Jack’s Formulation: A Cognitive-Behavioural Approach

Using one of the examples provided, clearly summarise the service user’s experience of distress

Jack has experienced many forms of distress throughout his life due to a build-up of ‘unresolved issues’.  Recently, he has experienced feeling “high’ in mood’ but then he often lapses ‘into tears’ demonstrating his current distress fluctuates easily. However, this is a recent development in Jacks history of distress. At the age of 4, he was sexually assaulted leaving him feeling isolated from his family which worsened after moving to a new area Jack experienced harassment and being burgled leaving him feeling vulnerable. He fell into alcoholism which led to arguments with his mother which resulted in him being made homeless and further isolated him from his family. He then struggled when his mother became ill and the family’s financial situation worsened which is when he experienced ‘paranoia’ and ‘persistent delusional disorder’. His fantasy experiences reflect his feelings of anger, loss of control and confused feelings for his father.

Provide a plausible explanation of the development and maintenance of the service user’s difficulties, and how they may relate to one another; drawing on psychological theory and principles and details provided in example

The experiences Jack has been through during his childhood through to his adult life lead to Jack repeatedly feeling lonely. After Jack was sexually assaulted, he felt alone and isolated. This was exacerbated by his parents’ divorce, losing contact with his father and being forced to leave his local community. Furthermore, the divorce would have been extremely distressing for Jack. This would of had a lasting effect as typically children that experience divorce experience more negative life events than those with married parents (Lindbery & Wadsby,2009). Additionally, those that experience parental divorce find it difficult to adjust in response to these negative events (Lindbery & Wadsby, 2009). Jack begun to struggle to deal with the emotions he felt due to losing contact with his father and Jacks’ sisters as they felt this was a good thing which caused conflict and further emotional distance between them. This led to being isolated from both his mother and sisters more extremely. This reached its peak when he was made homeless and was now both emotionally and physically isolated leading to his diagnosis of depression.

However, the main cause of distress for Jack is his self-loathing due to feeling he has not been able to protect his family. As a child there were ‘strong expectations’ for him to fun the family business thus he felt he had to protect his family. As he grew older his family’s financial worries also grew, he tried to help with his paper round however they still ended up having to leave their community and lost their home. This led to jack feeling a failure and when he could not help the family, he relied on substances to manage feelings of self-loathing. However, when his mother became ill his coping mechanisms failed and he became overwhelmed. This was the trigger event for Jacks delusions which are linked to his childhood trauma (Bailey et al., 2018). His delusion’s cause him a lot of anger as he believes that Robbie Williams ‘raped one of his sisters’ and that he is owed stolen royalties. Furthermore, he is fearful of being attacked by Robin Williams minders. His experiences of ‘psychosis’ is not uncommon in child victims of sexual assault (Bebbington, 2018). Furthermore, childhood trauma increases the risk of psychotic disorder or symptoms in later life and Jack experienced several forms of trauma In his earlier years  (Bebbington, 2018; Spataro et al., 2018; Bailey et al, 2018). Thus, a great deal of Jacks current distress stems from his childhood experiences previously highlighted.

Jack also experiences a great deal of distress due to being fearful of becoming his father. He eludes to how his father was a violent alcoholic who left him feeling abandoned. It was also his ‘male boss’ who sexually assaulted therefore Jack has had a difficult experience with male role models. This caused further confusion and mistrust for males in his life. Jack describes a ‘frightening experience’ of seeing his father’s face when he looked in a mirror, further highlighting his fear that he has become his father (a violent drunk). Jacks main male role model abused alcohol when they were in distress causing it to also be Jacks main coping mechanism despite his previous negative experience of it. Johnson and Pandina (2009) detail that alcohol use is strongly determined by use of the same sex parents and determined dysfunctional coping (such as alcoholism) in sons. This demonstrates the detrimental effect his father has had on Jacks life.

