1. BIOPSYCHOSOCIAL ASSESSMENT
DATE(S) OF ASSESSMENT: 09/10/2011
DATE REPORT WRITTEN: 09/13/2011
NAME : Michael “Sonny” Corinthos, Jr.
DOB : 04/21/1965 AGE: 46
MARITAL STATUS: Divorced
OCCUPATION: Mob Boss
RESIDENCE/LIVING CIRCUMSTANCES: Lives alone in an estate home known as Greystone
ADDRESS: 410 Greystone Drive, Port Charles, NY 12201
PHONE: (315) 555-2138
SOCIAL SECURITY : 981-67-0048
REFERRAL SOURCE: Dr. Robin Scorpio-Drake
PRIMARY CARE MD: None
REASON FOR REFERRAL
Dr. Scorpio-Drake found the client in his bedroom (which he physically destroyed) in a depressed
mood following the end of his marriage to Brenda Corinthos in August 2011. Dr. Scorpio-Drake
found client’s prescription for Lithium, which client admitted to her he has not taken for the past
Client sought therapy at the urging of his family and friends due to a major depressive episode
within the past month that was triggered by the failure of his most recent divorce and
noncompliance with lithium carbonate over the past three months. Client stated his latest
episode resulted in mood swings which consisted of depressed mood, violent behavior,
diminished pleasure in almost all activities, insomnia, and decreased appetite. Client denied any
suicidal ideation. Client began taking lithium carbonate a week ago and feels much better, but
wanted to talk about his last episode because he wants to be the best he can be for his children.
When asked to describe his last episode he stated, “Feels like you’re falling into a bottomless pit.
You can’t get out and you destroy everything and everyone you love. And I will very much like
it to stop.”
HISTORY OF PRESENT ILLNESS
Client reported no experience of the presenting problem during childhood or adolescence. He
recalled three prior episodes of what he termed “breakdowns” in 1999, 2003, and 2006. Client
described these breakdowns as follows: “There’s darkness inside of me, a place that has no
bottom. If hell is absence of God, then this place is the absence of light. I know it’s there
because I try to avoid it. I try to ignore it, but it’s pulled me in three times. It’s like being in a
nightmare and not being able to wake up.” Medical records indicate in 2006 he also engaged in
hypomanic behavior, as evidenced by the description of bizarre behavior which included a
spontaneous and uncharacteristic purchase of a very expensive automobile (client does not drive).
2. Client was not diagnosed with Bipolar II Disorder until 2006 by Dr. Laney Winters. At the time,
client treatment plan consisted of lithium bicarbonate and weekly psychotherapy.
Mr. Corinthos leads a criminal organization and is referred to as a mob boss. He admits to
engaging in unlawful behavior as early as 15 or 16 years of age, but in spite of his criminal
history which spans across his life and evidence to the contrary, he insists that his only line of
business is that of a coffee importer. This is not a sign of delusional thinking, but a way of
protecting himself from criminal prosecution. He has been involved in murders, money
laundering, extortion, assaults, and various other crimes for which he has never been convicted.
When asked to describe what his future looks like Mr. Corinthos states he is unable to consider
any long term plans because of the nature of his business and lives one day at a time. This type
of thinking leads him to live in the moment, thus not taking the time to contemplate the
consequences of his actions. Those close to him report he is prone to aggressive behavior when
things do not go his way and they spend a lot of time trying to manage his anger. It is also
reported that he is known to blow any perceived slight out of proportion and sees it as an act of
betrayal, disloyalty, or disrespect for which retaliation can be dealt in a range of manipulative or
aggressive behavior ranging from emotional cutoff to murder. He believes that he would not
have to engage in violence if people did not make him do so. Friends and family report that he
does his best to keep them safe from others, but that they often feel that Mr. Corinthos poses the
greatest risk to their safety and his own because he will often do things to upset the peace
between himself and other crime families without thinking about the repercussions.
SIGNIFICANT MEDICAL HISTORY
Surgeries: Gunshot wound (1994): Shot while helping to break someone out of jail; Gunshot
wound (Dec. 2000): shot outside the police station; Stabbed (June 2001)- by a rival mobster;
Gunshot wound (Dec. 2003): shot by police; Gunshot wound (Jan. 2012): shot by an unknown
Significant medical issues that required treatment longer than two weeks: Encephalitis (Feb.
2006): contracted during an outbreak that hit Port Charles, NY.
