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PLEASE NOTE, IF LESS TESTS ARE GIVEN OR IF LESS PATHOLOGY EXISTS, YOUR REPORT WILL BE CONSIDERATELY SHORTER THAN THIS SAMPLE Name: A Sample Age: 23 Sex: M Referred By: You Interpret Date: 12/20/0 Test Date: 12/20/01 PSYCH SCREEN, INC. PHONE AND FAX (800) 588-9412 PSYCHSUITE 4.0 -- ADULT To aid in diagnosis and treatment planning, Mr. Sample was administered a battery of psychological tests including the Shipley Institute of Living Scale, Matrix Reasoning subtest of the WAIS - III, Minnesota Multiphasic Personality Inventory-2, Millon Clinical Multiaxial Inventory - III, SASSI-3, State-Trait Anger Expression Inventory, Jesness Inventory, Derogatis Sexual Functioning Inventory, Multiphasic Sexual Inventory - I, Level of Service Inventory - Revised, Personality Assessment Inventory, and Detailed Assessment of Post Traumatic Stress. The following test findings are based on Mr. Sample's responses to a widely used standardized psychological test. As with all such tests, the validity of test results is limited by Mr. Sample's honesty and self-awareness. The report below should be taken as generalized probability statements that are made without benefit of clinical interview or history. Further clinical verification is needed to assist in the interpretation of test findings in light of Mr. Sample's unique history and present circumstances. Since the MMPI-2 is a complicated test with multiple scales that measure similar constructs, at times inconsistencies in test results may occur due to Mr. Sample's different elevations on similar scales. When this occurs, clinical investigation to evaluate his true status is suggested. As psychological tests were designed primarily for diagnosis and treatment planning purposes, the findings below focus on problems, deficits and pathology and de-emphasize Mr. Sample's strengths. Because of this, use without collaboration, other than for the clinical screening purposes, for which they are intended, may be misleading. The following is a CONFIDENTIAL REPORT meant for qualified Mental Health, Correctional and Substance Abuse professionals. While feedback of test findings to clients is highly encouraged and should be an integral part of therapy and treatment planning, clients should not be given copies of this report, as they are probable to misunderstand report contents and their tentative nature. VALIDITY OF TEST RESULTS VALIDITY OF TESTS OF PSYCHOPATHOLOGY MINNESOTA MULTIPHASIC PERSONALITY INVENTORY-2 (MMPI-2)VALIDITY OF PERSONALITY TEST RESULTS MILLON CLINICAL MULTIAXIAL INVENTORY-III (MCMI-III)VALIDITY OF SUBSTANCE USE TESTS SUBSTANCE ABUSE SUBTLE SCREENING INVENTORY-3 (SASSI-3)TEST VALIDITY OF PTSD SPECIFIC TESTING (DAP) PTSD specific testing did not have a "fake good" response set, with Mr. Sample not minimizing his problems and pathology. TEST RESULTS INTELLECTUAL FUNCTIONING Mr. Sample's level of intellectual functioning is in the Bright Normal range as testing suggests well above average cognitive functioning. Verbal abstract reasoning is in the Bright Normal range with him presently having an above average ability to think in terms of general principles, solve logical problems, and generalize between situations. Mr. Sample's Bright Normal vocabulary demonstrates an above average premorbid learning ability and that he has received environmental stimulation. Verbal abstraction is IQ appropriate and does not indicate Organic Brain damage. Significant levels of emotional upset are reported which may interfere with memory, concentration, abstraction and judgment. In a test of visual abstract reasoning, Mr. Sample scored in the Bright Normal range demonstrating above average visual problem solving. His vocabulary was congruent with his level of visual abstraction. Both visual and verbal abstract reasoning capacity were similar. Mr. Sample is not reflective or thoughtful which can limit insight and judgment. He does not try to understand the world in cognitive, rational ways. Mr. Sample's use of repression and denial may lead to a lack of cognitive processing. Mr. Sample is an emotionally oriented individual who reacts to situations based on his feelings rather than on rational analysis. Concentration difficulties are probable with Mr. Sample being distractible, preoccupied, and inattentive. This may cause Mr. Sample to miss important environmental cues leading to decreased judgment and coping. He is an extremely cognitively rigid individual who has fixed ideas from which he has trouble deviating. Mr. Sample may fail to take in additional information or alter his opinion once an idea is formed. Poor judgment and situational misperceptions can result from reacting in terms of these fixed beliefs without seeing if they match the current situation. At this level, delusional ideation may occur. Mr. Sample is likely to be ambivalent to the point where problem solving and judgment are adversely affected. Mr. Sample may show poor planning, as he is severely cognitively impulsive. A lack of proper cognitive mediation and/or planning is likely as he often acts without considering consequences or alternative courses of action. Due to his cognitive style, Mr. Sample may have severe difficulty learning from his experiences and may repeatedly make the same mistakes. Moderate levels of racing thoughts and flight of ideas may be occurring. Severe obsessive ruminations and worries are reported that are very likely to disrupt Mr. Sample's cognitive efficiency. Levels of brooding over problems exist to the point where he may lose control of his thought processes. Mr. Sample reports severe feelings of mental dullness to the point where he now feels incapable of processing information and he does not trust his own judgment. Significant Schizotypal features were evident in testing. PAI and MMPI-2 measures of overall mental confusion and psychotic symptoms were in agreement. Testing indicates strong mental confusion that may interfere with reality testing and judgment, as Mr. Sample presently has difficulty with logical goal-directed thought. Mr. Sample described his thinking as very scattered, vague, disorganized, illogical, atypical and/or unrealistic. Excessive fantasy may be used to escape reality. In the MMPI-2, Mr. Sample reported that he has extremely atypical thoughts and sensory experiences. This is to a degree that may indicate psychosis. Hallucinations, delusions, ideas of reference, and strange physical experiences are probable. This needs to be clinically examined. PAI findings indicate possible low-grade hallucinatory-like experiences. Mr. Sample feels as if he is losing control over his thinking as severe ego alien ideas make Mr. Sample feel as if he is "losing his mind". A significant amount of Mr. Sample's mental confusion and poor judgment may be secondary to emotional problems disrupting his thinking and judgment. PERCEIVED LIFE STRESS, RESOURCES AND SUPPORT Mr. Sample described a severe amount of present stress. He reports having few supportive people in his present life to help him deal with problems and reduce his stress level. Mr. Sample is very unmotivated to seek out psychotherapy, and sees psychological interventions as unlikely to help him deal with his life stressors. His attitudes and personality may markedly interfere with Mr. Sample's ability to profit from psychotherapy, should he enter into therapy. EMOTIONAL FUNCTIONING MMPI-2 overall depression scores were higher than PAI depression scores by between 1 and 1.5 standard deviations, which may affect the validity of the test findings given below. Reasons for this inconsistency in the level of depression reported need to be clinically determined. Testing shows severe levels of depression that need further mental health treatment if they are clinically present and are not due to substance use, withdrawal, or malingering. Test scores may indicate a Major Depression or may represent a severe Adjustment Disorder. Severe levels of sadness, ahedonia and dejection exist. Mr. Sample experiences severe cognitive symptoms of depression including thoughts of hopelessness, helplessness and failure that can adversely affect self-esteem and judgment. Severe physical symptoms/signs of depression are endorsed which indicate a Major Depression. Mr. Sample's level of true depression may be significantly less than what he subjectively experiences as he overly focuses on feelings. Severe subjective depression is noted with Mr. Sample being extremely despondent. Severe Dysthymic character features exist, as