Kathleen Swanson PSY472 April 5, 2011

Case Study #2

I. Background Information:

Our client is a 15.11 year old male. He stands about 5'6 tall and weighs approximately 140 pounds. He has informed us that his is in general good health and has no allergies. Currently he is in the tenth grade.

His grades for the first semester of the tenth grade were as follows: English, B-; Mathematics (Geometry), B-; Art (a major course), B+; Spanish, D; Biology B-; and World Civilization, C. For the second semester, he received these grades: English, D; Mathematics, D; Art, B-; Spanish, L-; and World Civilization, L. Please note that an L is between a C and a D. He reports that he recently got 100% on a test in Biology.

According to the client, he studies approximately hour a day at home since he has three (3) study periods a week at school. He also indicated that he watched TV eight to ten hour a week. His activities include being a homeroom representative and a member of the school wrestling team. He used to play the piano and take lessons on the violin. His violin instructor, who used to play in the Boston Symphony, says that the boy has talent, but just doesn't work or practice.

In terms of a career, the client said that he wants to become a commercial artist. He reads lots of aviation and science-fiction. He also has a fascination for war movies, and a passion for guns and shooting. His family has guns and a sort of shooting range in their basement. They sometimes go out to shooting ranges in the local community.

The client does not have many friends and the ones that he does have, his parents consider undesirable. They believe that his friends are either actual or potential delinquents.

Our clients father is 53 years old. He is a reasonably successful traveling salesman; however, he calls himself a manufacturer's representative. He has had two years of college and some training in electrical engineering. He has also done some machine designing. He reports that the client can do anything he wants, but lacks motivation. The mother, 46 years of age, graduated from a top woman's college on the East Coast. She works full-time as a researcher.

The client has an older brother, 18 years of age, who attends a small respectable men's college outside of Boston. It was during one of his visits home from college that the following incident occurred when the parents were not at home. The brother told the client to go to bed, but the client declared that he wouldn't go to bed and went after his older brother with a knife. The older brother did not get hurt in the assault. The parents merely reported the incident to us; they did not take any further action. The incident took place just a few weeks before the boy came to be tested. Good

II. Psychodiagnosis of Family Type: In reviewing the background information and client responses to projective assessment techniques, Sentence Completion, and Blacky Picture Test, the client seems to have come from a Judgmental family type. While there may be characteristics of this type, he comes from a

predominantly Ambivalet home. Lots of reaction formation in use! The family seems to demonstrate a certain amount of structure and stability. The mother and father both work, indicating that the family is able to at least provide for basic needs and as evidenced in the client having previously taken violin lesson, they are able to afford beyond basic needs. The mother and father have both attended college, the mother graduating from a top woman's college. The older brother attends a respectable college providing yet another model for the client in regards to positive consequences of hard work. Okay Even with such distinct structure and modeling, all of which would indicate a nurturing family type, the client shows defensive behaviors that are commonly seen in judgmental family types, displacement, compensation, and too a lesser extent, denial. Nice insights; data to support this idea. In the case of this client he seems to displace his worry, anxiety and guilt onto subjects concerning war, acts of violence and brutality, his disdain for people and a world that is violent. Reaction formation? He also expresses an overwhelming concern for the state of the world which appears dim. He shows some of the actual source of some of his worries and fears in the following statements: #7 I think my future may be dim, but I know I must prepare myself for my life's remainder.dim? Lifes remainder? What do you make of this? ; #26 When I think of my future, I hope there will be a world in which to have a future.; # 12 I want to know if I will ever reach my goal in life.; # 30 My family worries a great deal about me. I hope that I can make them happy and proud of me. These are the few statements that express actual fears of the client. Yes, nice integration of data; good for youThat majority of his statements show him displacing these fears into a preoccupation with the war and violence that plagues the world as seen in the following: #15 I think that life is a waste sometimes, especially when I hear about the war.; #17 What bothers me the most is violence and war.; #24 I I could only stop all wars and bring society to the realization that there is too much suffering I would die peacefully. Is this realistic thinking? What is also notable is that in spite of the fact that he just recently went after his brother with a knife all he appears more preoccupied with the dim state of the world. However, despite his displacement, some of his fear over the incident is seen in his depiction of Card #8 and cartoon #9. In card 8 the client feel