Physical/Occupational/Speech Therapy: None found in medical records or via self-report
Current (medical, physical, psychiatric): lithium carbonate 600mg 2x day (oral), prescribed by
Dr. Laney Winters in June 2009 to treat Bipolar Disorder. Became noncompliant in May 2011
and has been compliant since August, 28, 2011.
Past (medical, physical, psychiatric): lithium carbonate 800mg 2x day (oral), prescribed by Dr.
Laney Winters (2006- 2009) to treat Bipolar Disorder; acyclovir 10mg (IV) every 8 hours for 21
days prescribed by Dr. Monica Quartermaine (2006) to treat encephalitis.
BORN & RAISED: Brooklyn, NY
PARENTS: Adele Corinthos Woods, mother-deceased at age 40 (2/14/1944 - 7/21/1984). Mr.
Corinthos was born to his mother at 21 years of age out of wedlock and was primarily a single
parent until she wed Deke Woods in 1973. Mrs. Woods was a homemaker and was described as
loving, caring, and nurturing. Mr. Corinthos stated she was not much of a disciplinarian, but
taught him to respect women. Mr. Corinthos was 19 years old at the time of his mother’s death.
Although Mrs. Woods died from sudden cardiac arrest, Mr. Corinthos blames his step-father,
Deke Woods for her death even though he predeceased her by two years. He often felt like he let
his mother down because he was a trouble maker and was unable to protect her from his
physically abusive and alcoholic step-father. Mr. Corinthos vowed to never physically abuse a
woman because his mother was the victim of domestic violence by his step-father.
Mike Corbin, father, living, age 69 (8/9/1942-). Mr. Corbin was 23 years old at the time of Mr.
Corinthos’ birth. Mr. Corbin co-parented with Mr. Corinthos’ mother for approximately three
years before abandoning them both. He periodically appeared in Mr. Corinthos’ childhood, but
was never really a father figure to Mr. Corinthos. Mr. Corbin has been struggling with gambling
addiction for over 30 years. He and Mr. Corinthos reported they have mended their relationship
and keep in touch.
Deke Woods, step-father, deceased at age 45, (9/3/1939- 11/30/1982). Mr. Corinthos’ step-father
was a police officer and described as living a double life. Mr. Corinthos stated his step-father
appeared to be well respected by those in his neighborhood, but at home he was an emotionally
and physically abusive alcoholic towards the client and his mother. Mr. Corinthos stated that
although he was just a kid, he believed that his step-father had nothing but hatred for him and his
mother. He was 17 years old at the time of his step-father’s death. He stated the world is a better
place without this “monster”. Mr. Woods was murdered as the result of a mob hit by Joe Scully,
the mob boss who became Mr. Corinthos’ mentor. Mr. Corinthos told Mr. Scully about the abuse
he and his mother suffered at the hands of Mr. Woods and he was found murdered the next day
from two gunshot wounds, one in the head and one in the heart.
The client’s mental health during childhood was marked with abandonment by his biological
father and witnessing and being a victim of domestic violence at the hands of his step-father. Mr.
Corinthos reported his step-father would often lock him in a closet as a form of discipline and as
such, he has developed claustrophobia, for which he has never sought treatment. He also
reported a disdain for police officers because his step-father was one and believes them to be
dishonest and untrustworthy. Mr. Corinthos suffered numerous beatings by his step-father and
recalled having bruises that lasted for weeks and black eyes, but reported he was never seen by a
doctor. During his teen years Mr. Corinthos began to fight back against his step-father and
fearing for her son’s safety, his mother asked him to leave home at age 16. His mother never left
his step-father and he continued to physically and emotionally abuse her until his death.
Lily Rivera (Married 01/2000; dissolved by her death 04/2000)
Caroline “Carly” Corinthos Jacks (Married Sept. 2000; Divorced 11/2000)
Caroline “Carly” Corinthos Jacks (Married Feb. 2001; Divorced 08/2001)
4. Caroline “Carly” Corinthos Jacks (Married 03/2002; Divorced 02/2003)
Caroline “Carly” Corinthos Jacks (Married 01/2007; Divorced 04/2007)
Claudia Zacchara (Married 12/2008; Dissolved by her death 11/2009)
Brenda Barrett (Married 02/2011; Divorced 08/2011)
CHILDREN (NATURAL & ADOPTED)
Dante Falconeri (son)
Michael Corinthos, III (adopted son)
Kristina Davis (daughter)
Morgan Stone Corinthos (son)
Unnamed son (deceased in utero)
Unnamed son (miscarried)
Baby girl McCall (miscarried)
Unborn child (miscarried)
EDUCATION: Mr. Corinthos attended St. Anne’s Catholic School in Brooklyn, NY from
kindergarten until 8th
grade. He then attended St. Francis of Assisi School in Brooklyn, NY
until he dropped out of school at age 16.