Mr. Sample is a pessimistic individual who looks for the worst in situations. Chronic psychological signs of depression such as lack of pleasure, negativism and feelings of helpless and hopelessness are probable. He is very pessimistic and makes many negative self-statements. PAI and MMPI-2 scales measuring overall anxiety were in agreement. Such severe levels of anxiety are reported that Generalized Anxiety Disorder, Panic Attacks, Phobias, ADHD, Mania and PTSD need to be clinically ruled out. Mr. Sample reports being so nervous that he has trouble dealing with everyday stress, pressure, and demands. He easily feels panicky, distraught, and vulnerable due to over evaluating objective danger, as Mr. Sample feels threatened by people or events commonly seen as of little or no concern. Levels of anxiety reported are likely to interfere with coping skills, increase impulsivity and lead to aversive consequences that can produce more anxiety. Severe levels of worry were described, as Mr. Sample is an over-ruminative worrier. Significant autonomic over-arousal is said to occur that may lead to physical problems and increase hyperactivity and impulsivity. Mr. Sample's level of anxiety is significantly less than what he subjectively experiences as he focuses on anxious feelings. Severe subjective feelings of anxiety were described, with Mr. Sample feeling easily overwhelmed. Testing shows severe phobias and/or tendencies to develop phobias. An exceptionally high level of generalized fear is reported that may constrict Mr. Sample's behavior. He is easily scared and reacts with fear to a wide variety of situations. Mr. Sample has multiple specific fears that might lead to avoidance behavior. Significant Obsessive Compulsive Disorder symptoms were endorsed to the point of possible clinical significance. Mr. Sample is a very rigid inflexible individual who adheres to fixed behavior patterns to an unproductive degree. He often overly focuses on details and misses general principles. Change and novelty are very likely to cause anxiety. Very severe Post Traumatic Stress Disorder symptoms were endorsed. His PTSD symptoms are probably very disruptive to Mr. Sample's day-to-day functioning as they are likely to lead to impulsive self-defeating behavior, impaired judgment, mood swings and/or behavioral avoidance. In the DAP, Mr. Sample reports having been exposed to a moderately above range of traumatic events when compared to those who have been exposed to at least one traumatic incident. This may lead Mr. Sample to have a complex clinical picture, though this index does not measure the frequency or intensity of each specific type of traumatizing event. Mr. Sample admits to exposure to the following type of traumatizing situations: childhood physical abuse, received serious threats that someone would harm him, witnessed an assault(s) on others, was sexually assaulted, saw other unspecified traumatic events that would cause fear of injury or death. The last index traumatic event was reported to have occurred in the last month. At the time of the traumatic event(s), Mr. Sample reports experiencing very severe levels of psychological distress that probably included extensive fear, helplessness, guilt and shame. Such severe reactions are often associated with greater overall later PTSD symptomatology. An average amount of dissociation, including possible depersonalization and/or derealization, was said to have occurred during the trauma, when compared to others in traumatic situations. DAP results indicate that Mr. Sample's overall present PTSD symptomatology is in the Severe range. This includes severe reexperiencing/reliving of traumatic experiences via intrusive thoughts, flashbacks, memories, and/or dreams of the event, moderate avoidance of trauma associated stimuli, feelings and thoughts, and severe autonomic over arousal including probable sleep difficulties, irritability, hyper alertness and vigilance, and startle responses. This level of autonomic arousal may result in somatic complaints and substance use to lessen arousal. Mr. Sample does not describe presently experiencing dissociation. Significant substance abuse that may be associated with PTSD is not reported. Mr. Sample does not report significant suicidal thoughts that may be related to PTSD symptoms. Mr. Sample reports severe present impairments/problems in his daily functioning as a result of his PTSD symptoms. At present, Mr. Sample reports experiencing average amounts of overall anger. Moderate levels of subjective angry feelings are currently admitted to. Mr. Sample is now experiencing average pressures to be verbally aggressive. He admits to an average generalized tendency to verbally express anger. Average pressures to physically express anger are currently said to exist. This is coupled with average overall generalized tendencies to physically express anger. Present current pressures to express anger physically and verbally are equal. Mr. Sample reports having equivalent levels of generalized long-term tendencies to verbally and physically express anger. It is significant that while present subjective angry feelings are reported, Mr. Sample does not admit to experiencing pressures to act out in an angry manner. Present low levels of anger reflect typical longstanding patterns. An above average level of Trait Anger is admitted to with Mr. Sample presenting himself as generally experiencing mild levels of anger. He does not describe himself as being quick tempered. Mr. Sample displays an average sensitivity to other's criticism and rejection. Perceived disapproval does not appear to be a key source of anger. Once anger is consciously experienced, Mr. Sample reports making normal efforts to suppress his anger. An extreme amount of energy is then invested in calming down and reducing remaining conscious anger. This over control may result in emotional and behavioral constriction and avoidance. Despite making significant efforts to lessen anger, a significant level of anger is still experienced by Mr. Sample. Mr. Sample describes making average efforts to control acting out on anger when anger is consciously experienced. Average tendencies to express anger behaviorally once it is consciously experienced are said to exist with him not overly acting on angry feelings. His significant efforts to repress, suppress and/or deny anger are coupled with an ability to not act on anger once it reaches awareness. Mr. Sample's tendency not to act out on anger is important as significant irritability, high levels of Trait anger and/or general tendencies to experience angry feelings are reported and would otherwise result in direct anger expression. While generally out of touch with underlying feelings due to strong defense mechanisms, Mr. Sample is presently experiencing strong feelings that can lead to impulsive behavior with little insight or awareness. Mr. Sample has severe problems dealing with his own feelings and is now often experiencing them as strange and alien to himself. Impulse control is poor with Mr. Sample impulsively acting out directly on feelings to gain immediate gratification with little forethought of consequences or alternate courses of action. Impulsivity may lead to self-defeating behavior. Mr. Sample subjectively experiences a significant lack of control over his impulses and worries about being overwhelmed by and acting out on negative feelings. PAI scales measuring overall mania were significantly higher than MMPI-2 mania scales, with the tests differing by more than 1.5 standard deviations. This makes test findings concerning overall mania symptoms highly questionable. Reasons for this inconsistent self-report should be clinically investigated. Mr. Sample's reported energy level is significantly raised with him being an action-oriented individual who acts out when bored. Periodic hyperactivity, labile affect and poor self-control are probable. Fearlessness and increased energy may lead to poor judgment and reckless behavior. Further testing may be needed to rule out Mania or Attention Deficit Hyperactivity Disorder if symptoms are not due to substance use Mildly above average levels of sensation-seeking behaviors were described, as Mr. Sample can become bored and act without consideration of consequences. A severe lack of subjective drive and ambition is reported. Mr. Sample feels so lacking in energy that he frequently does not want to engage in activities or complete tasks. ALCOHOL AND DRUG USE The MMPI-2 reveals moderate addiction proneness and possible substance