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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 Test Age: 12 Sex: M Referred By: You Interpret Date: 12/19/01 Test Date: 12/19/01 PSYCH SCREEN, INC. PHONE AND FAX (800) 588-9412 To aid in diagnosis and treatment planning, Mr. Test 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-A, Millon Adolescent Clinical Inventory, SASSI-A2, State-Trait Anger Expression Inventory, Jesness Inventory, Derogatis Sexual Functioning Inventory, Multiphasic Sex Inventory - Adolescent, Problem Oriented Screening Instrument for Teenagers (POSIT), Traumatic Symptom Checklist for Children. The following test findings are based on Mr. Test's responses to a widely used standardized psychological test. As with all such tests, the validity of test results is limited by Mr. Test's honesty and self-awareness. This report 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. Test's unique history and present circumstances. Since the MMPI-A is a complicated test with multiple scales that measure similar constructs, at times inconsistencies in test results may occur due to Mr. Test'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 may de-emphasize Mr. Test's strengths. Because of this, use without collaboration, other than for the clinical screening purpose, for which they are intended, may be misleading. This 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 likely to misunderstand report contents and their tentative nature. VALIDITY OF TEST RESULTS = VALIDITY OF TESTS OF PSYCHOPATHOLOGY VALIDITY OF PERSONALITY TEST RESULTS Mr. Test appeared to have read the tests and did not respond randomly. VALIDITY OF SUBSTANCE USE TESTS Mr. Test did not randomly answer questions about his substance use. PTSD SPECIFIC TEST VALIDITY (TSCC) PTSD specific testing has a moderate "fake good" response set in which Mr. Test minimized problems and pathology. This may limit the validity of the following test results, as underlying pathology may be moderately more extensive than indicated in the results given below. INTELLECTUAL FUNCTIONING Testing demonstrates Superior potential intellectual functioning. Verbal abstract reasoning is in the Superior range with him displaying an exceptional ability to think in terms of general principles, solve logical problems, and generalize between situations. Mr. Test's Normal Vocabulary evidences at least an average learning ability. PROBLEM AREAS Mr. Test was asked about several areas of life functioning that often are problematic for adolescents. Mr. Test reports mild levels of suicidal ideation, which need to be clinically evaluated. Intervention to deal with suicidal ideation may be warranted. He reports lacking a stable sense of identity that guides behavior. Because of this, Mr. Test is easily influenced by situational factors and so can be extremely erratic and unpredictable in his actions. He reports occasional mild intrusive thoughts of past abuse. Moderate to severe problems with body image are reported. Mr. Test reports average levels of sexual concerns. Eating Disorder symptoms are not admitted to. He is excessively self critical to the point of creating self-fulfilling prophesies. Mr. Test reports being extremely insecure about peer relations. Mr. Test describes an average level of sensitivity to social cues. Mr. Test admits to moderately delinquent tendencies. Extreme family dysfunction is reported. EMOTIONAL FUNCTIONING In testing, Mr. Test reported having significant levels of depression that may be of clinical significance. Many subjective feelings of sadness and dejection exist, as Mr. Test feels hopeless, helpless, and discouraged. This level of depression may be due to situational factors, may indicate Dysthymia or may show an adjustment to a chronic long-term clinical Depression that the person has in part learned to live with. Many physical symptoms/signs of depression are endorsed which suggest a Major Depression. A preoccupation with his physical state may also exist as Mr. Test denies good health and makes a wide variety of somatic complaints. Mr. Test's level of true depression is congruent with what he subjectively experiences with him not minimizing nor focusing on feelings. Significant subjective depression is noted with Mr. Test being quite despondent. Moderate levels of anxiety are reported with Mr. Test being prone to situational stress. He is often apprehensive, easily frightened, "on edge," and unable to relax. This anxiety may interfere with coping and increase impulsivity. Mr. Test's level of anxiety is significantly less than what he subjectively experiences with him overly focusing on anxious feelings. Mr. Test reports a strong subjective experience of anxiety and nervousness. An extreme level of overall current PTSD symptoms is reported. This may include the reliving of traumatic experiences (intrusive flashbacks and dreams), avoidance of stimuli and feelings associated with the traumatic event, and hyper-arousal (high energy, hyper-vigilance and startle reactions). Mr. Test described presently experiencing moderate dissociation that could include a degree of derealization, Depersonalization, and detachment and leave him distracted, shutdown, and/or numb. This dissociation strongly follows a classic pattern often found in PTSD and reduces Mr. Test's sensitivity to what is happening around him. Dissociation may be a means for Mr. Test to avoid negative feelings/intrusive events and can reduce his ability to effectively cope with his environment. Mr. Test also described a mild degree of daydreaming/escaping into fantasy. Very severe overall concerns with sexuality were present in testing. A very severe preoccupation with sexuality and/or a heightened, developmentally inappropriate, level of sexual behavior were described by Mr. Test. A mild amount of distress with issues of sexuality was reported