.
When he has been approached about changes in his behavior, he
was very embarrassed and reluctant to
speak. He said that he has a glandular condition which is
affecting his weight.
You are concerned that he may be developing an eating
disorder.
1. COMMUNITY SETTING
You are at a shopping mall with your friend Jane when suddenly
she starts to look really sick and says things are
spinning. Jane’s breathing is increasing and it sounds like she is
struggling to catch her breath. She starts to
panic and grabs at you, holding her chest. She says she is
terrified something bad is about to happen. You
suspect she may be having a heart attack or a panic attack.
2. FRIEND
Don, a 26-year-old married IT technician, is suffering from
periodic feelings of extreme fear that overcome him
with no warning. These feelings began 6 months ago, soon after
the birth of his first child, and in the past
several weeks have escalated so that they occur once per week.
Yesterday, he had two such attacks and he is
now apprehensive that he may be going crazy, because he has
no idea why he is so fearful. Upon questioning,
he says that he feels dizzy and faint during these episodes and

6. that he has also been trembling and
experiencing tingling sensations in his hands.
3. CLIENT
Anne, a 45-year-old unemployed single woman, complains that
she has experienced discrete bouts of
nervousness for a number of months, the source of which she
cannot understand. Specifically, her heart beats
rapidly, she feels dizzy, she has hot and cold flashes, and her
hands and feet tingle. Simultaneously, feelings of
intense apprehension overwhelm her. She now feels so much
apprehension about the possibility of these
horrible sensations occurring that she never goes out alone. She
has had one attack in the past month. Before
the symptoms started, she says she was happy and healthy. The
symptoms began six months after the
unexpected death of a favorite uncle.
4. WORKPLACE – College Professor
You teach an introductory course comprised primarily of
freshmen. One of the assignments that you have
given to the students requires each student to give a 5 minute
oral presentation. Most of the students have
done their presentations. A young student gets up to do his
presentation. He looks very nervous and pale, and
then his breathing becomes very rapid and shallow, he clutches
his chest. You suspect that the student is
having a panic attack.
5. WORKPLACE
Your office is a busy and somewhat chaotic place. You are
trying to move through the crowded and noisy
reception area when you notice a member of the public standing
in the middle of the area looking pale and
distressed. She is not someone you know, but she suddenly
grabs at you, clutching her chest with her other

7. hand. She sounds as though she is struggling to breathe. She
manages to say, in a strangled voice, “Help me,
the room is spinning!”
6. WORKPLACE
Don, a 26-year-old IT technician, is suffering from periodic
feelings of extreme fear that overcome him with no
warning. They began 6 months ago, soon after the birth of his
first child, and in the past several weeks have
escalated so that they occur once per week. Yesterday, he had
two such attacks and he is now apprehensive
that he may be going crazy, because he has no idea why he is so
fearful. He discloses that he feels dizzy and
faint during these episodes and that he has also been trembling
and experiencing tingling sensations in his
hands. Unfortunately, the new server for the office is about to
be installed and it is imperative that all systems
are running problem free before the approaching assessment and
reporting deadline. Don expresses great
concern about his ability to cope with the workload involved.
1. FRIEND
Julia is the 21-year-old daughter of your close friends and has
been best friends with your son since he and Julia
were in elementary school. She discloses to you that she has

8. been drinking and taking "party" drugs regularly. You
notice that she seems very sad lately and you discuss this with
her. Julia discloses that things at home and at school
have been really bad and even though she knows that the
drinking and drugs are bad for her, it is the only time that
she feels good and happy.
2. FAMILY
My husband and I have been married for 18 years and have two
daughters, 17 and 16, and a son, 12. He is 49 and I
am 44. A year ago he was a moderate drinker, just two or three
beers a day, but now he is drinking a bottle of wine
as well as liquor every night. He denies he has a problem, but
he is wrong. He drinks every night and is drunk every
weekend. He used to be a good husband and father, but during
the past year, I have lost confidence in him.
If I try to talk to him about his drinking, he becomes verbally
abusive. He is very unpleasant. The girls are ashamed
of him and are threatening to leave home and live with their
grandmother.
How can I get him to seek help when he won’t admit he has a
problem? My mother thinks I should secretly
videotape him and show him how he is behaving. Could this
bring him to his senses? We cannot go on living like
this. The children’s lives are being badly affected.
3. WORKPLACE
You are concerned about a co-worker who has been really
difficult to work with lately. On a few occasions over the
past month he has called in sick, when he seemed okay the
afternoon before. He is usually at the center of the
very active office social life and regularly leaves from happy
hours having had a few too many. No one ever minds,
as it is all part of the fun of working here. But lately he has