use. Secondary substance use may exist with Mr. Sample's use caused by personal problems with substances used to avoid the pain he feels. Further evaluation for possible alcohol and drug use is indicated. Mr. Sample reports moderate, but significant, indications of characteristics typically found among drug-dependent individuals in the PAI. Test findings do not indicate characteristics similar to those found among alcohol-dependent individuals. Mr. Sample indicates a preference for drug over alcohol use. Severe characteristics similar to those found among individuals who are alcohol-dependent are reported in the MCMI. Mr. Sample expresses a preference for alcohol over drug use. The above findings need to be taken in conjunction with the SASSI results given below, as the SASSI was designed to detect addiction even in resistive clients. Non-abusive use of alcohol and few alcohol-related symptoms are reported on face valid measures. Face valid measures do not indicate addictive levels of drug use and drug-related symptoms. Significant Obvious Attributes common among chemically dependent individuals were reported by Mr. Sample as he acknowledges having "character defects"/personality traits common among dependent individuals. Subtle Attributes empirically found among chemically dependent individuals were not apparent in testing. Mr. Sample reports having been involved in a family or social system where severe levels of substance use have occurred. Test scores indicate a low level of ACOA issues and codependency. Despite his level of reported substance use, Mr. Sample's level of involvement in social systems where extensive substance use exists indicate a high chance of addiction. Signs of substance dependence exist which require professional intervention. If needed, moderate duration treatment is indicated due to moderate levels of underlying addictive tendencies found in testing. SOMATIC FUNCTIONING Severe current concerns about a wide variety of physical problems is reported which may indicate that Mr. Sample is over concerned about and fixated on his health. Mr. Sample reports severe GI symptoms in testing. Significant neurological problems were described. Severe Hypochondriac complaints (often without a clear organic basis) are probable as Mr. Sample reports an extensive range of physical symptoms that may include intake, elimination and pains in internal organs. A history of physical symptoms, most of which are vague, and a severe preoccupation with bodily functioning are probable as he overly focuses on minor illnesses which causes more concern than would normally be expected. Such scores may also reflect true physical problems that need to be clinically ruled out. Mr. Sample may have true physical symptoms, some of which may be stress-related. When physical problems exist, exaggeration of symptoms is probable. Mr. Sample now feels extremely below par mentally and physically. A moderate tendency for psychosomatic problems to develop under stress exists. These symptoms can be used for secondary gain. When confronted on this, Mr. Sample may become hostile and feel persecuted. A severe tendency for conversion symptoms to develop exists. Even though Mr. Sample displays tendencies to somatize, current severe levels of stresses and/or stress proneness can cause legitimate stress-related somatic problems to develop including cardiovascular and gastric symptoms. Somatic problems may be used to indirectly express anger or to manipulate others. Many secondary gains are probable as Mr. Sample uses physical complaints to vent feelings, escape responsibility and to control others with little awareness. INTERPERSONAL FUNCTIONING Mr. Sample is an odd, peculiar and eccentric individual who lacks basic social skills. His unusual behaviors and thought patterns make it difficult for others to relate to him. Mr. Sample is an extremely introverted individual who tends to be much more comfortable when alone. An attachment deficit probably exists as Mr. Sample avoids and withdraws from others. Social withdrawal secondary to Mr. Sample's depression may occur as he may have lost interest in daily activities and have low energy. A very high level of social discomfort and anxiety exists. Mr. Sample reports average levels of social confidence. He reports having severe doubts over his ability to deal with and relate to others. Mr. Sample almost entirely lacks a sense of empathy. Extreme needs for love and affection exist where Mr. Sample does almost anything to receive love. Such needs may be extremely difficult to fill resulting in a high level of frustration. Codependent relationships are probable. Mr. Sample's level of suspiciousness and/or social withdraw may interfere with Mr. Sample's ability to meet his needs for love. Mr. Sample is extremely passive and submissive. He does not want to take responsibility and can become lost without someone telling him what to do. Mr. Sample voices an extreme need to be dependent on others. Codependency issues are paramount. Mr. Sample generally feels different, estranged and unusual. He often feels extremely misunderstood by others. MMPI-2 scales measuring paranoid symptoms were significantly higher than similar PAI scales, with the tests differing by more than 1.5 standard deviations. This makes the test findings given below concerning paranoid symptoms highly questionable. Reasons for this inconsistency in the level of self-reported paranoia should be clinically determined. An extreme degree of interpersonal suspiciousness was described. Mr. Sample is extremely vigilant and constantly monitors his environment as he expects others are out to harm him. Mr. Sample projects blame for his problems, sees the world as threatening, and feels that he is unfairly treated. Marked feelings of prosecution are probable. He expects others to be exceedingly untrustworthy, devious and likely to act out for personal profit, as Mr. Sample constantly expects others to lie, cheat, and manipulate to gain advantage. When Mr. Sample feels slighted, he feels resentment to an average degree. He is a very self-righteous, moralistic, individual who feels that he lives up to high ethical standards and can have hostile feelings when others do not live up to his standards. PAI and MMPI-2 measurements of antisocial tendencies were in agreement. He often blatantly ignores social rules and conventions and does what he pleases, as the severe antisocial trends reported in testing suggest that Mr. Sample acts without feeling a sense of obligation or responsibility to others. He has marked trouble with authority, resents rules and is quite rebellious. Power and control issues may exist with Mr. Sample wanting others to do what ever he pleases. He accepts authority and social standards. Mr. Sample generally does not justify his behavior. He is usually honest and is not opportunistic in the way he deals with others. Mr. Sample tends to question his value system and may not act in a responsible manner. Mr. Sample's relationships tend to be stormy and conflictual. He has difficulty maintaining a long-term relationship. A moderate amount of family problems were reported with Mr. Sample at times feeling unloved and unsupported by his family. Conflictual family relationships and much anger are probable. Many social problems are reported, with Mr. Sample feeling largely unloved and unsupported. Dysfunctional, conflictual relationships are probable. He feels very unsupported by others. Severe problems with Mr. Sample's current work attitudes and behaviors exist. His emotional problems may be interfering with his work performance. An average focus on work was described with Mr. Sample not seeing himself as overly preoccupied with work. SELF IMAGE Mr. Sample lacks a stable sense of identity and generally feels unsure about what he wants from life. Mr. Sample lacks an internal compass and has difficulty knowing what he wants to do in situations. This can lead to much ambivalence and anxiety. His behavior tends to be inconsistent and erratic, with Mr. Sample having severe difficulty sustaining goal directed behavior. Feelings of self-efficacy are low. Mr. Sample feels so unable to cope that he withdraws into fantasy. He is extremely self critical, focuses on negative and has difficulty acknowledging the positive in himself. Mr. Sample has an average sensitivity to what others think of him. Mr. Sample feels very uncomfortable and unhappy with himself. Extreme guilt and regret are reported. Mr. Sample has an extremely poor self-esteem and feels unattractive