Gary is a 42-year-old African American engineer at a local firm. He has always been a high achiever and can drive himself hard. In the past year he was in a serious car accident when he was hit by a drunk driver and he lost his 69-year-old mother after a 4 month bout of pancreatic cancer. While Gary has recovered fully from the accident he is very nervous driving. He has started experiencing panic attacks and general anxiety about driving. He tried counseling once but said “it wasn’t for me.” He has been diagnosed with Panic Disorder and Post Traumatic Stress Disorder. He is a regular though moderate user of alcohol (4-6 drinks per week, mostly on the weekend). His physician initially prescribed paroxetine (20 mg. a day) but Gary said it killed his sex drive and he quit taking it after 10 days. His doctor is open to prescribing him a benzodiazepine but wants Gary to try counseling one more time if she prescribes that. She says the PTSD is the primary problem, believing treatment gains made in Gary’s PTSD will result in the panic subsiding. Again, Gary was hesitant to go to counseling

1) Why do you think Gary is so reticent about counseling? How would you discuss this with him if you were the therapist?
2) What would you tell Gary about the side effects?
3) Why do you think the doctor was hesitant to prescribe the alprazolam?
4) Gary asks you if he will get “strung out” on the alprazolam. How would you respond?