One Flew Over the Cuckoo's Nest on Randle Mc Murphy. Psychology Paper

Content
Film Character Case Conceptualization Paper
Attached Files:
sample intake.doc (37.5 KB)
A case conceptualization is required. Students will select one film during the semester and analyze a character from the film using one of the theories covered in class.
The case conceptualization will be 3-4 pages in length (double-spaced) and will include APA formatting. The following should be included:
1) Brief Summary of Relevant Background Information (as available)
Demographics (e.g., age, gender, race, ethnicity, etc); social history; history of trauma/abuse; strengths and weaknesses; other issues that may be relevant in counseling.
2) Presenting Concerns
The client’s current thoughts, feelings, behaviors, and symptoms that have brought her/him to counseling, and a brief history of the concerns.
3) Diagnostic Impressions
Use DSM-IV-TR or DSM-V diagnosis/diagnoses, including specific criteria.
4) Theoretical Conceptualization
Drawing from theories of counseling, describe in some detail your conceptualization of the client, the presenting complaint, and the psycho-legal issue (if applicable). This should include details regarding: the therapeutic relationship, therapeutic goals, techniques and methods, and anticipated outcomes of therapy. In your discussion, discuss biological, psychological, socio-cultural, institutional, and/or diversity variables impacting the case, if applicable.
1989, Ann and her second husband received about six sessions of (predominantly psychodynamic) marital counseling which she found “mildly helpful.”
In October, 1996, Ann’s family physician prescribed Prozac which initially helped reduce her depressive symptoms. The depression worsened in December, 1997, and she discontinued the medication on her own.
E. Personal and Social History: Ann grew up the middle child of three. Her parents were Italian immigrants and her mother did not speak English. Ann considered herself the “ugly duckling” of the family. Her older sister was considered thin and pretty while Ann was called “chubette” and “big nose.” She felt as if she were an extra burden to her family since they strongly wanted a boy when she was born. Her younger brother was born 18 months later and received nearly all the family’s attention. She describes her father as having been strict, controlling, demanding, and very concerned about what others thought of him. She describes her mother as quiet, unhappy, not affectionate, and old-fashioned. Ann felt unloved and unable to measure up to her siblings.
Ann attended Catholic school where she reports being trained to be “the perfect soldier.” She married for the first time at age 18. She reports that she was abused and controlled by her first husband who was violent at times. She believed she deserved the abuse and submitted to his wrath. When she finally got the courage to leave the marriage, she did not have her family’s approval and to this day resents their lack of support.
Ann remarried in 1989. Her second husband reportedly spent a lot of time with young men and Ann suspects he was bisexual. He ceased having any sexual relations with her about three years after their marriage. Though they tried marriage counseling briefly, her husband was unwilling to work on modifying the situation and they divorced in October of 1996.
F. Medical History: Ann did not have any medical problems which influenced her psychological functioning or the treatment process.
G. DSM IV Diagnoses:
Axis I: Major Depressive Episode, Recurrent, Severe
Rule out Bulimia Nervosa
Axis II: Avoidant Personality Disorder
Axis III: None
Axis IV: Divorce, Multiple Relationship Failures
Axis V: GAF Current—68. Best in Past Year—80.
II. CASE FORMULATION:
A. Precipitants: Ann’s second divorce probably precipitated a recurrence of depression. Although it was she who initiated the divorce, she nevertheless felt rejected, believing that if she were more loveable, her husband would have fought to save the relationship. Feeling not only unloved by and unloveable to her husband but also unloveable in general, she began to isolate herself. She was no longer getting much positive input from her friends, family, and co-workers because of her lack of contact with them—but, like the divorce, she perceived this self-initiated reduction of contact as their rejecting her, instead of her withdrawing from them. She became increasingly sad and lonely and other depressive symptoms began to develop.
C. Strengths and Assets
Ann has had many years of success in her professional life. In her role as teacher, she is extremely well-liked by her students, and given high praise from her peers.
III. TREATMENT PLAN:
A. Problem List:
1. “Ann bashing”--hating self (ugly and unlovable)
2. Depression; especially loneliness, sadness, crying
3. Avoidance and isolation: wanting to be loved but fearing rejection
4. Anxiety: fearing serious consequence of unrelenting depression
5. Binge eating and abuse of laxatives
6. Resentment towards parents for lack of affection and love
B. Treatment Goals:
1. Reduce dysfunctional behaviors: Verbally berating herself
Bingeing and purging
Isolation
2. Reduce negative distorted thinking.
3. Increase self worth, self-value and self-image. (Modify unloveability and not-good-enough (defective) schemas).
4. Find healthier ways to have fun.
5. Gain confidence to go out alone and take risks in pursuing intimacy again.
6. Build assertiveness skills and reduce subjugation.
C. Plan for Treatment:
The treatment plan was to reduce Ann’s depression through helping her respond to her automatic thoughts (especially those connected with unloveability) and activity scheduling (especially to increase socializing). We also worked on alternative behaviors to bingeing when she was upset. Next, we tested her assumptions about being rejected if she displeased people and then worked on assertiveness skills. We are currently working at the belief level, modifying her view of herself as unloveable and defective.
CASE WRITEUP EXAMPLE
I. CASE HISTORY
A. Identifying Information: Ann is a 44-year-old, twice-divorced, Caucasian woman who has no children, lives alone, and has been working full-time as a Spanish teacher for the past 22 years.
B. Presenting Problem: Ann sought treatment due to an escalation in her depression which started in October, 1996. She reported that she was also binge eating and overusing and abusing laxatives at least once a week, though she was much more concerned by the depression than the eating/laxative problem.
