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Case Study #1
 
Michelle LooneyHistory:
 
Nick is a 25-year-old, single African American man. He works with actors and helps them tobegin their careers. This had begun to make him feel overlooked. He decided to focus his energyon his own career. He has no lover because he finds people “superficial.” His father was analcoholic who had many affairs. He was very critical of Nick but he was not around muchcausing Nick to feel a sense of abandonment. His mother was chronically depressed about theaffairs and in turn, trying to compensate for his feelings, formed a relationship with her son thatwas inappropriate and way too close. At the age of 18 the relationship with his mother changedand he began to feel a greater sense of abandonment and that is when he made a suicide attempt.He had a very rough childhood outside of his family problems. He was constantly picked on bythe other children for being “odd.” All of that changed when he began to body build in highschool.
Assessment:
 
In order to test Nick, I will have to use the Mental Status Examination, Self-Report ClinicalInventories (MMPI-2, NEO-PI-R, MCMI-III and SCL-90-R) and Projective testing (RorschachInkblot Test, TAT). The Mental Status Examination will help me to see what Nick is thinkingabout and why he is acting the way that he is. The Minnesota Multiphasic Personality Inventory(2) will be useful in showing Nick’s personality functioning level. The NEO PersonalityInventory (Revised) will help me to classify the particular personality disorder that Nick has. TheMillion Clinical Multitaxial Inventory will help in the diagnosis of a personality disorder that is inthe DSM-IV. The SCL-90-R will help me to assess his overall functioning. The Rorschachinkblot Test will be useful in determining how Nick views the world around him. The ThematicApperception Test could be used to see if Nick has any personality needs, such as achievement,power or nurturance.
 
Diagnosis:
 
Axis I:
None
Axis II:
Narcissistic Personality Disorder (301.81) with Borderline traits
Axis III:
Deferred
Axis IV:
Sense of abandonment by mother and father during childhood, suicide attemptat 18.
Axis V:
Global Assessment of Functioning (current): 50
Case formulation:
Nick’s distant relationship with his father and his inappropriate relationship with his mothercaused him to feel abandoned as a child. These feelings lead to a suicide attempt at the age of 18.And after many letdowns at work he began to focus his time and energy on promoting himself and became very full of himself. Nick’s childhood causes him to have trouble with any kind of relationship. He is afraid that if he lets anyone in and gets close to them that they will hurt himand leave him feeling abandoned again. Therefore, he is withdrawn and tries to separate himself from all other people. His job has caused him problems because in it he gets no respect from thepeople around him and so he has begun to think that if he wants to be famous or do well in his jobthat he has to treat people with no respect. Which in turn leads those people to treat him with lessrespect and the vicious cycle is begun. It appears that his first suicide attempt got him theattention that he so desperately craved and so now he has started to feel that if he says that he iscontemplating suicide or if he makes an attempt that he will get the attention of other people.Because to him, even bad attention is some attention.
Goals:
I feel that Nick would be best served with individual psychotherapy sessions that meet 2-3 times aweek for one hour. The first thing that we need to deal with is the expression of suicidal thoughtsand help him to see that suicide is not the answer for any problems. Then we need to move to his
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