Diagnosis of Maurice Minnefield - Essay Example

Diagnosis and Assessment of Maurice Minnefield Northern Exposure Introduction Maurice Minnefield is a sixty year old, Caucasian male who moved to Cicely Alaska after he retired from the U.S. Air Force. He was also an Astronaut. He moved to Cicely with a woman, Shelly Tambo, who was an ex-beauty queen and 40 years younger. (Museum of Broadcast Communications, 2010). He moved to Cicely with the thought of purchasing new territory and perhaps marrying; unfortunately, when he went to Cicely he lost his girlfriend to another man eventually. Maurice now owns most of the town and he does not mind letting people know this fact. Background and Presenting Information Maurice is the son of Bertha Minnefield who was a homemaker and Arthur Minefield a maker of airplane parts. In Maurices words, his father, "made airplane parts and made money" (Official Barry Corbin Site). Maurice developed an early interest in flying because of a dinner guest who came to his home on Sundays and told stories of flying. Maurice talks favorably about his father but he does not have a lot to say about his mother. Not much is known about Maurices childhood because he did not talk about this in the first interview. He talks more about his accomplishments as though he was attempting to impress the counselor. He talks about his accomplishment in high school where he became an Eagle Scout and president of the Young Republicans Club. He also graduated as the Valedictorian of his class and began military training at Annapolis afterwards (Official Barry Corbin Site). He reports that he loved Boot Camp USMC, Parris Island because in his words, "you walked in one man and you walked out another" (Official Barry Corbin Site). Maurice has stayed the course of being a military man and this was a very important aspect of his life that gave him a structure that made sense to him. Maurice became a "fly boy" in the Korean War and is proud of the fact that he had 15 confirmed kills during that time. This was a very important period for him because he gained a level of self respect and became more of a man in his eyes. He eventually became an Astronaut and is now a multi-millionaire. Maurice had many endorsements and he had "plenty of women" because they liked to sleep with him because he was famous (Brand and Falsey, 1992). Maurice currently lives by himself in a large home outside Cicely. He has had a long-term relationship with a police officer, Barbara, who shares his love of the military and of guns. He has recently asked Barbara to marry him and she has accepted, though they have not set a date yet. Maurice states that Barbara is the only woman who he feels comfortable with to the point that he could "let her take control." (Official Barry Corbin Site). He feels that of all his "conquests" Barbara is the only one that is worthy to wear his ring. Maurice has longed to have a family, but to date he has not had one. At one point he was looking for an heir to his fortune and to his home. He thought about adopting Chris Stevens, an ex-con who works at Maurices radio station, KHBR, but this did not work out. Maurice has also become somewhat of a father figure to Ed Chigliak, a Native American male who was orphaned as a child. Maurice also attempted to extend his love for children to Shelly and Holling when they had a child; he thought the baby was the reincarnation of one of his relatives, but this did not work out (Brand and Falsey, 1992). Maurice eventually fulfilled his search for an heir when a Korean man, Duk Won, appeared at his home stating that Maurice was his father. At first, he rejected the idea of a Korean son because it was against his morals to have a son that was not white. Duk Won came to America with his mother and his son, to see Maurice for the first time. Maurice did not know he had a son or a grandson. Eventually, Maurice had blood tests done, checked out letters and other documents, which all checked out so he acknowledged Duk Kwon as his son. The challenge for Maurice is that he does not speak Korean so always had to talk to Duk Won through an interpreter. Duk Won came to him once again, later in his life, to request permission to marry; this was difficult because he was marrying the daughter of "the enemy" ; eventually, Maurice swallowed his pride and gave him permission to marry (Brand and Falsey, 1992). Maurice is not the nicest person in Cicely. He admits that he is opinionated but he sees this as just who he is and how he operates. He believes that the people of Cicely owe him a lot because he owns most of the town and gave jobs or opportunities to most of the people who live there. He recently brought a doctor to town so that Cicely would have healthcare on a regular basis. Presenting Problem There are basically two reasons that Maurice has come to counseling. First, he is aware that people in Cicely do not always like him and some find him abrasive. He is wondering why this is because he sees himself as a genuinely nice guy. The second reason is because he is afraid that he is showing homosexual tendencies. He states that ever since Ron and Eric, two "pansy boys" moved into Cicely and started a bed and breakfast, he has worried that he is also homosexual. He has been teased by the guys because of his collection of antiques, his love of show tunes and his fetish for womens shoes. Maurice worries that these things "make him gay" which is abhorrent to him and against his very being (Official Barry Corbin Site). However, he does admit to having a dream about wrestling with a famous male, but he says "nothing happened" in the dream. Of the two issues, Maurice has asked that we concentrate on the first issue of why people seem not to like him. Data Collection Methods The data collected was from interviews with Maurice and with people he trusts in Cicely. Five Axis Diagnosis After talking with Maurices and consulting the DSM-IV-TR, the diagnosis that best fits Maurice is Narcissistic Personality Disorder. Axis I None Axis II 301.81 Narcissistic Personality Disorder Maurice has a grandiose sense of self-importance. He believes that he has a reputation to uphold because he used to be an Astronaut. He expects the towns people to respect and revere him because of this reputation and because he owns most of the town. He does not understand why people seem to tolerate him rather than really be his friend. Maurices major motivation in Cicely is to make it "the next boomtown on the cusp of the new Alaskan Riviera" (Share TV). Maurice spends a lot of time talking about how unique and special he is and how he belongs to Cicelys elite. He has a sense of entitlement and expects all of Cicely to do as he tells them. If they go against what he has said, he will threaten to fire them or try some other petty retaliation (in many discussions with him, he has described some of the things he has done to others). Maurice cannot empathize with others and he always appears arrogant, haughty and many people say he is both homophobic and bigoted. Maurice wants to think that he is young, viral and a ladys man. He is insulted when someone brings to his attention that he is older. Most recently he became upset because he received a letter from Social Security saying that he was eligible for a small stipend. His reaction, "I am not ready to collect Social Security. I dont need it! Hell, I dont even believe in it!" (The Official Barry Corbin Site). Axis III None Axis IV Problems related to the social environment -- Currently Maurice is not married and he has no immediate family still living. He has a son but he does not see him very often, because he lives in Korea. Because he acts like he is better than everyone else, he has no real friends in Cicely. Most people tolerate him and leave him alone, unless he invites them to his house. He does have a couple of special times each year when he and Holling go hunting or to the baths nearby. Maurice can appear cruel, cold and manipulative. He considers Holling Vincoeur his best friend although Holling is the man who took Shelly from him (in Maurices mind). He lives alone. Healthcare A curious note is that although Maurice has access to healthcare, he has not taken good care of himself. He has bad teeth, and he recently had a "coronary episode" that he felt was incorrect. This area may be an area that Maurice will have to address in the future. Axis V GAF=90 (Current) Maurice functions well in his community and does not seem to be bothered by his Narcissism generally, but since he is going to marry Barbara, he is suddenly thinking about the people in town. Related Psychosocial and Family Issues Maurice has never been married though he longs for a family. He has an "illegitimate" Korean son and he has proud of the fact that he has bedded several women, but he saw that as a privilege of being an ex-Astronaut. Maurice has difficulty relating to people because he says what he feels and makes no apologies. Most people let him be and he does not interact well with others. Maurice is also very insecure when it comes to some types of people. Although he has had several women in his life, he was not able to consider that a Duchess who came to Cicely to see him and to take part in a fox hunt, could want him in her bed. He also has a very bigoted outlook on life when it comes to people who are different, which means he can be offensive. Related Career and Vocational Issues Maurice has always had an entrepreneurial attitude and one of his dreams is to create Cicely in his own image. He would like to see a large tourist trade, a strip mall and anything else that would attract tourists. This would bring more money to the town and to him. Maurice is constantly on the look out for investments that will bring him more wealth. Proposed Treatment and Intervention Options Most literature states that Narcissistic Personality Disorder is very difficult to work with in psychotherapy because building rapport becomes a problem. Also, the range of narcissistic pathology is broad and very different in each person (The Cleveland Clinic, 2010). In order to treat Maurice, several things must be taken into consideration. The counselor would need to allow Maurice to talk, as though it were his idea, so that the counselor could ease into building rapport. The challenge with Maurice is that once he feels that his problem is resolved, he may stop counseling, whether he is finished or not. There are basically three therapies that have been used with Narcissistic Personality Disorder: Psychodynamic approaches, drug therapy and Cognitive Behavioral Therapy (CBT) (Nevid, Rathus and Greene, 2005). The major psychodynamic principle that has been used is the concept of self psychology developed by Hans Kohut. Kohut focused his attention on narcissistic personalities (Nevid, Rathus and Greene, 2005). His belief was that narcissistic personalities were covering up deep feelings of inadequacy with their grandiose self-importance. By always needing a constant amount of praise, the narcissist stopped themselves from suffering in their insecurity (Nevid, Rathus and Greene, 2005). Kohut specifically allows transference from the narcissist to "create a therapeutic