Mr. Jackson, a 25-year-old, individual, Caucasic male was referred for psychological testing by the staff tooth doctor, Dr. Perry. Dr. Perry became concerned about handling Mr. Jackson because of the many processs that he had been given that required medicines that have habit-forming potency. Dr. Perry gave Mr. Jackson an ultimatum that he needed to acquire evaluated by a psychologist or the tooth doctor would mention him to another dental professional. Psychological testing is needed to measure the degree of Mr. Jackson ‘s anxiousness and emphasis, substance usage, if there is any DSM-IV-TR diagnosing, and if curative or pharmacological intervention is needed.
The undermentioned information was gathered from Mr. Jackson ‘s Dentist Dr. Perry and from Mr. Jackson himself. Mr. Jackson reports that he has been evaluated by Dr. Perry every bit good as several other tooth doctors in the past 10 old ages for chronic alveolar consonant jobs. It was noted in his history that Mr. Jackson has had a long standing history of hapless dental attention. Dr. Perry has been handling Mr. Jackson for repeating, acute tooth abscesses that have resulted in five root canals in the past 10 old ages. Dr. Perry has treated Mr. Jackson on two occasions for tooth extractions over the past six months. Dr. Perry has given Mr. Jackson pain medicines following the two tooth extractions. Dr. Perry has become concerned about the increasing demand for Mr. Jackson to undergo processs necessitating medicines because these medicines have habit-forming potency.
Mr. Jackson reported that he avoids the tooth doctors, chaws baccy, and does non brush his dentitions on a regular basis which has led to crisp hiting hurting in his dentition. Mr. Jackson stated that he tries “ to get by with this for a piece on my ain with intoxicant or marihuana ” and that he will, “ get serious uncomfortableness in my oral cavity and jaw, concerns, blurred vision, and jobs standing up. ” He besides reports that he frequently drinks before sing Dr. Perry for an exigency consult. Dr. Perry reports that Mr. Jackson avoided dental attention followup for his last root canal which caused it to go re-infected, taking to the tooth being extracted. Dr. Perry stated that Mr. Jackson had a panic onslaught in the waiting room and that he thought he left to smoke marihuana in order to quiet his nervousnesss. Mr. Jackson stated that he felt Dr. Perry was being unreasonable and gave him an unjust ultimatum to acquire a psychosocial rating.
The undermentioned information was given from Mr. Jackson ‘s mental wellness interview. Mr. Jackson dropped out of Rowan High School when he was 17 and has worked in a assortment of eating houses gross revenues, and uneven occupations before going employed at Wal-Mart. Mr. Jackson reported that he had a hapless relationship with his parents who he had frequent statements with. Mr. Jackson ‘s male parent was imprisoned when he was five old ages old and he stated that his ma was “ ever working and ne’er place ” . Mr. Jackson besides suggested that when his female parent was place they argued about his hapless school public presentation and friends. Mr. Jackson said that his female parent thought his friends were a “ bad influence ” . Mr. Jackson threatened to go forth place many times and has now severed all ties with his parents. Mr. Jackson said that he participated in “ diversion drug usage ” on his ain clip but refused to lucubrate when prompted for inside informations. Mr. Jackson suggested that people frequently find him hard to acquire to cognize and that he could non remember a kid goon friendly relationship that lased longer than a few hebdomads. When asked about current societal relationships, the client reported that he on occasion had tiffin with coworkers but that he seldom socialized with his coworkers outside of work.
Dr. Perry ‘s referral inquiries are as follow: ( a ) ascertain the degree of presently experienced emphasis, consciousness of his hurt, and his hazard for ego or other injury, ( B ) evaluate if proving supports clinically important DSM-IV-TR Axis I conditions, ( degree Celsius ) recommendations for curative and pharmacological intervention demands stipulating specific curative intercessions that may be helpful.
Mr. Jackson consented to a mental wellness interview but arrived 30 proceedingss tardily. Mr. Jackson arrived at the proving session comfortably dressed. A just grade of resonance was established and the client was oriented to individual, topographic point, and location. Mr. Jackson denied any present open hallucinations or delusional thought. Mr. Jackson seemed dying during the interview and both testing Sessionss.
