Running head: CASE STUDY THREE 1
Case Study Three
Kirsten Lee Ann Sheridan
Liberty University
Case Study Three
CASE STUDY THREE 2
I. Key Issues
A. Mr. Boyle presented with many key issues which are reflected within this case study.
Below is a list of key issues presented and exhibited by Mr. Boyle. The key issues
listed below are organized by their significance of effect, seriousness, and
importance.
1. The initial and most significant key issue regarding Mr. Boyle and this
case study is his recent heated interaction with the school board. This presents
as the most significant key issue as it has put his job as principal in jeopardy.
Thus, potentially triggering loss of his career, income, marriage, family, et
cetera which could be further triggering his array of other emotions and
responses (i.e. his increasing irritability, aggression, suspicion, distrust,
control, and depression, difficulties and challenges, and substance use).
2. A second important key issue presented and exhibited by Mr. Boyle are
his responses. Mr. Boyle presents and exhibits concerning responses through
his reflected behaviors of difficulty in getting along with others where he has
recently become more aggressive through being more irritable and
argumentative with his wife, his peers, and his school’s staff and personnel,
and continued strict, distrustful and apprehensive interactions with his
children, always facing difficulties making friends and trusting others, always
having been a suspicious person which is increasing (paranoia surrounding the
idea that he believes the school board, school staff and personnel, and former
parents are conspiring against him), his self-centeredness and conceitedness
(egotistic through believing he deserves a raise, reflecting a sense of
CASE STUDY THREE 3
entitlement across his settings, and that everyone is simply jealous of him), his
recent escalation in drinking alcohol (substance use through binge drinking
and denial regarding this being an issue), and his recent and increasing
feelings of somberness, hopelessness, and helplessness. This is chosen as
secondary key issues as Mr. Boyle’s responses are significantly impacting and
affecting his entire life, and those in it, and will continue to if not intervened
promptly and addressed accordingly.
3. Thirdly as an important key issue, Mr. Boyle’s marriage is at risk for
divorce, as his wife shared to him that she will leave him based on his
difficulties and challenges interacting with others. This is chosen as an
important key issue as it could be triggering other issues and responses
presented and exhibited by Mr. Boyle and could also produce further concerns
and matters for Mr. Boyle, his life, family, career, et cetera.
4. A final significant key issue to consider is that of Mr. Boyle’s potential
exposure to trauma as he reported he came from a very poor family. This is
chosen as an important key issue as it has been affecting and impacting his
entire life which he reinforced, and may continue to, negatively, if support is
not provided and the potential trauma addressed accordingly.
B. The shared list above regarding Mr. Boyle’s key issues presenting in this case study
are listed and organized, as shared, based on their significance of effect, seriousness,
and importance. These are also organized because of how they are affecting his
mental and physical health, and if supported and addressed accordingly and in order,
successful and satisfactory treatment outcomes can be achieved. With that, the first
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key issue needs to be addressed immediately as this is essentially triggering and will
continue to trigger further regressive responses and outcomes for Mr. Boyle and his
life (family, career, mental and physical health, et cetera). To approach this and
prevent further altercations and escalations, intervening here and addressing this issue
initially could assist in a successful outcome for Mr. Boyle and his life (family, career,
mental and physical health, et cetera) through receiving appropriate treatment (i.e.
psychotherapy). Secondly, the second key issue then needs to be addressed as Mr.
Boyle’s responses are also regressing and significantly impacting and affecting
impacting his life (family, career, mental and physical health, et cetera) and will
continue to without receiving appropriate treatment to assist in achieving a successful
outcome. To address Mr. Boyle’s escalating and regressing responses and behaviors,
appropriate objectives, strategies, and interventions need to be implemented to
stabilize him through the provision of and engagement in appropriate treatment (i.e.
identifying with, practicing, and acknowledging healthy social skills, coping
mechanisms, grounding skills, reality versus nonreality, parenting strategies, et
cetera) which could assist him in achieving a successful outcome. Following this, Mr.
Boyle’s third presenting key issue needs to be addressed to assist him in saving his
marriage and preventing divorce as the loss of his wife and children to an extent (for
example, weekend visitations), whom present as natural supports in his life, and the
effects from divorce could further prompt other significant, regressive responses and
life experiences. To achieve a successful outcome regarding this key issue and to
prevent further regressive responses and life experiences for Mr. Boyle and his
family, interventions and treatment approaches such as engaging in family therapy
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could assist with this key issue. In doing so, a potential satisfactory outcome could
present through helping the healing process of Mr. Boyle, his family, and his life.
Lastly, the fourth presenting key issue that needs to be addressed is Mr. Boyle’s
potential exposure to trauma when he was growing up. This presents with importance
and significance and should be addressed it in doing so, could assist in Mr. Boyle in
addressing his past, preventing future regressive responses, and changing some of his
responses and behaviors he presents and exhibits now (and has throughout his life).