Effectively outline the benefits and limitations of diagnosis – for explaining the service user’s difficulties and devising an intervention

Diagnosis would in some ways aid Jack as he blames himself for not protecting his family enough therefore, a diagnostic label may help him blame his condition not himself as a whole. Additionally, it could help his family understand him more and understand how they could support him better and it may also ease tensions between himself and his mother.

There is a great deal of debate over mental illness labels currently and some support against them. Labelling theory indicates that people with psychosis who accept a mental illness label will function less well than those who reject a diagnosis (Warner et al., 1989). As accepting a diagnosis could make Jack feel that he is ‘broken’ and that his distress cannot be changed because ‘it is just the way he is’. This could lead to him going ‘off the rails’ again.  Thus, rejecting a label could be more effective for Jack going forward. Furthermore, the diagnostic label could add to Jacks feelings of shame and failure due to the stigma associated with them (Ben-Zeev, Young & Corrigan, 2010).

Briefly outline an intervention plan clearly related to the service user’s experience of distress and your explanation of the development and maintenance of the service user’s difficulties 

Jack has tried fearlessly to protect and support his family throughout his life however, circumstances have caused the family great distress. To help Jack progress it is important he discovers he is not to blame and also develop better coping mechanisms which will ultimately help him hold down a job. Most importantly, Jack needs the support of an alcoholic’s recovery team as this is his main negative coping mechanism. This will enable him to find more positive coping mechanisms which will not affect his ability to hold down a job or cause conflict with his family as his substance abuse does. The alcoholics anonymous meetings will also help him evade relapses, furthermore as he is a very social and previously ‘popular’ child he will hopefully engage with the AA community. This will enable him to make lasting bonds with sponsors and other members. Humphreys et al. (1999) reported that ‘enhanced friendship networks’ and improved active coping mediate reduced substance abuse during self-help programmes.

Furthermore, regular Cognitive Behavioural Therapy sessions would aid Jack in understanding his feelings and to further enhance his coping. Despite struggling to hold down a job, Jack has shown great resilience due to the fact he kept applying and trying new jobs. Jack demonstrates a great desire to improve therefore if he applies this to the sessions and the alcohol recovery programme, he could be very successful. The sessions will also help him feel listened to as he currently does not. It will also allow him to understand his fantasies and how to manage his behaviours in response to them.


Ängarne-Lindberg, T., & Wadsby, M. (2009). Fifteen years after parental divorce: Mental health and experienced life-events. Nordic Journal of Psychiatry, 63(1), 32–43. https://doi.org/10.1080/08039480802098386

Bailey, T., Alvarez-Jimenez, M., Garcia-Sanchez, A. M., Hulbert, C., Barlow, E., & Bendall, S. (2018). Childhood Trauma Is Associated With Severity of Hallucinations and Delusions in Psychotic Disorders: A Systematic Review and Meta-Analysis. Schizophrenia Bulletin, 44(5), 1111–1122. https://doi.org/10.1093/schbul/sbx161

Bebbington, P., Jonas, S., Kuipers, E., King, M., Cooper, C., Brugha, T., Meltzer, H., McManus, S., & Jenkins, R. (2011). Childhood sexual abuse and psychosis: Data from a cross-sectional national psychiatric survey in England. The British Journal of Psychiatry, 199(1), 29–37. https://doi.org/10.1192/bjp.bp.110.083642

Ben-Zeev, D., Young, M. A., & Corrigan, P. W. (2010). DSM-V and the stigma of mental illness. Journal of Mental Health, 19(4), 318–327. https://doi.org/10.3109/09638237.2010.492484

Humphreys, K., Mankowski, E. S., Moos, R. H., & Finney, J. W. (1999). Do enhanced friendship networks and active coping mediate the effect of self-help groups on substance abuse? Annals of Behavioral Medicine, 21(1), 54. https://doi.org/10.1007/BF02895034

Johnson, V., & Pandina, R. J. (1991). Effects of the Family Environment on Adolescent Substance Use, Delinquency, and Coping Styles. The American Journal of Drug and Alcohol Abuse, 17(1), 71–88. https://doi.org/10.3109/00952999108992811