MMPI Interpretive Summary
Mr. Jackson became defeated during the MMPI-2 and asked for several interruptions during the proving session. The client ‘s degree of motive and cooperation with the disposal of the MMPI-2 appears to be questionable for the consequences to be interpreted. Mr. Jackson required 25 proceedingss to finish the MMPI-2 which is untypical of most people who complete the MMPI-2 in one to two hours. He omitted one point. The Client ‘s MMI-2 profile reveals some incompatibility of point indorsement and it is possible that this individual may hold indiscriminately responded [ VRIN, F raw-Fb natural ] . He acknowledged more unusual experiences on the first 370 points, bespeaking that he is sing a important sum of emphasis [ F ] ; than the last 197 points [ F raw-Fb natural ] . This individual may hold over reported [ F, F-K+raw, Fb, Fp ] . This profile suggest that this individual is non likely to hold underreported [ L, K, F-K- , S ] . Given the strong possibility of random responding and the overreporting of Mr. Jackson ‘s profile, it is non likely to give an accurate portraiture of his true implicit in psychological position. As such, Mr. Jackson ‘s MMPI-2 profile is considered invalid for reading.
PAI Interpretive Approach
Code types- ALD/DRG with elevated ANX and ARD [ interpreted from manual ] . Elevations on Subscales ANX-C, ANX-A, ARD-P, BOR-S, SOM-H [ interpreted from manual ] .
PAI Interpretive Summary
Mr. Jackson was less defeated during the PAI testing and did n’t inquire any inquiries. Mr. Jackson required 50 proceedingss to finish the PAI which is typical of most people. He did non exclude any points. The client ‘s PAI profile is valid for clinical reading. Mr. Jackson ‘s PAI profile does non demo any form of extremely likely random reacting [ ICN, INF ] . Mr. Jackson ‘s profile does non uncover marked or calculated hyperbole of symptom ailments of negative feeling direction. [ low NIM, MAL, RDF ] . There were besides no indicants of defensiveness or positive feeling direction [ low PIM, DEF, CDF ] . Mr. Jackson ‘s profile suggest that he gave an accurate portraiture of his true implicit in psychological position and is PAI profile is considered valid for reading.
[ Moods/Experienced Distress ] Individuals with this profile may hold a history of polysubstance maltreatment including intoxicant and other drugs. This profile indicates that this individual may be sing a moderate grade of emphasis as a consequence of troubles in some major life country [ STR ] . This substance maltreatment may do troubles in societal relationships and work public presentation which serve as an extra beginning of emphasis and may farther take this individual to imbibe and utilize drugs. [ ALC/DRG ] . This profile suggests that this person ‘s current operation may be compromised [ DRG ] . Persons with this profile may hold damage that is associated with hurt and fright environing some state of affairs. [ ARD ] . It is likely that this person has multiple phobic disorders and phobic behaviours that interfere in a important manner and will monitory their environment in an attempt to avoid contact with the object or state of affairs that they fear [ ARD-P ] . This individual may exhibit important anxiousness and tenseness and may look tense much of the clip [ ANX ] .
[ Cognitions ] Persons with this profile frequently have trouble cutting down their imbibing despite repeated efforts at soberness, experience guilty about their imbibing, describe small control over the consequence that their imbibing has on their lives. [ ALC ] . Persons with this profile frequently have an internalizing attack to anxiousness and be given to be argus-eyed to the experience of anxiousness and have feelings of being ill at easiness which tend to hold an conceptional mark or beginning [ ANC-C ] . Persons with similar lifts may hold debatable knowledges [ ANX ] including concern and concern about current issues. This sum of concern and concern may compromise this person ‘s ability to concentrate and go to to state of affairss. This individual may besides be probably to be overconcended about issues or events over which they have small or no control. [ ANX-C ] .
[ Interpersonal Relations ] Substance maltreatment every bit good as impulsivity by this individual is likely to be doing terrible break in societal relationships every bit good as work public presentation [ ALC/DRG, BOR-S ] which is doing an extra beginning of emphasis for this individual [ ALC/DRG ] . Substance maltreatment may besides be doing wellness complications [ ALC ] . Persons with this profile are likely to hold a history of societal and occupation failure that was related to their imbibing. [ ALC/DRG ] . Profiles of this nature suggest that this individual may be seen as insecure and self-doubting, brooding, and uncomfortable in societal state of affairss [ ARD ] . Persons with this profile may besides be seen as high strung, nervous, timid, and dependent [ ANX ] . This individual may hold a inclination to move impetuously with small attending paid to the effects of their actions. These Acts of the Apostless may be viewed by others as ego damaging or suicidal. [ BOR-S ] .