upset that this card that he sees showing blacky as jealous and hurt that the sister is receiving all of the attention, doesn't follow the previous depiction of blacky's character as tough. The client shows his true fears over the incident with his brother and his concern over what will happen to him in his interpretation of cartoon #9, where he states, I think Blacky has somehow killed Tippy and his conscience is bothering him and he is very frightened at the outcome and what happens to him now. It is interesting how when given the opportunity to complete the sentences, he is able to turn the attention to the subjects he prefers to focus on, while he is unable to do so in both of the picture tests. Superior flow of ideas and integation of data; good for you

The boy also demonstrates a compensatory defense mechanism in many of his sentence completion responses. He seems to be aware of his intelligence which may make him feel even more shameful of his poor marks. He might appear self confident as he mentions his brains and intelligence in questions 22 and 35, however it is hard to believe that he is truly a confident young man when he focuses so heavily on his art, and acts as if achieving the goal of commercial artist will make everything okay, as seen in the following responses: #1 The best thing that I draw is portraits; #5 I do not like to be morose and worried because I love my personality and artistic talent.; #10 I'm determined to become a commercial artist; how will this happen? Does macho dad approve of it? #14 What pleased me the most is my ability to be a fine artist.; #16 When I succeed in being a successful artist, I shall turn my efforts to make a more pleasant world.; #37 I would like to be a well known commercial artist.; #38 I dream of the time when I may have my own quaint studio and be successful.

While it is normal for adolescents to lack a complete grasp of future reality, the client seem to complete circumvent the issue of needing adequate grades to move on to college, the need to study, to ignore the full burden of his poor grades, and to acknowledge his lack of self esteem by throwing

himself fully into his dream of being an artist. It is one thing to have a desire and dream and to make movements towards such a dream, but the client give the impression that he spends the most time thinking about the dream in an effort to numb out the reality and compensate for his lack of confidence. This leaves him motionless in his present state and being that he is not in complete denial or completely unaware of at least a fraction of these things, he does in fact experience jealousy towards his brother who is not stagnant but moving towards an actual goal. This mechanism of displacement renders him motionless, but because it does not offer the more bullet proof protection from inadequacy that denial may, he demonstrates feelings of rejection with regards to his brother. Superior analysis even though incorrect predominant family and great integration of data

III. Analysis of Tests:

The client took both the Stanford-Binet and WAIS IQ assessments. His full scale IQ was quite high in both.yes, he is very bright but an underachiever. Why/ What is going on? On the StanfordBinet, his total IQ was found to be 131, which places him in the 99.1%. The WAIS assessment was slightly lower in respects to ranking. His Composite score of 120 placed him in the 91%. While both tools provide valuable information, in the case of this client the WAIS provided other information that could prove to be useful. It is important to note the lack of discrepancy between his verbal IQ of 118, and his performance IQ of 120, which shows little possibility for any possible delay restricted to either learning style.okay However upon reviewing the sub-test scores, the client achieved the lowest scores on digit span,7, digit symbol, 10, picture completion,11, and arithmetic, 12. All of which test in part the alertness and concentration capacity of the test taker. Given that his grades are quite low in comparison to his superior IQ, his lower performance on these sub-tests and their association to concentration and attention to fine detail and alertness, it may benefit the client to further screen for attention deficit disorder (or attention deficit hyperactivity disorder). You are really into this analysis

