​CASE CONCEPTUALIZATION AND TREATMENT PLAN: Jack

Name: Krista
Date​: 5.20.19

Identifying Information

Jack is a 45 year old realtor. He has two grown children and two step children. The woman he is
married to is his second wife. His first wife is bitter towards him and so is his son from that
marriage. His current wife, Suzanne, discovered he was having an affair with a woman from
work. After the discovery of the affair Jack withdrew a large amount of money from their joint
bank account. He does not show much remorse for either the affair or the withdrawal. He says he
has not been able to sleep after the discovery of the affair and wants to avoid a second divorce.
Though he calls himself a successful businessman and boast about his accomplishments, his
business partner refuses to work with him after investigating his business methods and is in fact
involved in a lawsuit with him. He does not show any regret concerning the loss of this business
relationship. His company went bankrupt, and Suzanne reports that Jack gambles in his financial
dealings. As a teen he reported having a lot of energy, stealing, drinking underage and skipping
school. He never apologized for the stealing but believes he has made up for it by purchasing
items as an adult. He reports that he currently drinks and receives testosterone injections for
energy.

Referred By ​Family friend

Presenting Problems / Goals / Interventions

Problem # 1: Lack of empathy (Narcissistic Personality Disorder) [Feelings/affect]

As exhibited by the way he talks about his past affair (“these things just happen”), the
woman he had the affair with (“she meant nothing to me”), and the account withdrawal
(“this is just part of business”)

Goal #1: To help client connect with others emotionally by learning and using CBT
techniques at home, to be tracked in a journal daily, and participating in group therapy
once a week.

This will be accomplished by CBT along with regular Group Therapy

Problem #2: Financial decisions/gambling [Behavior]

As exhibited by his previous bankruptcy due to poor business decisions, his risk
taking/gambling at work, the recent sizeable withdrawal
 Goal #2: Client will meet with a financial advisor once a week with his wife in order to
organize his finances and have complete financial transparency, in therapy we will work
to re-frame the client’s thoughts in regards to money management

This will be accomplished by CBT

Problem #3: Client has difficulty sleeping [Thoughts/cognitions]

As exhibited by thoughts and stress regarding his affair and potential divorce

Goal #3: Client to have a full (7 hr) restful night’s sleep at least two nights per week.

This will be accomplished by daily mindfulness and journaling before bedtime

Precipitating Events (BIG events in the client’s past): ​Rebellious behavior as a tee, client’s
first divorce, filing for bankruptcy, losing his business partner, being involved in a lawsuit,
having an affair,

Activating Events (Smaller events in the most recent past): ​Suzanne considering divorce,
being unable to sleep, withdrawing a large amount of money from the joint account

History

(1) Problem History

Client has a history of breaking the law and lying/cheating since he was a teenager. This
is his first time in therapy

(2) Individual History

Client prides himself on being a successful business man and a family man. He buys gifts
for members of his family to make up for any failings

(3) Family History

Client’s parents had a strained marriage, his dad was authoritarian and his mother was
quiet and submissive

(4) Marital History

He has been married twice. The first marriage ended in an affair. The second marriage
has been stable, although Jack has been absent for much of it.

(5) School or Career History

In school Jack was rebellious, he skipped school a lot and got into trouble. He was
successful at work until some of his business schemes caused him to go bankrupt.
Schemas:

Higher Power: The client believes he is a good person who has made up for anything he may
have done wrong. He believes he is in good standing with God

Self: Client feels he is more intelligent and more successful than other people

Others: The client believes other people will praise him for his accomplishments, and that if they
don’t it must be because they are incompetent

The World: The client believes the world is a competitive place, and that a person must get ahead
by cheating, taking risks, and doing whatever is necessary

The Future: The client believes everything will work out for the best in terms of his success in
life

Stressors: ​Possible divorce, not being able to sleep, bad relationship with his former business
partner, ongoing lawsuit, financial troubles

Client’s Strengths/Assets:

1. Creative in his business dealings

2. Desire to do whatever is necessary to avoid divorce

3. Loved by his children

4. Resourceful

5. Takes care of himself physically (works out)

​ sychological Assessments/Evaluation: ​Narcissistic Personality Inventory, ​The Delinquent

P
Activities Scale

Working Hypothesis:

The client has Narcissistic Personality Disorder, Conduct Disorder, and a gambling addiction. He
lacks empathy in regards to his recent affair and faulty financial dealings. Having ended his
affair, we will focus on helping the client reframe thoughts in the context of reality using CBT.
The client will attend group therapy once a week to help in understanding others’ perspectives.
In addition it seems that the client has a gambling problem, having made risky decisions at work
and hidden subsequent financial problems from his wife. We will focus on using CBT techniques
and mindfulness to solve this problem. With these two things being addressed, the client’s sleep
habits should improve. To help with better sleep, the client will keep a daily journal and practice
daily mindfulness. The client and his wife will also attend therapy sessions together as they work
through the aftermath of the affair. Following these initial problems we will address Jack’s
current use of alcohol and testosterone injections.

Definitive Diagnosis: ​Narcissistic Personality Disorder 301.81 (F60.81), Conduct Disorder

Adolescent-onset type Callous-lack of empathy, mild 312.82 (F91.2), ​Gambling Disorder, mild
312.31 (F63.0)

Obstacles:​ Lack of empathy, gambling addiction, regular drinking, testosterone injections

Therapist / Degree: ​Krista Lyn

Licensure or Certification​: Pursuing a Master of Arts Degree in Clinical Mental Health

Counseling

Date​: 5.20.19