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Psychodynamic Theory and Its Perspectives in Therapy Essay

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Updated: Mar 27th, 2020


Many psychologists believe that conscience is the foundation of dignity and respect amongst human beings. Sociopathy is a mental disorder that results in development of weird behaviors such as negative attitude towards other people and urge to distress colleagues and/or friends.

Sociopaths are primarily motivated through self-centeredness. They have a tendency to compete with other people for goals that they cannot achieve. This essay provides an analysis of Doreen’s case with a view of illustrating how the psychodynamic theory relates to other therapeutic theories that are used in therapy.

The Case of Doreen

Dr. Doreen Littlefield, a psychologist who works in a hospital has a covetous sociopathic mannerism that is revealed through her jealousness and incessant behavior of imitating the character of other people (Segal, Coolidge, & Rosowsky, 2006). In the context of this case, Doreen has a friend, Dr. Jackie Rubenstein, a star psychologist staff whom she loves outwardly. However, she hates her inwardly because of her beauty and brilliance.

Indeed, Doreen hates her friend so much that she wants to terminate her life. However, killing her friend is a difficult task to comprehend because she knows that the action will attract public’s attention.

As a result, she resolves to destroy Dr. Rubenstein’s reputation. She interferes with Dr. Rubenstein’s patient whom she perceives as handsome by deliberately assaulting him to embarrass Dr. Rubenstein. Nonetheless, Doreen is not worried about her immoral actions. This situation makes her a sociopath because such people lack humane characteristics (Rutan, Stone, & Shay, 2007).

Provide an assessment/diagnosis for Doreen Based on DSM-V

The diagnosis of sociopathic traits comprises a checklist of behaviors that are provided in the DSM-V manual (American Psychiatric Association, 2000).

Pervasive Behavior and Infringement of the Rights of Other People

Pervasiveness and infringement of the rights of other people is the first step towards diagnosis of sociopathic behavior based on the DSM-V (American Psychiatric Association (2000). At the outset, the patients who are sociopaths defy laws and norms that are stipulated by different institutions. In most cases, such patients commit criminal activities that warrant arrests. For example, Dr. Doreen kicks a patient at some point.

This situation drives the patient into an acute paranoid state. According to the American Psychiatric Association (2000), it is clear that Doreen’s action towards the patient is violent. Therefore, it can warrant an arrest. Furthermore, an attempt that was made to investigate the case exposed that she kicked the patient as a way of revenging against her fellow acquitted staff. This scenario is an act of crime that violates the hospital regulations.

Doreen’s behavior is an act of jealously since her colleagues have value-added attitudes towards patients. Doreen practiced psychiatry without authorization. Instead, she has obtained various counterfeit recommendations to convince other people that she has the obligation to handle psychiatry patients. In addition, she has committed many unsubstantiated assaults. Doreen’s actions reveal the various traits that a sociopath possesses (Krueger, Markon, Patrick, & Iacono, 2005).

Secondly, most sociopaths indulge in deceptive and manipulative activities. For example, Doreen is an unqualified doctor. However, she pretends to be a medical professional irrespective of her colleagues’ knowledge that she is incompetent and has no certification that grants her permission to deal with psychiatry cases.

Sometimes she assaults patients, as realized in the case of Dennis. The case analysis unveils that Doreen manipulates Jackie because she realizes her bad actions towards Dennis. As a result, Jackie gets worried about her reputation since it remains at the stake of Doreen’s cruelty in case she spills the beans (Krueger et al., 2005).

Furthermore, sociopaths are impulsiveness and fail to plan (American Psychiatric Association, 2000). The case of Doreen brings about a realization that sociopaths lack the ability to plan. In ability to plan is realized when Doreen sees a customer advocate whose wife suffers from depression during a local television show known as the ‘Buyer Beware’.

On realizing that Doreen is his wife’s therapist, the customer threatens to uncover Doreen’s behavior and even emphasizes that he will kick her out of the room if the hospital fails to assign a new therapist to his wife.This situation clearly shows Doreen’s inability to take heed of the consequences of her cruelty (Segal et al., 2006).

Moreover, they are irritable and highly aggressive. In most cases, sociopaths are aggressive and irritable. The case analysis reveals numerous incidences where Doreen gets annoyed due to unsubstantiated reasons. On the day of her expulsion, she turns to the directors and warns them of the mistake they have made to fire her.

