Psychology Case Study on Fictional Character

Taneka Gibson 

Case Conceptualization Cruella De Vil

Introducing the Character

Cruella is the head of the London fashion house called House of De Vil. Cruella has two passions cigarettes and fur.  Anita Dearly is one of Cruella’s employees and hinted to be her best fashion designer. Cruella first took interest in the Dalmatian puppies when Anita drew spots on one of the designs. Anita, inspired by her dog designs a coat made with spotted fur. Cruella, leaps on the idea of making garments but out of actual Dalmatians. Cruella learns that Anita’s Dalmatian, Perdy has given birth to 15 Dalmatian puppies, Cruella offers the Anita’s family a large check for the newly born puppies, but they decline.  Cruella is outraged and fires Anita and set plans to get even.  Cruella has hires man, named Mr. Skinner, a taxidermist. She hires him to kill and skin the puppies for the designs. Cruella sent Horace and Jasper Badun to capture the puppies, but they fail thanks to the involvement of the farm animals. Cruella herself then went after the puppies after her henchmen were defeated, and located the puppies to the farm. She tried to kill them but fell victim to the farm animals, who managed to trick and outwit her and defeated her by knocking her into mud. Cruella was later arrested for her crimes along with her henchmen.

Case Summary

Identifying Information.  Cruella is a 60 something year old Caucasian female who was admitted to Gibson Center for Wellness mandated as part of her probation.  She often known for her stylish but loud and flamboyant demeanor.  She is noted to be vain, egotistical, and her mental unpredictability.  Her employees have stated she has a harsh personality, a terrible temper, and bizarre taste, and is cruel without concern or remorse.

Goals for treatment:  Cruella met with assigned therapist for a formal Comprehensive Clinical Assessment to determine most appropriate diagnosis base on client interview and medical record review.

Diagnostic Impression

Primary Diagnosis:  301.81 (F60.81) Narcissistic Personality Disorder

Additional Associated Factors:   Z65.1 Imprisonment or other incarceration, F17.209 Unspecified tobacco-related disorder, Z65.3 Problems related to legal circumstances

Discussion of Diagnostic Impression

Cruella has been mandated by the court to seek mental health services due to her pervasive pattern of grandiosity, need for admiration, and lack of empathy.  Her behavior led to imprisonment due to believing she was above the law. She is a wealthy woman and has access to a variety resources to benefit from mental health treatment.

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Cruella’s presenting behaviors are consistent with Narcissistic Personality Disorder per DSM-V (Association, 2013, p. 669).  The diagnosis of Narcissistic Personality Disorder, is included in chapter with several other personality disorders, Paranoid personality disorder, Schizoid personality disorder, Schizotypal personality disorder, Antisocial personality disorder, Borderline personality disorder, Histrionic personality disorder, Avoidant personality disorder, Dependent personality disorder, Obsessive-compulsive personality disorder, and Personality change due to medical condition.  According to DSM-V, a personality disorder is defined by a pattern of inner experience and behavior that deviates markedly from the expectation of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood is stable overtime, and leads to distress or impairment (Association, 2013, p. 645).

Cruella is a single sixty something year old women who is demonstrating symptoms that are compatible for an individual that has a grandiose sense of self-importance.  She often known for her stylish but loud and flamboyant demeanor.  She is noted to be vain, egotistical, and her mental unpredictability.  Her employees have stated she has a harsh personality, a terrible temper, and bizarre taste, and is cruel without concern or remorse.

A clinician may consider the differential diagnosis of Antisocial personality disorder.  The diagnosis can be ruled out because Antisocial personality disorder is distinguished from Narcissistic personality disorder because the symptoms patter must be noted beginning since age 15 years (Association, 2013, p. 659).  Another diagnosis that can be ruled out is Mania or hypomania but grandiosity may emerge as part of manic or hypomanic episodes, but the association with mood change or functional impairments helps distinguish these episodes from narcissistic personality disorder (Association, 2013, p. 672).

Case Conceptualization

Once demographic information is collected during intake and clinical interview is completed by counselor, analysis of diagnostic criteria and client symptoms was confirmed for Narcissistic Personality Disorder.  Cruella concerns and past behaviors were described Narcissistic Personality Disorder.  Next, her counselor developed a case conceptualization.  The purpose of the diagnostic impressions is to describe the client’s concerns, the goal or case conceptualization is to better understand and clinically explain the person’s experiences (Schwitzer, 2015).

Cruella presents for clinical interview it is noted that she has two toned colored hair.  Her hair is colored black on one side and white on the other.  She is wearing a skintight dress, and an oversized mink coat that includes a long train.  She constantly smoked everywhere she went and often would thump ashes on others or on the floor.

Case Note

Purpose:  The focus of today’s session was on developing a level of trust with the client by creating a therapeutic environment.  Consistent eye contact, active listening, unconditional positive regard, and warm acceptance were used to help build trust with the client.  An emphasis was placed on the client being able to express problems, wants, and goals.

