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Subject: Melvin Udall
Melvin Udall is a writer who lives alone in his apartment. Udall seems to be very different or odd from the other people around him. He seems to be so different because of his strange habits. He is a kind of person that what he wants, he gets, just like ho he wanted carol, a waitress. He wanted that Carol will serve her during his breakfast. He wants everything in order. He always makes sure that all of his things arrange properly, just like when they went out for a trip. He has a checklist of the things that he needs. He always makes sure that the doors are lock. He most prefers to use his own things which he thinks that it cleaner than the others. He wipes everything that he will touch or hold. He doesn’t walk in messy or wet floor/road. He is very meticulous. He tells everything that is in his mind without thinking if it would hurt other.
B. Diagnostic Evaluation Melvin Udall diagnosed that he has Obsessive Compulsive Disorder. He developed obsession. Melvin Udall has a major Behavioral Disorder which is Personality disorder but can also be classified as anxiety disorder. He tends to be so perfectionist and meticulous in everything he does. • Fear of being contaminated by shaking hands or by touching objects other have touched.
He shows this kind of symptoms. He was afraid to touch other things that
have been touch by other person. One situation was that when he needs to open the door, he wiped first the doorknob. He always makes sure that it is clean. He always wears gloves. Another situation was that when he and Carol went out for a date and the waiter offered a coat but her refuse to wear it and buy his own. Thinking this kind of behavior seems to be very different for a normal people. • Continuously struggles involving neatness and details of everyday life. All of his things are organized. He put everything in order. Everything has its own place. When they went out for a trip to Baltimore for Simon to visit his parents. Melvin Udall has his Checklist about the things that he must bring. He also took a long time just for taking a bath. It showed when Melvin and Carol out for a date. Carol fall asleep because she waited too long for Melvin finished taking a bath.
Checking Doors repeatedly to make sure they’re locked.( OCD symptoms involving consumptions)
It was very obvious that Melvin Udall always checked the door before he close it.
He feel annoyed that why he makes sure and repeatedly check the he closes the door. C. DSM-IV-TR Multiaxial Evaluation Report Form AXIS I: Clinical Disorder Other Condition That May Be a Focus Attention Diagnostic Code DSM- IV name __ __ __ . __ __ __________________________ __ __ __ . __ __ __________________________ __ __ __ . __ __ __________________________ AXIS II: Personality Disorders Metal Retardation Diagnostic Code DSM- IV name __ __ __ . __ __ Obsessive Compulsive Disorder __ __ __ . __ __ __________________________ AXIS III: General Medical Conditions ICD-9-CM code ICD-9-CM name __ __ __ . __ __ __________________________ __ __ __ . __ __ __________________________ __ __ __ . __ __ __________________________ AXIS IV: Psychosocial And environmental Problems Check o o Problems with primary support group Specify: ___________________________ Problems related to the social environment Specify: It was hard for Melvin to communicate with people, to say his feelings. Educational Problem Specify: ________________________ Occupational problem Specify: _______________________ Housing problem Specify: ___________________________ Economic problem Specify : _________________________ Problems with access to health care services Specify: _________________________________________ Problems related to interaction with the legal system/crime. Specify: _________________________________________ Other psychosocial and environmental problems Specify: His too meticulous that leads him to be afraid with the things in his environment which he thinks dirty.
