DR. Michael Shery, clinical
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Psychological Assessment: Anger Status and Management
Subject: John Doe
Date of Report: November 16, 2011
Background of Incident Requiring Anger Assessment
The subject worked for several years as a trainer at a large corporation before being laid off.
After persistently searching for a job, he finally found steady work as an installer for an insulation
contractor which lasted for several years. But the work had dramatically scaled back, until he ended up on
unemployment because of the lack of work.
He had then been unemployed for most of 2008 through 2009, getting unemployment compensation but
getting no interviews from job applications which was very frustrating for him. He also had some major events
coming in the year 2009, that included his oldest son’s graduation from high school.
His family took a long weekend trip to Charleston and also decided to combine a pre-paid family
vacation to Disney in Florida with a visit to the subject's mother, who was 90 and going blind. He hadn’t
visited her in over 7 years.
In the meantime, his wife and he felt that they could do some major improvements around the
house, including landscaping and work on their gazebo and deck. His failure to finish these projects created
friction, stress and major arguments.
Subsequently, the subject and his wife had a severe argument, which seemed to mainly settle around a
difference of opinion about where to plant a tree. The subject finally refused to plant it. His
brother-in-law agreed to do it, to calm things down.
The subject's wife then threatened to cancel the Charleston trip though they finally went at the
last minute because of the pre-paid airfare. Unfortunately, they spent 4 days constantly bickering and
His son graduated from high school in June, further delaying the completion of improvement tasks and
the subject decided that his brother in law, who had moved in with them on Dec 08; should finally move and
find another place to live.
However, his wife refused, so the subject, himself, asked the brother-in-law to leave on July 09.
The subject reports a very unfortunate history of starting and juggling many projects at once, then never
finishing any, or at least to his satisfaction.
He reports that his wife subsequently gets angry and that he gets resentful because of never
feeling appreciated for what he does. Their arguments then degenerate into name calling, foul language and
physical outbursts like throwing things around the house or slamming doors.
His arrest that August occurred after approximately a 3 day onslaught of their arguing and name
calling behavior. He was already anxious about a list of things that he promised to complete before they went
on their trip to Florida and, further complicating things, their older son and daughter threatened to refuse
to go because of all the turmoil.
He reports being extremely stressed out and disappointed, because this family trip to his mother's,
because of her advanced age, might possibly their last and he might have to just go alone. Then his
wife made the offer that if he finished the list, then they would all still go.
The subject first refused, then relented and grudgingly started working like a “crazy” man until he
was exhausted and could do no more while the projects were still incomplete. He gave up and went to bed,
planning on going alone on the trip with his youngest son.
He retired for the night and then, at 3AM, 2 hours before he was going to just take his son and
go to Florida, his wife came down to the basement where he was sleeping, started arguing and said
that his youngest son would not be allowed to go. He then “snapped” and went after her while they were
arguing in the basement.
He reported that his intentions were to “spank her like a bratty child” and that the incident
progressed from slapping, to kicking, then punching. He ended up chasing her upstairs and the altercation
started again; he slapped her, pulled her hair and he reports that she then physically
Then in a “defensive move,” he reports, to prevent her from hitting him, that he grabbed her wrist
to pull her down, then, her wrist snapped. He reported that initially, he didn’t believe she was seriously
She then cradled her wrist, then called the police. By the time the police arrived, he reports her
being outside, upset, but somewhat calmed down.
The subject reported being very upset that he could possibly have hurt her and let things get so out
of control. The police interviewed both of them then called paramedics, with her refusing
Police arrested and processed him and he was out on bail about 3 hours later. An emergency 72 hour
Order of Protection was placed against him.
In the meantime, his wife made arrangements to get to the airport and fly to Florida with her son.
The client, amazingly, flew to Florida himself, met them at the airport and they went together to see his
That same day she went to an emergency room in Florida and discovered that indeed her wrist was
fractured. The three of them, then spent a few days visiting with his mother and sister and spent some time
at the beach. His two older kids flew down later, went to Disney World, then flew
He was arrested for assault and battery, but the legal proceedings stretched out for an entire year.
He was finally assigned a public defender and the case was plea bargained down to a simple misdemeanor; he
was charged with a $5 fine and one year of probation.
He made about 5 or 6 court appearances during that year, though his wife did not attend any of
them. During that time, on his own, he reports getting some interventions with doctors, then a psychiatrist
That is when he had undergone a first anger assessment with which he was dissatisfied because he
reports that the examiner had confused his case with someone else's. He subsequently refused to pay for it
before it was completed and subsequently contacted this examiner.
The following are the findings of that assessment.
