Comprehensive Psychological Evaluation Name: Jennifer Martin (pseudonym) Age: 31 DOB: April 30, 1977 Address: 123 Main Street Anytown, Missouri 12345
Phone: (123) 456-7890 Date(s) of Evaluation: February 5, 10 & 14, 2009 Date of Report: February 23, 2009
Reporting Clinician: Andrew J. Knoop, Ph.D. **CONFIDENTIAL INFORMATION** This written report contains confidential information and has been prepared for the client named above with the understanding that the information will not be released to other individuals, programs or agencies without the written authorization of the client or the minor client’s parent/legal guardian, except when the release of information is required by law. Reason for Referral: Jennifer Martin was referred in order to undergo a comprehensive psychological evaluation for the purpose of determining relevant treatment foci for individual therapy. Assessment Procedures: Semi-Structured Clinical Interview Mental Status Examination Minnesota Multiphasic Personality Inventory – 2nd Edition (MMPI-2) Millon Clinical Multiaxial Inventory – 3rd Edition (MCMI-III) Relevant History and Clinical Interview: Demographics Jennifer Martin is a 31-year-old Caucasian female who resides with her husband, Grant Martin, and their 4-year-old son in Anytown, Missouri. Jennifer reported that she graduated from the University of Missouri (Columbia, Missouri) in May 2000 with a Bachelor’s degree in Art Education. Since that time, Jennifer stated she worked as an elementary art teacher in the Anytown R-II School District from 2000 to 2003, but chose to stop teaching when she and her husband decided to begin their family. Jennifer reported that her son was born in 2004. In 2007, Jennifer reported that she began teaching art on a part-time basis in the same school district. She noted that although the school district offered her a full time teaching position, she decided to remain a part-time employee in order to have more time to spend with her family. Additionally, she noted that she and her husband are hoping to have another child within the next 12 months.
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Current General Concerns During the clinical interview, Jennifer noted that she often wonders whether it would be better for the family if she would teach on a full-time basis, and admitted that she now regrets turning down the school district’s full-time teaching offer. She stated that, given the current economic recession, she is worried that if her husband loses his job, the family will not have enough financial resources to avoid losing their home. Jennifer described her relationship with her husband as strong and loving, but admitted that they struggle financially, and their current financial situation has been the source of recent intense arguments and misunderstandings. Because of these disagreements, Jennifer reported that she feels guilty that she is not contributing more to the family’s income, but also believes that spending time with their son is just as important to the family’s overall success. When asked about the degree of worry she experiences, Jennifer reported that she worries every day about a number of concerns, not just finances, and feels some degree of helplessness that she cannot change their current circumstances. She reported that she has sought counseling from the pastor of their church, which she reported was helpful, but she noted that the counseling did not alleviate her worry, which she reported has increased in severity over the past six months. Jennifer denied any significant medical concerns, reported that she was not taking any medications, and denied any legal history. Current Reported Mental Health or Emotional Symptoms During the clinical interview, Jennifer denied the presence of significant symptoms of depression or elevated mood and denied the presence of delusions or hallucinations. Regarding symptoms of anxiety, Jennifer reported that she considers herself a worrier and reported that she worries about a number of things. Primary concerns include the family’s financial woes, the overall safety and well-being of her child, the possibility that the family might be in an auto accident. She reported that she makes sure she locks their windows and doors when the family is home “because you never know who might be sneaking around.” She reported that she has felt some of these worries since her son was born, but noted that the family’s recent financial difficulty during the past 12 months has caused her worries to become more pronounced. Jennifer noted that she finds it difficult to control the worry, and experiences sleep difficulty, fatigue and general irritability accompanying the worry. When asked if these symptoms have had a negative affect on her current daily functioning, she acknowledged that her worries and irritability have caused marital strain, and that her vigilance regarding potential intruders make it difficult for her relax in the evenings and during the night, which also contributes to some degree of sleep difficulty. Despite the presence of these concerns, Jennifer reported that she does not avoid people, does not have significant difficulty participating in her daily activities, denied the presence of unusual or persistent fears and denied the presence of obsessive thoughts other than those associated with potential intruders. Finally, she denied the presence of compulsive behaviors and reported that she has not experienced any significant physical or emotional trauma or abuse. Mental Status Examination: During the mental status exam, Jennifer was oriented to person, place, and time, and her affect was generally congruent with regard to content. Her mood was stable. She denied the presence of delusional thought processes or hallucinatory perceptual disturbances. With regard to memory, she was able to recall three of three items immediately after presentation and after a five-minute
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delay. She performed well on the “serial 7’s” task, providing five correct responses. Her general fund of knowledge and functional reading ability was intact. Jennifer was able to carry out a simple three-step instruction. Her interpretations of two common sayings were accurate, but tended to be more concrete. Overall, her judgment, knowledge, and insight appeared to be within expected ranges for her age. Behavioral Observations: Jennifer presented as an active and alert woman. During the three evaluation sessions, she was dressed casually in jeans and a sweater or long-sleeved t-shirt and exhibited good hygiene. Rapport was easily established for both sessions. During the interview, Jennifer wept briefly (less than one minute) as she was discussing the family’s financial struggles, but recovered quickly and appeared to become more cheerful when she was discussing the time she spends with her son. Jennifer readily completed both of the paper and pencil test without complaint and elected to take a 10-minute break between tests to rest her eyes and use the restroom. The examiner adhered to standardized administration of all procedures. Consequently, the obtained results are considered valid estimates of her emotional and personality characteristics. Assessment Results: MMPI-2 The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is a broad-based paper and pencil test designed to assess a number of significant patterns of personality, emotional and behavioral disorders. It consists of 567 statements that a subject marks true or false. A summary of the results are presented below as T-scores, with a mean of 50 and a standard deviation of 10. Scale scores that are considered elevated are denoted with an asterisk (*). Validity: VRIN TRIN F FB FP FBS L K S Clinical: 1 2 3 4 5 6 7 8