environment" in which the narcissist can develop their self-esteem (Maret Educational Series, 2006). Brief therapy is also helpful for some of these personalities, especially when the individual cannot deal with the rigors of psychotherapy. Brief therapy is short-term that has as its goal to improve adaptation instead of altering the individuals character (The Cleveland Clinic, 2010). CBT is one of the types of brief therapy that is often used with narcissistic personality to help them understand how to deal with their behaviors and how these behaviors affect others. In working with Maurice, the first place to start with him would be to understand more about his family of origin. He speaks favorably about his father but not so well about his mother; I would want to know why. A Foundations Assessment would get used to gather the information needed about his background. I suspect that feelings of anxiety in any situation cause Maurice to feel vulnerable. It would be important to understand whether Maurice is experiencing depression or anxiety that affects him from time to time. Because of his worry about being homosexual, it would be important to understand the anxiety. In mot situations, a medical workup would also be done to rule out any medical condition, however, Maurice has had a recent physical and was found very healthy. I would use CBT with Maurice with the purpose of helping him develop the whole self (ego) (Maret Educational Series, 2006). In other words, it would be very important to heal the "fractured ego" so that he could be able to deal with feelings of inferiority more effectively (Maret Educational Series, 2006). CBT would be very important to use with Maurice so that he could find ways to try on new behaviors. He would take part in goal setting so that he would resist the urge to think that the counselor was trying to "fix" him. One of the challenges with relationships is that sometimes an individual must find themselves vulnerable and this is difficult for the narcissistic personality. For Maurice, it has been difficult in the past to deal with insecurity and vulnerability, except with Barbara. As his counselor, I would want to know why this is different with her. Some of the work with Maurice would be to improve his self-esteem so that he learned to rely on his own self-worth instead of looking for others approval of him. Some of the areas we may work in would include: 1. Maurices idea of success and why he sees it as important. 2. Boundary issues should be discussed for him to realize that other people have rights. This would include where their rights end and his begin. 3. An exploration of Maurices self-worth would be in order once the therapist has rapport with him. 4. Another area would be to work with the fractured parts of the ego to help him become more self-reliant and self-contained so he does not need as much outside affirmation from others (Maret Educational Series, 2006). One of the challenges for Maurice will be that he may abruptly stop therapy if he feels threatened in any way. We may have to have a contract for a certain amount of sessions. Homosexual Feelings Although Maurice is saying that he is worried about this, it is not something that needs to be addressed in a long-term process necessarily. During the course of counseling, it would be important to educate him about homosexuality and the fact that liking things antiques and show tunes does not make him homosexual.. If he finds that he is having homoerotic fantasies, or that he wants to act on these fantasies, this may be a concern for later. Continuing Assessment and Proposed Follow-up Maurice may have difficulty in the future dealing with his natural vulnerability and his possible homosexuality. However, he does allow vulnerability with Barbara and this may be very helpful for him after they are married. One follow-up activity that may work for Maurice is to do self-monitoring of some of the behaviors that stop people from interacting with him. As an example, when he is acting superior, he may be able to write down how he is feeling at the time and what triggered the feelings. This may help in further sessions in that we could use these incidents to help him develop other people skills. Narcissistic Personality Disorder does not have a cure so there may be times when he would need to come back to therapy. References American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders. Text revision (4th ed). (DSM-IV-TR). DC: American Psychiatric Association. Brand, J. and Falsey, J. (dirs) (1990). Northern Exposure. IMDb. Retrieved July 30, 2010 from http://www.imdb.com/title/tt0098878/ Maret Educational Series (2006). The narcissistic personality type in a nutshell. Maret Educational Series. Retrieved July 22, 2010 from http://maretsoftware.com/ archives/personalities/narcissistic.pdf Nevid, J.S., Rathus, S.A. and Greene, B. (2005). Abnormal psychology in a changing world. NJ: Pearson Share TV. (n.d.) Maurice J. Minnefield. Retrieved May 6, 2010 from http://sharetv.org/shows/northern_exposure/cast/Maurice_j_Minnefield The Cleveland Clinic. (2010). Narcissistic personality disorder. Retrieved July 22, 2010 from http://my.clevelandclinic.org/disorders/personality_disorders/ hic_narcissistic_personality_disorder.aspx The Museum of Broadcast Communications. (2010). Northern Exposure: U.S. Dramedy. Retrieved May 6, 2010 from http://www.museum.tv/archives/etr/N/html/ N/northernexpo/northernexpo.htm The Official Barry Corbin Site (2009). Maurice Minnefield. Retrieved June 22, 2010 from http://www.barrycorbin.com/Maurice/man.htm Read More