Structure of Assessment:The assessment consisted of
4 in-office interviews with the subject, 1 with his wife and administration of the Personality Assessment
Inventory (PAI), the Millon Clinical Inventory III, the Brown ADD Scales and the Aggression
Mental Status: During the interviews the subject was
alert, oriented to person, place, time and situation. His levels of judgment and insight were sound, as was
his ability to remember and concentrate. He showed no signs of disordered thought processes and his
manifested affect was appropriate to the content of his verbalizations. Intellectually he appears to function
in the high average to high range and he denies ever having any hallucinations or suicidal or homicidal
Dysfunctional History of Anger-Related Events: The subject reported no history of bar fights or other anger-triggered situations which
caused him significant legal problems. He indicated that his anger is mainly an issue confined to the
parameters of wife and family and appears to be aware of the risks of badly managed anger.
Summary of the Subject's Interviews: His Understanding of Anger and its Impact:
Heviews himself as frustrated and very troubled by his lack of employment and the
periodic severe arguments which occur between him and his wife. Also, he seems very troubled by his inability
to complete tasks and finish household projects to which he commits himself. He is aware that anger,
unchecked, can have troubling consequences, particularly with his wife, and is motivated to improve the way
he interacts with her when frustrated.
Summary of his Wife's Interview: Her Understanding of Anger and its Impact:
She alsoviews herself as frustrated but not excessively troubled by his lack of employment. She
reports that the periodic severe arguments which occur between them, primarily are triggered by his inability
to complete tasks and finish household projects in a timely manner.
She also appears aware that anger, unchecked, can
have troubling consequences in their marriage and is very confused about the role his ADHD may play in his
agitation and failure to complete tasks. Also, she is sorry she reported the incident necessitating this report
because she feels the legal process has not been helpful.
The last physical examination
the client had was more than a year ago; he recalls having no problems at that time. The client's last dental
exam was within the last six months. He is currently having problems with his teeth.
He reports having had surgery
performed more than once. His family history includes heart trouble or stroke, high blood pressure, and
He believes that he is mainly
in good health with the presence of some minor problems.
He is near-sighted and
far-sighted. His history also includes high blood pressure and a heart murmur. He reports having had prostate
problems and has also suffered from arthritis.
The client has recently had a
problem with being overweight. He also reports recently experiencing hearing loss, ringing or buzzing in his
ears or head, poor equilibrium, memory lapse, poor concentration, and numbness.
In addition, he has
experienced heart palpitations and leg cramps that wake him up. He reports urinary urgency and a weakened urine stream.
Regarding sexual intercourse, he complains of inhibited arousal/interest.
He reports recently noticing
increased dryness of his skin. The client reports that he has recently been troubled by neck pain, back
pain, joint pain, muscle cramps, swollen/tender joints, and neck/joint stiffness.
The client currently drinks
alcohol several times a month. He usually drinks beer or wine. He does not report any usual diagnostic signs of
current pathological alcohol use, and he has not experienced an increase in tolerance over time. No usual
diagnostic signs of psychosocial impairment caused by alcohol use were reported.
He does not report any use of
unprescribed psychoactive drugs. He has experienced repeated episodes of persistent depressed mood and
diminished energy level accompanied by difficulty concentrating, social withdrawal, and irritability.
He indicates that he has
experienced repeated episodes of persistent elated mood, increased energy level, racing thoughts, and
uncontrollable talkativeness accompanied by heavy spending, increased sex drive, inflated self-confidence, and
He does not report having
experienced thought broadcasting, thought insertion, thought withdrawal, auditory distortions and
hallucinations, grandiose beliefs, persecutory beliefs, or feelings of being
The client has not experienced
anxiety or panic attacks. No phobias were mentioned. He denies having had unwanted, repetitive thoughts or
having performed repetitive acts. His current sleep pattern is characterized by waking up too early and having
trouble falling back to sleep, excessive daytime somnolence, and feeling unrefreshed by sleep.
The client reports his primary
sexual orientation to be heterosexual. He is currently married and living with his wife. He reports being
married twice. He reports having natural children and a stepchild. He lists his partner's race as white,
religion as Protestant, and gender as female.
His partner has a college
education in nursing and works full-time in a hospital setting. Their relationship is troubled by problems
concerning money, excessive arguing, and domestic chores. The client believes that their relationship suffers
from a lack of affection, trust, and time spent together.
He reports that his elementary
school performance was usually excellent. In general, he greatly enjoyed elementary school and describes himself
as being popular with most schoolmates.
In high school he received
mostly B's. His extracurricular activities included athletics and student government. He remembers having
difficulty in high school because of problems at home and having to work.