T-score 57 58 60 54 43 64 50 59 46 T-score 59 42 48 51 59 44 54 57
Content: ANX FRS OBS DEP HEA BIZ ANG CYN ASP TPA LSE SOD FAM WRK TRT
T-score 67* 51 56 58 44 55 63* 46 43 57 54 45 65 51 58
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Supplementary: A R ES MAC-R AAS APS MDS O-H Do Re Mt GM GF PK
T-score 69* 53 43 59 42 53 67* 55 43 57 42 38 56 46
9 0
55 59
An analysis of Jennifer’s validity scales indicate that she paid attention to item content and responded in a forthright manner to the test items. There is no evidence of a response style that would invalidate the obtained results. Consequently, the results of this MMPI-2 profile are considered valid and interpretable. Jennifer’s MMPI-2 clinical profile reveals significant scale elevations on the A and ANX scales, suggesting that she tends to be anxious and uncomfortable, and may second-guess her own abilities and decisions. In stressful situations, she may become increasingly disorganized and indecisive. Additionally, Jennifer likely feels worried and apprehensive regarding a variety of concerns in her daily life. She tends to feel pessimistic about the possibility that things will get better, which likely results in feeling overwhelmed with daily responsibilities and typical social expectations. Additionally, significant elevations on the FAM and MDS scales indicate potential concerns with regard to relationship difficulties within the family. Jennifer is likely to feel as if she does not receive the levels of support and understanding from close family members that she expects, which may result in some degree of resentment or anger that may surface in arguments or ineffective communication styles. The MMPI-2 profile also reveals a secondary concern with regard to her expression of anger. A moderately elevated score on the ANG scale suggests she may view others as uncaring or selfish, tends to be less trusting in relationships, may be demanding toward others but resent demands placed upon her and may be more hostile or overbearing in her dealings with others. MCMI-III The Millon Clinical Multiphasic Inventory – 3rd Edition (MCMI-III) is a self-report inventory designed to assess a number of significant patterns of personality, emotional and behavioral disorders. It consists of 175 statements that a subject marks true or false. A summary of the results are presented below as base rate scores. Base rate scores above 74 represent elevated levels of concerns. Baser rate scores that are considered elevated are denoted with an asterisk.
Modifying Indices: X Y Z
Base Rate 52 55 62
Clinical Personality Patterns: 1 2A 2B 3 4 5 6A 6B 7
Base Rate 20 84* 52 47 51 27 36 12 69
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Clinical Syndromes: A H N D B T R SS CC
Base Rate 82* 51 36 20 60 0 30 62 22
8A 8B S C P
60 47 64 29 67
PP
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An analysis of Jennifer’s validity scales on the MCMI-III indicates that she paid attention to item content appropriately and responded in a forthright, truthful manner that neither exaggerates nor minimizes the presence of any personality and behavior concerns. Consequently, the obtained personality profile for Jennifer is considered valid and interpretable. Regarding personality patterns, Jennifer’s profile reveals an elevated base rate score on Scale 2A. Individuals with elevated base rate scores on Scale 2A tend to be vigilant and always on guard in their environment for real or perceived threats to their emotional wellbeing or selfesteem. Should such a threat present itself, these individuals often take strong measures in an attempt to avoid the discomfort associated with the threat to the degree that they often isolate themselves from specific social situations and opportunities. Despite desiring fulfilling social contact and positive interpersonal relationships, Jennifer may often find herself unable to take the risk of disappointment and hurt that often come in interpersonal relationships, and instead tends to avoid potentially hurtful situations. Her internal conflict between wanting satisfying relationships and feeling the need to avoid potentially hurtful relationship often creates significant frustration and a significant degree of social isolation. Regarding clinical syndromes, Jennifer’s profile reveals an elevated base rate score on Scale A. This elevated score indicates Jennifer likely feels tense, indecisive and restless, and may experience related physiological symptoms that include increased heart rate, muscle tension, excessive perspiration, nausea and racing thoughts. Jennifer likely experiences a generalized, often unfocused state of tension or worry, which may be marked by difficulty relaxing or general restlessness. Additionally, Jennifer is likely to experience significant worry, apprehension in new experiences, and some degree of increased alertness to the presence of perceived trouble in her environment. In combination, the presence of these two score elevations suggest a person that is hypervigilant in her current daily functioning and worried about the possibility of negative outcomes to the extent that she often isolates herself from activities and relationships from which she would typically derive enjoyment. Others may report that Jennifer tends to worry about things over which she has no control. Additionally, Jennifer may have experienced negative reinforcement for past attempts to engage with others and participate in social or occupational pursuits to the extent that she may now have negative expectations for similar encounters; consequently, she remains alert to these potentially negative situations and often chooses to avoid them altogether. Assessment Conclusions and Clinical Impressions: Jennifer Martin was referred in order to determine relevant treatment foci for individual therapy. Jennifer is a 31-year-old Caucasian female who resides with her husband, Grant, and their 4year-old son in Anytown, Missouri. She is employed as a part-time art teacher.
