Ordinary People Essay
I decided to base my clinical assessment of a movie character on Conrad Jarrett, the lead character of the film Ordinary People. Conrad is seventeen years old and is the only child of Beth and Calvin Jarrett. The Jarrett’s live in the affluent suburb of Lake Forest, Illinois, where Calvin works as a successful tax attorney. The Jarrett’s have just recently experienced a family tragedy, where their eldest son, Buck, drown in a boating accident, while Conrad witnessed the entire event. Six month after the accident, Conrad has become severely depressed, and slit his wrists with a razor blade in a failed suicide attempt.
His parents discovered him unconscious in the bathroom, and immediately committed him to a psychiatric hospital. He spent eight months in treatment and has recently returned home, as well as resumed his classes at Lake Forest High School. He is struggling socially, academically, and has a strained relationship with his mother, Beth. Immediately following his discharge, Conrad continues to experience nightmares, and flashbacks to the boating accident in which he watched his older brother die from drowning.
He is also experiencing chronic agitation, appetite loss, poor concentration, and avoidance of his former friends and extracurricular activities. When Conrad was receiving treatment, he was initially diagnosed with major depression with agitation, without active suicidal ideation. He attends psychotherapy twice weekly with Dr. Tyrone Berger. I have based the Axis I diagnosis of Post Traumatic Stress Disorder on the analysis of Conrad’s symptoms, which support my clinical decision. Conrad witnessing his brother drowning is the exposure to a traumatic event, which is the basis of this disorder.
This event has involved both a loss of a loved one, as well as his response to the event which has involved intense fear, horror and hopelessness. In Conrad’s case he has also responded with disorganized and agitated behavior. Conrad is also struggling with persistent re-experiencing of the event. This is demonstrated by his frequent flackback memories, recurring distressing dreams, and an intense negative psychological response to any objective or subjective reminder of the traumatic event.
Conrad is also presenting signs of persistent avoidance and emotional numbing, by avoiding former friends, quitting the swim team, and a general withdrawal from significant life activities. He has shown in his sessions with Dr. Berger that he is has a decreased capacity to feel certain feelings, specifically related to his brother’s death. He has also shown in his interactions with others, that he believes the event changed him and has now not made him “normal” to others.
Regarding physiological response issues, Conrad has shown an increased difficulty falling or staying asleep, problems with anger, and concentration, since the traumatic event. The duration of his symptoms have been for more than one month, dating back to the event itself, which was over one year ago. Also, each of Conrad’s symptoms has lead to clinically significant distress or impairment involving his life, social relations, extracurricular activities, and all around important areas of functioning. I have decided that no Axis II is present so I have coded it as V21. 9. Conrad does not demonstrate any symptoms that indicate a personality disorder or mental retardation. His symptoms seem to have started after he experienced the tragic loss of his brother. In addition, Conrad does not have any general medical conditions that would be listed under Axis III. In regards to Axis IV, Conrad has been experiencing severe psychosocial and environmental problems since the death of his brother. However, Conrad has seemed to struggle with problems related to his primary support group, particularly his mother, from a young age.
His relationship with her has become even more strained since Buck passed away. Conrad’s mother, Beth, is a very cold woman. She is not very supportive toward Conrad and seems embarrassed by his recent actions. She seems more concerned with what other people will think of her family than actually caring for her family. She hasn’t dealt with Buck’s death and does not know how to grieve. This has had a very negative effect on Conrad and he feels that his mother would have probably rather he died than Buck. Since the accident, Conrad has socially withdrawn from his friends and activities he one enjoyed.
He is having major problems reconnecting to his friends primarily because it is too painful to see them because they remind him of Buck. He also spent so much time in the psychiatric hospital that he missed out on almost an entire school year. He has made a connection to Karen, a fellow patient, while receiving treatment and they have formed a special bond. She had been suffering from depression and had also attempted suicide. Conrad would call her whenever he was feeling down and she was the one person he felt really understood him.
Unfortunately, Karen lost her battle with depression and suddenly committed suicide. Losing this support has devastated Conrad. He now cannot adjust to his normal life and literally feels alone in his struggle. Since returning to Lake Forest High School, Conrad has shown increased discord with teachers and classmates. He has gotten into a fight with several classmates and has quit the swim team. He seems to not enjoy being back at school particularly because the environment reminds him of how his life used to be when Buck was alive.
He has show increased anxiety when he is in school and can’t seem to concentrate on his schoolwork. In analyzing Conrad’s Global Assessment of Functioning for Axis V, I have considered all of his present symptoms. I believe Conrad is functioning at a 50 because he is still struggling with suicidal ideation and has serious impairment in social and school functioning. Since the suicide of his friend Karen, he has had considerable flack backs of his own suicide attempt and has been increasingly depressed.