[ Treatment Considerations ]
Alcohol jobs are hard to handle and the class of these troubles is likely to affect a chronic rhythm of periods of remittal followed by backslidings [ ALC ] . This profile suggests that this individual would profit from a focussed substance maltreatment intervention plan. The possibility of comorbid psychiatric diagnosings is likely in individuals with similar profiles which would do intervention more complex and involve multiple intervention marks. [ ALC/DRG ] . It is likely that this person may be physically depended and may necessitate medical detoxification within intervention. Tonss in the scope of this profile are more likely to reflect maltreatment of drugs. [ DRG ] . These persons may besides hold really small respect for their wellness. [ DRG, SOM-H ] . Elevations such as in this profile may reflect favourable predictive mark because it represents an recognition of the badness of the effects that alcohol abuse has created in their lives. The badness of the effects associated with the effects of intoxicant may be a powerful motivation factor and suggest that this client is ready for alteration. [ ALC/DRG ] . This individual may be sing a big sum of emphasis and anxiousness. Their preferable scheme appears to be neglecting to pull off the anxiousness. [ ANX-A ] .The anxiousness and hurt this individual is sing may besides be a motive for intervention. This individual may hold debatable knowledges that are related to their hurt and could be addressed in cognitive behavioural therapy. [ ANX ] .
Since Mr. Jackson ‘s MMPI-2 profile is invalid Dr. Perry ‘s referral inquiries can merely be addressed through information from the client himself, his chart, and his PAI profile.
( a ) Mr. Jackson ‘s PAI profile suggests that he is sing a moderate grade of emphasis as a consequence of troubles in some major life country. His profile besides suggests that his substance maltreatment may do troubles in societal relationships and work public presentation which may be an extra beginning of emphasis and may farther take him to imbibe and utilize drugs. It is non curtain if Mr. Jackson ‘s deficiency of societal relationships is due to his imbibing or if this has ever been something that he has struggled with. It is besides non clear as to whether his work public presentation has suffered due to his usage of drugs and intoxicant or if it is more related to his chronic tooth hurting. Mr. Jackson ‘s PAI profile besides indicates that he is cognizant of his emphasis and of the effects associated with his intoxicant and drug usage. Mr. Jackson may be coming cognizant of the effects associated with his intoxicant and drug usage but it is non clear precisely how much of this he is cognizant of. Mr. Jackson admits that he deals with his hurting by utilizing intoxicant or marihuana and that his hurting becomes worse and he has to travel in for an exigency consult. It is non clear if he is cognizant that his imbibing and drug usage may perchance be doing the state of affairs worse. His PAI profile besides suggests that Mr. Jackson may hold a inclination to move impetuously with small attending paid to the effects of his actions. Mr. Jackson ‘s PAI profile does non propose any marks of ego or other injury ; nevertheless other facets of his profile reveal that he may exhibit ego damaging and suicidal behaviour. For illustration, Mr. Jackson ‘s usage of intoxicant and marihuana are more so likely doing his dentition jobs worse and could be considered self destructive.
( B ) Mr. Jackson ‘s chart/interview and proving consequences form the PAI indicate that Mr. Jackson may be sing symptoms of Substance Abuse for Alcohol and hemp. Criteria for Substance Abuse from the DSM-IV-TR are as follows:
A. Maladaptive form of substance usage taking to clinically important damage or hurt, as manifested by one or more of the undermentioned, happening within a 12 month period:
1. Perennial substance usage ensuing in a failure to carry through major function duties at work, school, or place. ( Mr. Jackson asked Dr. Perry to subscribe a medical release for an drawn-out leave from his occupation at Wal-mart. Mr. Jackson reports holding problem concentrating, is distracted, and operates at a low degree of efficiency at work due to acute tooth hurting which he true copes with by utilizing intoxicant and marihuana. )
4. Continued substance usage despite holding persistent or perennial societal or interpersonal jobs caused or exacerbated by the consequence of the substance. ( Mr. Jackson reports that vitamin E has severed all ties with his parents, that others find him hard to acquire to cognize, and that he seldom socializes with them outside of work. More information is needed to determine if his jobs in societal state of affairss are exacerbated or affected by his usage of intoxicant and hemp. )
B. The symptoms have ne’er met the standards for Substance Dependence for this category of substance. ( No information is provided refering Mr. Jackson ‘s demand for addition sums of intoxicant or hemp or if he has markedly diminished consequence with continued usage of the same sum of intoxicant or hemp. No information was given about backdown. No information was given refering if Mr. Jackson ‘s substance usage of intoxicant or hemp is taken in larger sums or over longer periods of clip than was intended. No information was given refering if Mr. Jackson was unsuccessful at trying to cut down or command substance usage. It is non believed that Mr. Jackson spends a grater trade of clip in order to achieve intoxicant or hemp although he might be passing a batch of clip to obtain pain medicines. It is non clear that Mr. Jackson ‘s societal and occupational activities have been given up due to his intoxicant and hemp usage. Last Mr. Jackson has continued to utilize intoxicant and hemp despite his recurrent alveolar consonant jobs. )