The client was also administered the Kuder Preference Record. He showed a notable preference for the artistic, 98, Mechanical, 78, Literary, 73, Musical, 68, and Persuasive, 60. any indications of sex role confusion According to the text, on the average, boys score higher on mechanical, computational, scientific, and persuasive scales, while girls score higher on the artistic, literary, musical, social services, and clerical scales. The client seems quite content with his preference for the arts, and even superior, as he indicated in his sentence completion question # 25 To me people, are all monsters, mostly knowing nothing of the arts, just brutality. I feel that I must somehow correct this. However I wonder if this propensity for things that are on average preferred by girls, and his shorter stature, and limited social network, didn't contribute somewhat to his feeling estranged and feeling such a need to compensate. It is impossible to determine from his responses with out further inquiry, as to whether his love for art made it hard for him to make friends with other males, since at this point he feels so drawn to compensate with his talents in art. Grade 94

IV. Analysis of Productivity Indices:

When evaluated on the nine indices of productivity, the client demonstrated a total score of 17 out of a possible 36. Considering that 8 of those 18 points were attributable to his health and sexual role identity, the remaining seven indices rated quite low, which may explain such heavy reliance upon defensive mechanisms, his underachievement in school, and the attack upon his brother. Affect Rating Interpretation

In respects to affect, the boy scored a 1, which was translated to poor productivity. He lacks the ability to understand his fears and worries and displaces most if not all of these upon concerns for the violence and atrocities in the world as seen on the sentence completion test #15 I think that life is a

waste sometimes, especially when I hear about the war.; #17 What bothers me the most is violence and war.; #24 I I could only stop all wars and bring society to the realization that there is too much suffering I would die peacefully. While he indicates his concerns rest mainly with the violence in the world, his answers to the Blacky Picture Tests indicate that he is concerned with what will happen to him after stabbing his brother as seen in cartoon #9, where he states, I think Blacky has somehow killed Tippy and his conscience is bothering him and he is very frightened at the outcome and what happens to him now. or in card #8 where he interprets, He sees his sister getting all of the attention. The client also is unaware of his compensatory methods that hold the place where actual confidence should reside.some superior points; elaborate Independence R I

The client rates Moderately productive with respect to Independence. He exhibit many great qualities that lend themselves to productive movement, such as a passion for something separate of what others appreciate, even in contrast with what is typical for his gender, and more than likely most of his teammates on the wrestling team. He shows no wavering in his desires and goals because it is less common of other boys. He did not respond in any way to indicate that his choice of passion was based in any part upon what his parents wanted him to pursue, and neither parent had studied or pursued art, in so much as was revealed in the background information or test responses. The ability to define one's likes and dislikes separate of others is indeed a valuable component of independence. However, also inherent in one's independence, is the ability for an individual to be responsible. The client has expressed an awareness of his grades when he responded to question # 19 with, I am held back from doing what I want because of my poor grades. In spite of this awareness he admits only studying 30 minutes a day at home, even after his grades dropped by nearly 50% between the first and second semesters. Also as he responded again in the sentence completion test, #20 All my life I have wanted good grades, but didn't study at all. His previous violin instructor had said he had talent, but

just doesn't work or practice. Without the practice of responsibility one will not be able to attain their personal goals set forth, and their ability to be independent will suffer. Excellent section here Self Esteem R I

The client demonstrates poor self esteem, rendering him very poor productivity with respect to this particular indiceindex . As mentioned earlier, throughout much of his testing he engages in frequent compensatory methods in order to affirm to himself and others, his worth and talents. Self esteem is derived from both the self and from others. His parents seem to express openly, their confidence in his abilities, but are just as open about their belief that he does not work hard and could actually accomplish much more. He father stated that the client, can do anything, but lacks motivation. The client goes to such lengths to constantly address his talents, brains, intellect, and artistic abilities and aspirations that it is pretty clear he is not only trying to convince himself but also the family on which he places great value. He longs to have their approval,yes, this is very true as much as he feels his brother has earned more so than him. It is also worth mentioning that his lack of motivation may be more due to his fear of trying and failing. It seems easier to continue to tell oneself about what you are capable of accomplishing than to risk the fear of actually trying and still being unable to accomplish what you set out to do. Given that so many of the clients responses seem defensive of these fears, and his responses as mentioned above reflect a jealousy and fear of disappointing his family, it seems very likely that the boy's underachievement is due to a fear of failure, and by holding back from complete effort he is sparing himself the reality of a potential fall. Keen insights Empathy With respects to empathy the client was found to rate a 2. While he has voiced many concerns for the world and social betterment, on a scope that extends far beyond even his local community, he is too unsure of his accomplishments to refrain from feelings of competitiveness with his brother.I agree Given how he responds to his brother, it is possible he may respond this way to other male peers,