OCCUPATION: Mr. Corinthos has been involved in the mafia since age 16 and currently heads
one of the five crime families on the U.S. east coast. He also owns a coffee shop and an Italian
MILITARY SERVICE: None
LEGAL/CRIMINAL HISTORY: Mr. Corinthos has been involved a very long list of crimes for
which he has orchestrated or directly committed himself however, he has never been convicted of
any. He is suspected of numerous murders or attempts, use of explosive devices, and RICO
violations. His known criminal history follows:
• Put out a hit that resulted in the death of Lieutenant Poletti
• Put out a hit on Jagger Cates (1993)
• Shot and killed Scully, the man who had befriended him as a teenager and had Sonny's
stepfather killed (1995)
• Broke Brenda out of jail when she was arrested for murdering Pierce Dorman (1997)
• Arrested by the FBI for racketeering (09/1999)
• Blackmailed A.J. into giving Carly a divorce (03/2000)
• Arrested by the FBI when Carly and Roy DiLucca set him up (04/2001)
• Helped fugitive Angel Ellis skip town (10/2001)
5. • Arrested for locking Skye Quartermaine in a boathouse; not guilty (03/2002)
• Faked his death to flush out Luis Alcazar; later shot him after Alcazar found Brenda and
Jax at her old cottage (09/2002)
• Shot both Lorenzo Alcazar and Carly Corinthos (10/2003)
• Held a gun up to Faith Rosco's neck (10/2003)
• Attempted murder; tried to shoot and kill Lorenzo Alcazar (11/ 2003)
• Kidnapped Samantha McCall (11/2003)
• Shot and killed Ben Rogers to protect Sam (01/ 2004)
• Sent Jason to kill Brian Beck (02/2004)
• Held Brian at gunpoint (02/ 2004)
• Killed the assassin who planted the explosive in his limo (04/2004)
• Arrested for racketeering (11/2004)
• Ordered Jason to kill Lorenzo Alcazar (2007)
• False imprisonment; kidnapped Johnny Zacchara and held him prisoner in an abandoned
mental hospital (03/2008)
• Shot Dante Falconeri, a police officer who he learned is his son (01/2010)
• Set a bomb off in Johnny Zacchara's car, nearly killing his daughter, Kristina (2010)
• Shot Johnny Zacchara in self-defense; crooked cop made it look like murder attempt
• Jumped bail and went to Rome (08/2010)
• Drugged Jasper Jax and then called the police to arrest him to use as evidence against Jax
in a custody with Carly Corinthos Jax (07/2011)
• Shot his friend Dr. Robin Scorpio-Drake in her home, his intended target was Jasper Jax
• Attempted to murder Jasper Jax by tampering with his plane which resulted in a plane
COGNITIVE IMPAIRMENTS: none
PSYCHOTIC SYMPTOMS: Mr. Corinthos reported previous auditory and visual hallucinations
of his dead wife Lily on several occasions during depressed episodes.
DISSOCIATIVE PROBLEMS: none
IRRATIONAL ANXIETY: Mr. Corinthos reported he experiences anxiety when confined in
small spaces such as a jail cell and because of this, vows never to be imprisoned for his crimes.
He has claustrophobia that stems from being locked in a closet by his step-father when he was a
UNUSUAL FEARS: Fear of being confined in small spaces
REPETITIVE THOUGHTS OR ACTIONS: none
6. AVOIDANCE: none
INCREASED AROUSAL: none
HYPER VIGILANCE: Mr. Corinthos lives in a constant state of hyper vigilance due to the fact
that he is a mob boss and is vulnerable to attack at any moment from other criminals or
apprehension by law enforcement.
FLASHBACKS: The client has experienced flashbacks throughout most of his life. His
flashbacks center around two traumatic events in his life: the domestic physical and emotional
abuse of he and his mother and the death of a previous wife, Lily, who was pregnant with his
child at the time she was murdered by a car bomb that was intended for him.