Spataro, J., Mullen, P. E., Burgess, P. M., Wells, D. L., & Moss, S. A. (2004). Impact of child sexual abuse on mental health: Prospective study in males and females. The British Journal of Psychiatry, 184(5), 416–421. https://doi.org/10.1192/bjp.184.5.416

Warner, R., Taylor, D., Powers, M., & Hyman, J. (1989). Acceptance of the Mental Illness Label by Psychotic Patients. American Journal of Orthopsychiatry, 59(3), 398–409. https://doi.org/10.1111/j.1939-0025.1989.tb01675.x

Jack’s formulation, a systemic approach

Using one of the examples provided, clearly summarise the service user’s experience of distress

Jack has had many experiences of distress including periods of mania and low mood. When Jack was young two of the male figures in his life were violent towards him, this might have caused Jack to feel lost and frightened. He had feelings of self-loathing caused by his father, perhaps, making him turn to alcohol and failing his GCSEs. It did not help that at this time, his parents had a divorce and his dad left, which could have led to Jack feeling confused and uncertain about his place in the family and in society. This may have made him feel alone with no one to talk to which could have caused his paranoia and delusions.

Provide a plausible explanation of the development and maintenance of the service user’s difficulties, and how they may relate to one another; drawing on psychological theory and principles and details provided in example

There are many factors in Jack’s life which have contributed to his difficulties. The difficulties are mainly due to his father, as when Jack was younger he was an alcoholic and violent, the difficulties then developed because of his father leaving and divorcing his mother and then seeing his father’s reflection in the mirror which brings back the emotions he had when he was younger. The effect on the family of the father leaving was distressing for Jack, his mother and sisters. Perhaps for Jack, this was more distressing, as he may have seen himself as the father figure after his dad left and the fact, they lost their house and lost contact with the Italian community he could have blamed it on himself. As it has been set from when he was younger, that his family had strong expectations of him, as the only son, being successful. Jack experiences confusion and feels lost in relation to his father leaving after everything he has done which perhaps causes Jack to portray the qualities of his father onto another male figure he looked up to, Robbie Williams, saying he stole from him (like his dad taking away the family’s comforts and happiness) and that he raped one of his sisters (like his dad’s violence towards the family).

The family display beliefs about the man being the ‘breadwinner’, as the dad had a successful business and Jack was going to continue this success, so Jack feels Robbie Williams stole his success (his talent for music). The difficulties are interpersonal within the family, mainly affecting himself and his mother because of their relationship to the father, due to Jack being the only son and the mother being divorced by the father which clearly affects her emotionally. The relationships in the family are affected by the difficulties Jack had. Jack’s relationship with his father is affected as he has mixed feeling of love and hate towards his father. His relationship with his mother is affected because of the downward spiral caused from the loss of his father and from the pressure Jack felt to hold the family together as the only male figure. The relationships also affect the difficulties, as his dad leaves the family and the mother kicks Jack out the house. His mother and sisters may have felt Jack was behaving similar to the father and became frightened so admitted him to hospital.

Effectively outline the benefits and limitations of diagnosis- for explaining the service user’s difficulties and devising an intervention


  • Jack having someone to talk to about his feelings will be good for him as he felt unable to confide in his family and talking about his thoughts may help the therapist understand the delusions
  • Having a diagnosis may help Jack come to terms with his delusions as he may be able to understand why he has these thoughts and he will be able to get help from services
  • Jack being diagnosed may help him not feel alone, as other people experience similar thoughts and feelings


  • Jack knowing about the diagnosis may make it worse as it could make him blame himself more and make him feel less masculine and successful
  • Jack may find it hard to confide in people and trust them since his father left him and his mother kicked him out during the hard times in his life

Briefly outline an intervention plan clearly related to the service user’s experience of distress and your explanation of the development and maintenance of the service user’s difficulties

A possible intervention for Jack would be family therapy, in order to help resolve family issues with his mother and sisters, so Jack no longer feels alone. This would help Jack to express his thoughts and feelings about his experiences to his family and hear their experiences, so they can understand each other’s difficulties. During the family therapy, the family could design a genogram to display the family relationships over generations and their medical history. It can help the family pick out patterns of behaviour that are destructive and help the family understand how relationships are viewed from different members of the family.