I have chosen to analyze Conrad’s diagnosis of Post Traumatic Stress Disorder from a Cognitive Behavioral Therapy approach. Cognitive Behavioral Therapy seeks to change the way a trauma victim feels and acts by changing the pattern of behavior. I believe Conrad can greatly benefit from this approach because he has always been very hard on himself and struggled with self esteem issues, and since the accident his feelings of self worth have plummeted. If Conrad works on specific techniques to change the way he views himself, he can take the first step toward recovery.
Part of Conrad’s diagnosis has to do with feelings of extreme guilt, or survivor’s guilt. Conrad was on the boat when Buck drown and could do nothing to save him. He feels responsible for his death and struggles to understand why he survived and his brother didn’t. To make matters worse, Conrad feels that his mother would have rather him die and Buck be alive today. For Conrad, this isn’t just an irrational thought; in fact his mother has always favored Buck, and has been very cold and unsupportive toward Conrad his entire life.
The reluctant behavior of Conrad’s mother also acts as an important factor for developing Post Traumatic Stress because her lack of support leads to more vulnerability for Conrad towards traumatic experiences. Since his mother has been unable to deal with the family stress and has left town, this may stir up more feelings of guilt from Conrad. His relationship with his father has become more solid since his mother left and having this support has really helped Conrad cope. Conrad finds life increasingly difficult to handle because of the recurrent and intrusive recollections of the death of his brother.
One way that Cognitive Behavioral Therapy can help with this in particular, is to help Conrad learn to identify the thoughts that make him feel upset and replace them with less distressing thoughts. Conrad could learn to think of things that make him feel good and learn to insert those thoughts into his head whenever he feels a flash back occurring. Conrad has also struggled with the guilt he feels of his attempted suicide. He feels guilty that his family had to suffer because he was unable to cope with his brother’s death.
He dwells on the fact that his mother had to clean up all of the blood after he slit his wrists in the bathroom, and that she ruined her brand new rug. He constantly beats himself up over these trivial things when they really do not matter. Because of these feelings, Conrad has developed a very low self esteem and cannot function normally. By replacing Conrad’s irrational thoughts of guilt with forgiveness and acceptance, he may be able to realize that he cannot changed what has happened but learn to cope with what lies ahead.
Exposure Therapy is another intervention of Cognitive Behavioral Therapy that could greatly benefit Conrad, specifically targeting his learned behavior of avoidance. Conrad has been avoiding social situations, interacting with his mother, but overall he has been avoiding his feelings directly related to his brother’s death. Conrad and his mother were the only two people who did not cry at Buck’s funeral. He has mentioned on several occasions that he does not know how to feel, that he basically feels numb inside. It is important for a Therapist practicing CBT to help the client understand why the learned avoidance serves a purpose.
In a way Conrad is trying to prevent the traumatic experience from happening again. Conrad needs to recognize that by avoiding thoughts, memories, and emotions he is preventing himself from fully processing the experience. For Conrad, I would suggest In Vivo Exposure because it will directly confront his avoidance of the emotions he feels towards his brother’s death. In a therapy session, I would encourage Conrad to express his emotions and take a more confrontational approach with him. He is very reluctant to feel anything because he says that when he allows this he feels “lousy”.
CLIENT MAP OF CONRAD
Diagnosis: 309. 81 Post Traumatic Stress Disorder Objectives of Treatment: Goals (social, relational, occupational, etc. In short form) Improve coping skills Reduce anxiety Reduce depressed feelings Reduce suicidal ideation Assessments as Needed: Initial assessment needed? After treatment, will you see the client for periodic check-ins? How often? Clinicians Characteristics Viewed as Therapeutic: In many cases, the effectiveness of the rehabilitation strategy may be only as good as the relationship between the client and the counselor.
What are (at least) TWO characteristics necessary in a therapist treating THIS PATIENT SPECIFICALLY.
Location of Treatment: In a treatment facility? A therapist’s office? Outdoors? Where should your client be treated? Interventions to Be Used: Specific to your client’s preferences ex. a session with an agoraphobic might involve walking into the street with them. (Other ex. role-playing, hypnosis, etc. ) Emphasis of Treatment: Used with goals, what will the focus be? Ex. If the goal is to keep a job, then the emphasis of treatment might be interpersonal skills and occupational skills.
Nature of the Treatment: If the issue is with a married client, will you use couples therapy as well, or will you lead them through the grief process involving a divorce? Timing: How often will they meet with their therapist? For what time period (6months, a year, etc. )? Medications needed: If none, write N/A. Adjunct services: Will they also need medical treatment, occupational therapy or another service? If none, write N/A. Prognosis: In this particular case, do you think treatment will be effective? How would you define success/recovery with this particular client?