He reports no major antisocial
behaviors in high school. The client describes himself as being neither popular nor unpopular with other
students and as being neither happy nor unhappy in high school. The client reports graduating from high school,
college and having completed all the requirements for a master's degree in education except for the required
The subject reports going
through a divorce. He also reports having declared personal bankruptcy and he filed a disability claim based on
his having a mood disorder that was denied. He also reports having been charged and convicted of misdemeanor
battery with this report being part of the consequences.
There are no other charges
pending against him. He has he has never been committed to a psychiatric institution.
Psychiatric and Medical History: The subject reports a
previous history of psychiatric evaluation and psychopharmacologic treatment. He has been previously
diagnosed as having a mood disorder and ADHD and has been prescribed various medications at various times,
including Trileptal, Abilify, Celexa, Lexapro, Strattera, Adderall, Ritalin and Concerta. At the time of this
report he has stopped taking all prescribed medications because doubts about their effectiveness,
Test Findings-Personality Assessment Inventory (PAI)
The PAI clinical profile is marked by a significant elevation
on the DEP scale, indicating that the content tapped by this scale may reflect a particular area of difficulty
for the respondent.
The respondent reports a number of difficulties consistent
with a significant depressive experience. He is likely to be plagued by thoughts of worthlessness, hopelessness,
and personal failure.
He admits openly to feelings of sadness, a loss of interest
in normal activities, and a loss of sense of pleasure in things that were previously enjoyed. However, there
appear to be relatively few physiological signs of depression.
The respondent describes his thought processes as marked by
confusion, distractibility, and difficulty concentrating. He may also have problems communicating clearly with
other people because of speech that may tend to be tangential or circumstantial.
According to the respondent’s self-report, he describes NO
significant problems in the following areas: antisocial behavior; problems with empathy; undue suspiciousness or
hostility; extreme moodiness and impulsivity; unusually elevated mood or heightened activity; marked anxiety;
problematic behaviors used to manage anxiety; difficulties with health or physical
Also, he reports NO significant problems with alcohol or drug
abuse or dependence. However, attention should be paid to the possibility of denial of problems with drinking or
drug use, as the respondent described certain personality characteristics that are often associated with
involvement with alcohol or drugs.
The self-concept of the respondent appears to involve a
generally negative self-evaluation that may vary from states of harsh self-criticism and self-doubt to periods
of relative self-confidence and intact self-esteem. This fluctuation is likely to vary as a function of his
During stressful times, he is prone to be self-critical and
pessimistic, dwelling on past failures and lost opportunities with considerable uncertainty and indecision about
his plans and goals for the future. Given this self-doubt, he tends to blame himself for setbacks and sees any
prospects for future success as dependent upon the actions of others.
Interpersonal and Social
The respondent’s interpersonal style seems best characterized
as one of autonomy and balance. With both interpersonal scales scoring in the average range, his assertiveness,
friendliness, and concern for others is typical for that of normal adults.
He is experiencing notable stress and turmoil in a number of
major life areas, including his current unemployment, financial status, and family conflicts. He experiences his
level of social support as being somewhat lower than that reported by the average
He has relatively few close relationships outside of his
immediate family. Importantly, interventions directed at his problematic relationships (such as those involving
family or marital problems) may be important in alleviating this source of
Treatment considerations involve issues that can be important
elements in case management and treatment planning. Interpretation is provided for three general areas relevant
to treatment: behaviors that may serve as potential treatment complications, motivation for treatment, and
aspects of the respondent’s clinical picture that may complicate treatment
With respect to anger
management, the respondent describes himself as being rather impatient and easily irritated. He is relatively
quick-tempered at times, and he may be easily provoked by the actions of those around him.
However, he does not report any specific
aggressive behaviors that are recurrent problems for him.
The respondent is not reporting distress from thoughts of
self-harm. The respondent’s interest in and motivation for treatment is typical of individuals being seen in
treatment settings, and he appears more motivated for treatment than adults who are not being seen in a
His responses suggest an acknowledgment of important problems
and the perception of a need for help in dealing with these problems. He reports a
positive attitude towards the possibility of personal change, the value of therapy, and the importance of
In addition, he reports a number of other strengths that are positive indications for
a relatively smooth treatment process and a reasonably good prognosis.
Millon™ Clinical Multiaxial Inventory-III
difficulties, which have occurred for an undetermined period of time, may take the form of an Axis I
On the basis of the test data
(assuming denial is not present), it may be reasonable to assume that the patient is exhibiting psychological
dysfunction of mild to moderate severity.
This patient often feels
misunderstood, tense, and depressed. Overly sensitive to how others react to him, he frequently overreacts,
withdrawing or displaying self-derogating attitudes.