To achieve a satisfactory outcome regarding this key issue, further intervention and
treatment should be put into action once Mr. Boyle’s other key issues have been
efficiently and effectively addressed. While his potential exposure to trauma may
reflect and be causation for Mr. Boyle’s responses throughout his entire life, the most
recent increasing, regressive responses need to be addressed first and Mr. Boyle
stabilized before uncovering his potential exposure to trauma. In doing so and being
mindful of this, a successful treatment outcome could be achieved while also through
the engagement and implementation of further psychotherapy.
II. Diagnostic Impressions
A. Based on the content presented in this case study regarding Mr. Boyle’s key issues
and responses as well as information provided within and according to the the DSM-5
manual, Mr. Boyle’s exhibited and presented key issues and responses should be
associated with the DSM-5 (2013) category of “Personality Disorders.” In further
considering this category and the criteria associated with it according to the DSM-5, it
would then present as appropriate to diagnosis Mr. Boyle with “Paranoid Personality
Disorder (301.0/F60.0) which is under “Cluster A Personality Disorders” (APA, 2013,
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p. 649). This diagnosis presents as the most appropriate diagnosis for Mr. Boyle as he
exhibits and meets all the diagnostic criterion associated with this disorder (A. and
B.). Further regarding criteria associated with this disorder and according to the
DSM-5 (2013), paranoid personality disorder exhibits suspicious and distrustful
patterning behaviors in response to one’s personal perception that other individuals
behaviors and responses are malicious, vengeful, and bad-natured which are present
and exhibited throughout this case study and by Mr. Boyle. With that and according to
the DSM-5 manual (2013), Mr. Boyle meets criteria section “A.” associated with this
disorder as he exhibits and has exhibited seven out of the seven responses in the
section through his presenting, recurrent and on-going, and escalating suspicions,
distrust, malignant perception of others and preoccupation with this, lack of genuinely
confiding in others, feeling threatened and belittled, holding of grudges, false
perceptions of attack on his character from others, and aggressive responses while he
also meets the criteria in section “B.” as his responses do not only occur concurrently
throughout the duration of other disorders such as depressive, schizophrenia or
bipolar with features of psychosis, or other psychotic disorders, and cannot be
associated with any other medical conditions and their accouterments of physiology.
While this presents as the most appropriate diagnosis and disorder regarding Mr.
Boyle, differential and other diagnoses and disorders were considered. Differential
diagnoses that were examined throughout this category were “other mental disorders
with psychotic symptoms, personality change due to another medical condition,
substance use disorders, paranoid traits associated with physical handicaps, and other
CASE STUDY THREE 7
personality disorders and personality traits” (APA, 2013). These differential disorders
were, however, ruled out as Mr. Boyle does not present with any other mental
disorders with psychotic symptoms, does not have another medical condition that was
made aware, began substance use after his experiences and responses, does not have a
handicap that can be linked to his paranoia that was disclosed, and does not have or
meet the criteria for any other personality disorders or traits. Also, an “other”
diagnosis and disorder that was also investigated was that of “Narcissistic Personality
Disorder (301.81/F60.81)” (APA, 2013) disorder based on Mr. Boyle’s responses of
grandiosity regarding his successes. However, this did not present as the most
appropriate diagnosis and disorder when considering all Mr. Boyle’s responses in
totality and especially his reflection on how he could be overreacting and at fault for
some of the presenting issues. This leaves paranoid personality disorder as the most
appropriate diagnosis and disorder for Mr. Boyle.
B. As shared above, differential and other disorders were considered yet also eliminated.
This is because currently it seems that only paranoid personality disorder is the most
appropriate diagnosis for Mr. Boyle.
III. Treatment Recommendations
A. In further considering this case study and Mr. Boyle and his disorder and diagnosis,
appropriate treatment recommendations should surround implementation of
applicable objectives, strategies, and interventions to assist Mr. Boyle in becoming
suitably stabilized, mindful, social, and healthful. For Mr. Boyle to successfully and
satisfactory achieve these able-bodied responses, treatment recommendations should
further consist of these goals; Mr. Boyle will identify with his paranoid responses to
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assist him in exhibiting stabilization, Mr. Boyle will learn and exhibit mindfulness,
Mr. Boyle will learn and practice appropriate social skills, and Mr. Boyle will learn
and practice healthy coping mechanisms. For Mr. Boyle to ultimately achieve these
goals through the implementation of effective objectives, strategies, and
interventions, these treatment recommendations should also consist of psychological,
biological, social, and spiritual approaches. Based on that, the following treatment
recommendations and approaches should be implemented in the following order;
1. A recommended psychological treatment approach for Mr. Boyle presents
as an initial approach as according to Kring and Johnson (2018),
psychotherapy is the treatment of choice for personality disorders as
psychotherapy can elicit changes in personality. This would be significantly
beneficial for Mr. Boyle and in becoming stabilized, mindful, social, and
healthier through identifying with and changing his responses.
