Case 10 - Thomas F.

Thomas F. was brought to therapy by his wife, who reported that he was having "crazy ideas about her." Tom maintained that his ideas were not crazy and insisted that his wife was having affairs with at least two men, both family friends.

Tom, forty-seven, and Carmen, forty-two, had married three years ago after a courtship of five year's duration. This was the second marriage for both. Tom had three children from his first marriage; these children lived out of the country with their mother. Carmen's only child from her first marriage had been killed in an accident when he was ten years old. Since they had lost the children from their first marriages, Tom and Carmen hoped that they would be able to have children together and reported being extremely happy when Tom, Jr., was born almost a year ago. However, their son brought considerable stress into their lives.

Tom and Carmen had met at the computer firm where both worked, Tom as a programmer and Carmen as administrative assistant. They were together almost constantly, both at work and at home. However, when their son was born, Carmen took a position at a local hospital, working nights in the admissions room, so that someone would always be available to care for their son. Tom was home with him during the evenings and nights, and Carmen was with the child during the day. They saw very little of each other, and nearly all of their energy was focused on parenting. Both had few friends or outside interests to give them support. They had bought a new house, and added debts prevented them form going out frequently, as they had when they were dating. In addition, Tom's mother had cancer, and Tom and Carmen were trying to spend as much time as possible helping her.

About two months ago, Tom began to express suspicions about how Carmen was spending her daytime at home. She assured him that she was too exhausted to do much more than care for Tommy, maintain the house, and try to get some sleep. However, tom's accusations grew worse, and he insisted that Carmen was having sexual relationships with at least two men in his absence. During this time, he continued his job as a programmer; and, except for several days in which he had left work precipitously in an effort to catch Carmen with her purported lovers, his performance at work had been unaffected. There was no prior history of mental disorder in either Tom or any of his first-degree relatives.