Section 1: A Brief Summary of the Case Study
Ted Bundy developed antisocial behavior from childhood. The case study suggests that he developed negative feelings towards his mother for not revealing his father’s identity. Furthermore, he lived with an aggressive grandfather who caused him to resort to violence. Although Ted’s mother remarried and had other children, the victim did not bond with the rest of the family despite efforts to incorporate him. Ted struggled with social relationships, education, and other aspects of life. Mostly he preferred staying alone although he pretended to be actively involved in the social sphere, including politics. Ted gradually began abducting, torturing, and killing young women. Interestingly, Ted could not resist the temptation to continue with his behavior despite arrests and his realization of the legal implications. In fact, he attempted to justify his actions using his experience from law school. By the time of his death—he was executed by electrocution—he had not given up his desire to kill.
Section 2: The Actual Assessment
Demographic Information
The case study does not indicate Ted’s age, race, and ethnicity. Nonetheless, accordingly, Ted was never married, considering his struggles with maintaining social and romantic relationships. His family background also suggests that he never knew his father, implying his mother must have been separated with her husband. Little exists in the case study likely to reveal Ted’s economic status, but inferably, he did not struggle to make ends meet because he worked on political campaigns and at a suicide hotline. Ted may have dropped out of college, but he still enrolled to a community college, where he studied psychology.
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Presenting Problem
Ted presents with antisocial personality disorder, where he had challenges maintaining social and romantic relationships. The case study indicates that his behavior caused him to develop a strong desire to kill young women. Notably, despite his understanding that his behavior had adverse implications for self and others, he could not stop. In fact, he developed defensive tactics, including providing legal justifications for his actions.
Relevant History
The case study suggests that Ted’s problems have a significant relationship with his past. Notably, he began his aggression and antisocial behavior as a child. The patient did not like his mother for refusing to reveal his father’s identity. As a child, Ted could shock his mother by placing knives around her bed and standing in her way while smiling. His experiences with an abusive grandfather aggravated Ted’s social condition, driving a strong desire to detach from others even though he pretended to be socially engaged. Therefore, Ted’s history plays a critical role in his predicament.
Symptoms
The patient presents with numerous symptoms, including a disregard for wrong and right. He also uses charm and wit to manipulate others who would then become his victims. The patient also has reoccurring legal issues because he cannot resist the desire to kill. Furthermore, Ted does not show empathy for others, which is why he enjoys torturing them. The core of his issues stem from the fact that Ted has abusive, poor relationships with others.
Case Formulation
Macneil and colleagues developed a model for case formulation, commonly called the 5Ps of case formulation (Macneil et al., 2012). According to the cited literature, the five elements are: (1) presenting problem, (2) predisposing factors, (3) precipitating factors, (4), perpetuating factors, and (5), protective factors. Accordingly, the patient presents with antisocial personality disorder, where, as described, he is a serial killer. The predisposing factors are significantly environmental, mostly connected to his troubled family relationships during childhood. According to the case study, Ted felt that his mother let him down by refusing to reveal his father’s identity.
The precipitating factors in Ted’s case study include the idea that the patient strives to act secretly. Mostly, the Ted pretends to be normal, while he struggles having the right relationships with others. Therefore, he does not have the right support that would help him cope with his symptoms because he does not reveal anything. The perpetuating factors in the case study include the fact that he uses his legal understanding to argue his case in addition to acting secretly. Lastly, the protective factors include the need for the client to get the right social support that may help him begin coping with his condition. Such support may exist in the client’s subscription to a therapy session.
DSM-IV Multiaxial Assessment
Clinicians have often relied on multiaxial assessment proposed by The American Psychiatric Association (APA, 2013) in diagnosing clients presenting with different mental health challenges. According to the APA, the assessment offered mental health experts an approach to communicating with other professionals and coordinating services to the clients. The fifth edition of the DSM (Diagnostic Criterial for Mental Health issues) avoids the multiaxial approach, but it is critical to apply the criteria for Ted’s case. The client’s symptoms would place him in Axis II, which the APA used to provide information concerning personality disorders and mental retardation (APA, 2013).
Treatment Plan
Studies report different approaches to managing antisocial personality disorder. Nonetheless, the Cognitive Behavioral Therapy (CBT) is the most recommended because of its importance in building coping strategies for patients presenting with a spectrum of personality disorders. According to Rothbaum et al. (2011), CBT insists on the critical role of formulation in guiding therapy for patients presenting with symptoms like Ted’s. The objective of the therapists is always to develop compassionate CBT formulations, those that are necessary in building an understanding of the clients’ views of themselves and others and how they could suffer if they behaved in ways that could harm others. CBT’s success is also significantly underpinned by the ability of the therapists to understand the client’s history.
The CBT model proposes that therapists establish the factors that may have been contributing to Ted’s symptoms. The process is critical in the therapy’s success because it helps the interventionists to relate Ted’s condition with his past. The focus then shifts to striving to counter the adverse experiences in the patient’s life that may have been the leading drivers for the reported symptoms ( Davidson et al., 2010). As the latter literature indicates, the patient is in need for proper social support, which the therapists may initiate by striving to change Ted’s sense of self and others. In this case, the therapist leads Ted into thinking about his life and that of those around him, finding any differences and similarities. This way, Ted may begin realizing his importance to others and what he may begin doing to contribute positively to others’ lives. Notably, the process of social support is also pegged on the levels of family support that Ted may be receiving, explaining why the therapist must strive to include relatives and friends in the session. The focus may also be shifted to Ted’s ability to develop and sustain romantic relationships, where the therapist may invite him to perceive women positively instead of thinking about them as victims. The negative thought process that could be driving the client’s behavior may also be mitigated by further economic support, helping the patient to find and actively engage in employment.
References
American Psychiatric Association (APA) . (2013). Diagnostic and statistical manual of mental disorders . Arlington, VA: American Psychiatric Publishing.
Davidson, K., Halford, J., Kirkwood, L., Newton‐Howes, G., Sharp, M., & Tata, P. (2010). CBT for violent men with antisocial personality disorder. Reflections on the experience of carrying out therapy in MASCOT, a pilot randomized controlled trial. Personality and Mental Health , 4 (2), 86-95.
Macneil, C. A., Hasty, M. K., Conus, P., & Berk, M. (2012). Is diagnosis enough to guide interventions in mental health? Using case formulation in clinical practice. BMC medicine , 10 (1), 1-3.
Rothbaum, B. O., Meadows, E. A., Resick, P., & Foy, D. W. ( 2011 ). Cognitive-behavioral therapy . New York, NY: Sage.
