Provided by the client
The following information was provided by the client. The client appears to be alert and oriented at the time of interview and test administration. He has stated that he has never been to a psychiatrist for his mental health. The client reports that he comes from a broken family. The structure of his family has its roots of dysfunction when his father left their family when he was 2 years old, as well as his mother who has been serving time in jail when he was born. The client shared that he was left under the care of his grandmother. When his grandmother died, the client became independent and looked after himself.
The client has been referred to different treatment centers that have attempted to offer assistance and treatment to him. He described his father as someone who didn’t care about him. As a response to the client’s perceived thought of his father, he wishes that his father would stand as a father figure in his life that shows concern and love for him. The client feels that his parents’ absence during the formative years in his life has harmed the formation of his values and personality. The client shared that
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The client also shared that he has two sisters and one older twin brother. He elaborated that he has an older sister and a younger sister. The client also said that he grew up witnessing how his mother was with different men all the time during the time his mother was released from jail. The client recalls he was born with heroin and was detoxified at birth. The client reported that he has a history of addiction with several illegal drugs since he was younger. At school age, the client reported that initially started abusing heroin when he was 7.
He later on experimented with marijuana upon reaching the age of 11 years old until he was 16 years old. The client also discussed that he started drinking alcohol at the age of 11. By the time the client was 11, he moved on to smoking weed. The client then added that he explored to other illegal substance namely LSD, cocaine, and continued taking heroin. The client looks back the time when he was 15 years old. It was the height of his dependence on heroin and would find himself constantly involved in fights. As a consequence, the client was sent to juvenile prison in Oregon for 2 years. Later on, he dropped out of school in 10th grade.
The client reported that he spent most of his years in adulthood in jail for up to six times. The client has served approximately 2 years for drug charges. The client openly shared that he grew up rebellious in school and dislike the idea of attending classes. Given the poor or weak structure of a broken family, the client finds companionship with peers older than him. The client stated that his older friends have in one way or another substituted the void and broken relationships he has with his family. The client exhibited signs of transference on his fixation of a woman to whom he was in love since he was 7 years old.
He finds it difficult to let go of the memory of the woman that he is keenly attracted to. The said woman never married him because of her relationships with different men. The client may be a grown man but has yet to let go and forget about the woman to the extent that he can not maintain a personal relationship of the opposite sex. The client has shown ways to overcome his seemingly difficult and troubled childhood. He reported that he is presently residing with his mother. The client acknowledges the fact that he had been addicted to illegal drugs.
He, together with his mother, actively seeks to eliminate his involvement with drugs by regularly attending a methadone clinic. The client is maintaining a lifestyle free from illegal drugs and alcohol for a record of 4 years up to the present time. The client expressed his difficulty in handling relationships with the opposite sex and much more maintain these relationships. The client stated that he has never had a genuine and supportive relationship with women. The client also reported that despite the mentioned difficulty with relationships with women. He also has the same case of relationship with regard to his sisters and twin brother.
The client has not grown up to be close to his siblings in terms of open communication and having a supportive relationship. It can be gathered from the responses of the client that he is actively seeking way to start anew in life by repairing broken relationships that has been damaged since he was younger. The client has reported that he has started talking with his 18 year-old son since a couple of years ago. The father of the client is alive. The client may not have ever seen his father but he has talked to him on the phone for sometime now. The client is currently diabetic, high blood pressure and has undergoing dialysis last week.
The source of anxiety mainly stems from his current health conditions with multi diseases as mentioned. The client is nervous about his life as he thinks he only has seven years to live. The client has expressed disappointment on how events in his life have turned about. He has been taking maintenance medications to manage his health problems. The client always relapsed until this last time in Methadone maintenance treatment. Methadone Maintenance Treatment reduces if not eliminates the use of heroin, and criminality associated with heroin use, and allows patients like Mr.
O to improve their health and social productivity. Thus it is expected that Mr. O corrects his dependence on heroin but Methadone treatment does not in any way a curative treatment for opiate addiction. The client acknowledge that problems encountered during adolescence involving drugs, alcohol, and drug pushing all resulted to his educational attainment as a high school drop out. One of the things that the client feels depressed is his educational background. It is noteworthy that the client acknowledges his status as a high school drop out but believes to be a person who knows what he wants out of life.
TEST RESULTS WAIS IV The WAIS IV test is the most popular intelligence assessing scale. It measures the vocabulary, arithmetic, and visual spatial capabilities of the client. In the WAIS IV test result of the client, he performs well in the processing speed index with a confidence interval of 107-124. It shows that the client has rapidity on processing simple or routinely information with less error. Thus, he don’t have difficulty on performing tasks such as learning a new material or other routinely and structured information. His score index in both verbal and perceptual organization is average.
