Clinical Psychology Paper (Case Study)

Awareness of the range of psychological problems encountered in clinical practice in terms of clinical presentations (e.g clinical features and diagnostic criteria).

Excellent

Very good

Good

Competent

Pass

Fail

Ability to identify and implement appropriate assessment tools or strategies.

Demonstrate an ability to conduct a clinical formulation in relation to psychological problems, e.g., 5 Ps of clinical formulation.

Detail appropriate therapeutic treatments and recommendations for subsequent care plans relevant to the case study.

Evidence of broad independent reading that details support for all sections (assessment, formulation and treatment recommendations).

Are you demonstrating the pros and cons of assessments, evaluations, and treatment strategies?

Very good

As a L6 student, you should be able to demonstrate a high standard of writing, paraphasing and referencing.

Excellent

Very good

Good

Kyle has not previously worked, and he no longer has a relationship with his family – his mother left him shortly after birth, and he has not seen his step-mother or father since he was 15 years of age. Kyle had a son when he was 22-years-old. However, he died within the first six-months of life. Kyle has a long history of poly-substance use, and he was a frequent heroin from the age of 19 until he went cold turkey during his recent admission to prison.

Significant History

Kyle was born into a home in a deprived area of a large English city. His father worked long hours in a factory and his mother was unemployed. During the first year of Kyle’s life, his father perpetrated serious violence towards his mother. There were frequent fights and the police attended the home multiple times. Due to this abuse, Kyle’s mother left the family home without him.

When Kyle was approximately two years of age, his father remarried and his step-mother moved into the home. However, the violence continued, and their relationship was frequently punctuated by aggression and violence. Kyle felt a need to protect his mother. However, his father would call him a “pussy” if he showed any tenderness or upset in such situations. As such, his step-mother would tell Kyle that he needed to “man up” so that he didn’t become a victim too. Despite this, physical punishment was common, and his father would hit Kyle for even the slightest transgression. As Kyle developed, he learnt to keep his feelings hidden, maintain a smile on his face, and behave well at all times. He felt powerless in the home and would often daydream as a form of escape.

Kyle was curious at school, though he often struggled. However, he did not wish to draw attention to himself or be exposed. Therefore, he faded into the background and behaved. His teachers described him as “quiet, well-behaved, though largely absent”. He had difficulty with peer relationships and was the target of bullying. He lacked assertiveness and would attempt to please others when he could.

As Kyle got older, he became increasingly detached from the world around him. He spent large amounts of time outside of the house, walking aimlessly. He attempted to avoid his father, though the violence continued; Kyle developed an awareness of his father’s warning signs and tried hard to appease his father’s temper. His step-mother provided some support, though this was usually practical, and she did not encourage strong emotional expression. Kyle felt a strong urge to protect her and there were occasions whereby he would tend to her injuries after she had been assaulted by his father.

At school, Kyle continued to drift. However, he had started getting into fights. These would occur in the context of pervasive bullying – of which Kyle was a victim. He would find that – when the provocation reached unbearable limits – he would ‘snap’. Kyle rarely remembered his actions after the event, though others reported that he became almost uncontrollable in his rage. Kyle was suspended several times for fighting; he felt singled out and as if his emotions were toxic and forbidden.

Things at home continued to be bad for Kyle and his step-mother. Indeed, things came to a point whereby his step-mother left his father when Kyle was 15. This was a shock to Kyle. However, his step-mother cut all contact at this point. Kyle’s father blamed Kyle and the violence turned towards him. Eventually, his father ‘kicked him out’ of the home and Kyle became homeless. Kyle did not return to school and instead turned to drugs to help with the cold, the danger, and the intolerable negative feelings that were bubbling inside. He started using cannabis and alcohol, before moving onto take heroin when he was 19.

Life on the streets was difficult for Kyle. He felt unsafe and became suspicious of people around him. He was targeted by thieves and verbally abused by members of the public. He became involved with a group of drug users, who would provide him with cheap heroin. However, the price he paid was severe. The group prostituted Kyle for money. He felt worthless, though also powerless to change anything. His use of heroin increased.

At the age of 22, Kyle had his son, with his partner Naomi. Kyle was delighted about this, though disaster soon struck. The child was brought up around drug users and dealer – social services were involved, though slow to respond – his son died of cot death at the age of six months. Kyle increased his heroin usage to cope with this new pain. He separated from Naomi and soon returned to live on the streets.

Back on the streets, Kyle started to hear voices. He heard two voices, one male and one female. The voices expressed their anger at the world and instructed Kyle to seek revenge for the injustices done to him. Kyle was terrified and attempted to quash these intrusions through increased heroin use and alcohol. He rarely felt ‘present’ and the world was foggy and indistinct.

The next 18 years of Kyle’s life followed a repeating pattern, whereby he would try his best to survive in the dangerous world. He would use drugs to numb and only buy food as an afterthought. He was suspicious of others and did not become closely involved with anybody, preferring to keep people at arm’s length. He avoided conflict and was described by others as “incredibly passive and people-pleasing”. He spent time in prison and psychiatric hospitals – often a result of acquisitional offences (robbery, theft etc.) (he would be sentenced to serve time in prison before becoming psychotic and requiring transfer to hospital). When in hospital, he would acquiesce to the wants of the clinical team, though he rarely made any meaningful progress. He behaved and tended to pass quietly back onto the streets.

At the age of 40, Kyle was discharged into the community and given a council flat. However, he struggled to maintain this lifestyle and found himself back on the streets. Kyle had been moved to a new area and he did not know anybody, nor how to buy drugs. He was target by some local youths in the community, who would pay him small amounts of money to do humiliating acts. They would also film themselves attacking him. Kyle was also suffering the challenges of heroin withdrawal, and he was finding that the voices were becoming intolerable and that his feelings of anger, fear, and loss were coming uncomfortably close to the surface.

Eventually, it all became too much for Kyle and he snapped. He was in a local off-license. He was feeling paranoid, and the voices were particularly bad. A man pushed in front of him in the queue and Kyle attacked him. Kyle had no recollection of events, though the police report indicated that he had entered into a prolonged and vicious assault, which had only been stopped when three members of the public had restrained him.

Kyle was sentenced to seven years in prison for the assault after being charged with section 18 wounding. However, at prison things did not go well. He started using drugs again and had frequent near-death experiences. He was soon referred and transferred to the MSU, after a psychiatrist noted his excessive paranoia and distressing voices.

Current Status

Kyle is now at the MSU and awaiting assessment. He keeps himself to himself and spends large amounts of the day sleeping or resting in his room. He is polite and pleasant with staff, though has a tendency to deflect enquiries as to his internal world. He does acknowledge the presence of voices, though indicates that he is “ok”. He denies the need for help and reports that he simply wants to leave. Notably, Kyle has a lot of interests and has expressed a desire to complete his education. He enjoys fantasy novels, television comedies, and puzzles. He has been introduced to mindfulness and has indicated that he might be interested in this.

His psychologist is now preparing to assess him, with the following questions in his mind:

1.      What are the presenting problems?

2.      What are the factors that have led to his psychological difficulties, both environmental and psychological?

3.      How can psychological intervention help to improve his wellbeing and reduce his risk?

4.      What other support can be put in place to help support Kyle recover?

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