MOOD PROBLEMS/CHANGES: As indicated earlier, Mr. Corinthos was diagnosed with
Bipolar Disorder in 2006. He exhibits mood changes that are characteristic of this diagnosis.
Most recent episode was depressed.
SLEEPING PROBLEMS: The client has experienced an inability to sleep uninterrupted
throughout the night.
EATING PROBLEMS: The client experienced decreased appetite when in a depressed mood.
PROBLEMS WITH IMPULSE CONTROL: Mr. Corinthos’ past is riddled with instances of
problems associated with impulse control. He rarely delays self-gratification and is more prone
to act on emotions than rational thinking. His lack of impulse control often leads to conflicts
with those he loves most or puts them in harm’s way. For example, he planted a car bomb in
Johnny Zacharra’s car which instead almost killed the client’s daughter, Kristina. Any perceived
slight or disloyalty in his eyes is met with vengeance with no chance of him thinking things
through or considering the fallout if he is wrong about his assumptions. In August 2011, his false
assumption that his wife, Brenda, left him to be with his romantic rival, Jasper Jax, led the client
to attempt to kill Mr. Jax. Both attempts failed, but one attempt resulted in the client shooting
one of his good friends in the arm. Despite evidence to the contrary, Mr. Corinthos refuses to
believe that Mr. Jax had nothing to do with his wife leaving him.
PHYSICAL COMPLAINT ABOUT ILLNESS OR PAIN: none
ADJUSTMENT PROBLEMS: In the past three months, Mr. Corinthos’ marriage (his 7th
Brenda ended in divorce. Subsequent to learning his marriage was over, he experienced a
depressive episode that lasted for approximately one week. Symptoms consisted of depressed
mood, violent behavior, diminished pleasure in almost all activities, insomnia, and decreased
appetite. He was unable to work and engage in social activities. He did not leave his residence
until near the end of his depressed mood at which time he left to attempt to kill Jasper Jax.
SUBSTANCE ABUSE HISTORY (Past/Present): Corinthos is a non-smoker who has an
occasional alcoholic drink or caffeinated beverage. He reported he rarely consumes alcohol to
the point of intoxication. He reported no illegal drug use or abuse of prescription medications.
7. The client denies any substance abuse history or dependence. No information to the contrary was
found from other parties or related records
ABUSE HISTORY: The client was a victim of domestic physical and emotional abuse by his
step-father when he was a child. In addition to beatings, he was repeatedly locked in a closet
EATING DISORDERS: Mr. Corinthos denies any past or present occurrence of eating disorders
or related symptoms.
SEXUAL HISTORY: Sexual problems/complaints: None
BEHAVIOR OBSERVATIONS: Mr. Corinthos is a 46 year old divorced, Hispanic male who is
approximately 5 feet 7 inches tall and medium build. He appears to be in good physical
condition, well groomed, and is dressed appropriately. The client sits in an upright posture
and exudes confidence. He expresses appropriate affect and mood until he discusses his
childhood abuse, at which time he smiles while abruptly ending conversation on this topic.
His speech was normal. He was cooperative except when asked to provide more details
about his childhood.
SLEEP PATTERNS: Approximately 6 hours per night, usually wakes up once per night
EATING: maintains a balanced diet with no intake of fast food.
ACTIVITIES OF DAILY LIVING: Client normally starts his day at 6:00 a.m. He exercises for
about an hour before he begins his day. Most of his day is spent managing his criminal activities
from his office at his Italian restaurant. He comes and goes as he pleases so he works as little or
as much as he desires. He is usually home around 10:00 p.m. each night.
MOTIVATION: The client wants to repair his relationships with his children.
ANXIETY: The client experiences anxiety when confined to small spaces.
IMPULSIVITY: The client has low impulse control. He lives in the moment and does what feels
good to him without considering the consequences.
RACING THOUGHTS: The client minimizes his responsibility for his own behavior with
statements such as: “If people were loyal or honest with me I wouldn’t have to do the things I
ATTENTION: The client was able to state his full name and displayed good short and long term
memory with no difficulty as he was able to recall the three words he was instructed to
CONCENTRATION: The client has no problem with his concentration. He was able to spell
his name, recite the days of the week, and the months of the year, all in order and then backwards.