It shows that the client has ease in verbal reasoning and comprehension when it comes to acquired knowledge and attention to verbal stimuli. He also possesses attentiveness to detail and visual motor integration. He scored lowest in the working memory index that explains he may have trouble processing incoming information such as calculations and transformation processes. The client as depicted by his low working memory index has attention and learning limitations specially on arithmetic. With an over all scaled score of 91, the client belongs to the normal distribution of IQ range between 85 and 115.
MMPI The MMPI test was conducted to provide an overview of the personality style and emotional symptoms of the client. The client’s responses show significant defiant behavior which is likely to have gotten him into troubles. He report antisocial behavior and is likely to have poor coping mechanisms to stress and changes, to have been involved with the criminal justice system, and to have difficulties with people in positions of authority. He also reports a substantial history of substance abuse and history of frequent use of alcohol and drugs.
He has shown to have a history of problematic use of drugs, and to have had legal dilemmas as a result of substance abuse. He also holds a history of juvenile delinquency and criminal and anti social behavior and to experience short term, conflictual interpersonal relationships. The client maintains to project an image of adequacy, control and effectiveness in this test. The test result also shows how he is hesitant on becoming emotionally involved with people. He has shown poor tolerance to stress and pressure. BAI Test The BAI test has enabled the client to pick out random symptoms of anxiety.
The client has experienced moderate numbness or tingling, feeling hot, and unable to relax. Thus, it is evident on the results from the BAI test that the client is aware on his responses on how he copes with stress and changes. Incomplete Sentences The content of Mr. O’s responses on the incomplete sentences test shows development on how he sees life. His general outlook in life has changed from hating life to a positive perception of himself who can make the most out of life. One of the things he wishes others to know is that he is a giving person.
The client shared negative responses on the subject of his father. He stated that he feels unwanted by his father. He views the latter as always out of his life. His biggest frustration lies in his “very dysfunctional” family. The client perceives hating his father as one of the ways to get back at him. The client views his family as having no best thing or quality. The client expressed his anger on the way he was brought up lacking the presence of his parents. He chooses breathing as a relaxation technique to cope with the anxiety felt upon discussing the ties of his family.
MCM-III In the MCMI-III 14 Personality Disorder Scales (Coordinate with DSM-IV Axis II disorders), the client has a high score in the schizoid personality disorder scale or eccentric personality disorder (Type A) that explain how the client is socially withdrawn and introverted. The client also obtained a score of 83 as an anti social falling under Dramatic Erratic Personality (Type b) that depicts the client as having a pattern of disregard for the violation of rights of others and has low self esteem. IMPRESSIONS AND INTERPRETATIONS
It was noted that during the evaluation test proper that the client was trying to create a favorable impression of him by not being honest in responding to some of the items. He sought the ego defense mechanisms of repression as shown during test taking. During the session of administering the test, it is noted that the client unconsciously avoid elaborating on his socially deviant ways in the past. The client would lower his gaze or look at other direction to avoid making eye contact on the subject of further discussing his relationship with his father. He may have been repressing or defensive in test taking.
The client has shown poor tolerance to stress and pressure. This defense mechanism may become a barrier on determining the real underlying mechanisms of the mental health of the client. The medical condition of the client as having Hepatitis C, Diabetes, Arthritis, Migraines, Insomnia and Hypertension are manifestations of aging, poor lifestyle, poor coping mechanisms and can be effects of prolonged drug use in the past. Heroin increase the risk of developing Hepatitis C due to the route of intravenous or use of needles especially when he had shared needles with other users.
The client has taken LSD in the past which may have contributed to adverse reactions such as terrifying thouts and feelings, fear of losing control and despair while on LSD. VII. SUMMARY AND RECOMMENDATIONS The previous information gathered from the series of evaluation tests and interview suggests the following recommendations to the referral questions: • The client would benefit greatly once he has gradually reconnected with the same people with whom he has frustrations.
• There is a need to provide individual therapy focusing on the following areas relaxation techniques and increased awareness of the self defeating patterns he creates in relationships. • Relaxation techniques are numerous in number that the client can select based on the setting or context he has namely if he is an outpatient, day hospital, inpatient and others. • The client can undergo a series of specific intervention procedures such as emotional support, family therapy, vocational training, and cognitive behavior therapy.
• Emotional support can be greatly effective when the family of the client is involved. It can start with his mother as the client and his mother have a non-hostile relationship. The client can move on reconnecting with his father, son, and siblings. In this way, the client has a recovered sense of identity that was lost as he had reported from the “very dysfunctional” nature of his family. • Family therapy seeks to resolve any barriers in communication that tend to result pent up anger and frustrations of Mr. O to his family.