Jack’s Formulation – Psychodynamic

Using one of the examples provided, clearly summarise the service user’s experience of distress.

Jack has suffered from a lot of distress in many aspects of his life. He experiences “highs and lows” in his moods, at his lowest feeling “hopeless” and “lapsing into tears”. He has been diagnosed with depression and suffers from negative thoughts about his life, as well as suffering from paranoia and delusions. This leaves him feeling very anxious to leave the house and worried about his and his family’s safety and financial means. He experiences mixed feelings when thinking about his estranged father which causes him a lot of confusion. He feels very isolated after leaving a close community and failing to meet new friends.

Provide a plausible explanation of the development and maintenance of the service user’s difficulties and how they may relate to one another, drawing on psychological theory and principles and details.

Unfortunately, Jack did experience a lot of trauma while in adolescence and growing up, which is a very important developmental period in terms of identity development, relationships and academic achievements. Due to a lot of trauma happening during this vital time, it could be that a lot of his problems have stemmed from the disruption of his normal development during this time. Also, Jack is maintaining his distress and difficulties through avoiding his past negative experiences, such as being abused, which he may see as a safety behaviour but it is hindering his ability to overcome his obstacles (Freeman et al, 2001).

Throughout Jack’s life, he has witnessed the rise and fall of his father’s business and the complications that have arisen from that. He did feel close to his father and his father’s personal issues have deeply affected him. He may feel anxious to become like his dad and this is something that is causing him severe distress when he looks in the mirror. This fear and worry are then maintaining the delusions that he has with regards to his dad.

Also, through failing his GCSE’s, he may constantly have feelings of disappointment and failure with many other things in his life. GCSE’s are also seen as a steppingstone to working in higher paid jobs and working scenarios and therefore the failure of this, means that he is unfortunately maintaining the cycle of getting different jobs and then leaving them as he has become unhappy with his life. He aspires to do more than a low-paid job.

Effectively outline the benefits and limitations of diagnosis – for explaining the service user’s difficulties and devising an intervention. 

Benefits of diagnosis:

– He will be able to access services that can help him overcome his distress

– Has previously complied with treatments and therefore may find it helpful in helping him overcome his difficulties

– Having a diagnosis may provide him with clarification on his experiences and help him to understand why he feels and behaves the way he does

Limitations of diagnosis:

– He may possibly feel some stigma after receiving a diagnosis from society and the people around him

– He may feel frightened by having his experiences labelled in a term that he doesn’t feel quite comfortable with


Briefly outline an intervention plan clearly related to the service user’s experience of distress and your explanation of the development and maintenance of the service user’s difficulties.

If Jack is still using alcohol and drugs, the first step would be to aim to get him to stop using them so that any treatments are able to be trialled without interruptions from substances. This can be done through using a detox or rehabilitation program. The next step would be to introduce and support Jack with the use of medications to help control his delusions while also receiving some Cognitive Behavioural Therapy (CBT) to help him to understand and identify his delusions and irrational behaviours. Once these unhelpful behaviours are identified, Jack may be able to reduce his distress around these experiences and recognise that these experiences are not real and therefore can move on with his life. It may also be useful to undergo some interpersonal therapy to help him build up relationships with his family and to make new friends.


Freeman, D., Garety, P.A., Kuipers, E. (2001). Persecutory delusions: developing the understanding of belief maintenance and emotional distress. Psychological Medicine.