Mr. Jackson may besides hold symptoms associated with a Specific Phobia. The DSM-IV-TR standards are as follows:
Marked and relentless fright that is inordinate or unreasonable, cued by the presence or expectancy f a specific object or state of affairs. ( Mr. Jackson avoids the tooth doctors saying that he is afraid to come in on a regular footing. Mr. Jackson besides chews baccy, and does n’t brush his dentitions on a regular basis. He tries to get by with his fright of the tooth doctors on his ain utilizing intoxicant and marihuana usage. )
Exposure to the phobic stimulation about constantly provokes an immediate anxiousness response, which may take the signifier of a situationally edge or situationally predisposed Panic Attack. ( Mr. Jackson had a panic onslaught in the waiting room of the tooth doctor and Dr. Perry reported that he though Mr. Jackson left to smoke marihuana in order to quiet his nervousnesss. )
The individual recognizes that the fright is inordinate or unreasonable. ( More information is needed to determine if Mr. Jackson understands that his fright is inordinate or unreasonable. )
The phobic state of affairs is avoided or else is endured with intense anxiousness or hurt. ( Mr. Jackson avoids the tooth doctors if he can, and when he can non he frequently drinks intoxicant before traveling to see the Dentist. Once at the tooth doctors he may see a terror onslaught which causes him to go forth and smoke marihuana in order to quiet his nervousnesss before returning to the tooth doctors. )
The turning away, dying expectancy, or hurt in the feared state of affairs interferes significantly with the individual ‘s normal modus operandi, occupational operation, or societal activities or relationships, or there is pronounced hurt about holding the phobic disorder. ( Mr. Jackson asked for a medical release from Dr. Perry for his occupation at Wal-mart because of his inordinate dental issues. Mr. Jackson besides has marked distress refering his fright of the tooth doctor which leads him to non care for his dentitions decently. )
In persons under at 18 old ages, the continuance is at least 6 moths. ( Mr. Jackson is older than 18 ) .
The anxiousness, Panic Attack, oh phobic turning away associated with the specific object or state of affairs are non better accounted for by another mental upset. ( Mr. Jackson ‘s fright of the tooth doctor does non seemed to be accounted for by another mental upset ) .
M r. Jackson ‘s PAI profile suggest that he may besides hold another anxiousness upset such as Social Phobia, which is taking to his deficiency of relationships, but more information demands to be gathered.
( degree Celsius ) Alcohol and drug maltreatment jobs are hard to handle and the class of these troubles is likely to affect a chronic rhythm of periods of remittal followed by backslidings. Mr. Jackson ‘s profile suggests that this he would profit from a focussed substance maltreatment intervention plan. A intervention such as this may assist Mr. Jackson to get by with periods of remittals and backslidings. Mr. Jackson may profit first from single therapy and so from group therapy. Group therapy would give him an ideal topographic point to work through his interpersonal issues and give him a topographic point to pattern the behaviours that will assist him cover with his substance maltreatment every bit good as relationships with others who are fighting with similar state of affairss to his ain. A 12 measure plan such as Alcohol Anonymous may be helpful in Mr. Jackson ‘s intervention. Alcoholics Anonymous is one of the most dominant attacks to alcoholism intervention in the United States. Alcoholics Anonymous would be helpful to Mr. Jackson because it would offer him a much needed support system and may besides assist him make trade with rhythms of remittal and backslidings. It is likely that Mr. Jackson may be physically dependent on intoxicant or drugs and may necessitate medical detoxification within intervention. Mr. Jackson may besides profit from an educational theoretical account that could be used to learn him about the more complex issues and symptom forms that are experienced with drawn-out intoxicant and substance maltreatment. Mr. Jackson may hold debatable knowledges that are related to his hurt and could be addressed in Cognitive Behavioral therapy. Mr. Jackson may besides profit from systematic desensitisation within Cognitive Behavioral therapy in order to turn to his fright and anxiousness associated with the tooth doctor. If his frights of the tooth doctor are addressed, Mr. Jackson may so hold an easier clip get bying with his intoxicant and drug maltreatment.
On Thursday March 11, 2010 agenda a meeting with Mr. Jackson to discuses his MMPI-2 profile and his PAI profile and discourse the interventions that are available for him. Watch closely to detect Mr. Jackson ‘s reaction to his MMPI-2 feedback. Conduct a Clinical interview to determine Mr. Jackson ‘s degree of intoxicant dependance and other diagnosing where more information is needed. On Friday March 12, 2010 if needed send the client to medical detoxification and put up a meeting with a substance abuses intervention professional. On Monday March 15, 2010 set up an assignment for Mr. Jackson to run into with a Psychotherapist, perchance one who comes from a Cognitive Behavioral point of view.
Jennifer Taylor, B.S.
Clinical Psychology Graduate Student