that might indicate a degree of fear about sex, the presence of occasional unwanted sexual thoughts/feelings, and/or anxiety causing sexual behavior. At present, Mr. Test reports experiencing average amounts of overall anger. Average levels of current subjective angry feelings are admitted to. Mr. Test is now experiencing average pressures to be verbally aggressive. Average pressures to physically express anger are currently said to exist. Both subjective angry feelings and pressure to act out in an angry manner were denied. Present pressures to express anger physically and verbally are equal. Present levels of anger may not reflect longstanding anger patterns as higher levels of trait anger are admitted to. The level of anger presently described is lower than what he reports typically experiencing and so may be uncharacteristically low due to lack of stress and/or anger inhibiting situational factors. Very high levels of Trait Anger are admitted to as Mr. Test described himself as generally experiencing severe levels of anger. He is extremely quick tempered with anger often evoked with minimal provocation. Mr. Test is overly sensitive to criticism and rejection and so may perceive/exaggerate criticism and rejection where none actually exists. Feelings of rejection can provoke intense anger that may lead to further rejection. Mr. Test displays severe tendencies to be authoritarian and often intimidates others with his anger. He reports generally experiencing anger to an average degree. Mr. Test's experienced level of anger may not accurately reflect his true anger level as he also reports significant efforts to repress, suppress and/or deny anger to the point where his conscious experience of anger may be significantly reduced. Once anger is consciously experienced, Mr. Test makes very strong attempts to suppress his anger. However, his efforts to suppress anger are generally unsuccessful since Mr. Test reports often experiencing heightened levels of anger. Well above average amounts of energy are then invested in calming down and reducing remaining conscious anger. This is to the point where anger can often be over controlled. Excessive monitoring and repression may lead to emotional and behavioral constriction and avoidance. Despite making significant efforts to lessen anger, a significant level of anger is still experienced by Mr. Test. Mr. Test describes making mild efforts to control, rather than act out on anger when it is consciously experienced. Severe tendencies to act out on anger once consciously experienced are said to exist. While significant efforts to suppress, repress and/or deny anger are reported, Mr. Test directly expresses anger once he becomes aware of it. Mr. Test's tendency to act out on anger once it is felt is likely to be expressed as significant irritability, high levels of Trait anger and/or generalized tendencies to experience anger are reported. Level of antisocial traits found suggests that Mr. Test may lack emotional depth. However, he can experience diffuse and well-rationalized anger and resentment. He is not prone to guilt, worry or remorse. Mr. Test does not see them as strange or foreign to himself. Impulse control is poor with Mr. Test 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. Test subjectively feels able to control his impulses and is not overly concerned acting out on them. Mr. Test's reported energy level is mild to moderately raised with him being an action-oriented individual who when bored may act out. Periodic hyperactivity, labile affect and poor self-control are likely. Increased energy may lead to disinhibition, poor judgment and recklessness. Moderate psychomotor hyperactivity is reported with heightened speech, thought, and motor activity possible. ALCOHOL AND DRUG USE The MMPI-A reveals significant addiction proneness and possible substance use. Mr. Test tends to be extroverted, sensation seeking, and impulsive which may lead to acting out behavior including substance use. Further evaluation for possible alcohol and drug use is indicated. In this test, Mr. Test does acknowledge having significant substance use-related symptoms and attitudes. MACI results do not indicate substance abuse. This should be clinically verified as people who are in denial of their chemical dependency, as well as individuals without such problems, may score similarly in testing. The above findings need to be interpreted in conjunction with the SASSI results given below as the SASSI was designed specifically to assess addictive tendencies even in clients with strong denial: Mr. Test reports absolutely alcohol sobriety and does not admit to any use-related symptoms on face valid measures. Mr. Test reports absolutely no drug use or use-related symptoms on face valid measures. Severe Obvious Attributes empirically found among chemically dependent individuals were endorsed by Mr. Test. Average levels of Subtle Attributes of chemically dependent individuals were found. Average levels of substance use related symptoms and consequences are admitted to. Blackouts, tolerance change, loss of control, hangovers and withdrawal signs are unlikely. Mr. Test doers not feel that substance use has had a significant effect on his life. Average levels of involvement with family and/or friends who heavily use substances are reported. If true, social factors are not likely to encourage substance use. Mr. Test has positive attitudes toward substance use. Use of substances is not seen as unusual, negative or abnormal, with him focusing on seeing substance use as positive and enhancing. While testing did not support a diagnosis of chemical dependency, the degree of defensiveness found and/or elevated Secondary Classification Scale makes this finding questionable and worthy of further clinical investigation. SOMATIC FUNCTIONING Severe current concerns about a wide