Intervention:  The client was engaged using the cognitive behavioral therapy approach.  The client’s history of illegal activities was collected.  The client was asked to list negative consequences that have accrued to her behavior.  The clients level of insight toward the presenting problems was assessed.  Open-ended questions were used to help the client explore her own motivation for change.

Assessment:  The client reported that she had a history of rule breaking, lying, physical aggression disrespect for others and the law.  The client acknowledges that her disregard for the law resulted in serious problems.  The client, after describing her pattern of disrespect for others feelings, showed no remorse for her behavior.  The client refused to take responsibility for her decisions and actions.  The client described an inclination to dominate al social and business situations by be too direct and overbearing.  The client described a pattern of perpetual impatience with any waiting, delay, or interruptions.

Treatment Goals and Objectives

Long-term:

• Develop and demonstrate a healthy sense of respect for social norms, the rights or others, and need for honesty.
• Accept responsibility for own behavior and keep behavior within the acceptable limits of the rules of society.
• Achieve an overall decreased in pressured, driven behaviors.
• Develop social and recreational activities as a routine part of life.
• Alleviate sense of time urgency, free-floating anxiety, anger, and self-destructive behaviors.

Short-Term:

• Cruella will verbalize an understanding of the benefits for self and others of living within the laws and rules of society.
  • Therapist will teach the client that the basis for relationship is trust that the other person will treat one with respect and kindness.
• Cruella will admit illegal and or unethical behavior that has trampled on the law and or the rights and feelings of others
  • Therapist will explore the history of the client’s pattern of illegal and or unethical behavior and confront her attempts at minimization, denial or projection of blame.
• Cruella will list three actions that will be performed that will be acts of kindness and thoughtfulness towards others.
  • Therapist will assist the client in listing three actions that she will perform as acts of service or kindness for others.
• Cruella will learn and implement calming skills to manage pressure situations.
  • Therapist will teach client calming techniques (e.g. muscle relaxation, paced breathing, calming imagery) as part of tailored strategy for responding appropriately to feelings of pressure when they occur.

Evidence Based Best Practices (EBBP) Type of treatment

Narcissistic personality disorder is described as a debilitating and hard-to-treat condition. Often, interpersonal relationships can be brutally distressed, both socially and occupationally, which makes it very difficult for individuals with this disorder to experience a fulfilling life and appreciate their desires. Research suggest, effective treatment of narcissism encompasses aggressively resonating with the client’s self-definition and the way the client observes the presenting problem; producing self-reflection in the client during the preparation phase; identifying the many possible therapy detours and dead ends that can result from overactivation of defense; identifying and treating core experiences of early nonengagement, neglect, and trauma that may have been initially covered (i.e., blocked from awareness) by defenses; identifying and empathetically correcting distortions in the client’s perception of the therapist; and dodging nontherapeutic countertransference reactions originating within the therapist (Mosquera, 2015).  EMDR uses an eight-phase approach and addresses memories, current triggers, and future situations (Mosquera, 2015).

Cognitive-behavioral therapy (CBT), the counselor helps the client recognize negative and distorted thoughts and replace them with positive ones based. CBT approach commonly integrates talk therapy to bring awareness to harmful inner dialogues and repeated maladaptive behaviors. Once acknowledged, the therapist assists the client in substituting these with healthy ones (Christensen, 2014).

Psychodynamic therapy approach emphases on unconscious thinking processes that influence an individual’s behavior. The goal is to increase the client’s self-awareness of these unconscious ideations and help him make the connection between these and distorted conscious thought processes and behaviors. When used in narcissistic personality disorder therapy sessions, the clinician guides the client in exploratory unanswered conflicts from connection in past dysfunctional relationships, usually beginning with the individual’s parents or other primary caregiver (2014).

Medication

There are no medications specifically used to treat narcissistic personality disorder. Nevertheless, if you have symptoms of depression, anxiety or other conditions, medicines such as antidepressants or anti-anxiety drugs may be accommodating.  Thus, psychiatrist and do not use medication as treatment for narcissistic personality disorder directly. In its place, the provider may prescribe medication to address any co-occurring mental disorders, such as depression or obsessive-compulsive disorder (Publications, 2016).

References

Association, A. P. (2013). Diagnostic and statistical manual of mental disorders (5th Ed). Washington DC: American Psychiatric Association.

Christensen, J. F. (2014). Behavioral medicine a guide for clinical practice. New York: Mc Graw-Hill Education.

Jongsma, A. E. (2006). The complete adult psychotherapy treatment planner. New Jersy: John Wiley and Sons, Inc.

Jongsma, A. E. (2014). The adult psychotherapy progress notes planner. New Jersy: Wiley.

Mosquera, D. K. (2015). Understanging and treating narcisism with EMDR therapy. Journal of EMDR Practice and Research, (9) 46-63.

Publications, H. H. (2016). Drugs.com. Retrieved from Drugs.com: www.drugs.com

Schwitzer, A. M. (2015). Diagnosis and Treatment Plainning Skills. Los Angeles: Sage.