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AFTER READING THE CASE STUDY, ANSWER QUESTIONS 1-5 IN PARAGRAPH FORM. DIAGNOSE USING DSM-V AND PROVIDE SUPPORTING EVIDENCE FROM THE DSM AS TO WHY YOU MADE THE DIAGNOSIS. The class materials attached may be used as resources if needed. When discussing possible interventions for the client, include specific resources in your area (Dallas/Fort Worth, Texas).
1. What would your preliminary diagnosis be?
2. What are Chris’ strengths?
3. What are the psychosocial and cultural factors involved in this case?
4. Discuss possible interventions that might be an appropriate fit for Chris. What type of prognosis would you give Chris and why?
5. What value conflicts or biases arose for you in reviewing this case, if you were the practitioner for this client?
Identifying Information
Client Name: Chris Hawkins
Age: 32 years old
Ethnicity: Caucasian
Marital Status: Single
Background Information
Chris is a 32-year-old youth director at a large metropolitan church in a large southeastern city. Everyone in the parish highly regards him for his commitment of time and energy to the youth ministry at the church. As a single male, he has been a role model to many of the young boys who attend church school during the year and church camp during the summer. Chris has gone the extra mile in providing leadership and direction to the youth program. He has spent many long hours developing relationships with the young boys and their families. Chris has been in charge of the youth Sunday school, sports activities, outings, and special events designed for the youth at the church. He has been singled out as an outstanding minister in the community by the local community of churches. He is always positive, enthusiastic, and hardworking. He never complains about working overtime to accomplish his goals. He has been able to establish the admiration, respect, and trust of both youth and parents alike. Chris has spent a great deal of time working with boys from single-parent homes. He often takes on the “big brother” role to these children since the father is usually absent. He has taken them on day trips and overnight camping excursions. Because boys grow to trust him, they often go to him when they have trouble at home or school. He has spent many afternoons tutoring boys who were having trouble in school with a particular subject, such as math, and has been working on the implementation of an after-school program for boys aged 5-12 at the church. On several occasions, Chris has had boys over for dinner and a slumber party. Chris explains to the parents that this gives them a night off to do as they please. On one occasion, an 11-year-old boy who had been in trouble at school spent the night with Chris, with his mother’s permission, so that Chris could counsel him. The following day, the young boy told his mother that Chris had sexually molested him. The mother immediately contacted the head minister of the church. The minister brought Chris in for questioning, and Chris denied the allegations. He alleged that the boy was a “mixed-up” kid who was angry at Chris for not letting him stay up past midnight to watch MTV. Following these allegations, Chris has been suspended from all activities that involve contact with the youth and has been admonished to get a lawyer since the mother is reportedly filing charges against him. His lawyer has referred Chris to a sex-offender treatment facility for a series of tests.
Psychologist’s Records
Chris is given the following tests: the Wechsler Adult Intelligence Scale, the Millon Clinical Multiaxial Inventory III, Substance Abuse Subtle Screening Inventory, Third Edition (SASSl-3), Jesness Inventory, Multiphasic Sex Inventory, and the Shipley Institute of Living Scale. The sex-offender treatment provider, a psychologist, provides the following report after scoring and analyzing the scales. The results of the administered standardized instruments are based on Chris’ responses. As such, the validity of the test results is limited to Chris’ unique history and present circumstances. Chris’ level of intellectual functioning is in the average range (Full IQ 95-110). Abstract reasoning is also in the average range in relation to Chris’ ability to think in terms of general principles, solve logical problems, and generalize between situations. Chris appears to have read the tests and did not respond randomly. The results indicate a moderate set of good fake responses. Chris answered some questions in a socially desirable manner in order to minimize pathology. This social desirability factor may limit the validity of the following results, as underlying pathology may be more extensive than indicated by the scales. Anger responses are very low, indicating the possibility of repressed anger. Chris may have difficulty acknowledging and coping with angry feelings. Anger could build up, resulting in explosive behaviors.
Impulse control is poor. Chris acts impulsively without consideration of alternatives. He desires immediate gratification without considering the consequences. Chris exhibits chronic tendencies toward illogical, disjointed thought, which can lead to poor judgment and odd, eccentric behavior. Results also indicate moderate levels of interpersonal mistrust and suspiciousness that can lead to defensiveness and withdrawal. On the personality scale, Chris scored in the severe range of character pathology. His scores are consistent with schizoid, avoidant, and obsessive features that are likely to affect daily functioning. Scores are highest for the schizoid factors. Results reveal Chris as a person who fears rejection, which culminates in a sense of humiliation, low self-esteem, and withdrawal. He denies having normal sexual drives, interests, and attraction to age-appropriate heterosexual relationships. Instead, he presents himself as asexual. These results may indicate that Chris is minimizing sexual pathology in testing or may indicate a low sex drive. He also exhibits mild to moderate cognitive distortions and immaturity typically found in sex offenders. Results indicate that Chris engages in a moderate degree of rationalization justifying his sexual deviancy, blames others, and makes excuses for his acting-out behaviors. His profile indicates significant pathological behavior similar to that found in child molesters. Chris also admits to engaging in public masturbation and acknowledges actively looking for opportunities to carry out his sexual fantasies. Results also indicate mild impotence and significant feelings of sexual inadequacy. Chris appears mildly motivated to seek treatment for sexual problems, but this alone may be insufficient for successful treatment. The psychologist concluded this report with a diagnosis.
Follow-Up Information
Several weeks later, Chris is charged with indecency with a minor and child molestation. His lawyer plea-bargains an agreement. Chris pleads guilty to a lesser charge and serves 6 months in jail followed by 4 years of probation, including weekly attendance in court-mandated sex-offender program. After a year of treatment, Chris admits in therapy to having fondled at least one child under the age of 18 years old. He also admits to having ongoing fantasies about having sex with young boys. He has some insight into the fact that these behaviors emanated from having been shamed and physically abused by his father, who was an alcoholic, and having had an unsupportive mother. Chris is currently employed as a manager of a fast-food restaurant. He has complied with the terms of his probation and has regularly attended group and individual therapy sessions.
Pomeroy, E. (2015). The clinical assessment workbook: Balancing strengths and differential diagnosis. (2nd ed.). Boston: MA: Cengage Learning
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