Nadine has been dating Jim for eight years. They began dating incollege and Nadine reports that she remained supportive of Jimthroughout his years in medical school and residency as a doctor.Nadine reports that it has not always been easy for her as sheoften will feel neglected by Jim due to his busy schedule, thoughshe has never communicated these feelings to Jim, since she doesnot want to appear “selfish” or “nagging” and she does not want tobe a cause of further stress in his life. Nadine was recentlydiagnosed with kidney disease, which has created a considerableamount of stress in her personal and professional life. She reportsthat her graduate school program was not understanding of her needto miss classes due to multiple doctor appointments. Furthermore,she was not able to request a medical leave from her program, whichultimately led to her having to leave her graduate program due toher medical issues. Nadine reports that while she has discussedthese current stressors with Jim, he does not always appear tounderstand the loss she is feeling. She reports that Jim will tellher that she should seek legal action against her school and thatshe should not be so passive. Nadine reports that Jim is oftendismissive regarding the severity of her condition, noting that shewill be fine. Nadine expresses a desire for Jim to accompany her ondoctor appointments, however she will not ask him as he hasrepeatedly mentioned how busy he is and how little time he has forhimself outside of work. Nadine reports that she will often cry toherself every day due to the fear she has regarding her healthcondition as well as her feelings of failure that she was not ableto complete her studies due to becoming sick. Nadine has expressedthat she would like to have Jim join a session in order to help hercommunicate what she has been feeling, as well as address thecontinued detachment she reports within their relationship. Jim hasthus far not agreed to join Nadine in therapy, reporting that hisschedule does not make it possible and he does not believe thattherapy is necessary to address the issues within theirrelationship, but rather that it is Nadine’s passivity which iscausing her unhappiness.

1. What are some negative automatic thoughts that you identifyNadine to have? What are negative automatic thoughts that youidentify Jim is having? Describe cognitive behavioral techniquesthat you would use with this couple?

2. Do you believe that Jim and Nadine will be able to workthrough their conflict? If yes, what are the indicators that thiscouple has a chance to solve their problems? If no, what are theindicators that this relationship is headed toward the end?