Presenting Information: Henry is a 46-year-old Japanese man. He was born in Japan and moved to the United States by himself when he was in his early 20s to go to college and work. He presents to counseling with multiple complaints of depressive symptoms, anxiety about being in social situations, relationship problems, and financial challenges. He reports feeling irritable and down most of the time but continues to go to work even though he does not have the energy. He also states that he experiences nervousness when he is around people at work and socially, so much so that he has begun to isolate himself. He feels afraid to talk to people because he thinks, “They will look at me like I am stupid and just walk away. So I just don’t talk to people. I am better off that way anyway because nobody understands my situation.” He states that it is difficult for him to come to counseling because his Japanese beliefs do not support counseling. Strong encouragement from one of his American friends convinced him to come.

Social History: Henry states that he was engaged to be married but his fiancée left him for another man about six months ago. They were together for about three years. Henry says, “I came home from work one day and she had all of her stuff packed. She told me she did not love me anymore, and then she left. I just did not know what to say or do, and ever since then I have been stuck.” His fiancée was Japanese, too, but was more Americanized than Henry feels he is. Even though he has lived in the United States for many years, he states that he tries to remain close to his cultural roots. Henry has never been married and does not have any children. He has a few friends but says that he does not spend much time with them anymore. He feels like they see him as weak because he can not move on from the breakup. He was also involved in karate as a four-time black belt but has dropped out of the dojo.

Mental Health and Addictions History: Henry states that he has never been to counseling and has never abused any substances.

Family History: Henry’s family still live in Japan, and he feels that they have a close relationship. His parents are elderly and are very traditional in their Japanese ways, so he does not talk to him about his problems or about seeking counseling. He is an only child. Henry reports that while in high school he was bullied a lot by other students and frequently physically harmed. He tried to talk to his father, but his father said that he had to be a man and stand up for himself. Henry continued to be bullied but never spoke of it again. He said he had forgotten about the incidents for many years but has now begun to think about it more. He reports that he has even had nightmares about his coworkers and friends bullying him.

Occupational and Educational History: Henry has a bachelor’s degree in business and computer technology and is the information technology specialist at a local company. He is currently having financial problems due to his fiancée moving out and taking a substantial amount of money from their joint savings account.