variety of physical problems is reported which may indicate that Mr. Test is over concerned about and fixated on his health. Physical complaints (often are without a clear organic basis) are probable as Mr. Test reports a broad range of physical symptoms that may include intake, elimination and aches and visceral pains. A history of physical symptoms, most of which are vague, and a preoccupation about bodily functioning is probable. Mr. Test overly focuses on minor illnesses which causes more concern than would be expected in most persons. Such scores may also reflect true physical problems that need to be clinically ruled out. Symptoms may be stress-related. When physical problems exist, an exaggeration of symptoms is probable. A moderate tendency for psychosomatic problems to develop under stress exists. Physical symptoms can be used for secondary gain. When confronted on this, Mr. Test may become hostile and feel persecuted. Conversion symptoms due to repression are possible, but not probable. Current high 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 likely as Mr. Test uses physical complaints to vent feelings, escape responsibility and to control others with little awareness. INTERPERSONAL FUNCTIONING Mr. Test is extremely introverted and tends to be much more comfortable when alone. An attachment deficit probably exists as Mr. Test avoids and withdraws from others. Social withdrawal secondary to Mr. Test's depression may occur as he may have lost interest in daily activities and have low energy. Mr. Test reports experiencing significant levels of social discomfort and anxiety. Mr. Test reports average levels of social confidence. He subjectively feels an average ability to effectively relate to and deal with others. He feels isolated and alienated from others. Mr. Test believes that people do not understand him and does not trust that people will help him. Mr. Test has a severely limited sense of empathy. Mr. Test reports having below average needs for attention. Average needs for affection, love and intimacy are reported. Mr. Test's level of suspiciousness and/or social withdraw may interfere with Mr. Test's ability to meet his needs for love. Mr. Test is a dominant individual who likes to take the lead in situations. He may have difficulty following others. His dependency needs are in the average range with him having the ability to both be independent and dependent as situations require. Mr. Test has mild feelings of being estranged, different and unusual. He feels moderately misunderstood by others. Mr. Test is a severely suspicious and distrustful individual. He blames others for his problems. He often over reacts to social situations and easily feels taken advantage of. This lack of trust leaves Mr. Test interpersonally guarded, touchy and argumentative. An extreme degree of interpersonal sensitivity and vigilance was described. Mr. Test generally does not blame others for his problems nor does he see the world as unusually threatening or unfair. He sees others as very untrustworthy and devious. He feels others will act to their own ends without considering his needs. Mr. Test is not unusually self-righteous or moralistic. He rarely develops distrustful or hostile feelings when others do not live up to his standards. The significant antisocial trends reported suggest that Mr. Test wants to do as he pleases without feeling a sense of obligation to others. He has trouble with authority and resents rules. Power and control issues are likely. Verbal threats and aggression may be used to gain other's compliance. Mr. Test's relationships tend to be stormy and conflictual. He has difficulty maintaining a long-term relationship. Multiple family problems are reported with Mr. Test feeling exceptionally unloved and unsupported by his family. Dysfunctional, conflictual relationships and severe anger are probable. Mr. Test reports having unproductive school attitudes and behaviors that may interfere with his school performance and leave him feeling unable to perform at his school. Mr. Test has an average level of educational and life objectives. He is motivated to perform to an average degree. Frustration tolerance and persistence are average. SELF IMAGE Mr. Test usually does not care what others think of him. Mr. Test feels uncomfortable and unhappy with himself. Significant guilt and regret are likely. Mr. Test appraises his own abilities as below average. Mr. Test subjectively identifies himself as having moderate antisocial values and tendencies toward acting out antisocially. He tends to be impulsive, have difficulty with authority figures and act out in defiance of social rules. He has significant problems with authority and social standards. Mr. Test can rationalize that his ends justifies his means. On occasion he can be dishonest and opportunistic in dealing with others. DEFENSES Internalization Withdrawal Avoidance Rationalization Projection Externalization of blame Acting out PERSONALITY FUNCTIONING Moderate Self-Defeating patterns are evident in testing with Mr. Test having difficulty in accepting and dealing with success. Testing indicates significant Borderline Personality features. Mr. Test has poor ego strength, as his sense of identity is not well developed. These factors lead to unpredictable, situationally determined behavior as Mr. Test 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. Test 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 to the above personality problems, testing indicates very severe basic character pathology. He has deeply ingrained dysfunctional personality patterns that are likely 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 Avoidant, Antisocial, and Passive-Aggressive features. Of these, Passive Aggressive and Avoidant features are predominant and should be emphasized in the description given below. Mr. Test is an