and useless. Mr. Sample easily feels rejected and can often projects his own feelings of being unattractive and useless. Lowered self-esteem and feelings of being incompetent, uselessness and inadequate may in part be secondary to depression. Mr. Sample describes himself as having average levels of characteristics that are stereotypically feminine and denies having any stereotypically masculine qualities. Mr. Sample's repertoire of behaviors is in the average range with him acknowledging having average levels of feminine characteristics. Mr. Sample can be so self-righteous that he may fail to see his faults. PERSONALITY FUNCTIONING Mr. Sample's testing indicates very severe character pathology. He has deeply ingrained dysfunctional personality patterns that are probable to cause interpersonal and intrapsychic problems. These patterns must be taken into account in diagnosing and treating other psychological problems (Axis I Disorders). Testing indicates significant Avoidant, Dependent, and Passive-Aggressive features that are likely to effect daily functioning. Of these, Dependent and Avoidant features are predominant and should be emphasized in the description given below. Although Mr. Sample has many unmet dependency needs and wants others to take care of him, he projects his low self-esteem and sees others as critical and rejecting. Mr. Sample sets bounds passive-aggressively as he is afraid to express his anger and frustration directly. Because of feeling incapable of doing things, he sets boundaries through frustrating demands by being inefficient, stubborn, and incompetent. Mr. Sample may focus his interpersonal needs on one or two others, with whom he is likely to have dysfunctional relationships. Anxiety and anger are his primary feelings. Mr. Sample reports being unduly dependent on others and does not independently pursue his own needs. Because he expects not to be loved, he is sensitive to rejection, offense, and humiliation leaving him uncomfortable, withdrawn, lonely, and shy. Mr. Sample focuses on problems without seeing positives and blames others for his difficulties. Exaggerated help-seeking behaviors can occur. Obsessive thoughts, over reliance on analytical thinking, and over personalization of events are common. Even though Mr. Sample denies most of his emotions, he is often irritable and malcontent as he expresses his underlying anger through subtle attacks, blame, insults, and complaints. Underlying worry and anger can result in mood swings and tantrums. Emotional reactions especially occur when issues of separation or abandonment are present. Maladaptive behavior may result from rebelliousness, avoidant behavior, and/or following peers. MMPI-2 RESULTS INDICATE THAT IN ADDITION TO THE ABOVE PERSONALITY PATTERNS, Mr. Sample ALSO IS: Testing indicates significant Borderline Personality features. Mr. Sample has poor ego strength, as his sense of identity is not well developed. These factors lead to unpredictable, situationally determined behavior as Mr. Sample reacts to his constantly changing conflicted thoughts and feelings. Intense sudden rages and depressions lead to dramatic behavioral outbursts, capricious "up and down" mood swings, and dependency independence cycles. While Mr. Sample has strong needs for love and nurturance, he tends to form Hostile Dependent relationships and manipulatively attempt to control others through extreme and often hostile tactics such as self-mutilation. He engages in a series of transient, stormy relationships based on alternating idealization and deflation. In addition, MMPI-2 results indicates that Mr. Sample is a rigid, perfectionistic, overly conscientious individual who is afraid of making mistakes and not living up to his standards. This can lead to lack of action and to feelings of insecurity and inadequacy. He is anxiety prone and often emotionally over reacts to situations. Out of fear of failure, he rigidly attempts to follow set patterns, which results in a series of nonproductive, compulsive behaviors. Mr. Sample is overly sensitive to rejection and is watchful for disapproval. His fears of rejection make him uncomfortable in social situations and can lead to withdrawal and loneliness. To avoid rejection and criticism, Mr. Sample attempts to follow rigid patterns of thinking, feeling and acting. He can be obsessed about doing things the right way. Fear of making mistakes can result in indecision, ambivalence, and procrastination, which prevent completion of tasks. Mr. Sample is over intellectualized and often escapes into fantasy to gratify needs for contact and discharge of anger. Racing thoughts, cognitive rituals, preoccupation, and "black or white" dichotomous thinking are probable. Mr. Sample can be so strongly focused on details that he often "can't see the forest for the trees." His attention is rigid and narrow with him having a strong need for closure. Mr. Sample is typically tense and joyless as he expends a great deal of energy on constricting his feelings. Much anxiety about embarrassment and humiliation exists because Mr. Sample is afraid to be found inadequate. Occasional intense, righteous indignation occurs when others do not live up to his standards. Likewise, Mr. Sample can apply these standards to himself and suffer from guilt. SECONDARY MMPI-2 SCALE ELEVATIONS FURTHER SUGGEST THAT Mr. Sample is: Mr. Sample is a cynical, pessimistic, demanding individual who complains a great deal, especially about somatic issues, but is resistive to help. He easily feels defeated, does not see ways to improve his own life and is rarely satisfied. Rather than act directly to better his situation, Mr. Sample can manipulate others with his physical complaints and adopt a dependent role to avoid responsibility. Is easily depressed and has negative thought patterns. He may be very pessimistic and make many negative self-statements. Mr. Sample is likely to be slow and cautious, with him often having trouble initiating actions. A lack of persistence and follow through is to be expected. Lowered self-esteem and feelings of incompetence, uselessness and inadequacy are likely. Is manipulative, over dramatic and represses feelings upon which he may later act on with little awareness. Mr. Sample can be self-centered, childish, and immature and may lack insight into his behavior. Relations with others tend to be superficial. His underlying dependency needs may be hard for Mr. Sample to fill. His behavior tends to be based more on emotional reactions than on a rational analysis of situations. Has poor frustration tolerance and acts for immediate gratification without thought of consequences or social appropriateness. Mr. Sample can be self-centered and engage in impulsive acting out behavior without planning. At times Mr. Sample disregards rules and behaves in an irresponsible, hedonistic self-indulgent manner. He can have difficulty profiting from his experiences, both good and bad. Anger may be used to manipulate others. Mr. Sample experiences little anxiety or remorse. Tends to display strong characteristics commonly thought to belong to females. Is socially detached and has confused, atypical thought patterns. Mr. Sample is a somewhat odd, eccentric individual who has difficulty with logical thinking. Mild confusion, flight into fantasy and poor coping is likely. He tends to feel alienated, misunderstood, and out of place. Interpersonal communication can be impaired. Is introverted, interpersonally aloof, shy and easily embarrassed in social situations. PRIMARY IRRESPONSIBLE THOUGHT PATTERNS 2. External Reference --Sees his behavior as due to external factors beyond his control --Blames others for the consequences of his behavior --Often feels out of control, overwhelmed by situations --Adopts a "poor me" victim posture, feels unjustly treated by others 4. Motivational Deficits --Is unmotivated to change behavior or follow laws --Is lazy, takes the easy way out of situations --Is unable or unwilling to form or work toward goals --Avoids responsibility --Gives up easily when he faces obstacles --Plays "dumb" to avoid effort 7. Anxious Avoidance --Acts to minimize immediate anxiety without thought of long-term consequences --Has multiple fears and insecurities that he often fails to admit --Over attributes risk, easily feels apprehensive and vulnerable --Avoids situations where he may fail or feel rejected --Maladaptive activity often done to reduce anxiety or avoid perceived harm --Easily becomes anxious when faced by the consequences of his acts 10. Objectifies