It’s that time of the day again…
Time to put on my psychoanalytic cap and dive into the DSM IV and let the assessment phase begin…. I sit, with pen in hand and chart in front of me as I wait for my client to walk through the door, sit on the couch and fill me in with classified information that only our ears will have the luxury of hearing. Before he begins to divulge in his dossier I inform him of his rights to confidentiality and I explain when it is necessary for this contract to be broken.
He accepts my overture, lies back on the couch, and it’s time for me to begin to formulate a bio-psychosocial including a mental status exam of the man who lies before me.
The client Jesse Bruce Pinkman is a twenty-seven year old white male with green eyes, short haircut, slim, average height about 5’9 and is badly groomed. The client appears to not have shaven or gotten a haircut in quite some time. His face is bruised and scarred and appears to be healing from being badly beaten with a few scratches and a bruised right eye. He is dressed appropriately with the exception of wearing baggy jeans and an over-sized hoody.
The client was very moody and seemed distraught during the interview process. He made no reservations when it came to answering all the questions and made minimal eye contact as he lied on the couch often staring at the floor or at the ceiling while making minimal movement as if he were zoned out.
His mood was choleric and indignant with a depressed and blunted affect. Cognitively alert with a normal level of functioning with past hallucinogenic experiences but no delusions or obsessions. After we got through the content we dove straight into the process. I turn to Jesse and ask..
What brings you here today?
Jesse goes on to state his presenting problem…
He tells me he used to operate a major drug empire with his former partner who was once his High School Chemistry teacher Mr. White who is known by the street name of Heisenberg. During this phase the client was heavily abusing drugs which included marijuana, crystal methamphetamine and heroin. Jesse entered into a sober living house and completed an intensive inpatient program during his stay there. Once he graduated he began attending weekly meetings but eventually relapsed from traumatic related issues that were occurring in his social environment.
Jesse continues on to tell me about the horrors he witnessed, endured and was responsible for. The death’s of both of his former girlfriends, his responsibility in operating a drug empire and working with the cartel, his participation in disposing of human corpses that destroyed his aunts house and his act of killing a man in cold blood. He then tells me about his medical and legal history, his three-day hospital stay after being beaten by a DEA Agent, his social history and the countless murders of friends, enemies and children that haunt his soul every moment of his waking and slumber-land hour.
I sit in rumination as I listen to Jesse and think of how I will explore my counter-transference with my clinical supervisor later that evening and discuss the flood of emotion and feeling that has been aroused by this spine-chilling chronicle.
I look at the clock and fume at the thought of having to wrap up my session with my client but when time is up, it is up. There are plenty of other clients awaiting my services so they can drop sixty minutes worth of electrifying storytelling entitled “their lives” on me while I try to stay hinged to my chair and take in the provocative earful.
We wrap up our session, I gather my thoughts for a diagnosis and concur with my judgment.
- Axis I: 296.33 Major Depressive Disorder, recurrent, 309.81 Post-traumatic Stress Disorder, Chronic – Substance Dependence, with Physiological Dependence
- Axis II: V71.09
- Axis III: Loss of consciousness, post head trauma requiring 3 day hospitalization
- Axis IV: Problems related to social environment, drug involvement, murder
- Axis V: 69
Pleased with my summary, but not pleased with my emotion…
Why is that I already pity this man, a killer, a drug addict, another person going through life existing by exploiting crack fiends with his ability to cook up a pure batch. A murderer!! I tell myself this over and over again, but still, my mind is to busy looking at the soul of a broken man who is searching to regain his life, another human life succumbed by the evils of the universe and searching to find himself.
I don’t throw stones at my clients. It would just make me look more like their adversaries. I already applaud him for his vulnerability. The unnerving truth is that there is a piece of Jesse not only in all of my clients, but also in myself.
I dig deeper into my psychoanalysis and decide to do what other therapist do, sit on the couch of another therapist.
As I recline back, I fancy the thought of when I will see my client again, for I missed him. I awaited the day that he would come back and allow me to dissect his thoughts as I anatomize the part of my mind that contains psychic material that is only rarely accessible to awareness but has a pronounced influence on behavior ….the unconscious.
The part of me, that only my clients awaken.