MENTAL STATUS EXAM: The client is oriented x3. No further assessment deemed
8. COMPREHENSION (3 STEP COMMAND): The client was able to follow the three step
THOUGHT PROCESSES & CONTENT: The client’s thought processes and content are normal
SUICIDAL/HOMICIDAL -- SUICIDE ASSESSMENT SCALE: The client denies any current or
past suicidal ideation. He declined to comment on prior homicidal thoughts or acts, but states he
currently has no desire to kill anyone.
INSIGHT/JUDGEMENT: The client has good insight into the management of bipolar disorder,
but is unwilling to accept that a majority of the problems in his life are due to Antisocial
PERSONALITY FACTORS (REHABILITATION CASES): The client displays personality
issues that are characteristic of Antisocial Personality Disorder. As such, he has difficulty
maintaining personal relationships, obeying rules and laws, and has strained relationships with his
children. He shows little or no remorse for pain he inflicts on others and often blames the victim.
STRENGTHS: The client is willing to remain in compliance with his medication for Bipolar II
Disorder. He is amenable to therapy to help manage bipolar disorder symptoms and was
cooperative during the assessment.
LIMITATIONS: Mr. Corinthos refuses to accept a diagnosis of Antisocial Personality Disorder.
He insists that he is who he is and he will not change for anyone. When topics become
uncomfortable for him to discuss he tends to use his charm to change the subject or redirect
towards others. He also displays poor coping skills and he tends to act out in volatile and
destructive ways when stressed.
SUPPORT SYSTEMS: The client is estranged from three of his children and has strained
relationships with a couple of his friends and previous romantic partners. His support system is
inadequate at this time.
PROGNOSIS: Antisocial Personality Disorder has a chronic course and due to the
pervasiveness of personality disorders the client’s overall prognosis is poor. Mr. Corinthos
seems committed to complying with his medication for bipolar disorder and willing to meet
for psychotherapy. Since his depressed or hypomanic episodes are not rapid-cycling and he
is willing to seek treatment, the prognosis for this disorder is good. Since the occurrence of
symptoms related to claustrophobia is infrequent and the client is able to live relatively
symptom free, the prognosis for this disorder is good.
PATIENT CONCERN’S/GOALS: The client wants to be a better father to his children and
repair their relationships. He states he does not want to be sucked into what he calls the “dark
place” and will do whatever it takes to prevent this from happening again.
DSM IV-TR IMPRESSIONS
AXIS I- 296.89 Bipolar II Disorder, Depressed, Severe without Psychotic Features
300.29 Specific Phobia, Situational Type
AXIS II- 301.7 Antisocial Personality Disorder
9. AXIS III- None
AXIS IV- Inadequate social support, disruption of family by divorce, childhood
physical abuse, poor relationships
AXIS V- GAF= 57
Mr. Corinthos meets the following diagnostic criteria for Bipolar II Disorder: A) presence or
history of one of more Major Depressive Episodes, B) presence or history of at least one
Hypomanic Episode, C) there has never been a Manic Episode, and D) the symptoms in A and B
are not better accounted for by Schizoaffective Disorder and are not superimposed on
Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not
Otherwise Specified. The criteria for a Major Depressive Episode was met by the following
symptoms which endured for at least two weeks: (1) depressed mood most of the day, nearly
every day, (2) markedly diminished interest or pleasure in all, or almost all, activities most of the
day, nearly every day, (3) decrease in appetite nearly every day, (4) insomnia, and (8) diminished
ability to think or concentrate, or indecisiveness, nearly every day. Mr. Corinthos previously
experienced Hypomanic Episodes which were characterized by the following diagnostic criteria:
A) at least four days of persistently elevated, expansive or irritable mood, B: (2) decreased need
for sleep, (4) flight of ideas, (6) increase in goal-directed activity and (7) excessive involvement
in pleasurable activities that have a high potential for painful consequences.
Although Mr. Corinthos came in to discuss his Depressed Episode, he also meets the diagnostic
criteria for Antisocial Personality Disorder: (1) failure to conform to social norms with respect to
lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest, (3)
impulsivity or failure to plan ahead, (4) irritability and aggressiveness, as indicated by repeated
physical fights or assaults, (5) reckless disregard for safety of self or others, and (7) lack of
remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen
from another. Although Mr. Corinthos recently experienced a Depressed Episode, of more
concern is his reckless and dangerous behavior due to Antisocial Personality Disorder that
persists unchecked. It appears that the age of onset of the Antisocial Personality Disorder
occurred during adolescence, as evidenced by his criminal activities which began about age 15.