unreliable Criminal Thinker who does not attempt to follow societal norms. He is overly sensitive to potential rejection or humiliation and withdraws out of a fear of failure. Boundaries are set through both aggressive behavior and passive-aggressive rebellion as Mr. Test does as he pleases and resists limits Mr. Test is a contrary and negative person who controls others directly through anger and indirectly through frustrating demands by being inefficient, stubborn, and incompetent. Relationships tend to be superficial, as Mr. Test uses others for his own purposes. Mr. Test attempts to dominate and control through indirect anger. He finds fault as a defense against intimacy and blames others for his difficulties. Mr. Test has unique self-serving ideas of right and wrong, and often believes that he is being harassed and victimized. Pathological lying, deception, and disregard for the truth are likely. Mr. Test often escapes into fantasy to gratify his needs for contact and release of anger. Mr. Test anticipates pain and is a short-tempered, irritable, and aggressive individual who acts out impulsively on his immediate needs. Although much active Criminal Thinking is present, Mr. Test's acting out can also be based on fear of failure and criticism. Much underlying anger exists with Mr. Test alternating between expressing this anger in active and passive ways. Maladaptive behavior may be due to anxiety, avoidance, rebelliousness, and/or active Criminal Thinking. MMPI-A RESULTS INDICATE THAT IN ADDITION TO THE ABOVE PERSONALITY PATTERNS, Mr. Test ALSO IS: Mr. Test is a self-centered individual who tends to engage in impulsive acting out behavior. Mr. Test is self-centered and may have an overly positive concept of himself as well as elevated self-esteem and feels above social rules. He may become frustrated by his lack of accomplishment and is resentful of any demands placed on him. He disregards rules and behaves in an irresponsible, hedonistic, self-indulgent manner. Poor social adjustment is probable, with him having particular tendencies to act out criminally. He is an untrustworthy, unreliable individual who rejects obligations and does not attempt to follow societal norms. Mr. Test has unique self-serving ideas of right and wrong and often believes himself to be harassed and victimized. Mr. Test has difficulty learning from his experiences. Self-Defeating and passive aggressive behavior frequently occur as Mr. Test continues to act out despite feeling bad about doing so. He tends to be moody and irritable, especially when he does not get his way or is caught in inappropriate behavior. He vacillates between anger and depression with him becoming superficially depressed and remorseful after acting out. Mr. Test's anger may be used to manipulate others. A short-tempered, aggressive individual, Mr. Test acts out impulsively on his immediate needs. His frustration tolerance is poor, especially when he is bored. As he is impulsive, a special risk for suicide exists when Mr. Test becomes depressed. A Dysthymic victim stance exists as Mr. Test blames others for his problems and is easily discouraged. He may be very pessimistic and have many negative self-statements. Mr. Test often has trouble initiating actions. A lack of persistence and follow through is to be expected. Relationships tend to be superficial and predatory; Mr. Test exploits others for his own purposes and attempts to dominate and control through anger because many power and control issues exist. Despite considerable charm, poise, and verbal facility, Mr. Test is self-centered and largely incapable of attachment. SECONDARY MMPI-A SCALE ELEVATIONS FURTHER SUGGEST THAT Mr. Test IS: Mr. Test 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. Test can manipulate others with his physical complaints and adopt a dependent role to avoid responsibility. Is interpersonally mistrustful, sensitive and blaming. Mr. Test can be rigid, self-righteous, and grandiose. He is interpersonally suspicious, sensitive to what others think of him and may see others as being critical of and against him. He can become dissatisfied and feel that he is not getting what he deserves. 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 6. Failure to Profit from Experience --Sees each situation as novel and does not generalize --Has difficulty learning from past experiences --Rarely thinks of what has happened in similar past situations --Reacts in terms of immediate impressions without testing assumptions --Repeats maladaptive patterns 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 8. Control Issues --Feels compelled to control all people and things that are around him --Aggressively demands that things are his way; "my way or no way" --Punishes those who do not comply to his wishes --Steadfastly refuses to consider or comply with the wishes of others --Sees laws and social conventions as others attempts to control him CRIMINAL CHARACTERISTICS Mr. Test's overall score on a Discriminant Function analysis shows mild to moderate generalized delinquent tendencies. He has moderate underlying global predisposition to break social rules and act out antisocially. Mr. Test 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. Test 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. Mr. Test reports moderate social immaturity with his coping skills and social judgment being simplistic, naive, and childlike. He may be lacking in insight and empathy, with limited awareness of how his behavior impacts others. Mr. Test tends to be mistrustful and has trouble relating with authority figures whom he typically views as being unfair and untrustworthy. Hostility occurs when Mr. Test feels that others are attempting to control him. Average levels of automatic unconscious repression are seen in testing with Mr. Test having adequate guards against too easily being