MA Forensic Psychology

Case Vignette for Comprehensive Examination

Please read the vignette carefully. Based on information provided in the vignette, please compose a well-written and organized response to each of the questions that follow.

Presentation of the Problem

Ryan is a 61 year old Caucasian male who was arrested for violating a no-contact orderwith his ex-husband and two adopted sons. Police were called when he attempted to "break in" to the family home to obtain some personal belongings. While at the home, his ex-husband returned and a physical altercation ensued in which Ryan allegedly attacked his ex-husband with a kitchen knife.

No injuries were noted by police; His ex-husband, however, expressed intent to press assault charges. The circumstances surrounding the no-contact order are related to a series of incidences involving allegations of inappropriate sexual behavior with his children.

Six months before, a long history of marriage conflict "came to a head" and he informed Ryan that he wished to file for divorce. Ryan's ex-husband left the home with their two sons and filed a no-contact order against Ryan.

The basis of the no-contact order included allegations that Ryan had a "secret life of sex addiction," including frequent activity on "sex apps" and that he viewed pornography in front of their two sons. The ex-husband also alleged Ryan's inappropriate relationship with their oldest son, 16 year old, citing that he discovered sexually-provocative language in text messages.

A Child Protective Services Investigation and report was completed. Ryan adamantly denies these allegations of inappropriate sexual behavior with and in front of the children; He did however, verify he had been active on "sex apps" throughout the relationships in order to "hook up" with other men.

Psychosocial History

Ryan was born and raised in rural Mississippi. He comes from an intact family and is the youngest of four children. He referenced a narrative within the family that characterized him as the "unplanned pregnancy." Ryan described a "good childhood" and he denied a history of emotional, physical, or sexual abuse. He graduated from college and has had a successful career as an insurance broker.

When Ryan was age 9, his mother was diagnosed with breast cancer.She passed away four years later. This event caused tremendous emotional pain.

After his mother's death, his father began using alcohol heavily and eventually received voluntary inpatient treatment. Ryan reported a strained relationship with his father and a sense of rejection after he told his father he was homosexual. He experienced significant inner emotional conflict as an adolescent related to his sexuality.

He began to seek sexual contact with others and by age 17 was having sex with men for money. He does not believe he has a sexual addiction and denied any compulsive sexual behavior. He did note that he feels somewhat conflicted about his sexual behavior but tended to minimize its impact on his life.

Ryan was in a relationship with his ex-husband for 19 years. He described the relationship as chronically strained, stating that "I'm not sure I ever loved him." He also described his ex-husband as manipulative and unstable which instilled fear in the children. They have two adopted sons(ages 16 and 11). Both were characterized as having"special needs" and both sustained abuse when in the foster care system. Both children have received extensive inpatient and outpatient mental health treatment.

Ryan endorsed significant alcohol use throughout his life. After the loss of a previous partner, he began to drink more frequently and noticed a similar pattern to that of his father when he turned to alcohol after the death of his mother. After treatment, he stayed sober for 13 years. Currently, he considers himself a social drinker and consumes three to four drinks each evening. He does not believe that he has a drinking problem.

Ryan's psychiatric history is also positive for depression. He believes his depression started after the loss of his mother and "I never could shake it." He has been hospitalized three times for risk of harm to self. He reportedly made threats about ending his life and this was reported to the police by his ex-husband. He has been in therapy "on and off" and expressed a strong disdain for medication.

Behavioral Observations

Ryan was dressed casually and his grooming and hygiene were fair. He was mostly uncooperative but warmed up slowly over time. He appeared agitated and despondent. Eye contact was poor. He expressed a strong mistrust in the "system" and beliefs about being unfairly accused. He denies any wrong doing, stating simply, "I was in my own house!"

Ryan was fully oriented. His thought process was mostly linear with no apparent thought problems or abnormalities. His mood and affect were dysphoric.

He demonstrated mild emotional lability and became tearful when discussing his family and stressors in his life. Emotional expression appeared to be within normal limits and congruent with the topic.

His speech was normal for rate, tone, and intonation. Intellectual functioning was judged to be in the high average to superior range.

Based on the vignette provided above, please compose a well-written and organized response to each of the following questions. When writing your responses, please:

Use APA (6th Edition, Second Printing) Style, with 1-inch margins, double-spaced, 12 font, with a reference list at the end.

Write clearly and concisely.

Cite appropriate, and especially current, literature (empirical and/or theoretical).

Avoid all sexist idioms and allusions.

Remember to demonstrate your multicultural competence where appropriate.

Psychological Theory and Practice

What assessments (general and specific) would you conduct to enhance your understanding of the client's problems and how would your choice of assessment(s) inform your diagnostic impression and treatment planning?

Assessments may include structured or unstructured interviews, valid and reliable assessment measures, and/or formalized assessment procedures that may be conducted by yourself or by someone else referred by you.

Provide your diagnostic impressions (based on the DSM-5) for this individual. In narrative form, please describe how the individual meets the diagnostic criteria for the disorder(s) chosen in addition to the differential diagnostic thought process that you used to reach your hypotheses.

Be sure to include any additional (missing) information that is needed to either rule out or confirm your differential diagnoses impressions.

Legal Theory and Application

Explain the background, current presentation, and behavior of the client utilizing theories of offender and/or victim psychology and personality/psychological theories to support your position. Do not simply restate the client's presentation from the vignette.

Instead, provide a theoretical-based discussion of the client's behaviors as presented in the vignette.

Describe the psycholegal standards and/or definitions for each of the following: competence to stand trial, risk of dangerousness, and insanity.

Identify and describe one or more landmark case(s) for each standard (at least three cases total).

Describe the elements or issues that a mental health professional usually focuses on when assessing a person's adjudicative competence, risk and insanity, and any additional items that might be especially important to focus on in the provided vignette.

Research and Evaluation

Describe tests or assessment procedures you would employ to address the psycholegal issues of (competence to stand trial, risk of dangerousness, and insanity). You may refer to these from the Psychological Theory and Assessment Section "A" if you already covered them there. Discuss what the anticipated conclusions would be based upon information provided in the vignette.

Develop one empirically supported therapeutic treatment plan for the client in the vignette. Please make sure you summarize the empirical evidence with appropriate citations to support your treatment choice(s) in working with your client.

Be sure to discuss the effectiveness and limitations in working with this particular client, including this client's background, using the above treatment plans.

Interpersonal Effectiveness

What diversity factors, cultural considerations, or other demographic variables pertaining to this client would you take into account in rendering a diagnostic impression, choosing assessment measures, forming case conceptualizations, and designing the treatment plan? Be sure to discuss cultural/diversity factors that could apply even if they are not explicitly mentioned in the vignette.

Your writing, use of citations, ability to form a logical argument, and proper APA Style, including the use of paraphrasing, will be evaluated as a measure of your interpersonal effectiveness. No response is required for "B".

Leadership, Consultation, and Ethics

Describe how you would work within a professional treatment team to consult, triage, and treat this case. Include a description of the various members of the professional team with whom you would be likely to interact. Additionally, explain the roles and responsibilities of each member of the treatment team.

What are the ethical and legal dilemmas this vignette introduced? What would be your immediate steps and why? Please be specific and make sure that you describe your process of ethical decision making and the solutions/consequences to which this process might lead.

Your discussion should be informed by the American Psychological Association's Ethics Code as well as the Specialty Guidelines for Forensic Psychologists.