9. been morose and quiet at the bar after work. He just
sits there downing drink after drink.
You are getting worried because you and your colleague have a
joint deadline to meet and he is constantly
complaining about criticism of his efforts, his mistakes here and
there, and your constant nagging about deadlines.
You feel that you normally have a good working relationship
and that his outbursts are unjustified. One day when
he calls in sick, he unexpectedly says that he just can’t cope
with the pressure and he is thinking of resigning.
4. WORKPLACE
A 25-year-old single mail clerk complains that his stomach has
been giving him trouble. He has recently cut back on
his alcohol consumption and has been experiencing an
extremely upset stomach accompanied by trembling and
sweating. His reduced alcohol intake at present is in response to
an ultimatum from his boss to either cut down on
his drinking or lose his job. This, in turn, was prompted by his
third arrest in two years for drunk driving.
5. WORKPLACE– Police station
A male officer that you work with is in his mid-forties, married
with no children. He has seven years of experience
having joined the force later in life. You find him sitting with
the lights out two hours after his shift started. You see
that he hasn’t shaved for several days and you can smell alcohol
on his breath. He says he got little sleep last night
because he was drinking with friends until around 3 a.m. You
tell him that his behavior isn’t fair to you or the other
officers who depend on him or have to cover for him. He
responds by yelling, “why should I care when I’ve been
screwed over time after time by management.” He talks about
not getting a job that he was promised. Over the
past few months, you have seen him come to work in dirty

10. uniforms, unshaven, and smelling of stale alcohol.
Recently he also seems more accident prone.
1. FRIEND – rural setting
You live in a small town where conditions are extremely harsh.
It has been an exceptionally long, hot,
dry summer with weather conditions just right for wildfires.
Unfortunately, it was not long before a major fire occurred. It
was a tough time for all, but fortunately
your town was saved. Sadly, a neighboring town wasn’t so
lucky, and many homes were lost. Your town
pitched in to fight the fires and to provide support to the locals.
Many of the neighboring townspeople
are long time friends or family members. The losses felt by the
community were devastating.
You were there as a volunteer disaster relief worker and saw
that one of your friends had lost
everything. There were also other support workers and
counselors on hand. You are very concerned
about your friend, and his ongoing, highly-stressed reaction to
the situation. He is irritable, nervous, is
not sleeping very well and can’t stop thinking about the fire.
2. FAMILY
When my partner was 16 he came home from school and found
the body of his mother. She had had a
heart attack. He says he went into shock and was in a bad way
for some time. His father arranged for
him to talk with someone, and he eventually came to terms with

11. what had happened.
He is now 27 and we have been together for nearly a year. We
have been very happy together and he
has been the best thing that has ever happened to me. However,
three weeks ago our pet cat was hit by
a car and killed in front of our home. My partner came home
from work and found the cat in the gutter.
When I came home, I found him sitting in the dark. Since then
he has been having nightmares and
flashbacks. He keeps reliving the time when his mother died. He
is becoming anxious and withdrawn
and is not sleeping well.
3. WORKPLACE
It is the second week of the semester and the volume of students
coming into the library has been
steadily increasing and lots of students are accessing the library
for the first time. It is generally very
busy (as it always is at this time of year). Vivian, a new staff
member (employed on a 6 month fixed
term contract) is 20 minutes late to work and arrives looking
pale. You are busy helping a student, and
there is no opportunity for the usual morning greeting.
The supervisor of the section is at a meeting. Vivian sets about
to work shelving books nearby. You
notice that Vivian is having trouble sticking to the task, at times
she walks up and down the same row of
shelves to find the correct location for a book. See also seems
to be tense and nervous. You finally get
the chance to ask about her weekend.
Vivian replies that she had been involved in a car accident on

12. Friday night when driving home from a
party. The driver of the other vehicle swerved into her car,
rolled his car and was killed. Vivian says that
she has not been sleeping and can’t stop thinking about the
accident.
4. WORKPLACE
You work in the administration section of a chemical company.
You work closely with one of the plant
supervisors, with whom you are quite good friends. About 3
weeks ago, there was a fire at the plant. A
number of employees were evacuated, some suffering from
smoke inhalation. One employee was severely
burned and, despite prompt first aid at the site, died a couple of
days later while in intensive care in a
hospital burn unit.
Your employer offered all staff the opportunity to discuss the
incident with a counselor immediately
following the fire, but your colleague did not talk to anyone. He
was very distressed when he heard of
the worker’s death and took the rest of the day off. He has been
back at work every day since then,
but you are increasingly concerned about him. He is extremely
irritable with staff and quite jumpy. He
tells you he is not sleeping very well and can’t stop thinking
about the day of the fire. But he says that
there’s nothing that can be done and he has no intention of
discussing it with you or anyone else.