Jack’s Formulation: a psychodynamic approach

  1. Clearly summarize the service user’s experience of distress

It is evident from Jack’s case study that he has experienced many highly traumatic and distressing events which have impacted his mental health. Jack has been described as suffering from periods of low mood where he would ‘lapse into tears’ and periods of mania, where he would experience ‘quite high’ moods. Jack’s experience with significant male role models in his life such as his violent father leaving and the sexual abuse he received from his boss during a crucial part of his development may have contributed to the delusions he began experiencing after a particularly stressful time in his life (being made homeless and learning of his mother’s health problems). The delusions he frequently spoke about included Robbie Williams raping his sister and wanting to kill him, as well as commonly seeing his father’s reflection when looking in the mirror. These delusions highlight the fear that Jack experiences as a result of his past trauma. Furthermore, Jack suffered from substance abuse; taking drugs and drinking to cope with the unspoken trauma of his sexual abuse and the loss of his father.

  1. Provide a plausible explanation of the development and maintenance of the service user’s difficulties, and how they may relate to one another; drawing on psychological theory and principles and details provided in the example

Due to the emotional pain inflicted on Jack as a result of his previous life experiences, this formulation adopts a psychodynamic approach, which focuses on how Jack’s current situation has been shaped by his history and past relationships (Hinshelwood, 1991). In particular, Jack’s relationship with his father, his unstable home life and sexual abuse are all factors that will be considered.

Throughout the case study, it is evident that Jack identifies with his father. He has a complicated mixture of emotions for his father and struggles to understand whether he loves or hates him. Jack has also previously spoken of hallucinations he has had where upon looking in a mirror, he sees his father’s face in the reflection, this could imply that Jack is afraid of becoming his father. This is also highlighted in behaviours that Jack may have subconsciously adopted from his father, such as violence in the home, which Jack witnessed and was a victim of from a young age and issues with substance abuse as Jack, although aware of his father’s issues with alcohol, began drinking himself at the age of fifteen. The unresolved issues of dealing with his father’s abuse may have led Jack to abuse substances as a way of coping with unresolved trauma. Jack’s coping mechanisms are clearly not fully effective in preventing the emotional pain he experiences, the delusions and hallucinations he experiences may be a form of defensive withdrawal to prevent these past traumas from resurfacing, although it is very clear that these delusions are based around Jack’s fears and anxieties.

  1. Effectively outline the benefits and limitations of diagnosis – for explaining the service user’s difficulties and devising an intervention

Receiving a diagnosis of depression may impact Jack positively as it could help him to gain access to mental health services. Furthermore, by having a psychiatric diagnosis, this may help Jack to understand how his past has impacted his present and importantly, may reassure him and even encourage him to consider treatment options (Malla, Joober & Garcia, 2015). However, the effects of a diagnosis of depression may lead to self-fulfilling prophesy, which according to Scheff (1966), may cause Jack’s depressive symptoms to dominate his self-concept, further decreasing his mental state. For Jack especially, this may prove problematic as he is evidently vulnerable and struggles with self-efficacy and control over his behaviours (as shown through his drinking habit). Furthermore, the stigma associated with a diagnosis of mental illness has been found to lower self-concept, which particularly for vulnerable individuals, can further decrease self-esteem (Pasman, 2011). Therefore, although a psychiatric diagnosis of depression may potentially help Jack to receive medical care and understand how his past has influenced his present emotions, thoughts and behaviours, it could also have adverse effects on his mental health, causing Jack to feel more anxious and defenceless.

  1. Briefly outline an intervention plan clearly related to the service user’s experience of distress and your explanation of the development and maintenance of the service users difficulties

Jack’s evident fragility, instability in relationships and dependence on delusions to limit his emotional pain suggests that a supportive therapeutic relationship may be the most beneficial to Jack. Dynamic Supportive Therapy includes forming a relationship between the patient and the therapist and involves listening and being empathetic to the patient and increasing the patient’s coping skills, whilst also being a perceived role model to the patient (Misch, 2006). Dynamic supportive Therapy may be particularly beneficial to Jack as not only will it teach him effective methods of coping with his trauma but will also help him to build a healthy relationship and gain trust in his therapist; skills that will help his mental functioning and allow him to accept his past to regain control of his future.