overcome by feelings. Mr. Test reports below average tendencies to consciously deny problems and suppress disturbing thoughts. This lack of denial may indicate tendencies to become emotionally overwhelmed. Mr. Test 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. Average levels of social discomfort and self-consciousness are reported. Social anxiety is not likely to adversely influence Mr. Test's behavior. Mr. Test reports experiencing very high levels of angry feelings and may feel uncomfortable with his angry feelings. As he experiences high levels of anger, angry feelings may trigger criminal acting out. Mr. Test is an active Criminal Thinker who perceives the world in a distorted, egocentric manner that leads him to act antisocially. Mr. Test has limited interpersonal understanding and may project his own hostility by seeing others as threatening, angry, competitive, and in need of being controlled. Mr. Test rarely takes responsibility for his actions and has little awareness of the impact of his behavior on others. Relationships can be exploitive with Mr. Test quickly becoming negative, frustrated and aggressive when he does not get his way. SEXUAL FUNCTIONING NORMAL SEXUAL FUNCTIONING PLEASE NOTE THE DSFI WAS NORMED ON ADULTS, THUS THE FOLLOWING SCORES ARE IN COMPARISON TO INDIVIDUALS OVER 18. WHILE THE FOLLOWING RESULTS ARE GIVEN FOR INFORMATIONAL PURPOSES, THE EFFECTS OF Mr. Test's AGE AND THEREFORE LACK OF EXPERIENCE/EXPOSURE NEED TO BE TAKEN INTO ACCOUNT IN INTERPRETING THESE RESULTS. In a test of normal sexual functioning, Mr. Test described having a very low sex drive as compared to a typical adult, which may or may not be age appropriate. Mr. Test desires sex much less than normal for an adult. He admits to having participated in an exceptionally limited range of sexual behaviors and practices as compared to a typical adult, which may be age appropriate or indicate sexual inhibition, rigidity, or lack of interest. Extremely low levels of sexual fantasy when compared to an adult are reported. He does not admit to sexual thoughts and presents himself as asexual. While this may be age appropriate, it also could indicate a lack of interest in sex with denial and malingering needing to be ruled out. Expressed attitudes toward sex were moderately conservative, traditional and restrictive. Many taboos concerning sexual behavior were reported. Mr. Test'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. Test described himself as having many more characteristics commonly associated with femininity than like gender traits. The effects of this on his identity, self-image and sexuality should be clinically explored. A low normal body image and a low average degree of satisfaction with his body are reported. He can feel somewhat unattractive. A below average level of overall satisfaction with his sex life is reported. TESTS OF DEVIANT SEXUAL FUNCTIONING NORMED FOR ADOLESCENT MALES In a test of deviant sexual functioning, Mr. Test reports a low level of normal sexual drives and interests and does not admit to being sexually attracted to age-appropriate heterosexual relationships. Reported levels of sexual preoccupation are in the Normal range. Mr. Test has a poor fund of sexual knowledge; he does not display an adequate understanding of sex and sexual practices. Mild to moderate cognitive distortions and immaturity typically found among sex offenders exist which may indicate sexual problems. A moderate degree of rationalization exists as Mr. Test may justify his sexual deviancy, blame others and make excuses to rationalize acting out behavior. Mr. Test reports severe pedophilic tendencies in that he is likely to manipulate victims into sexual activity by grooming them over a prolonged period. Mr. Test may pre-meditatively meet his victims' needs in order to gain compliance. Mr. Test admits to significant pedophilic sexual fantasies. He admits to regularly and actively seeking out and grooming youth. A regular pattern of child molestation is admitted to. Periodic aggravated molestation utilizing force is reported by Mr. Test. Incestual assaults are admitted to. While both homosexual and heterosexual pedophilia is reported, a predominately homosexual orientation is said to exist. Rape behavior is not admitted to, though this may be due to denial. Mr. Test denies Rape fantasies. Mr. Test does not report actively looking for victims to rape. Mr. Test denies actively raping victims. Sadomasochistic tendencies are not admitted to. Mr. Test reports significant exhibitionistic pathology and behavior. Mr. Test admits to significant exhibitionistic sexual fantasies. He admits to high levels of actively seeking out exhibitionistic opportunities to the point where this is a major preoccupation. A limited amount of exhibitionistic behavior is admitted to. Mr. Test reports regular use of advanced exhibitionistic tactics. Mr. Test does not report signs of the following paraphilias: VOYEURISM Mr. Test reports mild signs of the following paraphilias (please check individual Multiphasic Sex Inventory - Adolescent items for more information): OBSCENE CALLS, BONDAGE/DISCIPLINE, SADO-MASOCHISM Mr. Test admits to significant signs of the following paraphilias (please check individual Multiphasic Sex Inventory - Adolescent items for more information): FETISH Mr. Test reports mild signs of the following sexual dysfunctions/disabilities: (please check individual Multiphasic Sex Inventory - Adolescent items for more information): PHYSICAL DISABILITIES, IMPOTENCE Mr. Test appears mildly motivated to seek treatment for sexual problems, though his motivation may not be sufficient for successful treatment. 