especially if one were to excel in art and share similar aspirations that would threaten the clients unique niche. Part of demonstrating empathy is to not only express concern for the state of affairs in the world outside you, but to have a concrete enough sense of identity such that the client would be able to extend understanding or compassion for a person completely separate of whether or not he felt competitive or threatened by their presence. Given the clients lack of esteem, and present defensive mechanisms, it seems unlikely that if faced with the existence of a male peer similar to himself, that he felt threatened by, that he would be able to empathize and show concern for this person separate of his fears. Cognitive Skills

The client's cognitive skills with respect to intellect and verbal ability to express himself, seem quite superior. IQ testing also supports that he is highly intelligent as his score showed him to possess a superior intelligence. His intelligence is most certainly an asset in productive movementright . He has many door open to him, that others with lower intelligence would not. However, there is more to cognitive skills than intellect alone. Intelligence can be looked at as more of a medium one uses to convey positive and direct thinking, a car one uses to drive sound judgment. The client has shown himself to be quite pessimisticgreat point as the focus of much of his thinking has been placed on things of a negative nature as seen in his responses to sentence completion questions #15 I think that life is a waste sometimes, especially when I hear about the war.; and #17 What bothers me the most is violence and war. He seems fixated on things that are depressing, and does little to fix these things, nor does he share plans on how exactly he would hope to improve upon all the negativity that consumes him. He also seems to lack any realism, more than likely due to the displacement of his fears upon this pessimistic thinking. He is living in a place where he does not deal directly with the issues that are directly touching him, like his jealousy and fear of failing. With out the proper direction that can only be derived from realistic thinking, he will be unable to use his intellect as a means of transportation, thereby rendering it somewhat useless at the present time. For this reason, in spite of his

intellectual abilities, He was given a score of 2 with respects to cognitive abilities. Coping The client lacks appropriate coping behaviors, most easily seen in his recent attack upon his brotherthis is serious . His poor productivity score of 1 on this indice indexe renders him motionless until he is able to find better more appropriate ways of coping with his feelings. Also factored into this score is the repeated use of defensive mechanisms, like compensation and displacement. In order to be productive the client must become aware of and accept the way he feels, and then approach them while staying firmly grounded within the present reality. As long as these coping behaviors continue, he will find himself stuck in this unproductive state. It seems noteworthy to mention that the parents waited weeks, without any other action, to act in response to such a serious attack with potentially life threatening consequences, if this seeming ambivalence is a common reaction, it could explain some of the poor coping skills of the client. Superior analysis Control over Impulses The client obviously demonstrates a poor control over impulses, which is why he received a score of 1 on this indiceindex. Even though his background is void of any other, mentioned, act of violence, this one act was one with life threatening consequences coupled with the clients inability to recognize the discrepancy between his sentence completion answers that centered around concern for violence and boasted of his artistic abilities and ambitions, at odds with his picture results which depicted jealousy, feelings of inadequacy and worry over his future. Also how his ambitions fail to ignite within him an urgency to work harder. This disconnect between the two tests and the lack of self awareness, ,okayallow the client to exist in a temporarily safe place, far away from what troubles him. Because he is unaware he makes no gains towards developing better coping skills, and when confronted with the source of his anxieties, namely, and in this most recent case, his jealousy of his brother, he has no ability to control a very hostile impulse that resulted in a serious act of violence. Gender Role