 Hinshelwood, R. D. (1991). Psychodynamic formulation in assessment for psychotherapy. British Journal of Psychotherapy8(2), 166-174.

Malla, A., Joober, R., & Garcia, A. (2015). “Mental illness is like any other medical illness”: a critical examination of the statement and its impact on patient care and society. Journal of psychiatry & neuroscience: JPN40(3), 147.

Misch, D. A. (2006). Basic strategies of dynamic supportive therapy. Focus9(2), 173-268.

Pasman, J. (2011). The consequences of labeling mental illnesses on the self-concept: A review of the literature and future directions. Social Cosmos2, 122-127.



Psychodynamic Formulation for Jack

Using one of the examples provided, clearly summarise the service user’s experience of distress.

The case study tells us of many of distressing experiences that Jack has endured throughout his lifetime. He has described his conflicting feelings towards his father’s actions and his leaving, his worry regarding himself and his sister’s safety alongside physical and sexual abuse as well as a big move of house which may have caused him to feel isolated.

Provide a plausible explanation of the development and maintenance of the service user’s difficulties and how they may relate to one another, drawing on psychological theory and principles and details.

All of the negative and traumatic experiences that Jack experienced occurred during his mid-adolescence. This period of time is when a person develops their own identity, gender and even achievements such as GCSEs. The experiences that occurred may have interrupted Jack’s chance to create his own sense of self and identity.

There is the possibility of an identity crisis as he sees his father’s face in the mirror and Jack is unsure on his feelings towards his father. On one hand, he may want to be like his father as he was in regard to success. On the other hand, he may not want to be like his father due to his violent and abusive personality.

Jack may also feel like a disappointment as he is the only male figure in his family and his inability to hold down a job due to his lack of motivation (may be caused by his negative experiences).

His delusional ruminations may indicate that he is struggling with the pressure he has put on himself and others. His delusional belief system may be a way for him to manage the negative experiences in his life. For example, him never dealing with the trauma of his sexual abuse may have led him to relate this to an idea of Robbie doing the same to his sister. Alongside this, his music ability may relate to Robbie stealing his music alongside a fear of Robbie’s friends beating him up which could derive from the harassment he experienced when he moved.

Effectively outline the benefits and limitations of diagnosis – for explaining the service user’s difficulties and devising an intervention. 


  • Diagnoses may allow Jack to come to terms with his negative experiences and allow him to understand why his actions have occurred and what he can do to better himself
  • Means better access to mental health services and other forms of additional help
  • May help him reconnect with family and friends if they understand what he is going through and why he acts the way he dos


  • May feel as though people are telling him about his own feelings and not allowing him to express things himself leading to frustration
  • Society may have a negative reaction to his diagnosis and treatment meaning he will struggle to interact with others
  • There is always a risk of Jack going further into his coping strategies when having to re-live/acknowledge the negative experiences he has endured

The positives outweigh the negatives here, but a strategic plan needs to be enforced so that any overwhelmingly negative effects of the therapy do not cause Jack to delve deeper into his negative coping mechanisms.

Briefly outline an intervention plan clearly related to the service user’s experience of distress and your explanation of the development and maintenance of the service user’s difficulties.

Firstly, Jack needs to be put on a rehabilitation programme for his alcohol and drug abuse. This will allow him to take part in other activities to help his recovery.

Once rehabilitation has begun, Jack should undergo some CBT sessions. The sessions should focus on Jack’s feelings regarding his physical and sexual abuse among the other negative experiences Jack had.

After Jack has begun coming to terms with his own personal feelings a form of family therapy should be put in place in order for Jack to reconnect with his family and friends and start building a support network again.

Jack’s Formulation, Psychodynamic approach

Clearly summarize the service user’s experience of distress

Jack has experienced abuse (physical and sexual), exhibits extreme mood swings, has witnessed his family going through hardship, was torn away from his old life and maybe felt isolated (would’ve lost friendship community when they moved and lost the Italian community in Swindon), felt abandoned/rejected by parents (father left the family and was later kicked out by mother) and harassment and bullying once they moved.