C. History of Present Concern: In October, 1996, Ann divorced her second husband and began to develop depressive symptoms (sadness, crying, social withdrawal, severe self-criticism). The depression worsened until it reached the severe level in March, 1997. At intake (May, 1997), her symptoms included the following:
emotional symptoms: sadness, anxiety, lack of interest in almost all
activities
cognitive symptoms: difficulty concentrating, believing she was worthless
and unloveable
behavioral symptoms: crying, social isolation
physiological symptoms: difficulty falling asleep, tiredness
She developed subclinical symptoms of bulimia nervosa in April, 1997. At intake, she reported that she binged, felt out of control of this behavior, and overused laxatives about once a week; she was (and is) intermittently preoccupied with a misperception that she is fat and is highly self-critical.
The major stressors in Ann’s life are social ones. Since her divorce she has withdrawn from friends, family, and co-workers. She has dated several times since her divorce but each date has been a “one-night stand,” which leaves her feeling rejected and defective. She used to derive significant satisfaction from relationships but has isolated herself and now feels sad, lonely, and rejected by others. While she finds it more difficult to do her job, work does not appear to be a significant stressor.
Ann restarted Prozac about 2 weeks ago (prescribed by her family physician) but thus far sees no change in her depressive symptoms.
D. Psychiatric History: Ann’s first episode of major depression occurred in 1977 when her first husband divorced her. She was hospitalized for three weeks and was given Elavil. She discontinued the medication (against medical advice) at discharge but initiated psychological treatment (cognitive therapy) for the first time. Her depression remitted after four months of this outpatient psychotherapy, though she remained in therapy on a biweekly basis for another year, working on Axis II issues.
In 1989, Ann and her second husband received about six sessions of (predominantly psychodynamic) marital counseling which she found “mildly helpful.”
In October, 1996, Ann’s family physician prescribed Prozac which initially helped reduce her depressive symptoms. The depression worsened in December, 1997, and she discontinued the medication on her own.
E. Personal and Social History: Ann grew up the middle child of three. Her parents were Italian immigrants and her mother did not speak English. Ann considered herself the “ugly duckling” of the family. Her older sister was considered thin and pretty while Ann was called “chubette” and “big nose.” She felt as if she were an extra burden to her family since they strongly wanted a boy when she was born. Her younger brother was born 18 months later and received nearly all the family’s attention. She describes her father as having been strict, controlling, demanding, and very concerned about what others thought of him. She describes her mother as quiet, unhappy, not affectionate, and old-fashioned. Ann felt unloved and unable to measure up to her siblings.
Ann attended Catholic school where she reports being trained to be “the perfect soldier.” She married for the first time at age 18. She reports that she was abused and controlled by her first husband who was violent at times. She believed she deserved the abuse and submitted to his wrath. When she finally got the courage to leave the marriage, she did not have her family’s approval and to this day resents their lack of support.
Ann remarried in 1989. Her second husband reportedly spent a lot of time with young men and Ann suspects he was bisexual. He ceased having any sexual relations with her about three years after their marriage. Though they tried marriage counseling briefly, her husband was unwilling to work on modifying the situation and they divorced in October of 1996.
F. Medical History: Ann did not have any medical problems which influenced her psychological functioning or the treatment process.
G. DSM IV Diagnoses:
Axis I: Major Depressive Episode, Recurrent, Severe
Rule out Bulimia Nervosa
Axis II: Avoidant Personality Disorder
Axis III: None
Axis IV: Divorce, Multiple Relationship Failures
Axis V: GAF Current—68. Best in Past Year—80.
II. CASE FORMULATION:
A. Precipitants: Ann’s second divorce probably precipitated a recurrence of depression. Although it was she who initiated the divorce, she nevertheless felt rejected, believing that if she were more loveable, her husband would have fought to save the relationship. Feeling not only unloved by and unloveable to her husband but also unloveable in general, she began to isolate herself. She was no longer getting much positive input from her friends, family, and co-workers because of her lack of contact with them—but, like the divorce, she perceived this self-initiated reduction of contact as their rejecting her, instead of her withdrawing from them. She became increasingly sad and lonely and other depressive symptoms began to develop.
C. Strengths and Assets
Ann has had many years of success in her professional life. In her role as teacher, she is extremely well-liked by her students, and given high praise from her peers.
III. TREATMENT PLAN:
A. Problem List:
1. “Ann bashing”--hating self (ugly and unlovable)
2. Depression; especially loneliness, sadness, crying
3. Avoidance and isolation: wanting to be loved but fearing rejection
4. Anxiety: fearing serious consequence of unrelenting depression
5. Binge eating and abuse of laxatives
6. Resentment towards parents for lack of affection and love
B. Treatment Goals:
1. Reduce dysfunctional behaviors: Verbally berating herself
Bingeing and purging
Isolation
2. Reduce negative distorted thinking.
3. Increase self worth, self-value and self-image. (Modify unloveability and not-good-enough (defective) schemas).
4. Find healthier ways to have fun.
5. Gain confidence to go out alone and take risks in pursuing intimacy again.
6. Build assertiveness skills and reduce subjugation.
C. Plan for Treatment:
The treatment plan was to reduce Ann’s depression through helping her respond to her automatic thoughts (especially those connected with unloveability) and activity scheduling (especially to increase socializing). We also worked on alternative behaviors to bingeing when she was upset. Next, we tested her assumptions about being rejected if she displeased people and then worked on assertiveness skills. We are currently working at the belief level, modifying her view of herself as unloveable and defective.
ACTOR MR. JACK NICHOLSON PLAY AS RANDLE MC MURPHY DO CASE STUDY ON HIM.
double space . 12 point type.