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 emotional conflicts Family issues Level of Depression or Anxiety Inability to deal with stress Negative peer groups Peer pressure RISK/NEEDS ASSESSMENT To screen for potential problem areas, Mr. Test completed the Problem Oriented Screening Instrument For Teenagers (POSIT), a self-report of problem behaviors. POSIT results indicated the following areas of HIGH RISK: SUBSTANCE USE PROBLEMS PHYSICAL HEALTH PROBLEMS MENTAL HEALTH PROBLEMS FAMILY RELATIONSHIPS PROBLEMS PEER RELATIONSHIPS PROBLEMS EDUCATIONAL STATUS PROBLEMS VOCATIONAL STATUS PROBLEMS SOCIAL SKILLS PROBLEMS AGGRESSIVE BEHAVIOR/DELINQUENCY PROBLEMS POSIT results indicated the following areas of MIDDLE RISK: LEISURE/RECREATIONAL PROBLEMS IDENTIFIED RISK FACTORS POSIT results indicated the following areas of HIGH RISK: SUBSTANCE USE PROBLEMS PHYSICAL HEALTH PROBLEMS MENTAL HEALTH PROBLEMS FAMILY RELATIONSHIPS PROBLEMS PEER RELATIONSHIPS PROBLEMS EDUCATIONAL STATUS PROBLEMS VOCATIONAL STATUS PROBLEMS SOCIAL SKILLS PROBLEMS AGGRESSIVE BEHAVIOR/DELINQUENCY PROBLEMS POSIT results indicated the following areas of MIDDLE RISK: LEISURE/RECREATIONAL PROBLEMS Possible Learning Disorder Is not reflective or thoughtful which can limit insight Low levels of cognitive mediation and thought are reported Concentrational difficulties are probable Is cognitively impulsive Due to their cognitive style, may have difficulty profiting by experience Overly high levels of disclosure Strong "fake bad" response set Depression High levels of generalized anger Is extremely quick tempered Severely over sensitive to criticism and rejection Above average energy is used to repress and control anger Above average energy is used to control the behavioral expression of anger Severe tendencies to act out on anger once experienced Severe tendencies to intimidate others with anger Has few guards against feelings once they are evoked Impulse control is poor Impulse control is questionable Underlying personality patterns may reduce impulse control under stress Psychopathic trends Paranoia Is introverted High social discomfort and anxiety Is extremely dominant Relationships tend to be conflictual Multiple family problems are reported Has problems accepting authority and social standards Interpersonal withdrawal Significant rationalization Strong projection Externalization of blame Acting out as a defense Generalized Delinquent tendencies exist Poor knowledge and acceptance of common social rules Displays criminal values/attitudes Is socially immature and irresponsible Is mistrustful of and has trouble relating with authority figures Is an active Criminal Thinker Mr. Test reports a low level of normal sexual drives and interests Identity does not match stereotyped images of his/her gender Has a poor fund of sexual knowledge Mild to moderate cognitive distortions typical of Sex Offenders Moderate justification of his sexual behavior Pedophilia Exhibitionism Paraphilia, Fetish Paraphilia, Obscene calls Sexual dysfunction, Impotence VERY SEVERE CHARACTER PATHOLOGY: Avoidant traits Antisocial traits Passive Aggressive traits Borderline Personality traits Paranoid traits FACTORS MITIGATING RISK Has adequate verbal abstract reasoning Vocabulary is at least low normal Visual abstract reasoning is adequate Racing thoughts and flight of ideas not reported No mental confusion evident in testing No indications of Psychosis No "fake good" response set No significant depression No significant anxiety Does not presently experience anger No Significant current pressure to verbally express anger No Significant current pressure to physically express anger Makes efforts to suppress, rather then express, angry feelings No addictive tendencies found Is not eccentric and lacking in social skills Does not report social withdrawal Is not isolated and alienated from others Average needs for affection, love and intimacy are described Dependency needs are in the average range Does not lack educational and life objectives Self-esteem is in the average range Is not overly grandiose Does not escape into fantasy Body image is at least average Reported levels of sexual preoccupation and thought are in the Normal range. DIAGNOSTIC CONSIDERATIONS RULE OUT AXIS I Factitious Disorder, Primarily Psychological Attention Deficit Hyperactivity Disorder Dysthymia Adjustment Disorder with Depressed Mood Major Depression, Moderate Intermittent Explosive Episodes Pedophilia Exhibitionism Paraphilia, Fetish Paraphilia, Obscene Calls Sexual Dysfunction, Impotence Conduct Disorder Oppositional Disorder Post Traumatic Stress Disorder Sexual Abuse Victim AXIS II WHILE UNDER THE AGE OF 18, TESTING SUGGESTS THAT THE FOLLOWING PERSONALITY FACTORS MAY BE AT PLAY: Antisocial and Avoidant features IN ADDITION, MMPI-A TESTING FURTHER SUGGESTS THAT THE FOLLOWING PERSONALITY FACTORS MAY BE AT PLAY: POSSIBLE PRIMARY FEATURES Antisocial features Passive Aggressive features POSSIBLE SECONDARY PERSONALITY PATTERNS suggested by the MMPI-A Avoidant features TREATMENT CONSIDERATIONS Based on Mr. Test's self-report, the following corrective treatment approaches are recommended. Care should be taken to ensure that these suggestions match Mr. Test's clinical presentation and history. If test invalidity indicators have been raised (see validity section), these recommendations may not reflect Mr. Test's true clinical needs. DUE TO SIGNIFICANT LEVELS OF DEPRESSION REPORTED, 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. Test 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: DEPRESSION, MOOD STABILIZATION, ANGER, ADHD Due to possible learning problems, much redundancy and multisensory input should be used. Care needs to be taken so that Mr. Test's treatment does not become a failure experience due to his learning problems. Self-esteem issues over learning deficits should be addressed in therapy. As it is likely that Mr. Test's emotions are interfering with his cognitive processing, immediate interventions to alleviate emotional distress are suggested. Mr. Test's excellent