others --Sees others only in terms of what they can do for him --Treats others as objects to manipulate and possess --Does not acknowledge the rights of others --Feels he owns others RISK/NEEDS ASSESSMENT The LSI-R was used to help in security classification and treatment planning decisions. Mr. Sample's overall score of 21 on the LSI-R is under the 35th percentile for a male inmate population. This score falls in the Low/Moderate category of Risk/Needs. USING STANDARD LSI-R CUTOFF SCORES WOULD SUGGEST THE FOLLOWING: Probation Guidelines: MAXIMUM Halfway House Placement: NOT APPROPRIATE UNLESS WITH INTENSIVE SUPERVISION/TREATMENT Institutional Classification: MINIMUM SECURITY LSI-R SUBCOMPONENT ANALYSIS The LSI-R id divided into 10 content areas that can provide information useful for planning rehabilitate programs and for the formation of supervision rules. CRIMINAL HISTORY: Mr. Sample has a moderate history of past legal involvement, which is a negative prognostic sign. He was rated as having three to four of the following historic risk factors: prior convictions, present multiple offenses, arrest before the age of 16, prior incarceration, escape history, Institutional misconduct, new charges while on probation, probation suspension/revocation, and a history of assault/violence were not found. EDUCATION/EMPLOYMENT: A mild level of educational and vocational adjustment problems were found. Mr. Sample may a degree of difficulty finding and maintaining employment and may have evidenced behavioral and/or learning problems in school. FINANCIAL: Either financial problems or a reliance on social assistance was found. FAMILY/MARITAL: Mildly dysfunctional marital and/or family circumstances exist. ACCOMMODATION: Mr. Sample's living situation is a positive one. LEISURE/RECREATION: He engages positive prosocial activities. COMPANIONS: Mr. Sample social support group is extremely antisocial and is not likely to support prosocial activity. ALCOHOL/DRUGS: Significant Alcohol and Drug use is reported that may be a factor in Mr. Sample's maladaptive activity. EMOTIONAL/PERSONAL: Severe emotional and personal problems were apparent, with his mental health problems likely to effect risk of recidivism. ATTITUDES/ORIENTATION: Mr. Sample displays a negative attitude and evidences severe criminal thinking tendencies that may lead to recidivism and interfere with treatment. CRIMINAL CHARACTERISTICS Mr. Sample's overall score on a Discriminant Function analysis indicates severe generalized delinquent tendencies. He has a significant underlying predisposition to break social rules and act out antisocially. Mr. Sample does not acknowledge following social rules as he has a marked disrespect for social standards and does not feel bound by typical social conventions. Mr. Sample displays attitudes similar to those often found among criminals in that he fears failure, enjoys taking risks, relies on chance rather than effort, wants to appear tough, and is gang-oriented. These attitudes may condone and contribute to maladaptive behavior. He describes himself as a socially mature individual with adequate coping skills. Mr. Sample tends to be mistrustful and has trouble relating with authority figures whom he typically views as being unfair and untrustworthy. Hostility occurs when Mr. Sample feels that others are attempting to control him. Significant, above average tendencies to unconsciously and automatically repress feelings are evident in testing. This may lead to a cycle of repressing and then explosively acting out on feelings with little awareness. Mr. Sample reports below average tendencies to consciously deny problems and suppress disturbing thoughts. This lack of denial may indicate tendencies to become emotionally overwhelmed. Mr. Sample indicates strong tendencies to become depressed and withdraw. While this may be in part in reaction to his acting out behavior and its consequences, depression itself may be a root cause and key trigger to his acting out. Moderate levels of social discomfort and self-consciousness are reported. This anxiety may adversely influence Mr. Sample's behavior, with it at times being an element in his acting out. Mr. Sample reports experiencing average levels of anger which do not seem to particularly be associated with maladaptive behavior. Mr. Sample is a very negative, distrustful, hostile individual who can act out his underlying emotional problems in Criminal ways. While many unmet dependency needs exist, Mr. Sample is reluctant to let others close out of fear that they will control or reject him. Mr. Sample's desires for acceptance cycle with chronic anxiety; the resultant internal conflict may lead to erratic acting out. Testing also shows Mr. Sample has other secondary motivation(s) for acting out including: Acting out can also be due to Mr. Sample's active Criminal Thought patterns and perceiving the world in a concrete, egocentric manner that leads him to act out. Mr. Sample rarely takes responsibility for his actions and has limited awareness of how his behavior affects others. SEXUAL FUNCTIONING Mr. Sample described having an average sex drive with him wanting to engage in sexual behaviors to a normal degree. Mr. Sample admits to having participated in a low average range of sexual behaviors and practices as compared to others. This may indicate mild sexual inhibition or lack of opportunity or interest. Average levels of sexual fantasy are reported. Expressed attitudes toward sex were extremely conservative, traditional and restrictive. An exceptional number of sexual taboos were reported. Mr. Sample's fund of sexual information is very poor. He greatly lacks knowledge about sex and sexual functioning. Misconceptions about sex may occur which can affect sexual functioning. His identity is strongly discrepant and does not match stereotyped images of his gender. Mr. Sample described himself as having many more characteristics commonly associated with the opposite gender than like gender traits. The effects of this on his identity, self-image and sexuality should be clinically explored. Mr. Sample has an extremely poor body image and feels very dissatisfied with his body and appearance. He feels that he is very unattractive which may significantly influence his behavior. A low average level of overall satisfaction with his sex life is reported. In a test of deviant sexual functioning, Mr. Sample reports a low level of normal sexual drives/interests and does not admit sexual attraction to age-appropriate heterosexual relationships. Reported levels of sexual thought/preoccupation are in the Normal range. Mr. Sample's fund of sexual information is marginal as he has areas where his sexual knowledge is inadequate. Mr. Sample's testing revealed significant cognitive distortions and immature thought patterns similar to those typically found among sex offenders. This finding indicates probable sexual problems, which need to be evaluated. A moderate degree of rationalization exists as Mr. Sample may justify his sexual deviancy, blame others and make excuses for acting out behavior. Mr. Sample does not report engaging in behaviors typical of child molesters, though this finding may be due to denial and needs verification. Mr. Sample admits to significant pedophilic sexual fantasies. He does not report actively looking for victims. A limited amount of actual child molestation is admitted to. Mr. Sample denies the utilization of force. Aggravated molestation utilizing force is not reported by Mr. Sample. Incestual behavior is not reported. Mr. Sample admits to heterosexual, but not homosexual pedophilic acts. Rape behavior is not admitted to, though this may be due to denial. Mr. Sample denies Rape fantasies. Mr. Sample does not report actively looking for victims to rape. Mr. Sample denies actively raping victims. Sadomasochistic tendencies are not admitted to. Mr. Sample does not report engaging in exhibitionistic behaviors, though this finding may be due to denial and needs verification. Mr. Sample does not admit to exhibitionistic sexual fantasies. He does not report looking for exhibitionistic opportunities. Incidents of exhibitionistic behavior itself are not admitted to. Mr. Sample denies the utilization of advanced exhibitionistic tactics. Mr. Sample does not report signs of the following paraphilias: VOYEURISM SADO-MASOCHISM Mr. Sample reports mild signs of the following paraphilias (please check individual Multiphasic Sex Inventory items for more information): FETISH OBSCENE CALLS BONDAGE/DISCIPLINE Mr. Sample