Case Study #1 Michelle Looney

History:

Nick is a 25-year-old, single African American man. He works with actors and helps them to

begin their careers. This had begun to make him feel overlooked. He decided to focus his energy

on his own career. He has no lover because he finds people “superficial.” His father was an

alcoholic who had many affairs. He was very critical of Nick but he was not around much

causing Nick to feel a sense of abandonment. His mother was chronically depressed about the

affairs and in turn, trying to compensate for his feelings, formed a relationship with her son that

was inappropriate and way too close. At the age of 18 the relationship with his mother changed

and 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 by

the other children for being “odd.” All of that changed when he began to body build in high

school.

Assessment:

In order to test Nick, I will have to use the Mental Status Examination, Self-Report Clinical

Inventories (MMPI-2, NEO-PI-R, MCMI-III and SCL-90-R) and Projective testing (Rorschach

Inkblot Test, TAT). The Mental Status Examination will help me to see what Nick is thinking

about 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 Personality

Inventory (Revised) will help me to classify the particular personality disorder that Nick has. The

Million Clinical Multitaxial Inventory will help in the diagnosis of a personality disorder that is in

the DSM-IV. The SCL-90-R will help me to assess his overall functioning. The Rorschach

inkblot Test will be useful in determining how Nick views the world around him. The Thematic

Apperception 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 attempt

at 18.

Axis V: Global Assessment of Functioning (current): 50

Case formulation:

Nick’s distant relationship with his father and his inappropriate relationship with his mother

caused 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 him

and 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 the

people around him and so he has begun to think that if he wants to be famous or do well in his job

that he has to treat people with no respect. Which in turn leads those people to treat him with less

respect and the vicious cycle is begun. It appears that his first suicide attempt got him the

attention that he so desperately craved and so now he has started to feel that if he says that he is

contemplating 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 a

week for one hour. The first thing that we need to deal with is the expression of suicidal thoughts

and help him to see that suicide is not the answer for any problems. Then we need to move to his
negative feelings toward other people. I want to be able to show him that people are not all

superficial but that they are actually a lot like him and that will hopefully lead him to have friends

and maybe even lovers. Then I would like to show Nick the proper respect and try to let him

know that he will do much better in life if he shows proper respect for the people he works with

and works for. Then challenge him to show respect to the people around him for one week and

see how things improve for him. Then I would like to try to help him understand that although he

is very talented there are other talented people and he is not the best there is. Then I would try to

help him become less exploitative of others and see if maybe there was someway that he could

help someone other than himself. And if he did so, then I would encourage him to try to do more

for other people and see how good that makes him feel to know that he has made a difference for

that person. Then my major long range goal will be for him to have at least one relationship

(friendship or otherwise) that last for more than a year and a job that is not all about him but that

does give him the respect and recognition that he rightfully deserves. He needs to stay at his job

for at least one year and he needs to try to rebuild the relationship between himself, his mother

and his father.