2. A second recommended treatment approach for Mr. Boyle would be a
biological approach as medication management could potentially assist him in
also becoming stabilized, mindful, social, and healthier through identifying
with, addressing, and changing his responses. This approach and
recommendation is supported as according to Kring and Johnson (2018),
medication management is often implemented on top of engagement and
participation in psychotherapy to further assist in successful treatment
outcomes. Kring and Johnson (2018) further share that medications such as
antidepressants can be prescribed to assist in treating some of the symptoms
associated with personality disorders such as those from depression which
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could be beneficial for Mr. Boyle as he is exhibiting and presenting with some
sullenness, hopelessness, helplessness, loss of interest, isolation, impulsivity,
irritability, and aggression.
3. A third treatment recommendation and approach would be that of a social
approach. An appropriate social treatment approach for Mr. Boyle would be
joining and engaging in a psychotherapy group for individuals with paranoia
personality disorder and/or personal disorders in general. This would be
beneficial and significantly impacting for Mr. Boyle as it would assist him in
becoming stabilized, mindful, social, and healthier as according to Gladding
and his textbook titled “Groups; A Counseling Specialty” (2016), these types
of groups address “personal and interpersonal problems of living…among
people who may be experiencing severe and/or chronic maladjustment
(ASGW, 2000, p. 331),” and support and assist individuals whom have
exhibited psychological issues for a considerable amount of time through
confronting them with “their unconscious conflicts so they can be resolved
(Lev-Wiesel, 2003, p. 240).” Such an approach presents as befitting for Mr.
Boyle as he presents and exhibits key issues and responses that would be
impacted by constructively through this therapeutic treatment
recommendation and approach.
4. A last treatment recommendation and approach that presents is a spiritual
approach. A recommended spiritual treatment approach for Mr. Boyle and to
assist him in satisfactorily and successfully further achieving stability,
mindfulness, appropriate social skills, and health, is that of receiving and
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engaging in Christian counseling. In doing so and according to McMinn and
his textbook “Psychology, Theology, and Spirituality in Christian Counseling”
(2011), Mr. Boyle can identify with his spiritual and psychological health
through further identifying with his self-sufficiency and accurate awareness of
self versus his faulty sense of self and that of self-absorption, self-hate, and
lack of self-restraint, his brokenness and accurate awareness of need in
comparison to his faulty awareness of need and that of playing the victim role
and exhibiting bitterness, helplessness, and cynicism, and a healing
relationship for him and what that looks like versus faulty, unhealthy relations
such as exploiting, depending, and splitting (all similar key issues presented in
this case study and exhibited by Mr. Boyle). If Mr. Boyle considers these
spiritual and psychological aspects according to McMinn (2011), he can
further identify with his sense of self more healthily and recognize his
responsibility to God, others, and himself. Thus, further assisting Mr. Boyle in
achieving stability, mindfulness, appropriate social skills, and health through a
theological approach.
B. Based on Mr. Boyle’s presenting and exhibited key issues and responses, disorder and
diagnosis, and shared treatment recommendations and approaches, improvements will
be evidenced by his satisfactory achievements and successful outcomes regarding his
goals through his ability to accomplish apt stable, mindful, social, and healthy
responses and skills. These will be further reflected through and evidenced by his
commitment, dedication, and continuous effective engagement and participation in
therapeutic settings (i.e. psychotherapy, Christian counseling, group therapy, et
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cetera), commitment to potential medication management, practice of appropriate and
healthy mindfulness, social, and coping skills across his settings, and identification
and recognition of his potential spiritual bond.
References
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American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders:
DSM-5 (5th ed.). Arlington, VA: American Psychiatric Association Publishing.
Association for Specialists in Group Work (2000). Professional standards for the training of
group workers. Journal for Specialists in Group Work, 25, 327-342.
Gladding, Samuel, T. (2016). Groups: A counseling specialty (7th ed.). United States of America:
Pearson Education, Inc..
Kring, A.M., & Johnson, S.L. (2018). Abnormal psychology: The science and treatment of
psychological disorders (14th ed.). Hoboken, NJ: John Wiley & Sons.
Lev-Wiesel, R. (2003). The group stories fabric technique (GSFT): A clinical tool for
understanding transference issues in group psychotherapy. Journal for Specialists in
Group Work, 28, 227-243.
McMinn, M. (2011). Psychology, theology, and spirituality in Christian counseling. Carol
Stream, IL: Tyndale House Publishers, Inc.