The client seems fairly content with his Gender/Sex Role Identity. He was given a score of 3, as he demonstrates a passion for something that is not ordinarily considered statistically normal for the average male. Furthermore, he is part of the wrestling team which, typically, is the sort of social group that celebrates masculine traits. The only issue of notable concern was his response to the Blacky Picture test which indicated a desire in him to be seen as tough, something he longs to be one day, also something he sees as being desirable to a female he may be interested in. On the Blacky Picture Test Cartoon # 10 he states I think Blacky is dreaming of his future as most little boys do...He is thinking about being a hunting dog, a very tough dog. Who wants him to be like this? Dad?Also in Cartoon #11 he says, Blacky is thinking about female dogs and the one who is going to fall in love with him when she sees him; when she sees him in the role of his first dream, being a hunting dog. Some of these depictions are quite healthy, especially given the boy is approaching 16, and interest in females, and wondering about the first time one falls in love is very healthy for his age. However, the client sees the female as falling in love with him, when he is walking in his dream of being tough and strong. This shows that the boy finds himself short of this dream, and given his shorter stature is fairly typical. Health The client has reported good health and nothing was presented to contradict this report of good physical health, so the client was given a total score of a four for this indice.index Superior analysis in this section; impressive work

V. Productive Personality Matrix:

Index Affect

Rating 1 Poor Productivity

Interpretation

Independence Self Esteem Empathy Cognitive Skills Coping Skills Control over Impulses Sex Role Identity

2 1 2 2 1 1 3

Moderate Productivity Poor Productivity Moderate Productivity High Productivity Poor Productivity Poor Productivity High Productivity

Health 4 Superior Productivity Score 17 out of 36, 47 % calculate mean

VI. Summary and Recommendations:

Our client is a 15.11 year old male who had recently assaulted his brother with a knife. He is in good healthy and presents as an underachiever in conflict with superior intelligence as indicated on both the Stanford-Binet and WAIS scales. The client appears to come from a judgmental family type, which is also corroborated with the typical findings of displacement and compensation defensive mechanisms. Due to his defense mechanisms and lack of awareness, he has rendered himself motionless in addressing the issues that leave him feeling inadequate and anxious in the first place. He feels jealous of his brother, worried his family wont accept him, do they? is receiving very poor grades, and is unable to make any gains in alleviating these concerns until he first realizes the extent of them, and then begins to feel safe enough to take a chance and make a real effort to achieve them. At present he is content with fantasizing about his future and focusing on concerns far removed from his own true worries. Superior points here

My first recommendation would be to have the client screened for ADD/ADHD, based upon the majority of his lower scoring sub-tests, being those that dealt with concentration and alertness. Okay

Although his overall IQ was ranked superior, any kind of discrepancy between portions of the test should be further investigated to reveal potential learning disabilities that are often undiagnosed in highly intelligence children and adolescents. I agree Should the client suffer from any learning disorders, alleviating the obstacle could provide much needed relief in one the sources of his anxiety.

I am also recommending that the client start weekly personal therapy and bi weekly family therapy.great In regards to personal counseling, the focus should be on understanding productivity and any obstacles to movement, then slowly starting to hold these typical obstacles against the clients in hopes that he will begin to see for himself how some may resemble those in his life. It is important to begin to help the client realize his fears and anxieties, his feelings of inadequacy and how he feels frozen in fear, afraid to actually try and fail. It's important to show him that in never trying he will find himself in the same place later, still dreaming about what he wants to be. It may be helpful to have the client make a list of his most important goals, and then have him explain what he thinks he needs to do to arrive there. Then, to have the client set promises to himself, for instance a promise to study an extra hour a day for 2 months and then see if it has gotten him anywhere, if not there is always the therapist who can help him find new ways to achieve the goal. It is important to approach the goal setting in a way that will not leave the client feeling vulnerable if they don't prove to be effective. More than likely they will, but it is his fear and perception that needs to be consoled. Impressive analysis overall Grade 92 Final Case 2 Grade93