abstract reasoning ability should be an asset in his treatment, though therapists also should be careful that Mr. Test does not use these skills to rationalize, intellectualize, avoid issues or adopt a co-therapist role. Exploration of the causes of visual problems as compared to verbal functioning should be investigated. Presentation of material in a verbal rather than visual format should be effective. Mr. Test 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. Test needs group therapy to enhance social skills, he may initially require much individual work to prepare him for group involvement. Due to his level of dependency, rebelliousness, and/or need for attention, Mr. Test is most likely to respond to peer feedback. Due to Mr. Test's level of interpersonal suspicion and mistrust, therapists must slowly approach him and build rapport. Constant checks on how Mr. Test interprets situations are necessary as Mr. Test 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. A kind, but firm approach is indicated, as therapists must support Mr. Test while also holding him accountable. Mr. Test 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. Test must improve his underlying self-esteem and social skills. Use of praise and positive reinforcement is particularly useful as Mr. Test 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. Test 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. Test's problem solving skills and frustration tolerance. A Cognitive Behavioral Criminal Thinking approach is primary, as Mr. Test must alter his Criminal Thought patterns if he is to act prosocially. Extensive value adjustment work is necessary as Mr. Test lacks knowledge of normal societal conventions. He must be taught what acceptable social standards are through educational and Cognitive Behavioral approaches. Power struggles are to be avoided with consequences given in a matter-of-fact way. Therapists should not accept excuses and rationalizations as Mr. Test needs to realize that his rebelliousness and "yes but" demeanor is self-defeating. Underlying issues of anger and control must be brought directly to the surface and dealt with. As Mr. Test 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. Significant environmental support and external structure are vital since Mr. Test needs external restraints to deter maladaptive behavior. Liaison between Mr. Test's probation/parole officer, caregivers, therapists, family, AA sponsor, and/or school are essential. Behavioral techniques such as discrete target behaviors and immediate consequences are suggested to teach Mr. Test to take responsibility for his actions and learn to connect his actions with consequences. Need for consistency and clarity are all important with Mr. Test not allowed to talk his way out of consequences. Mr. Test needs to learn more direct ways to deal with his feelings and to gain attention than through somatic problems. Do not let Mr. Test'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. Test's maladaptive behavior should be established. Mr. Test needs to learn anger control techniques. It is essential that Mr. Test 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. Test 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. Test's aggression are suspected. Due to Mr. Test's quick temper and irritability, care must be taken to help him identify potentially anger provoking situations before autonomic reactions develop. As he experiences much anger, work on how to detach from and reframe anger once it is evoked is important. As much of Mr. Test's anger may be due to over sensitivity to criticism, a stress inoculation approach coupled with self-esteem work may prove helpful. Mr. Test needs to put more effort into dealing with angry feelings that he experiences rather than acting out on them. Mr. Test needs to learn to regulate his moods through use of Cognitive Behavioral techniques and/or medication. AODA use may be a cause of Mr. Test's moodiness, though conversely, AODA use may be an attempt to self-medicate his emotional lability. Mr. Test 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. A Cognitive Behavioral approach to teach Mr. Test how to acknowledge and then detach from his feelings is necessary since he is prone to acting directly on emotions without thinking. Mr. Test needs education about the nature of emotions and must learn ways of not immediately responding once feelings arise. Insight-oriented technique may help Mr. Test 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. Self-defeating patterns evident in testing must be addressed in therapy because Mr. Test is likely to sabotage therapeutic efforts. As testing indicates significant family problems, an exhaustive examination of Mr. Test's family system is called for. Family therapy may be indicated. A need for vocational preparation and guidance is seen in testing. Mr. Test not only needs to develop positive work attitudes and behaviors, concrete assistance at gaining and maintaining employment is indicated. As social skills deficits are likely to contribute to Mr. Test's problems, social skills training is recommended. Mr. Test should be assisted in gaining self-confidence and social skills, especially assertive skills. His social insecurity may lead Mr. Test to associate with a negative peer group to gain acceptance. A Social Learning component is suggested to teach Mr. Test positive, prosocial skills to replace current maladaptive patterns. Mr. Test 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. Test develops the social and cognitive skills necessary to be successful. Mr. Test must develop a sense of identity and a stable value system. Therapists must assist Mr. Test to explore who they are, what they want, and what they believe in. It is likely that Mr. Test is overly self-critical and has self-esteem problems. Therapists should encourage Self-esteem enhancement through the development of mastery skills and positive behavior. While testing does not indicate addiction, a proneness to abuse exists which may require AA or educational programming. The reason for Mr. Test's lack of normal sexual drives and interests needs to be assessed if age in appropriate. 