Sample Answer Key for Worksheet to Accompany Mr. Jones
Date:
Your name:
Name of the client: Mr. Jones
Name of the movie: Mr. Jones
What is the chief complaint? (In the client’s own words, and report of others)
During a manic episode, Mr. Jones maintains that he has a “big personality” and that he is just a kid who has never grown up. He adamantly denies that he has a mental illness or that anything is wrong with him.
Other people, however, report that Mr. Jones takes hazardous risks (e.g., trying to fly from a roof) that endanger himself and others who have to “rescue” him. He went on a spending spree (completely out of money 2 days after withdrawing more than $12,000 from the bank). He is grandiose and impulsive; he talks nonstop. He invades the personal space of others, is very flirtatious with women, and cannot take no for an answer. Under increased stimulation (e.g., the rock concert), his behavior spirals out of control and he has to be forcibly removed by police. Mr. Jones arrives at the hospital with rapid-fire speech that often makes no sense.
During a depressive episode, Mr. Jones is sad, with downcast eyes and poor grooming and hygiene. He does not interact with people around him. He shows psychomotor retardation and slowed thinking, moving and talking slowly and struggling to perform simple math. He has crying spells.
Based on the above information and a close viewing of the movie, what questions would you raise during history taking? What are some possible answers? You might base your questions on:
History of the client’s illness
Past psychiatric history, treatment, and treatment outcomes
Psychosocial history
When did Mr. Jones first have symptoms or problems? How long has this been happening?
§ Mr. Jones reports that he took an overdose of Tylenol in college. He isn’t clear about whether this was an intentional suicide attempt, tending to downplay the event.
§ Mr. Jones describes being “too much trouble” for others since his college years. Because his exact age is not stated, the problems seem to have lasted about 20 years.
Does Mr. Jones have any close friends? Is he connected to his family?
§ Howard from the construction site is a friend of Mr. Jones. He has a genuine interest in Mr. Jones, invites him for dinner, visits him in the hospital, and alerts Dr. Bowen when Mr. Jones’ behavior becomes potentially dangerous. Otherwise, Mr. Jones mentions no friends. He describes a former girlfriend as being “dead,” although she is not. When asked if his parents are living, Mr. Jones replies, “They never were alive.” It seems that Mr. Jones’ denial of his illness and uncontrolled symptoms have alienated him from significant people.
What is Mr. Jones’ treatment history? What are barriers to compliance?
§ Mr. Jones is very familiar with commitment proceedings, having gone through this experience repeatedly. When an outpatient, Mr. Jones throws away his prescriptions. When asked if he will call Dr. Bowen for an appointment, he says “probably not.” His ongoing steadfast denial of his illness has prevented him from having effective or successful treatment.
§ During a manic phase, Mr. Jones feels omnipotent and unstoppable, qualities that he likes. He does not like how he feels (too slowed down, lacking creativity and energy, fine hand tremors) when taking medication. In fact, he states he is a “junkie” who needs his highs.
What other observations do you have about the client’s behavior?
Although Mr. Jones has an expansive elated mood, he quickly becomes hostile or irritated when things don’t go his way. He knocks a medication tray out of a nurse’s hands when she tries to give him his drugs during a cartoon show. At Howard’s house, he yells and curses when Howard doesn’t return his tools immediately. He stops talking to Dr. Bowen when she mentions his illness or symptoms. He has exceptional math abilities and is obviously intelligent, but he has no steady employment, lives in a dingy apartment, and has no car.
In your opinion, is the diagnosis discussed above accurate?
Yes
What DSM-IV-TR criteria support (or negate) this diagnosis?
§ When manic, Mr. Jones is grandiose, has pressured speech and racing thoughts, is distractible, goes on spending sprees, and becomes intimate with people he just meets (e.g., woman at the bank). His family relationships are impaired, and he requires hospitalization as a result of his potentially dangerous behavior.
§ When depressed, Mr. Jones looks sad, cries, and doesn’t engage in activities or get pleasure from any previously pleasurable activities. He has psychomotor retardation, diminished ability to concentrate, and no energy.
What treatment plan would you outline?
Stabilization through medication with minimal side effects; outpatient therapy to monitor compliance and build social skills and relationships; improved community functioning (such as through employment as a stable income source), and the creation of a structured daily routine
With what expected outcomes?
§ Mr. Jones will comply with treatment, including medication and therapy.
§ Mr. Jones will acknowledge his bipolar disorder and its effect on his life.
§ Mr. Jones will assess his strengths and weaknesses realistically.
§ Mr. Jones will function effectively in the community.
§ Mr. Jones will develop satisfying, effective interpersonal relationships.
§ Mr. Jones will demonstrate appropriate boundaries.
What factors made Dr. Elizabeth Bowen susceptible to the nonprofessional, unethical relationship with Mr. Jones?
She experienced the recent loss of a relationship. She hoped for a reconciliation with her ex-partner when, in fact, he brought his new girlfriend to meet her. Dr. Bowen described her ex-partner as unfeeling, a robot. By contrast, Mr. Jones is lively, flattering, and sensitive to her moods and needs.
Dr. Bowen’s lack of self-awareness (of her own needs and fragile emotional state) led her to become personally involved with Mr. Jones. She first violated professional conduct (telling him to “shut up,” taking it personally when he wasn’t committed). She later became involved in a sexual encounter with him. She made one feeble attempt to talk to the supervising psychiatrist, but did not follow through until it was “too late.”
Regarding the character, Amanda, who also has bipolar disorder and eventually commits suicide: What risk factors were present?
§ Amanda discussed suicide with Dr. Bowen and viewed it as an answer to her problems (e.g., “death is nothing to be afraid of . . . I’d welcome it.”)
§ She had a past history of five suicide attempts.
§ Upon discharge from the hospital, her parents coerced Amanda to leave a trusted relationship with Dr. Bowen and to see a new therapist (a friend of her parents).
§ Clients with bipolar disorder are at increased risk of suicide.