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During the clinical interview, Jennifer noted significant anxiety regarding the family’s financial concerns, especially as they are impacted by her decision to forego full-time employment for a part-time position. Additionally, Jennifer noted recent intense arguments between her and husband surrounding their financial concerns and her decision not to seek full-time employment. The results of the MMPI-2 and the MCMI-III clinical profiles reveal significant scale elevations on the scales that measure anxiety, suggesting that Jennifer tends to be anxious, tense and uncomfortable, may second-guess her own abilities and decisions and is likely to be disorganized. Additionally, Jennifer experiences related physiological symptoms that include increased heart rate, muscle tension, excessive perspiration, nausea and racing thoughts. She likely experiences a generalized state of tension or worry, which may include difficulty relaxing or general restlessness. In addition, Jennifer reported that she feels anxiety symptoms around the following situations: the overall safety of her child, the possibility that the family will be in an auto accident and home invasion by strangers. She reported the onset of these symptoms occurred approximately 12 months ago, noted that she continues to find it difficult to control the worry, and experiences sleep difficulty, fatigue and general irritability. Given the results of the structured clinical interview and standardized testing, it is determined that Jennifer meets the diagnostic criteria for Generalized Anxiety Disorder. In additional to the anxiety concerns, test results also suggest that Jennifer feels a general pessimism about the possibility that things will get better, hypervigilance for real or perceived threats to her emotional wellbeing or self-esteem, and avoidance of the discomfort associated with the perceived threat to the degree that she feels socially isolated. Although Jennifer denied avoiding social contact or avoiding the performance of her daily activities, the presence of elevated anxiety concerns and some degree of hypervigilance in her current daily functioning are likely to cause increased anxiety that may lead to an avoidance of effective communication or resolution of the dilemma she feels with regard to working full-time vs. spending time at home with her son. Given that Jennifer reported experiencing intense arguments regarding her employment decisions in the past, negative results from these conversations may have resulted in negative expectations for similar encounters; consequently, she is likely to be alert to these potentially negative conversations and may chooses to attempt to avoid them altogether. DSM-IV TR Diagnosis: Axis I: Axis II: Axis III: Axis IV:
300.02 V71.09
Axis V:
GAF = 65
Generalized Anxiety Disorder No Diagnosis or Condition on Axis II None Economic problems Problems with primary support group
Recommendations: 1. Jennifer is encouraged to share this written report with her current individual therapist in order to facilitate communication about appropriate therapeutic foci and treatment plans.
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2. The following suggestions for treatment foci are provided as guidelines with the understanding that Jennifer’s current therapist may have already incorporated similar suggestions into her treatment plan. Additionally, it is understood that the treating clinician is in the best position to make decisions regarding treatment. Suggestions listed below which are determined to be inappropriate at this time should be eliminated. a. Consider the possibility of conjoint therapy to address maladaptive communication patterns (possibly avoidance of communication on the part of Jennifer) and to reduce residual anger within the marital dyad. b. Implement and reinforce strategies designed to reduce Jennifer’s level of anxiety symptoms her feelings of being overwhelmed. c. Consider exploring the source and function of Jennifer’s possible avoidance of communication regarding full-time employment. d. Consider the roles that Jennifer’s level of anxiety and avoidance behavior may have regarding her decision-making process. e. Consider providing Mr. Martin a summary of these findings and work to find ways in which he can interact with Jennifer in order to help develop positive expectations for Jennifer regarding their conversations about employment. 3. Jennifer and her husband are encouraged to consult with their banker or a financial advisor with regard to the family financial situation. 4. Jennifer is encouraged to consult with her physician or be referred to a psychiatrist in order to learn more about the possibility of medication management for her anxiety symptoms. Thank you for allowing me to be of service. I hope the information provided in this report will prove useful.
Sincerely,
Andrew J. Knoop _______________________________________ Andrew J. Knoop, Ph.D.
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