He may be erratic in relating
to therapists and may have been disappointed in or ambivalent about plans for his treatment. Calm expressions of
genuine interest and attention may help moderate his discomfort and depressive feelings.
AXIS II: PERSONALITY PATTERNS
The following paragraphs refer
to those enduring and pervasive personality traits that underlie this man's emotional, cognitive, and
interpersonal difficulties. Rather than focus on the largely transitory symptoms that make up Axis I clinical
syndromes, this section concentrates on his more habitual and maladaptive methods of relating, behaving,
thinking, and feeling.
The profile on the MCMI-III
suggests that this man may be characterized as socially anxious, emotionally downcast, and self-sacrificing. He
is likely to assume a weak and passive role in close relationships and repeatedly places himself in inferior or
Most notable are a lack of
confidence and an avoidance of events that test his adequacy. Unusually insecure, he may permit others to be
exploitive and mistreating, often courting unjust criticism or blame.
Despite his self-defeating
style, he may resent those that he allows to exploit him because they are often abusive and inconsiderate
despite his efforts to please them. Occasionally, his resentment may surface into outbursts of
Because he believes his
security is threatened by expressions of anger, he usually discharges his resentment in an indirect manner. He
either withdraws from what he experiences as abusive relationships or convinces himself that he deserves to be
shamed and debased.
His underlying tension and
emotional dysphoria are usually present in disturbing mixtures of anxiety, dejection, and
His insecurity and his fear of
being left to his own devices appear to underlie his self-sacrificing and self-abasing behavior. Between
periods of quiet withdrawal and occasional negativism, he may be overly conciliatory and even ingratiating. He
hopes to evoke support and protection by acting weak, by denying himself, by expressing self-doubt, by
communicating needs for assurance and direction, and by displaying a desire to submit and
Moreover, he hopes to avoid
severe forms of humiliation and rejection by submerging his individuality, by subordinating his personal
desires, and by submitting at times to abuse and intimidation. This man's reported feelings of apathy and
worthlessness and his tendency to succumb easily to physical exhaustion and illness may reflect a persistent and
Simple responsibilities may
demand more energy than he can muster, and he may describe life as painfully empty. By withdrawing, seeing
himself as deserving to suffer, permitting exploitation, and undermining his occasional good fortune, he
precludes new, potentially favorable experiences for reorienting his life.
GROSSMAN PERSONALITY FACET SCALES
The Grossman facet scales are
designed to aid in the interpretation of elevations on the Clinical Personality Patterns and Severe Personality
Pathology scales by helping to pinpoint the specific personality processes (e.g., self-image, interpersonal
relations) that underlie overall scale elevations.
A careful analysis of this
patient's facet scale scores suggests that the following characteristics are among his most prominent
personality features. He has few close relationships, minimal "human" interests, and limited
deep personal involvement in his family relationships.
An inability to engage in the
give-and-take of deeper relationships may be observed. He can be rather vague and disengaged from group
interactions, appearing to be involved in his own preoccupations.
It is difficult for him to
enthusiastically mix with others even during pleasant social activities. Also salient is his characterological
inclination to be mournful, joyless, tearful, and morose, an emotional disposition that is intensified by his
tendency to be worrisome, pessimistic, and guilt-ridden.
His interest in life is
diminished, and he has little appetite for joy and closeness. He may go through the motions of relating to
others, eating, having sex, and even playing, but he does so with little enthusiasm.
His temperamentally based
inertia and sadness may undermine whatever capacity he may have to enjoy life. Early treatment efforts are
likely to produce optimal results if they are oriented toward modifying the personality features just
AXIS I: CLINICAL SYNDROMES
The features and dynamics of
the following Axis I clinical syndromes appear worthy of description and analysis. They may arise in response to
external precipitants but are likely to reflect and accentuate several of the more enduring and pervasive
aspects of this man's basic personality makeup.
A pattern of dysthymia is an
integral part of this man's characterological structure. He exhibits a cluster of chronic general traits in
which feelings of uselessness, dejection, pessimism, and discouragement are intrinsic
Preoccupation with concerns
over his social adequacy and personal worthiness, pervasive self-doubts, and feelings of guilt are all
part of a constellation of long-term features of this man's psychological makeup. His reports of feeling
aggrieved and mistreated are consistent with his belief that he deserves the anguish and abuse he
Consonant with his
intrapsychic dynamics, he may regularly set in motion conditions that further aggravate his
The client answered the
following statements in the direction noted in parentheses. These items suggest specific problem areas that any
treating clinician should investigate.