Mr. Corinthos refuses to accept this diagnosis and claims that he lives in a world where
ruthlessness is necessary for survival. Recently, his wife left him because he used illegal drugs to
drug his rival, Jasper Jax so that Mr. Jax could lose custody of his daughter. When that plot
failed, he vowed to kill Mr. Jax and accidentally shot Dr. Robin Scorpio-Drake, the client’s good
friend, instead. Subsequently, he arranged for the mechanical malfunction of Mr. Jax’s plane, but
Mr. Jax survived the plane crash. This is just one example of the client’s reckless, violent, and
impulsive behavior. Although not convicted of any crimes, Mr. Corinthos is a mob boss who is
suspected of various RICO (Racketeer Influenced Corrupt Organization) violations, murders
(committed by himself or arranged), assaults with and without deadly weapons, tampering with
evidence, extortion, and other crimes. He shows little or no remorse for hurting those who get in
his way and he impulsively pursues what he wants, no matter who suffers the consequences, even
his own children. He refuses to leave the mob life despite several pleas from his children,
friends, and spouses/romantic partners. He states he loves the power, money, and respect that
come with being a mob boss. He has been married seven times and each has ended because of
the murder of his spouse, which was directly related to his criminal activities, or because he
perceives any slight as disloyal, dishonest, or disrespectful. The differential diagnosis of
Narcissistic Personality Disorder was not made because the client displays aggression,
10. impulsivity, and criminal behavior, which are not components of Narcissistic Personality
The diagnostic criteria are also met for Specific Phobia, Situational Type because of Mr.
Corinthos’ admission that he suffers from Claustrophobia. He experiences: A) marked and
persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific
object or situation (being enclosed), B) exposure to the phobic stimulus provokes an immediate
anxiety response, which may take the form of a situationally bound or situationally predisposed
Panic Attack, C) the person recognizes that the fear is excessive or unreasonable, D) the phobic
situation(s) is avoided or else is endured with intense anxiety or distress, and E) the avoidance,
anxious anticipation, or distress in the feared situation(s) interferes significantly with the person’s
normal routine, occupational (or academic) functioning, or social activities or relationships, or
there is marked distress about having the phobia. Mr. Corinthos admits to being claustrophobic
as a direct result of being locked in a closet as punishment during his childhood. A diagnosis of
Panic Disorder with Agoraphobia was not made because it is characterized by unexpected Panic
Attacks and avoidance of several situations that are likely the triggers. The client is aware that
his anxiety is triggered when he is involuntarily confined to small spaces.
BEHAVIORAL DEFINITIONS & TREATMENT PLAN
1. Symptom: Frequent and impulsive anger and violent behavior
Goal A: Cooperate with a medical evaluation to assess possible medical conditions which may
contribute to poor anger control.
Intervention 1: Refer the client to a physician for a complete physical exam
Intervention 2: Review the client's medical history for possible organic causes of poor anger
Intervention 3: If necessary, refer client to physician for prescription for medication to control
Goal B: Identify situations, thoughts, and feeling that trigger anger and violence and the targets of
Intervention 1: Thoroughly assess the various stimuli (people, thoughts, situations) that trigger
the client's anger and the thoughts, emotions, and behaviors that characterize his responses.
Homework: Keep an anger journal where the client documents situations that trigger automatic
thoughts and reactions of anger or violence.
Intervention 2: Help the client realize he is angry by reviewing the frequency and triggers of
anger and violence.
Goal C: Decrease the frequency, intensity, and duration of angry feelings and violent behavior,
while increasing the use of new skills for managing anger.
Intervention 1: Explore the client's self-talk that regulates angry feelings and actions. Identify
and challenge biases and create new self-talk that creates a flexible and temperate response to
Intervention 2: Teach the client thought stopping and calming techniques as part of strategy for
responding appropriately to angry feelings in daily life. When processing the results of these
techniques, reinforce success and redirect failure.
Intervention 3: Teach the client conflict resolution skills via modeling, role-playing, and behavior
Intervention 4: Encourage the client to discuss his anger management goals with people he trusts
and who will support his desire to change.
11. Goal D: Verbalize an understanding of how childhood experiences of pain have led to an
imitative pattern of self-focused protection and aggression toward others.
Intervention 1: Explore the client's history of physical and emotional abuse and explain how the
pattern is repeating in the client's behavior.
Intervention 2: Assist the client in realizing that his pattern of self-focused behavior is related to a
dysfunctional cognitive schema that was developed in an attempt to protect him from pain.
