Read the following case study about John to establish a diagnostic formulation of the client. The assignment questions follow the case information.
John grew up in the Midwest with his mother Dana and his father Ed. His father was a cargo pilot who would often be away from the home for days or weeks at a time. When John’s father was home, he would severely whip John with his belt and hit him with a closed fist for minor mistakes such as forgetting to flush the toilet or not eating all of his dinners. However, his father would be lenient about more significant types of behavioral issues such as drinking from his mother’s beer or getting into fights with the neighborhood children.
John’s mother Dana was a town clerk and was also physically abused by Ed, and she often consumed large amounts of alcohol to cope with the effects of the abuse. She divorced Ed when John was 6 years old, and John only saw his father one other time in his life.
John’s mother remarried when he was 8 years old, and his stepfather began sexually abusing him shortly thereafter, which lasted until John was 12. John says that he tried to tell his mother about the abuse but that she became irate and insisted that her husband “was not gay.” At age 10 John tried to set fire to his stepfather’s bed while his stepfather was sleeping in it.
By age 15 John was spending his time mostly during the day breaking into people’s homes instead of going to school for “a place to hang out.” Sometimes for “fun” he would cut brake lines on parked cars and hide nearby as he watched unsuspecting drivers crash into things while trying to drive.
When he was in school, he was suspended twice for physical fights with the other students and once for theft. He was arrested at age 16 after stealing a car. He was also high on methamphetamines at the time and received drug charges as well. He was then placed in a juvenile detention facility where he received additional charges for fights with other residents and one instance of sexual assault on another resident. He knew that the state was legally unable to hold him at the facility after he turned 18. So he minimally participated in treatment and waited until his 18th birthday to be released.
As a young attractive and gregarious adult, John spent time making friends and staying with them for a few weeks or months until stealing from them after gaining access to their bank accounts. John also got into occasional fights in bars, and at age 21 was convicted of assault and battery on a roommate, for which he severed 4 months in prison.
At age 23 he married a woman in her 30’s with three children ages 5, 7, and 9, two of whom were boys. He sexually molested both of his male stepchildren for several years. His wife did not believe her sons when they told him about the abuse. It wasn’t until she came home early from work one day and caught him naked in a bedroom with her two sons that she recognized the sexual abuse. She divorced John, but sexual charges were not brought against him due to a lack of evidence. When John’s mother remarried when he was eight years old, his stepfather began sexually abusing him, which continued until John was twelve years old. The abuse, according to John, was discovered when he attempted to inform his mother about it. She became enraged and argued that her husband “was not gay.” When John was ten years old, he attempted to set fire to his stepfather’s bed while his stepfather was sleeping in the bed.
By the age of 15, John was spending the majority of his time throughout the day breaking into people’s homes rather than attending school in order to have “somewhere to hang out.” He would sometimes cut the brake lines on parked automobiles and hide nearby while watching unsuspecting people crash into things while attempting to drive for “fun.”
His school records show that he was suspended twice for physical clashes with other students and once for stealing while he was there. He was arrested when he was 16 years old for stealing a car. He was also under the influence of methamphetamines at the time, and he was charged with narcotics possession. He was subsequently transferred to a juvenile jail centre, where he was charged with numerous offences, including fights with other inmates and one instance of sexual assault on another inmate. He was eventually released. He was well aware that the state would be unable to detain him at the facility once he reached the age of eighteen. As a result, he only engaged in a small amount of treatment and was not freed until his 18th birthday.
After his divorce, at age 25 John supported himself by working odd jobs in construction. He eventually began posing as a contractor under a false name to give estimates for jobs only to never start them after cashing the large deposit that he insisted upon having. He even located and began living with an elderly great uncle in order to steal his social security income from him. John also often found girlfriends with young children whom he would molest while babysitting.
At age 29 John was arrested for possession of child pornography. He had ordered online an illicit magazine with children engaging in sexual acts. The item was seized in the mail and delivered to John by an undercover police officer posing as a mail carrier. After receiving the package, John was promptly arrested. Since it was his first child pornography offense, John was given one year of probation instead of a prison sentence.
John was also required to attend weekly individual therapy as a condition of his probation. John told his therapist all about his physically abusive father, sexually abusive stepfather, and alcoholic mother. He portrayed himself as a caretaker of his elderly uncle. He did not mention his fights, thefts, or sexual assaults of children. Fortunately, John’s therapist recognized the disorders that he presented with and identified that group therapy would be a more appropriate therapeutic setting for him.
CASE QUESTIONS
Explore the diagnostic impressions of the client and address the following questions.
Formulate a diagnostic impression for John with coding and specifiers from the DSM-5. Explain your answer in terms of how he meets diagnostic criteria for the disorder or disorders that you gave.
What were some of the contributing factors for John’s problematic behaviors?
What makes John so dangerous?
If you were a therapist in this case, what therapeutic modality would you use to treat him? Use 1-2 scholarly sources to support your answer.
Why do you think someone like John would benefit from having confrontational group therapy rather than individual therapy alone?
Using 1-2 scholarly sources, in what ways could diversity variables (such as age, race, gender, etc.) affect how a person with these types of disorders is treated within the criminal justice system?