37. I very often lose my
ability to feel any sensations in parts of my body. (True)
130. I don't have the energy
to concentrate on my everyday responsibilities anymore. (True)
27. When I have a choice, I
prefer to do things alone. (True)
92. I'm alone most of the time
and I prefer it that way. (True)
161. I seem to create
situations with others in which I get hurt or feel rejected. (True)
165. Other than my family, I
have no close friends. (True)
174. Although I'm afraid to
make friendships, I wish I had more than I do. (True)
People have said in the past
that I became too interested and too excited about too many things.(True)
Sometimes I can be pretty
rough and mean in my relations with my family. (True)
24. I began to feel like a
failure some years ago. (True)
112. I have been downhearted
and sad much of my life since I was quite young. (True)
142. I frequently feel there's
nothing inside me, like I'm empty and hollow. (True)
I'm ashamed of some of the
abuses I suffered when I was young. (True)
According to the MCMI III:
Axis I: Clinical
The major complaints and
behaviors of the patient parallel the following Axis I diagnoses, listed in order of their clinical significance
AXIS II: Personality
configuration composed of the following:
Traits; Depressive Personality Traits; Schizoid Personality Features; and Borderline Personality
The clinical syndromes
described previously tend to be relatively transient, waxing and waning in their prominence and intensity
depending on the presence of environmental stress.
Axis IV: Psychosocial and Environmental
The following problems may be
complicating or exacerbating his present emotional state. They are listed in order of importance: unemployment
and dysfunctional marriage
According to the PAI:
Listed below are DSM-IV diagnostic possibilities
suggested by the configuration of PAI scale scores.
Axis I Diagnostic
Axis I Rule Out:
296.20 Major Depressive Disorder, Single Episode,
296.89 Bipolar II Disorder
Deferred on Axis II
According to Brown ADD Scales, the
subject has a compelling case of ADHD making it very difficult for him to remember tasks, organize, finish
projects in a timely way and focus and sustain required attention.
Axis I- 314.01- Attention Deficit
/Hyperactivity Disorder Predominantly Combined Type
According to the Aggression
The subject scored in the high average range in his total score on this measure, suggesting a
tendency to have more difficulty than many in his age range in expressing anger
functionally-Result:Difficulty Expressing Anger.
The sub-scores follow: The subject
scored high on the Physical Aggression Scale
which would suggest that he has an increased pre-disposition to engage in
physical aggression when agitated.
Result: This suggests that the subject may find it difficult to control his
impulse to be physically combative when very angry.
He scored in the average range on the
Verbal Aggression Scale,
suggesting a pre-disposition to be as verbally argumentative as most people in his age range when facing
Result: He scores in the high average range on the Anger
Scale, suggesting that he is likely to experience more
hard-to-control irritability or frustration than others his age.
This suggests he is deficient in the
number of anger management skills at his disposal and would benefit from expanding his repertoire of anger
management coping strategies.
The Indirect Aggression
Scalemeasures his tendency to express aggression indirectly
rather than appropriately. His score is in the high average range suggesting a reluctance on his part to
express aggressive feelings assertively.
Result: He is more likely than others his age to use
counter-productive means such as passive-aggressiveness to express anger.Possible
Diagnoses: 312.35- Isolated Explosive
Diagnoses Suggested by the
Clinical syndromes, based on complete evaluation by examiner are as
314.01- Attention Deficit
/Hyperactivity Disorder Predominantly Combined Type; 300.4-Dysthymic Disorder;
312.35- Isolated Explosive
Axis I Rule Out:
Self-defeating Personality Traits, Depressive Personality Traits, Schizoid Personality
Features, and Borderline Personality Features.
Is any treatment or further evaluation needed? Yes
/ Treatment needs:
anger management; further assessment regarding the presence of bipolar disorder; marital
It is recommended
that the subject and his wife receive treatment on a weekly
basis (once or twice per week) to discuss their stressors, frustrations, impact of the subject's ADHD on their
relationship and the effectiveness of their problem solving methods until they are released by their therapist. If
his wife refuses to attend marital therapy, then the subject should receive the same treatment, himself, on an
The patient should consult a psychiatrist
to evaluate his need for psychotropic medication. If psychopharmacologic treatment is indicated, then the subject
should be required to receive it, consulting with his psychiatrist, on an ongoing basis until released from
treatment with a desired outcome.
Need for Court Supervision: As a result of this
assessment it is recommended that if the subject complies with the above treatment recommendations, it is
unnecessary for him to receive any other ongoing court supervision.
I appreciate working with the court system and Mr John Doe. I
look forward to assisting with any other assessments or consulting of a psychological nature, should the need
Dr. Michael Shery, Psychologist Date
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