Case Study of Bill

You have asked Bill to bring his wife to his second session. He arrives with his wife, Pam. You ask how he is doing today, and surprisingly he becomes quite agitated. He tells you it has been a terrible week because his second son “betrayed” him again. You learn that some years ago Bill disowned his eldest daughter after an argument. You try to get some detail about this, but Bill becomes too agitated to discuss the matter. The second son tried to mediate between Bill and his daughter last year. Bill responded that the son had to decide “which side he was on, just like in a war,” and warned him never to raise this issue again. The eldest daughter recently gave birth to her first child, and wanted her parents to be involved in the child’s life. She again asked the second son to mediate, and he attempted to do so.

Bill responded by accusing the son of being a traitor and throwing him out of the house. By the end of this account, Bill was tearful, exclaiming that there is nothing worse for a parent than when your own children betray you, plot against you, and stab you in the back. He notes that this is the price of greatness, to have those you love become jealous and turn on you. He speculates that this is because his second son “couldn’t hack it” in the military and could not get into West Point as he, Bill, had done. Bill felt that his son has harbored a grudge against him, and has been “just sharpening his knives for years, waiting for the right opportunity to cut me down.” At this point, Bill stands up and says he needs to take a walk around the block to regain his composure, as it is unseemly for a war hero of his stature to lose control. He turns to Pam and says, “You tell the psychologist how these bastards have ripped my heart out.” Wisely, you obtained a release of information and informed consent at the beginning of this interview, allowing you to obtain collateral information from Pam.

Pam is initially reluctant, but sheepishly begins to divulge some details. The original argument with the daughter occurred over a job Bill had lost. After losing a number of jobs because of his “bossiness,” the daughter persuaded her father-in-law to hire Bill in his small business. Within weeks, Bill had the place in an uproar, and left in the middle of an important customer transaction, claiming it was immoral for him to work at a place that did not “support God and country.” The daughter tried to explain to Bill the bind this placed her in. He called her a “Jezebel” and banished her from the family home.

In addition, since his discharge from the Army, Bill has held at least five or six other jobs in which he seemed to do well until he was ultimately fired for reasons that are not entirely clear. From what Bill has told Pam, it appears that the terminations were due to personality conflicts or nepotism by the owner of the business. Bill has been unemployed for the last three years, and is, Pam reports, frightened about applying for another job because of the possibility of rejection or failure (being fired again).

You also learn that Bill never actually attended West Point, but once attended training there while he was in the military. It was scheduled to last a month, but Bill was reassigned after a week. He refused to discuss why. Bill was never actually in combat. He was involved in ordnance supply but always says he was “close enough to the action to smell it.” Pam begins to open up, and admits that Bill is hard to live with, but after so many years, there is “not much else to do.” She also feels sorry for him, because he has no one else left in the world.

DQ 1

· Reformulate Diagnostic Work-Up

We now revisit the case of Bill from the previous unit. Imagine you have conducted a second interview with him. After pondering the case presented in this unit’s readings:

1. Reformulate your diagnostic work-up of Bill, given the new information in Part 2 of his case study.

2. Describe your decision-making process in arriving at this reformulation.

3. Evaluate the difficulties in accurately diagnosing personality disorders.

4. Discuss the difficulties in obtaining accurate information about clients’ histories.

Review the Case Study Response Guide to assist you with this discussion.

Response Guidelines

Review the posts of other learners and respond to at least two of them. Assess and add to their perception of how a clinician can overcome the difficulties they mentioned in obtaining an accurate history of Axis II individuals.

DQ 2

· Individual Differences

Find and report on psychological literature that addresses these three issues:

1. Discuss the role that individual differences (gender, ethnicity, socioeconomic status, sexual orientation, religious commitment, age, geography, and so on) may play in behaviors or attitudes that might be considered signs of a personality disorder.

2. Give examples to support your points.

3. Examine in writing at least three of these individual differences, but give particular attention to one of your choice.

 

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