Reference no: EM133868195

Case Vignette

Robert. 42 years old, has a long history of antisocial behavior and difficulty getting along with others. His verbally and physically abusive father was an alcoholic. Robert had many problems in school and had to repeat fourth grade. When he was 11 years old, the courts ordered Robert to spend time in a closed-custody facility for juveniles because his parents could not provide required supervision. Anger and hatred quickly replaced initial feelings of loss. Reports indicate that Robert had a 'short fuse" and responded to others with physical aggression. On release from the juvenile facility, Robert stopped all communication with relatives and felt satisfied that he was inflicting his pain and loss on them. He moved among foster homes, primarily because of his acting-out behavior.

School problems continued: eventually, he ran away to a large city far from home. With no education or job skills, he quickly became involved in robbery, drugs, and prostitution. He blamed the world for his problems. lashing out at those who tried to get close to him. He experienced great sadness but could not cry. In his late teens, Robert was part of an experimental treatment group after an involuntary admission to a psychiatric facility. The material presented was beyond his level of comprehension. A controlling coping style soon replaced his feelings of powerlessness. After treatment, Robert further isolated himself. He began heavy use of alcohol and drugs to self-medicate depressive symptoms. His thoughts became increasingly irrational, and he believed that the only way to deal with his feelings was to hurt others before they could hurt him. By 20 years of age, Robert's interpersonal difficulties, coupled with serious substance abuse, culminated in an indefinite sentence for a murder of which he had no recollection. Initially, he had no feelings about serving time.

Two years passed before he began to question his future and despise his situation. He made numerous suicide and self-mutilation attempts. He lived one day at a time; his formula for success was morphine and opiates. He sold drugs to make money in prison. He usually was "high" on something, which gave him a temporary sense of control over his emotions and environment. Robert began to realize that he had feelings of depression and turned to the health care center for prescribed antidepressants. When medication failed to solve all his problems," he turned to illicit substances for a temporary fix. He was in a vicious cycle of drugs, depression, and detoxification. After 20 years in prison, Robert states he has matured and is ready to lead a prosocial lifestyle. He has entered a specialized treatment program designed to deal with dual diagnoses and is beginning to deal with some of the feelings he has ignored for most of his life. He states that he will never be able to forgive himself for what he has done to himself and those around him. particularly the victim of his crime.

Reflection and Critical Thinking

• What do you think is Robert's most immediate problem?

• In counseling Robert, what issues or problems might the therapist encounter?

• What factors make the care of this client different from that of other clients with depression?

Reference.

Psychiatric- mental health nursing. Wanda K Mohr 8th edition