reports mild signs of the following sexual dysfunctions/disabilities: (please check individual Multiphasic Sex Inventory items for more information): PREMATURE EJACULATION PHYSICAL DISABILITIES IMPOTENCE Mr. Sample admits to significant signs of the following sexual dysfunctions/disabilities: (please check individual Multiphasic Sex Inventory items for more information): FEELINGS OF SEXUAL INADEQUACY Mr. Sample does not presently voice motivation to seek treatment for his sexual problems. PRIMARY CRIMINAL RELAPSE TRIGGERS Poor judgment Lack of Social Skills Lack of bonding to others Poor Work/Education skills Boredom Lack of structured time Lack of positive recreational activity Active Criminal Thought patterns Criminal opportunity Power and control needs Impulse control problems Uniqueness Inability to deal with failure AODA relapse Lack of environmental structure Failure to follow through with Aftercare Lack of Mental Health Treatment Unresolved Underlying Emotional Conflicts Family of Origin issues Level of Depression or Anxiety Inability to deal with stress Negative peer groups Peer pressure Negative Codependent relationships IDENTIFIED RISK FACTORS Severe levels of present stress described Lacks supportive people in his present life Is unmotivated to seek out psychotherapy Obsessive ruminations Mental confusion Possible psychosis Moderate "fake good" response set Strong "fake bad" response set Emotional upset may interfere with cognition Depression Suicidal thoughts/self-harm tendencies reported Anxiety Post Traumatic Stress Disorder symptoms High presently experienced anger Extreme energy is invested in repressing and controlling anger Has few guards against feelings once they are evoked Severe mood instability Impulse control is poor Energy is moderately raised Psychopathy likely Paranoia Is introverted, isolated High levels of social withdrawal Strong social anxiety exists Limited empathy Strong needs for love and affection exist Is extremely passive and submissive Strong needs to be dependent on others-Codependency issues Trouble developing rapport and intimacy Extreme degree of interpersonally sensitivity and vigilance Easily feels persecuted by others Is overly judgmental and critical of others Compulsiveness Relationship problems likely Problems with work attitudes and behaviors exist Lacking in ego strength; feels overwhelmed and unable to cope with problems Is overly self critical and focuses on the negative in himself Has poor self-esteem Displays significant attitude problems Significant financial problems Lacks a prosocial support group Substance use is seen in needs/risk assessment Mental Health problems identified in risk/need assessment Generalized Delinquent tendencies exist Poor knowledge and acceptance of common social rules Is mistrustful of and has trouble relating with authority figures Acts out emotional problems in criminal ways Active Criminal Thought patterns exist Expressed attitudes toward sex were extremely conservative Identity does not match stereotyped images of his gender Has poor body image Poor fund of sexual knowledge Significant Cognitive Distortions similar to Sex Offenders exist Moderate rationalization and justification of sexual behavior Probable Pedophilia Probable Bondage/discipline Probable Sexual Dysfunction, Impotence VERY SEVERE CHARACTER PATHOLOGY: Avoidant traits Dependent traits Antisocial traits Obsessive traits Passive Aggressive traits Borderline Personality traits Paranoid traits MILD TO MODERATE CHARACTER PATHOLOGY: Schizoid traits Histrionic traits Schizotypal traits FACTORS MITIGATING RISK Adequate abstract reasoning Adequate vocabulary skills Adequate visual abstraction No indications of Organic Brain Syndrome No Learning Disorder No significant current pressure to verbally express anger No significant current pressure to physically express anger Denies generalized anger problems Is not overly quick tempered Does not generally see others as overly critical or rejecting Does not easily forms resentments Average energy used to control behavioral expression of anger Makes efforts to suppress, rather then express, angry feelings Average tendencies to express anger once experienced Does not behaviorally avoid people Has average sensitivity to what others think of him Is not grandiose Does not have an extensive criminal history No extreme educational and vocational adjustment problems exist Absence of Marital and family problems Current living situation is positive Has positive prosocial activities and time management Is a socially mature individual with adequate coping skills Described having an average sex drive Admits to having participated in an average range of sexual behaviors Average levels of sexual fantasy are reported Overall satisfaction with his sex life is at least average Reported levels of sexual thought/preoccupation are in the Normal range DIAGNOSTIC CONSIDERATIONS RULE OUT AXIS I Malingering Factitious Disorder with Physical symptoms Paranoia Bipolar Affective Disorder II Obsessive Compulsive Disorder Panic Attacks with Agoraphobia Somatization Disorder Hypomania Dysthymia Generalized Anxiety Disorder Adjustment Disorder with Mixed Emotional Features Major Depression, Severe Post Traumatic Stress Disorder Pedophilia Paraphilia, Bondage/Discipline Sexual Dysfunction, Impotence Acute Stress Disorder AXIS II Personality Disorder NOS with Avoidant, Dependent, and Passive-Aggressive features PRIMARY PERSONALITY FEATURES SUGGESTED BY THE MMPI-2 Borderline Personality features Avoidant features Obsessive features Passive Aggressive features POSSIBLE SECONDARY PERSONALITY PATTERNS INDICATED BY THE MMPI-2 Histrionic features Antisocial features Dependent features Schizoid features TREATMENT CONSIDERATIONS Based on Mr. Sample's self-report, the following corrective treatment approaches are recommended. Care should be taken to ensure that these suggestions match Mr. Sample's clinical presentation and history. If test invalidity indicators have been raised (see validity section), these recommendations may not reflect Mr. Sample's true clinical needs. DUE TO SEVERE LEVELS OF DEPRESSION AND SUICIDAL THOUGHT REPORTED IN TESTING, IMMEDIATE EXHAUSTIVE CLINICAL INVESTIGATION OF POSSIBLE SUICIDAL IDEATION SHOULD OCCUR WITH NECESSARY INTERVENTIONS TAKEN. DUE TO SEVERE LEVELS OF AGGRESSION REPORTED, IMMEDIATE EXHAUSTIVE CLINICAL INVESTIGATION OF POSSIBLE HOMICIDAL IDEATION SHOULD OCCUR WITH NECESSARY INTERVENTIONS TAKEN. Mr. Sample NEEDS TO BE CHECKED MEDICALLY TO HELP DETERMINE THE EXTENT THAT HIS/HER PHYSICAL CONCERNS ARE GENUINE. Continued communication with his her physician is essential. PSYCHIATRIC REFERRAL FOR EVALUATION FOR PSYCHOTROPIC MEDICATIONS IS WARRANTED INCLUDING MEDICATION FOR: PARANOIA, DEPRESSION, ANXIETY, OBSESSIVENESS/COMPULSIONS, ANGER, AND ADHD. He does not report having supportive people in his present life that can help him deal with problems and reduce his stress level. Because Mr. Sample is unmotivated to seek out psychotherapy, and sees psychological interventions as unlikely to help him deal with his life stressors, his therapist must engage Mr. Sample and convince them that they could benefit from therapy. Therapists should initially not be overly confrontive and must pace their interventions. As it is likely that Mr. Sample's emotions are interfering with his cognitive processing, immediate interventions to alleviate emotional distress are suggested. Mr. Sample must become more flexible and learn how to develop and choose among alternative ways of thinking, feeling, and behaving. Stress reduction techniques may help Mr. Sample deal with underlying anxiety and free him to experiment with new behaviors. Mr. Sample's excellent abstract reasoning ability should be an asset in his treatment, though therapists also should be careful that Mr. Sample does not use these skills to rationalize, intellectualize, avoid issues or adopt a co-therapist role. Mr. Sample is more likely to initially profit from individual rather than group therapy as he lacks social skills and is so afraid of rejection that he will probably withdraw in a group setting. While in the long run Mr. Sample needs group therapy to enhance social skills, he may initially require much individual work to prepare him for group involvement. Due to Mr. Sample's level of interpersonal suspicion and mistrust, therapists must slowly approach him and build rapport. Constant checks on how Mr. Sample construes situations are necessary as Mr. Sample projects his own feelings onto others. He must be