She also shows a similar behavior to Jackie over the issue of Dennis, who was a customer, through their cellphone communication. Sociopaths always look for a weak point to hit back as a way of seeking security to their bad behavior. However, the possession of knowledge about the negative secrets of their friends or colleagues provides a basis of instilling fear in them (Kruegeret al., 2005).

Finally yet importantly, they also exhibit recklessness and disregard for the safety of self and/or others. Doreen, being a sociopath, is remorseless and never feels guilty for her wrong actions towards other people. As a result, she does not care about her friends, patients, and/or colleagues.

At some instances, she thinks of driving over other people with her vehicle. This case is evident where she attempts to drive over Jackie. Although her ill intentions are not fulfilled in most cases, she compliments the achievement of her goals by damaging the reputation of other people. Such behaviors are regarded as sociopathic (Segal et al., 2006).

Minimum age of 18 years

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), individuals who exhibit sociopathic behavior should be above the age of 18 years (American Psychiatric Association, 2000).

The fact that Doreen has been employed in a health institution as a doctor is an indication that she is over 18 years old. Therefore, her antisocial behavior can be said to be sociopathic. Individuals who are eligible for the DSM-V diagnosis criteria should be at least 18 years.

Conduct Disorder Characteristics at the age of 15 years

However, despite the aforementioned criteria B above, a sociopath may exhibit a conduct disorder prior to their fifteenth birthday (American Psychiatric Association, 2000). Before this age, sociopaths begin showing deviant behavior and lack of respect, which is perceived as conduct disorder. In the case of Doreen, there is no evidence that she experienced any mental illnesses that could have resulted in her antisocial behaviors. Nonetheless, she is adamant to the rules and regulations of the hospital.

Sociopathic Symptoms not caused by other Mental Disorders

According to the American Psychiatric Association (2000), the last criteria involve checking whether the patient has other mental disorders that can lead to maladaptive behaviors. However, the case analysis reveals that Doreen does not have any other mental disorders that resulted in her sociopathic behavior.

List and describe the ethical violations that are demonstrated by Doreen and provide evidence from NASW Code of Ethics

Ethical Responsibility to Clients

Doreen does not show ethical responsibility to her clients. At the outset, she fails to take her work seriously. Furthermore, she goes ahead and assaults her clients. This state of events is evident where Doreen assaults Dennis who later communicates the incidence to Jackie.

Therefore, Doreen never committed herself to serving her clients as required by the NASW code of ethics, which seeks to promote the wellbeing of clients (Waldman, Vazsonyi, & Flannery, 2007).

Doreen’s state of professional incompetence is also a violation of the NASW code of ethics. She lacks certification to handle psychiatric patients.

She is only an administrator in the organization and the reference letters that she possesses were acquired through sexual means from her supervisors. This behavior infringes the NASW code of ethics that requires professionals to be competent within the boundaries of education, training, and certification. Doreen was only an administrator (Gibelman & Schervish, 1993).

Ethical Responsibility to Fellow Workers

Doreen violates the code of conduct by disrespecting her colleagues. For instance, she aggressively addresses Jackie on phone after she is questioned about her attendance to a client. Furthermore, she does not respect the management.

In fact, she warns them on the impending risks that will accompany her dismissal from work (Gibelman & Schervish, 1993).Doreen is always irrational and aggressive to her colleagues. At one point, she went to an extent of disliking Jackie so inwardly that she even wished to kill her.

Nonetheless, Doreen understood her incompetence as a self-proclaimed professional. Instead of referring a client to a qualified professional, she insisted on attending to the patients. The case study reveals that she assaults her client, Dennis, after she fails to handle his situation.

When her colleague realizes the situation, she gets irritated and poses a threat to Jackie’s reputation. The Referral for Services code of ethics requires that a worker should refer clients to other professionals who are specialized in handling difficult cases (Gibelman & Schervish, 1993).

They should discourage and prevent unethical conduct. Otherwise, workers should strive to seek resolutions to conflicts that arise. Nevertheless, the case study reveals that Doreen remains adamant to such regulations. She strives to destroy the reputation of Jackie and other employees.

