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.
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.
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:
Psychological Theory and Practice
Legal Theory and Application
Research and Evaluation
Leadership, Consultation, and Ethics
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