made aware of this, as well as learn how his own behavior sets up negative reactions. Due to his level of dependency, rebelliousness, and/or need for attention, Mr. Sample is most likely to respond to peer feedback. A kind, but firm approach is indicated, as therapists must support Mr. Sample while also holding him accountable. Mr. Sample is most likely to change if he sees therapists as supportive, yet at the same time demanding change. In addition to changing thinking patterns, Mr. Sample must improve his underlying self-esteem and social skills. Use of praise and positive reinforcement is particularly useful as Mr. Sample is more likely to change his behaviors in order to receive praise than he would be to avoid punishment. Unless negative feedback is couched in carefrontational ways, Mr. Sample will ignore and discount it as criticism. Due to the degree of oppositionalness and/or explosiveness noted, a Collaborative Problem Solving Approach (Greene) is indicated to enhance Mr. Sample's problem solving skills and frustration tolerance. The LSI=R was used to help in security classification and treatment planning decisions. Mr. Sample's overall score of 21 on the LSI-R is under the 35th percentile for a male inmate population. This score falls in the Low/Moderate category of Risk/Needs. USING STANDARD LSI-R CUTOFF SCORES WOULD SUGGEST THE FOLLOWING: Probation Guidelines: MAXIMUM Halfway House Placement: NOT APPROPRIATE UNLESS WITH INTENSIVE SUPERVISION/TREATMENT Institutional Classification: MINIMUM SECURITY Due to Mr. Sample's moderate history of past legal involvement, care must be taken in placement and monitoring. Strict supervision rules with clear boundaries are indicated. He needs to be closely supervised and held accountable for his behavior. As Mr. Sample displays significant attitude problems and is likely to have Criminal Thinking tendencies, specific treatment for this is indicated. Help resolving Mr. Sample's existing financial problems is needed. This may include budgeting, help gaining employment and social service triage. As Mr. Sample largely lacks a prosocial support group, he needs encouragement to develop positive peers. Because his present associates are unlikely to support prosocial activity and may lead him into maladaptive activity, contact with negative friends should be limited. A Cognitive Behavioral Criminal Thinking approach is primary, as Mr. Sample must alter his Criminal Thought patterns if he is to act prosocially. Extensive value adjustment work is necessary as Mr. Sample lacks knowledge of normal societal conventions. He must be taught what acceptable social standards are through educational and Cognitive Behavioral approaches. Mr. Sample's attempts to dominate and control are prime therapeutic issues. Mr. Sample must develop faith in his ability to cope with situations over which he has little control and gain insight into the historical causes of his power and control issues. Power struggles are to be avoided with consequences given in a matter-of-fact way. Therapists should not accept excuses and rationalizations as Mr. Sample needs to realize that his rebelliousness and "yes but" behavior is self-defeating. Underlying issues of anger and control must be brought directly to the surface and dealt with. Rationalizing and intellectualizing must be challenged as Mr. Sample needs to learn that what he does is much more important than his reasons and intentions. As Mr. Sample blames others for his problems, therapists should encourage him to be responsible and accountable for his actions and not allow him to fall into Victimstance. Mr. Sample must learn to be less self-centered and increase his understanding of how his behavior impacts others through expressive techniques and victim script exercises. Behavioral techniques such as discrete target behaviors and immediate consequences are suggested to teach Mr. Sample to take responsibility for his actions and learn to connect his actions with consequences. Need for consistency and clarity are all important with Mr. Sample not allowed to talk his way out of consequences. Significant environmental support and external structure are vital because Mr. Sample needs external restraints to deter maladaptive behavior. Liaison between Mr. Sample's probation/parole officer, family, AA sponsor, caregivers, therapists and/or employer is essential. Insight-oriented technique may help Mr. Sample understand and deal with troubling Family of Origin issues as much maladaptive behavior is in part based on emotional conflicts rooted in his past. Insight-oriented techniques should be used to help him resolve underlying emotional conflicts and habitual self-defeating behavior patterns. Mr. Sample needs to learn to regulate his moods through use of Cognitive Behavioral techniques and/or medication. AODA use may be a cause of Mr. Sample's moodiness, though conversely, AODA use may be an attempt to self-medicate his emotional lability. A Cognitive Behavioral approach to teach Mr. Sample how to acknowledge and then detach from his feelings is necessary since he is prone to acting directly on emotions without thinking. Mr. Sample needs education about the nature of emotions and must learn ways of not immediately responding once feelings arise. Mr. Sample needs to increase impulse control and learn to see his feelings as "red flags" that call for problem solving rather than as imperatives upon which he must act. Use of Cognitive Behavioral techniques to increase cognitive mediation, to teaching problem-solving skills, increase frustration/stress tolerance through stress inoculation training, and discover impulse triggers is suggested. Mr. Sample needs to learn more direct ways to deal with his feelings and to gain attention than through somatic problems. Do not let Mr. Sample's somatic concerns lead to avoidance. Significant Depression is reported which may require Behavioral and Cognitive Behavioral treatment as well as Antidepressant medications. The role of Depression and/or Dysthymic Victimstance in Mr. Sample's maladaptive behavior should be established. Mr. Sample's Dysthymic victim stance should be addressed in therapy through use of Cognitive Behavioral techniques. He needs to gain insight on how this worldview creates a self-fulfilling prophecy Mr. Sample reports significant anxiety and could profit from Stress Management procedures as his anxiety may interfere with his ability to learn and/or may contribute to maladaptive activity and AODA use. High levels of anxiety are reported that may require Mental Heath evaluation/treatment if they are clinically seen. Stress management techniques and alternate ways of coping with anxiety and anxiety producing situations should be taught. Mr. Sample needs to learn anger control techniques. It is essential that Mr. Sample not be positively reinforced for covert or overt aggression. He must become aware of the negative impact of anger on his life to increase motivation to change. Cognitive Behavioral anger control technique in conjunction with Mr. Sample being taught prosocial, less aggressive ways of meeting his needs is necessary if he is to give up violence as a coping technique. Mood stabilizing medications may be indicated if biological components to Mr. Sample's aggression are suspected. Mr. Sample needs to learn anger control techniques. It is essential that Mr. Sample not be positively reinforced for covert or overt aggression. He must become aware of the negative impact of anger on his life to increase motivation to change. Cognitive Behavioral anger control technique in conjunction with Mr. Sample being taught prosocial, less aggressive ways of meeting his needs is necessary if he is to give up violence as a coping technique. Mood stabilizing medications may be indicated if biological components to Mr. Sample's aggression are suspected. Mr. Sample's cycle of repression alternating with explosive acting out is of major concern. He needs to gain insight into this pattern and develop adaptive ways to deal with his feelings. As signs of repressed anger exist, Mr. Sample must learn to acknowledge and positively use angry feelings. The possible role of Mr. Sample's repressed anger on AODA and maladaptive activity should be explored, as Mr. Sample needs to understand and resolve the historical causes of his anger. As he experiences much anger, work on how to detach from and reframe anger once it is evoked is important. Specific treatment for Post Traumatic Stress Disorder is needed if clinically seen, use of EMDR should