The Most Important Aspect of the Treatment Plan - Book Report/Review Example

?Target Client & Identifying Data My target it John Forbes Nash, who is the main character in the movie A Beautiful Mind. John is a graduate at Princeton University, with a background in mathematics. He appears to be in his late 20s when the movie begins. Problem Statement At first, when the movie begins, it is apparent that John is not entirely normal. He does not look anybody in the eye, he has odd behavior and few social skills. He is abrasive and insulting, and does not appear to have any friends. He approached a woman in the bar and outright asks her about what he needs to do, and how long he needs to wait, before she will have intercourse with him. The woman slaps him and walks away. At this point, it appears that John might have Asperger’s Syndrome, which is marked by an inability to make eye contact or regulate social interaction, the lack of social or emotional reciprocity and the failure to develop peer relationships appropriate to the developmental level. John displays all of these symptoms, because, in addition to what is state above, his relationships with his peers is lacking. His peers hang out with him, but it is clear that he does not fit in with them and his interactions with them are not normal. It would be difficult to imagine that he is friends with any of them. Also, John has an intensity of interest in his studies which might be considered abnormal. He doesn’t go to class, and spends days without eating or sleeping much, while he works on mathematical problems. However, it soon becomes obvious that John is suffering from hallucinations. His roommate at Princeton, Charles, was non-existent, but was, rather, created in his mind. He also hallucinates an official from the Department of Defense, who, he imagines, is asking for his help for a top secret mission to thwart a Soviet plot. Later, he also hallucinates the niece of his old roommate, Charles. Schizophrenia is marked by delusions, and it is also marked by a flat affect, which describes John’s affect. Inability to make eye contact is another symptom of schizophrenia displayed by John. The inability to make friends or care about friends, along with inappropriate social skills and extended time in social isolation are other symptoms displayed by John. Bio-psychosocial History 1. Social history and cultural dynamics John, when the story begins, has one relationship which appears to be somewhat close and somewhat normal, and that is with his roommate, Charles. His family history is unclear, as there is not a mention of his family, and no siblings or parents appear in the movie. Charles appears to be good support for John, as Charles is vivacious and outgoing, and seeks to bring John out of his shell. John interacts with Charles better then he does anybody else, which is not saying that much, for he is rude to Charles and cannot look Charles in the eye, the same as with everybody else. Charles, however, is persistent about trying to get to know John, so their relationship becomes a source of some support for John. Later on in the film, Alicia, a student in his class, asks him on a date and they fall in love and get married. Alicia is shown to be the rock solid support for John, as she seems not to mind that John has poor relationship or social skills, even with her, and John has trouble looking her in the eye. She seems attracted to John’s intelligence, and Alicia not only is extremely supportive of John when was diagnosed with schizophrenia, but she was beautiful and had impeccable social skills and manners, so she was able to negotiate the social world for John, as he was unable to do so on his own. The strength that John has is his superior intelligence. He is a genius in mathematics and economics. His other strength is relationship with Alicia. His colleagues are also a source of strength for him because, even though he does not treat them well, they still have patience with him and are sympathetic to his troubles. For instance, his formal rival, Martin Hansen, who is the head of the Princeton Mathematics Department, allows him to use the Princeton Library and audit classes, and this is the start of his recovery process from schizophrenia. His vulnerabilities are that he is unable to socially cope, he is having delusions and is paranoid, and, even though he soon has a son, he does not have the skills to interact with the child. He does not have a grasp on reality, as he believes that he is doing work for the Department of Defense, but he actually is not doing any such work. He also continually sees people who are not there, and has difficulty fitting in anywhere. 2. Economics/financial resources, living situation and environment As for his economic/financial resources, this is the source of some mystery. For the first part of the movie, John is working for the Pentagon, cracking codes. It is unclear what kind of work that he does after this. He hallucinates that he is doing important work for the Department of Defense, but he really is not doing this work. Therefore, it is unclear how he is getting paid. Alicia is not shown to be working, either. At any rate, there were years when John could not work because of his illness, so it is unclear how the John, Alicia and his son got the money to live. As for the living situation, he lives with Alicia and his son in a modest house. 3. Environmental/Support System His support system is mainly Alicia. Alicia is a strong woman who gets John the help that he needs. At first, John has a combination of shock treatment and pills, and he is institutionalized for a period of time in the movie. Alicia is shown to be by his side the whole way. She also makes sure that he takes his medicine as prescribed. John is shown to be despondent after getting out of the hospital, and unable to make love, which is frustrating for Alicia, but she does not leave. She tries to leave at one point, because John almost drowned their son when bathing the son, and John has a relapse of his schizophrenic symptoms because he secretly stops taking his medicine. However, as she is leaving, John appears in front of the car and states that he now knows that he is hallucinating Charles, Charles’ niece and the government agent, because the niece never ages. From there, John becomes determined to beat schizophrenia without pills or shock treatment, and Alicia supports this decision too, and vows to be there for him to help him get well. His other source of support is his old friend/rival, Martin. Martin has great sympathy for John’s plight, and, when John asks Martin if he could attend Princeton classes and use the library, Martin readily agrees and even gives John his own office. This simple act of kindness is the eventual road to John’s recovery, as he is able to once again be in an environment which is comfortable for