Ethical responsibility to Professionals

Social workers should accept responsibility based on existing competencies (Gibelman & Schervish, 1993). However, Doreen lacks this virtue. She acquires recommendation letters corruptly by seducing her supervisors. Her incompetency is realizable where she handles clients poorly.

At one instance, a client who realizes that she is his wife’s doctor threatens to inform the management to expel her. Doreen’s deceptiveness and dishonesty also violates the code of ethics. Since she was a mere administrator, her pretentiousness as a psychologist portrays her incompetence. She also deceives Ivy by shedding crocodile tears after mishandling her client, Dennis, whose condition had significantly deteriorated.

If you were Dr. Jackie Rubenstein and your supervisor brushed off your accusation, would you or would you not have taken additional step to report Doreen? Explain your response

The best way to handle Doreen’s case is to report the issue to the appropriate authority. The core value of administering therapy treatments should be client-driven. Dennis, who has a deteriorating condition, notes that Doreen, his medical attendant, has done a mistake. To maintain the client’s reputation to the hospital, Jackie should have solved Dennis’ problem as soon as possible and then try to make Doreen understand the situation in a manner that does not create a rift based on the lines of duty.

A. Why, in the psychiatric hospital, was it so hard for people to discover and understand Doreen’s diagnosis based on her behavior?

Many people fail to realize that sociopaths lack proper emotional functions. They fail to recognize that sociopaths can kill or destroy somebody’s property without feeling guilty or apologetic. This state of confusion makes people vulnerable to the consequences of sociopathic behaviors, as in the case of Doreen (Waldman et al., 2007). Doreen has an exceptional character that she uses to silence everyone who realizes her mistakes and incompetence in the psychiatric hospital.

B. Most of the people at the hospital had vast quantities of ethics and conscience, so why, when they finally found out about Doreen, did they let her go without a fight, so that Doreen might most likely strike out again somewhere else?

The hospital directors and other staff were not able fight Doreen because of her bizarre manipulations that she staged to destructthe hospital’s reputation. The hospital fraternity also dreads the impending public embarrassment in case they fire Doreen. She a sociopathic ability to manipulate the enterprise; hence, they cannot pursue criminal actions that she committed earlier. She also had the capacity to advertise them negatively by spreading propaganda to the public.

If you were asked to treat Doreen, would you use CBT or a psychodynamic theoretical framework? Explain your choice of a theoretical perspective and why you feel this choice of TX will work best for treating Doreen

The psychodynamic theoretical framework is the best therapy for treating Doreen. This method focuses on internal processes that pertain to needs, mental activities, and emotions that motivate human behavior. Overwhelming of internal and external demands by human requires management of all these factors.

Being a sociopath, Doreen lacks compassion. Therefore, the psychodynamic therapy is suitable to boost her senses and feelings towards others. Relationships are enhanced through the psychodynamic components. As a result, this theory will improve Doreen’s relationship with her clients and colleagues (Rutanet al., 2007).


The workability of the psychodynamic theoretical framework in treatment of sociopathic cases depends on its ability to trigger emotions in a patient. This therapy seeks enhancement of the factors that lead to improvement of a sociopath’s interactions with other people in a manner that creates positive relations. In many cases, psychologists have suggested the CBT mechanism can be applied in cases where other features, apart from the aforementioned, trigger the patient’s behavior (Rutanet al., 2007).

Reference List

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders: Text Revision (DSM-IV-TR). New York, NY: American Psychiatric Association.

Gibelman, M., & Schervish, P. (1993). Who we are: The social work labor force as reflected in the NASW membership. Washington, DC: NASW Press.

Krueger, R.F., Markon, K.E., Patrick, C.J., & Iacono, W.G. (2005). Externalizing psychopathology in adulthood: A dimensional-spectrum conceptualization and its implications forDSM-V. Journal of abnormal psychology, 114(4), 537.

Rutan, J.S., Stone, W.N., & Shay, J.J. (2007). Psychodynamic group psychotherapy, New York, NY: Guilford Press.

Segal, D.L., Coolidge, F.L., & Rosowsky, E. (2006). Personality disorders and older adults: Diagnosis, assessment, and treatment. Hoboken, NJ: John Wiley & Sons.

Waldman, I., Vazsonyi, A., & Flannery, D. (2007). The Cambridge Handbook of Violent Behavior and Aggression. Cambridge: Cambridge University Press.

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