be considered. Use of desensitization and implosion may be necessary to treat Mr. Sample's phobias. Medication, Behavioral and Cognitive Behavioral treatment of Obsessiveness may be required. As somatization is likely, Mr. Sample needs to be refocused away from somatic concerns once he has been medically evaluated. Medical problems should not be accepted as a way of avoiding responsible behavior and/or therapy. A Social Learning component is suggested since Mr. Sample must learn positive, prosocial skills to replace current maladaptive patterns. Mr. Sample now relies on maladaptive tactics to meet his needs with him having few alternative prosocial coping skills. Referral for education, volunteer work, job training, etc. should occur once Mr. Sample develops the social and cognitive skills necessary to be successful. As it is likely that Mr. Sample follows peers into maladaptive behavior, he must be empowered to independence. Development of a positive peer group is essential. Signs of substance abuse or proneness to abuse exist which may require AA or educational programming. Signs of substance dependence exist which require professional intervention. If substance abuse is clinically seen, Intensive outpatient AODA treatment is indicated, if detoxification is not necessary, due to significant underlying addictive attributes and lack of admission to chemical use in testing. The reason for Mr. Sample's lack of normal sexual drives and interests needs to be assessed. Remedial education, social and heterosexual skill training and self-esteem work may be required to heighten attraction to appropriate sexual outlets. Stepwise positive interaction with sexually appropriate partners is indicated. If Mr. Sample's low sexual interest is due to personality factors such as a Schizoid personality disorder, it is unrealistic to expect that Mr. Sample will increase his sexual attraction to age appropriate partners. Mr. Sample reports that he has very conservative and traditional sexual values. The impact of this on his life should be established. The clinical effects of Mr. Sample's reports of having many cross sex traits should be explored with psychotherapy if this is causing significant emotional or life problems. As a high degree of body dissatisfaction is reported, work to increase body image is necessary. This may include behavioral programs to increase positive health habits including diet, exercise and hygiene, as well as psychotherapy to facilitate self-acceptance. Sex education is essential as Mr. Sample's lack of knowledge of sexual functioning and behavior may contribute to his sexual acting out. Mr. Sample's Cognitive Distortions must be directly challenged through the use of Cognitive Behavioral interventions. Mr. Sample must not be allowed to maintain the thought patterns that can lead to sexual acting out. Mr. Sample must be held behaviorally accountable for his sexual behavior with therapists directly confronting Mr. Sample's justifications and rationalizations. Use of imagery to assist him seeing his role in sexual assaults, increased empathy with victims, and reduced Victimstance are indicated. Much Step 1 work is indicated since Mr. Sample needs to develop motivation to change. Carefrontation is needed to show Mr. Sample the effects of his assaultive behavior on his own and his victim's lives. Mr. Sample must replace sexual fantasies of youth with fantasies of responsible adult sexual activity. Aversive conditioning, covert sensitization, masturbatory satiation and thought stopping may be indicated. Mr. Sample must not be allowed to escape into fantasy as a way of coping or self-stimulating while being made aware of how such fantasies lead to maladaptive behavior. Mr. Sample admits to significant paraphilias that may require specialized treatment (please check individual Multiphasic Sex Inventory items for more information): BONDAGE/DISCIPLINE Mr. Sample reports signs of sexual dysfunction/disability that may require further medical and/or psychological treatment and that could be a factor in sexual acting out. See individual Multiphasic Sex Inventory items for more information. Specific treatment for Post Traumatic Stress Disorder is needed if clinically seen, use of EMDR should be considered. As multiple sources of trauma are reported, each may need individual attention in treatment. Mr. Sample must be helped to deal with his flashbacks/dreams in positive ways. Discrete problem solving and skill development, often on a behavioral level, is needed to reduce the effects of Mr. Sample's PTSD symptoms on his level of current functioning. Specific treatment for survivors of sexual abuse is indicated. His avoidance behavior must be gradually challenged, with Mr. Sample being helped dealing with stress provoking stimuli, feelings and thoughts. Variables: SHIPLEY INSTITUTE OF LIVING SCALE: VOC - 32 AB - 32 WAIS-III MATRIX REASONING SUBTEST: MATRIX - 12 MILLON CLINICAL MULTIAXIAL INVENTORY: V - 0 DISCLS - 78 DESIRE - 71 DBASE - 91 SCH - 66 AVD - 122 DEPSIV - 86 DEPND - 113 HIS - 61 NAR - 69 ANT - 62 AGR - 17 OBSV - 12 PAG - 99 SDEF - 67 SCHTYP - 67 BRDL - 65 PARA - 68 ANXTY - 93 SOM - 76 MANIC - 52 DEPR - 114 ALCH - 77 DRUG - 63 PTSD - 50 TGHTDIS - 66 MAJDEP - 106 DEL - 65 SASSI-3: FVA - 0 FVOD - 0 SYM - 9 OAT - 9 SAT - 2 FAMLY - 2 DEF - 4 SAM - 8 RAP - 0 STATE-TRAIT ANGER EXPRESSION INVENTORY: SANG - 54 SANGF - 68 SANGV - 44 SANGP - 44 TANG - 46 TANGT - 42 TANGR - 56 AXO - 40 AXI - 50 ACO - 58 ACI - 70 AXINDEX - 65 DETAILED ASSESSMENT OF POST TRAUMATIC STRESS: MVA - 2 DIS - 2 ACC - 2 VIOL - 2 THR - 1 HOM - 2 WAR - 2 ROB - 2 SA - 1 CSA - 2 OTH - 1 WIT - 1 CPA - 1 ONSET - 2 PB - 55 NB - 62 RTE - 67 PDST - 78 PDIS - 45 RELIV - 78 AV - 65 AR - 88 PTST - 78 IMP - 74 TDIS - 57 SUB - 45 SUI - 52 JESNESS INVENTORY: SMAL - 90 VALUES - 63 IMAT - 45 AUTISM - 61 ALIEN - 69 MANANGR - 58 WITHDRAW - 75 SOCANX - 65 REPRESS - 62 DENIAL - 27 ASOCIAL - 82 AA - 58 AP - 70 CFM - 44 CFC - 46 MP - 26 NA - 58 NX - 72 SE - 41 CI - 44 LEVEL OF SERVICES INVENTORY REVISED: LSI_TOTA - 21 CRIMINAL - 3 EDUCATIO - 2 FINANCIA - 1 FAMILY_M - 1 ACCOMMOD - 0 LEISURE_ - 0 COMPANIO - 3 ALCOHOL_ - 3 EMOTIONA - 4 ATTITUDE - 4 DEROGATIS SEXUAL FUNCTIONING INVENTORY: SINF - 31 SEXP - 42 SDRIV - 50 SATT - 34 SROLE - 26 SFANT - 54 SBODY - 24 SSATIS - 40 MULTIPHASIC SEX INVENTORY: SOCSEX - 23 SEXOBS - 5 COGDIS - 12 JUSTIF - 4 TRTATT - 2 CHMOL - 6 CHFANT - 4 CHCRUISE - 1 CHASSAUL - 1 CHAG - 0 INCEST - 0 BOY - 0 GIRL - 2 RAPE - 0 RFANT - 0 RCRUISE - 0 RASSAUL - 0 RAG - 0 SADOMAS - 0 EXHIB - 0 EXFANT - 0 EXCRUISE - 0 EXASSAUL - 0 EXAD - 0 SEXKNW - 17 FETISH - 1 VOYER - 0 OBSCENE - 1 BOND - 2 SADO - 0 SEXINAD - 3 PREJAC - 1 PHYSDIS - 1 IMPOT - 2 MMPI-2 VALIDITY SCALES: QUES - 0 L - 48 F - 86 FB - 75 K - 41 TRIN - 57 TF - 2 VRIN - 65 MMPI-2 CLINICAL SCALES: HS - 77 D - 93 HY - 66 PD - 92 MF - 66 PA - 97 PT - 94 SC - 74 MA - 47 SI - 66 MMPI-2 HARRIS LINGOES SUBSCALES: D1 - 90 D2 - 65 D3 - 91 D4 - 96 D5 - 91 HY1 - 45 HY2 - 34 HY3 - 93 HY4 - 77 HY5 - 40 PD1 - 58 PD2 - 55 PD3 - 46 PD4 - 94 PD5 - 91 PA1 - 106 PA2 - 76 PA3 - 36 SC1 - 68 SC2 - 78 SC3 - 83 SC4 - 78 SC5 - 69 SC6 - 79 MA1 - 45 MA2 - 49 MA3 - 47 MA4 - 50 SI1 - 48 SI2 - 58 SI3 - 77 MMPI-2 SUPPLEMENTARY SCALES: A - 87 R - 56 ES - 2 MACR - 60 OH - 65 DO - 0 RE - 37 MT - 85 GM - 0 GF - 58 PK - 92 PS - 92 APS - 999 DY - 999 MDS - 999 ST - 999 REL - 999 PR - 999 SOC - 999 MOR - 999 PHO - 999 CN - 999 ORG - 999 PSY - 999 HOS - 999 HYP - 999 MMPI-2 CONTENT SCALES: ANX - 85 FRS - 80 FRS1 - 85 FRS2 - 72 OBS - 73 DEP - 95 DEP1 - 93 DEP2 - 78 DEP3 - 85 DEP4 - 96 HEA - 80 HEA1 - 83 HEA2 - 72 HEA3 - 90 BIZ - 78 BIZ1 - 82 BIZ2 - 71 ANG - 43 ANG1 - 88 ANG2 - 30 CYN - 74 ASP - 69 TPA - 48 LSE - 96 SOD - 52 FAM - 63 WRK - 89 TRT - 81 PAI FULL SCALES: PAI_ICN - 55 PAI_INF - 52 PAI_NIM - 87 PAI_PIM - 62 PAI_SOM - 84 PAI_ANX - 99 PAI_ARD - 85 PAI_DEP - 79 PAI_MAN - 67 PAI_PAR - 79 PAI_SCZ - 66 PAI_BOR - 86 PAI_ANT - 87 PAI_ALC - 57 PAI_DRG - 68 PAI_AGG - 64 PAI_SUI - 77 PAI_STR - 99 PAI_NON - 72 PAI_RXR - 88 PAI_DOM - 22 PAI_WRM - 22 PAI SUB SCALES: PAI_SOM_ - 54 PAI_SOM_ - 59 PAI_SOM_ - 62 PAI_ANX_ - 99 PAI_ANX_ - 87 PAI_ANX_ - 73 PAI_ARD_ - 45 PAI_ARD_ - 67 PAI_ARD_ - 88 PAI_DEP_ - 86 PAI_DEP_ - 92 PAI_DEP_ - 66 PAI_MAN_ - 73 PAI_MAN_ - 22 PAI_MAN_ - 55 PAI_PAR_ - 84 PAI_PAR_ - 72 PAI_PAR_ - 55 PAI_SCZ_ - 62 PAI_SCZ_ - 58 PAI_SCZ_ - 67 PAI_BOR_ - 88 PAI_BOR_ - 76 PAI_BOR_ - 99 PAI_BOR_ - 66 PAI_ANT_ - 86 PAI_ANT_ - 55 PAI_ANT_ - 62 PAI_AGG_ - 56 PAI_AGG_ - 53 PAI_AGG_ - 58 SEX - M |
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