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. Test's low sexual interest is due to personality factors such as a Schizoid personality disorder, it is unrealistic to expect that Mr. Test will increase his sexual attraction to age appropriate partners. As Mr. Test reports engaging in an extremely limited range of sexual practices, the effects of this on his sexual adjustment should be evaluated if this is not age appropriate. Mr. Test reports having very conservative and traditional sexual values. The impact of this on his life should be established. The clinical effects of Mr. Test's report of having many cross sex traits should be explored with psychotherapy if this is causing significant emotional or life problems. Mr. Test reports such dissatisfaction with his sex life that further specific assessment and treatment are indicated. Sex education is essential as Mr. Test's lack of knowledge of sexual functioning and behavior may contribute to his sexual acting out. Mr. Test must be held behaviorally accountable for his sexual behavior with therapists directly confronting Mr. Test'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. Test needs to develop motivation to change. Carefrontation is needed to show Mr. Test the effects of his assaultive behavior on his and his victim's lives. Specialized treatment for pedophilia is warranted after a more detailed assessment of the factors leading to pedophilic behavior is completed. Treatment approaches including education, heterosexual skill development, counter conditioning techniques, and/or medical interventions such as Deprovera may be indicated. Mr. Test 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. Test 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. Test must not be allowed to be in places where potential victims are available. This may include parks, schools, malls, etc. It is vital that Mr. Test not be left alone with potential victims. As Mr. Test reports engaging in exhibitionistic behaviors, specialized treatment focusing on victim empathy and Covert Sensitization are indicated. Mr. Test must not be allowed Exhibitionistic fantasy or access to situations where such behavior may easily occur. Mr. Test admits to significant paraphilias that may require specialized treatment (please check individual Multiphasic Sex Inventory - Adolescent items for more information): FETISH, OBSCENE CALLS Mr. Test reports signs of sexual dysfunction/disability that may require further medical and/or psychological treatment and that could be a factor in his sexual acting out. See individual Multiphasic Sex Inventory - Adolescent items for more information. Acute treatment for PSTD/ASD is indicated. Use of EMDR should be evaluated. Evaluation of possible sexual abuse is indicated. If found, specific treatment for sexual abuse is indicated. As significant levels if dissociation are reported, this is likely to become a major therapeutic issue. Variables: SHIPLEY INSTITUTE OF LIVING SCALE: VOC - 22 AB - 34 WAIS-III MATRIX REASONING SUBTEST: MATRIX - 7 MILLON ADOLESCENT CLINICAL INVENTORY: V - 0 DISCLS - 87 DESIRE - 69 DBASE - 85 INT - 5 INH - 85 DOLE - 85 SUB - 50 DRM - 28 EGO - 31 ANT - 75 AGR - 73 CNF - 24 OPP - 91 SDEM - 76 BRDL - 84 ID - 94 SDEVL - 112 BDIS - 72 SEXDIS - 49 PINSEC - 101 SOCINSEN - 53 FAMDIS - 82 CHILDAB - 69 EATDYS - 56 AODA - 57 DELIN - 75 IMP - 103 ANXTY - 57 DEPR - 102 SUI – 65 ADOLESCENT SASSI2: FVA - 0 FVOD - 0 FRISK - 3 ATT - 6 SYM - 2 OAT - 14 SAT - 3 DEF - 4 SAM - 6 RAP - 0 VAL - 5 SCS - 5 STATE-TRAIT ANGER EXPRESSION INVENTORY: SANG - 46 SANGF - 50 SANGV - 44 SANGP - 44 TANG - 78 TANGT - 80 TANGR - 74 AXO - 74 AXI - 80 ACO - 60 ACI - 66 AXINDEX - 56 TRAUMATIC SYMPTOM CHECKLIST FOR CHILDREN: UND - 67 HYP - 43 ANXS - 45 DEPRS - 45 ANGR - 44 PTS - 77 DIS - 68 DISO - 72 DISF - 62 SEXCON - 77 SEXCONP - 79 SEXCOND - 64 JESNESS INVENTORY: SMAL - 90 VALUES - 67 IMAT - 66 AUTISM - 69 ALIEN - 67 MANANGR - 74 WITHDRAW - 75 SOCANX - 56 REPRESS - 49 DENIAL - 31 ASOCIAL - 66 AA - 64 AP - 74 CFM - 39 CFC - 51 MP - 33 NA - 64 NX - 52 SE - 34 CI - 35 POSIT SUBSTANC - 9 PHYSICAL - 7 MENTAL_H - 12 FAMILY_R - 7 PEER_REL - 7 EDUCATIO - 13 VOCATION - 5 SOCIAL_S - 5 LEISURE_ - 4 AGGRESSI - 12 DEROGATIS SEXUAL FUNCTIONING INVENTORY: SINF - 21 SEXP - 22 SDRIV - 24 SATT - 36 SROLE - 2 SFANT - 28 SBODY - 40 SSATIS - 37 ADOLESCENT MULTIPHASIC SEX INVENTORY: SOCSEX - 20 SEXOBS - 6 COGDIS - 4 JUSTIF - 6 TRTAT - 3 CHMOL - 21 CHFANT - 5 CHCRUISE - 6 CHASSAUL - 4 CHAG - 2 INCEST - 3 BOY - 2 GIRL - 1 RAPE - 0 RFANT - 0 RCRUISE - 0 RASSAUL - 0 RAG - 0 SADOMAS - 0 EXHIB - 10 EXFANT - 2 EXCRUISE - 3 EXASSAUL - 2 EXAD - 3 SEXKNOWL - 11 FETISH - 3 VOYER - 0 OBSCENE - 2 BOND - 1 SADO - 1 PHYSDIS - 1 IMPOT - 2 MMPI-A VALIDITY SCALES: QUES - 0 L - 45 F - 77 F1 - 85 F2 - 68 K - 44 TRIN - 57 TF - 1 VRIN - 54 MMPI-A CLINICAL SCALES: HS - 68 D - 74 HY - 62 PD - 72 MF - 49 PA - 66 PT - 58 SC - 57 MA- 60 SI - 50 MMPI-A HARRIS LINGOES SUBSCALES: D1 - 74 D2 - 68 D3 - 73 D4 - 85 D5 - 66 HY1 - 64 HY2 - 78 HY3 - 56 HY4 - 61 HY5 - 72 PD1 - 78 PD2 - 72 PD3 - 55 PD4 - 64 PD5 - 71 PA1 - 58 PA2 - 68 PA3 - 52 SC1 - 63 SC2 - 49 SC3 - 55 SC4 - 54 SC5 - 42 SC6 - 45 MA1 - 60 MA2 - 63 MA3 - 67 MA4 - 54 SI1- 45 SI2 - 57 SI3 - 52 MMPI-A SUPPLEMENTARY SCALES: A - 66 R - 38 IMM - 56 MACR - 67 PRO - 66 ACK - 67 MMPI-A CONTENT SCALES: ANX - 70 OBS - 56 DEP - 66 HEA - 79 ALN - 59 BIZ - 54 ANG - 86 CYN - 51 CON - 63 LSE - 53 LAS - 58 SOD - 49 FAM - 66 SCH - 67 TRT - 71 SEX - M |
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