Understanding Abnormal Behavior - Cengage Learning

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xxvi The Case of Steven V. This systematic training helped Steve greatly when he finally presented his report to his English class. Although he was anxious throughout the presentation, he felt that he had the anxiety under control. A similar program, which I developed for his heterosexual anxiety, proved only moderately successful. Steve’s Threat Against Linda ”She doesn’t deserve to live—I swear, I’m going to kill her.” Given the conduct in which it occurred, Steve’s threat to kill Linda placed me in a dilemma. My conflicting feelings and apprehensions were, no doubt, similar to those experienced by any therapist whose client threatens to kill someone or to commit suicide. Today more than ever, we as therapists must recognize that our work does not occur in a social vacuum. What we do or don’t do in therapy has not only clinical implications but ethical, moral, and legal ramifications as well. In that particular session Steve was becoming increasingly agitated about his breakup with Linda; his expressions of anger were stronger and stronger. He was quite depressed at the time, and in my therapeutic judgment, his venting of feelings was healthy. I had been working on that with him when he blurted out his threat. The first thoughts that came to my mind were questions: Does he really mean what he’s saying? How likely is he to carry out the threat? Is this just an empty threat characteristic of his anger and hostility? What should I do? Should I inform the proper authorities, breaking confidentiality, and risk losing Steve’s trust? I chose to go along with my clinical judgment to let Steve continue to express his feelings without cutting him off, while constantly assessing the strength of his anger and the likelihood of his acting impulsively. I made that decision for several reasons. First, in the time I had known Steve, he had made several suicide threats. In each case, when he was allowed to express his feelings, the suicidal ideation and threats diminished. I felt that his threat to kill Linda would follow a similar course. Second, despite his often bizarre thoughts and behaviors, I had never considered Steve to be a danger to others. He was more a danger to himself than to anyone else. Third, I felt that some other perspective was needed. There was still time to consult with colleagues about the case and to get their input. And last, I was prepared to cancel other appointments and extend our session if that became necessary. I felt that I could monitor Steve closely, and I even made an appointment for him to return the following day. In other words, after pondering all the issues, including the need to protect myself by informing the proper authorities or even Linda, I decided that the likelihood of his carrying out the threat was very low. Luckily this did prove to be the case. The dilemma for me as a therapist was not whether I should inform a potential victim or the appropriate authorities about a homicide that I deemed likely. I have no doubt that I would have taken that action if it were necessary. I was disturbed that I lacked the ability to precisely assess dangerousness and—even more—was unable to inform a client about the legal limits of confidentiality without adversely affecting our therapist-client relationship. An Epilogue to the Case Several years have passed since my sessions with Steve came to an end. He graduated from the university with a degree in English literature and went to a graduate school in the east. I did get the chance to see some changes in Steve that are definitely for the better. He relates reasonably well to people now, though I still consider him a loner. His bizarre behavior and ideation have eased off, but he still suffers from periodic bouts of depression. Whereas most clients need only brief periodic therapy to help them cope with life’s problems, I’m afraid Steve is one of those people who will need some form of therapy for the rest of his life. He has chosen to work toward a doctorate degree and to become a teacher, doing research and writing. I think this is as good a vocational choice as any. Not only does it play to his strengths (writing, reading, and research), but the college environment seems to be one of the few in which Steve has done well and has felt sufficiently secure. Perhaps this is a statement about academic life as well as about Steve. Some perceive it as a protected environment that is structured and, in some ways, undemanding. Copyright © Houghton Mifflin Company. All rights reserved.
Copyright © Houghton Mifflin Company. All rights reserved. The Case of Steven V. xxvii I don’t know what has happened to Steve since he left this university. I am aware that he signed a release of information form so that his case records could be transferred to the university he now attends. I can only assume that he has chosen to continue therapy, and I wish him well.
Page 1 and 2: Instructor’s Resource Manual Unde
Page 3: Contents PREFACE...................
Page 6 and 7: vi Preface Video Resources An annot
Page 8 and 9: The Case of Steven V. A NOTE ABOUT
Page 10 and 11: x The Case of Steven V. THE CASE OF
Page 12 and 13: xii The Case of Steven V. During th
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Page 20 and 21: xx The Case of Steven V. As I look
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Copyright © Houghton Mifflin Compa
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CHAPTER 6 Dissociative Disorders an
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CHAPTER 8 Personality Disorders and
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HANDOUT FOR DEMONSTRATION 5: SEXUAL
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HANDOUT FOR DEMONSTRATION 3: THE RE
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CHAPTER 13 Schizophrenia: Diagnosis
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Potential drawbacks 1. 2. 3. Copyri
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CHAPTER 14 Cognitive Disorders CHAP
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CHAPTER 18 Legal and Ethical Issues
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