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AXIS V: Global assessment of functioning Scale Score: 58
Time Frame: _____ D. Theoretical Conceptualization A theory that may explain OCD is the psychoanalytic theory of Sigmund Freud. Freud attributed obsessive- compulsive behavior to unconscious conflicts which manifested as symptoms. Freud describes the clinical history of a typical case of touching phobia as follows: “Once it starts, in early childhood, the patient shows a strong desire to touch, the aim of which is of far more specialized kind that one would have been inclined to expect. This desire is promptly met with an external prohibition against carrying out that particular kind of touching. The prohibition is accepted, since its finds support from powerful internal forces, and proves stronger than the instinct which is seeking to express itself in the touching. In consequence, however, of the child’s primitive physical constitution, the prohibition does not succeed in abolishing the instinct. It’s only result is to repress the instinct (the desire to touch) and banish it into unconscious. Both the prohibition and instinct persist: the instinct because it has only been repressed and not abolished and the prohibition because, if it ceased, the instinct would force its way through into consciousness and into accrual operation a situation is created which remains undealt with – a physical fixation – and everything else follows from continuing conflict between the prohibition and the instinct.” This can be an explanation why Melvin Udall seems to be afraid to touch ting touched by the other person. The instincts of the desire to touch the thing are being suppressed and drive out into the unconscious. This can be a reason why Melvin seems to be unaware of what he is doing. Unconsciously, he repeated doing it and it became a habit for him to the extent that he’s thinking that it is just normal for him just like checking the doors and wipe he doorknob before opening it. It starts with the instinct of the person. According to Freud an instinct is also said to be conservative because its aim is to conserve equilibrium of the organism by abolishing disturbing excitation. Since as what I have said its being refuse, suppress. An instinct can also be a repetition compulsion. It’s a process that repeats as often as it appears a cycle of event starting with excitement and terminating repose. This explains why Melvin tends to repeat of what he is doing just to feel the satisfaction of his need which is not completely appropriate. In the movie, it was not clear what the causes of OCD are. Some research has discovered a type of size abnormality in different brain structures. Some researchers believe that there is some type of abnormality in neurotransmitter serotonin. Serotonins have a role in regulating anxiety, involving in such process as sleep and memory function. Melvin Udall is a writer. I think he was able to develop OCD because of some worries about his writings, like the deadline of his writings and also lack of sleep. The neurotransmitter travels from the one nerve to the next synapses, serotonin must bind to the receptors sites located on neighboring nerve cell- it is hypothesized that OCD sufferers may have blocked or damaged receptor sites that prevent serotonin from functioning to its fuel potential . This explanation seems to be just same as the explanation of Freud.
E. Framework of the theoretical Conceptualization
Repetition of Behavior
F. Recommendations Cognitive Behavioral Therapy. This therapy involves application of learning principles in order to change. Using Behavioral cognitive Therapy for obsessive compulsive disorder I aim that the client (Melvin Udall) will be able to: To adapt/ learn new behavior. To reduce anxiety (e.g. of holding things that has been touched by the other person.) To prevent the client to act repeating of what he is doing. From the psychotherapy, I think cognitive restructuring can be use because it is a general for changing a pattern of thoughts that is presumed to be causing a disturbed emotion or behavior. This can help because, it is important that the client will e able to reduce anxiety. As what I have said stated in my strategy and methods, symptoms list is a big help. I recommend that a regular homework or assignment must be given so that the patient can continue to do a session of provoking his own symptoms because OCD occur anytime. As a therapist I must expose Melvin Udall to the things that signifies of his different symptoms, but gradually expose him but before doing it I must design a specific program of therapy that I will eliminate the conditions responsible for maladaptive behavior that will rain client to behave in more constructive ways. This treatment is just between me and Udall. It was said that CBT is more effective in both short and long term. Short term goal involve some change or modification on behavior, thinking or emotion of the client, but not a major restructuring of his personality. I must build a working relationship between me and Melvin. Set the main objectives, in this short term goal I should be able to reduce anxiety in dirty objects, avoiding repeating actions and some other symptoms. It should be 2 symptoms in a specific period of time with the use of the strategies and method of treatment. Until to see the difference the behavior of Melvin, until it reaches the long term goals that the patient will be able to overcome the problem and he will be able to develop on his own to prevent OCD. The use of exposure and response prevention or ERP or exposure therapy will be a good strategy or method for treatment. They use the list of different symptoms of the patient. As a therapist I should help the client to make or created his detailed list of symptoms. This list of symptoms of the patient is said to be a primary tool for treatment. The use of this symptoms list, the patient exposure to learn, starting with the least anxiety- provoking terms from symptom list. Another ERP tool is the Imaginal Exposure using short stories based on the client’s obsession. These stories are audio taped. Exposure to his symptoms will be a big help.
Submitted by: Laurel Kristin S. III-31 / BS Psychology Guidance Stream
Submitted to: Prof. Adonis P. David