Intervention 3: Teach the client the value of forgiveness of those who hurt him versus holding on
to hurt and rage and using it as an excuse to engage in antisocial behavior.
2. Symptom: Failure to comply with prescribed medication
Goal: Comply with the medication regimen, reporting any side effects or problems to physician
Intervention 1: Get the client to commit to taking the prescribed psychotropic medication
(lithium) as directed by his physician for treatment of Bipolar II Disorder
Intervention 2: With the client's informed consent, contact the treating physician to monitor
Intervention 3: Explore and address the client's fears, misconceptions, and situational factors that
interfere with medication compliance.
3. Symptom: Low level of social functioning in interpersonal relationships
Goal A: Acknowledge a pattern of self-centeredness in most relationships
Intervention 1: Confront the client's lack of sensitivity to the needs and feelings of others
Intervention 2: Assist the client in identifying those he hurt by his behavior
Intervention 3: Assist the client in identifying instances of arbitrary inference (drawing
conclusions with no supporting evidence or when there is evidence to the contrary)
Goal B: Attempt to repair damaged relationships by making amends for pain the client has
Intervention 1: Use role reversal to sensitize the client to his lack of empathy for others by
examining the consequences of his actions.
Intervention 2: Encourage the client to take specific steps to apologize and make amends to those
who have suffered from his hurtful behavior, such as writing letters of apology.
Intervention 3: Ask the client to make a list of thoughts, attitudes, and behaviors that must be
modified in order to decrease interpersonal conflicts and replace them with ones that will increase
4. Symptom: Consistent pattern of blaming others for what happens to him
Goal: Increase statements of accepting responsibility for own behavior.
Intervention 1: Explore the client's faulty beliefs and reasons for blaming others
Intervention 1: Give positive feedback when the client takes responsibility for his behavior
Intervention 2: Confront the client when he blames others and fails to take responsibility for his
own behavior and emotions.
5. Symptom: Failure to conform to social norms with respect to lawful behaviors
Goal: Admit to illegal behavior that infringed upon the rights and feelings of others.
Intervention 1: Examine client's pattern of illegal behavior and confront his/her attempts to
minimize, rationalize, deny it, or blame others for it.
Intervention 2: Emphasize the negative consequences for engaging in unlawful behavior such as,
physical harm or death to self and those closest to him and risk of imprisonment.
12. The client's predominant cognitive schema seems to be, "I must hurt others before they hurt me."
The development of this schema can be traced back to the childhood physical and emotional
abuse received from his step-father. Fostering a therapeutic relationship centered on empathy,
care, and understanding is crucial to building trust with the client as he extremely guarded and
apprehensive about trusting new people who enter his life. Patterns of aggression, reckless
behavior, and violence that were reinforced throughout his life, beginning in childhood, can be
modified as the client becomes aware of his automatic thoughts and cognitive distortions and
implements techniques to change or reduce their frequency. The client must develop an
understanding of how others view and experience his antisocial behavior.
Psychotherapy twice a week for six months is recommended along with compliance with the
prescribed psychotropic medication.
Upon discharge, I recommend a follow-up session with the client once a month for six months or
whenever the client feels the need. Following this period, follow-up will occur once every three
months. For one week prior to the follow-up session I would like the client to keep an anger
journal so that I can assess how he is managing his behavior. I feel the pervasiveness and
seriousness of Antisocial Personality Disorder requires more frequent follow up to ensure
adherence to the treatment goals. I also recommend that the client seek family therapy with his
children to repair those relationships. The client should be evaluated by his physician every six
months for medication compliance and to determine the appropriate dosage to minimize any side
effects. It is also suggested that the client attend a psychotherapy group for victims of child
abuse, but the client is not willing to share those experiences with strangers at this time.
American Psychological Association, (2000). Diagnostic and Statistical Manual of Mental
Disorders. (4th Ed.) Washington, D.C.
Corey, G.(2009). Theory and Practice of Counseling and Psychotherapy. (8th Ed.) CA:
Corsini, Raymond J. and Wedding, Danny (2011). Current Psychotherapies. (9th Ed.) CA:
Jongsma, Jr., A. E., & Peterson, L. M. (2006). The Complete Adult Psychotherapy Treatment
Planner. T. J. Bruce (Ed.). (4th ed.). Hoboken, NJ: John Wiley & Sons, Inc.