him and eventually he is recognized by some of the students and becomes a mentor for the students, which also helps his recovery. After more time had passed, John is able to become a professor at Princeton, and, in the most touching scene in the movie, he is given pens by his colleagues, which is a sign of great honor. John always sees his hallucinations, but he learns to ignore them and realize that they are not real. 4. Mental health/Emotional/Mental well-being John is diagnosed as a paranoid schizophrenic. The audience soon learns that his roommate never existed, the government agent doesn’t exist, and his roommate’s niece does not exist. The “work” that he was doing for the Department of Defense did not exist, nor did the building where he was dropping off his secret plans. That building was abandoned, and his secret plans were just piling up in the mailbox. Moreover, he has social/occupational dysfunction, as his poor social skills – lack of eye contact, lack of empathy, lack of social skills, flat affect – are other symptoms of the disorder displayed by John. His hallucinations were both auditory and visual, as he could both “see” and “hear” Charles, the agent, and the niece. He also had delusions of persecution, as he had the delusion that he was being followed by people who wanted to stop his work that he was doing for the Department of Defense, and, at one point, hallucinated that he was in a car chase and the car behind him was shooting at him. 5. Activities of daily living/job, hobbies, friends, volunteer work, etc. At the beginning of the film, John is a student, so his activities revolve around going to class and studying, mainly studying. He has some social life, as his fellow mathematics students take him out to a bar on at least two occasions, and one of these occasions is when he came up with the insight that would fuel his Nobel-Prize winning theory of economics. He does not seem to have any hobbies of note. Later on in the film, after John has a mental breakdown which lands him in the mental institution, and he comes out of the institution and makes the decision to try to tackle his schizophrenia naturally, he establishes a new routine. Martin, his old friend and rival, gives John an office in Princeton, full access to the library, and the ability to audit courses. This enables John to connect with the Princeton community, including the young students who recognize him and seek out his help as a mentor. John apparently goes to the college every day, to study in the library, and audit classes, and this goes on for a period of decades. At some point, John’s routine is that he is a professor there at Princeton, and has regained the respect that he had when he was a younger student. It is difficult to say if John has any friends, per se. He has colleagues and classmates, and the colleagues and classmates treat him kindly and respect him. However, because of John’s difficulty with empathy or socializing, John does not appear to be a friend to any of them. In other words, the friendship seems to go one way. For instance, Martin, the old “friend” who gave John access to a Princeton office and library, was always treated badly by John. John made fun of Martin, and, when Martin beat him at a game, John stormed off and sent the board pieces flying, ranting the whole way. There was never a scene where John treated Martin kindly, even though Martin always treated John kindly. Because John was never a friend to any of the men who attempted to befriend him, it could be said that John really did not have any friends. However, ironically, the one person who John did seem to have a real interaction with was Charles. He confessed personal secrets to Charles, and Charles actually made him laugh. He wasn’t rude to Charles, and seemed to be more at ease in Charles’ presence. Of course, Charles never really existed, so Charles could not be considered to be a friend, either. These are the only activities which John participated in. He was not religious, he did not appear to have hobbies outside of his mathematics, and no other social connections were shown. Precipitating Event for Counseling John is seeking counseling because he wants to get off of his medication and discontinue shock treatments. However, he is still having hallucinations and delusions. Presenting Problem John explains that the medicine blocks his creativity and thought process, makes him lethargic and depressed, makes him unable to participate in life, and unable to make love to his wife. History of the Presenting Problem The presenting problem has been going on for approximately 1 year, as this is the amount of time that John has been on the medication to treat his schizophrenia. He has dealt with the problem of the medication’s side effects by taking himself off of his medication. Because of this, his symptoms of schizophrenia have reoccurred, and he almost drowned his son in the bathtub because he is not in touch with reality. He is once again hallucinating that he is working for the Department of Defense on a top-secret mission. His wife is ready to leave, because she fears for her life and for the life of their son. Treatment Plan John needs a referral to a psychiatrist who can try different medications on him, starting with low doses and working their way up. He needs to try different medications. However, John does not wish to re-start medication, so the only treatment plan he is willing to try is counseling. The most important aspect of the treatment plan is John’s support system. Therefore, Alicia should undergo both individual counseling, to learn how to support John, and couple’s counseling, where I can counsel both of them about the challenges that they face. Alicia should also sit in on the individual counseling sessions with John. This will help Alicia understand what she needs to do to help John, as well as understand more about John’s illness and what he is going through. Moreover, John should start cognitive behavioral therapy in an effort to manage symptoms of schizophrenia, such as poor social skills and possible depression. The CBT may also help with reality testing, and may help John adhere to other treatment programs. The CBT may help John in that he can use the techniques when he hallucinates to assure himself that the hallucinations are not real, and give him coping strategies. It can also give him an alternative to his dysfunctional behavioral and affective reactions which are part of the symptoms of schizophrenia. CBT has been shown to be an effective therapy for schizophrenia (Sensky et. Al, 2007). Source Used Sensky, T., Turkington, D., Kingdon, D., Scott, J., Scott, J., Siddle, R., O’Carroll, M., Barnes, T. (2007) A randomized controlled trial of cognitive-behavioral therapy for persistent symptoms in schizophrenia resistant to medication. Arch. Gen. Psychiatry, 57: 165-170. Read More