Provide a plausible explanation of the development and maintenance of the service user’s difficulties and how they may relate to one another, drawing on psychological theory and principles and details 

  • All of Jack’s distressing experiences (domestic and sexual abuse, failing GCSE’s, losing community) happened mid-adolescence when Jack’s identity, gender and achievements are being developed – this is a crucial time which was subsequently interrupted which means Jack doesn’t have a clear sense of self and identity
  • Started with promising capabilities (sociable, popular, musically talented, opportunity to continue father’s business) and never capitalising on any of these possibly led to him feeling like he’s lost all his leads – got nothing good going for him anymore, gives up
  • Father was highly successful but also inflicted violence on the rest of the family means Jack wanted to and didn’t want to be like his father at the same time, led to a possible identity crisis (explains seeing his father’s face in the mirror)
  • Confusion about father combined with sexual abuse would’ve confused Jack’s perception of masculinity and instilled fear concerning trust, violence and betrayal as he’s been abused by the two main male authority figures in his life
  • Substance abuse is an attempt to dull the pain from the inner conflict he feels
  • All negative experiences could lead to Jack feeling a lack of motivation and drive which has led to his inability to hold down a job – being the only male figure and failing to take care of his family could also feel like disappointment
  • Delusions Jack talks of are his last attempt to manage and have some control over his personal experiences, delusions also seem to reveal underlying anxieties (Robbie stole his music = never addressed his musical ability, feels like he lost it at some point, Robbie’s friends are out to beat him up = the uncertainty and anxiety of being harassed by the community, Robbie’s friends raped his sister = the disparity he feels from being sexually abused)

Effectively outline the benefits and limitations of diagnosis – for explaining the service user’s difficulties and devising an intervention


  • being diagnosed with something may help him understand what’s going on in his life – why he struggles with substance abuse, why he feels so fragile and upset
  • makes mental health services more readily available


  • may feel dismissive – he could get the feeling people aren’t listening to him and therefore enforce feelings of powerlesness and discourage / frustrate him further
  • diagnosis comes with social stigma which could possibly endanger his work possibilities and exclude future emplyers (which would be counteractive to my suggestions for intervention)
  • combination of these two things may push Jack further into his avoidant coping strategies (substance abuse, delusions)

The cons outweigh the benefits so might be more strategic / efficient to enforce intervention without informing Jack of the diagnosis

Briefly outline an intervention plan clearly related to the service user’s experience of distress and your explanation of the deelopment and maintenance of the service user’s difficulties 

CBT to talk about his feelings of domestic and sexual abuse and other issues like the pressure of carrying on the family business but not being able to do so or losing his attributions like popularity and musical abilities

Family therapy to repair relationship with mother and sisters – will help him retrieve a place of belonging as well as emotional support

Some sort of programme that focuses on his habits (aims to weaken his relationship with drugs and alcohol), maybe replaces them with things like exercise, having a routine, things to do in free time to pass the time

Some sort of programme that targets building skills and work opportunities, helps him to figure out where he might want to work, create a CV and apply, end goal is a stable job and a stable income that he enjoys, feels rewarding and can hold down

Jack, a Psychodynamic Approach

Jack a Psychodynamic approach


Loss of contact with the Italian community when leaving Swindon may have caused Jack to feel detached with his heritage and uncertain of his place in the world. Sexual abuse at age 14 when masculinity and sexuality are being developed may have caused Jack difficulty in developing a strong sense of self.

Fantasies about self

Jack’s fantasies of his entitlement to a large sum of money may possibly come from his belief he was entitled to his father’s empire which he was supposed to inherit.

Self-esteem vulnerability

Jack may be envious of his sister’s current situation so projects his own experience of sexual abuse on to her to protect his own self-esteem.

Internal response to self-esteem threats

Jack seems to be experiencing grandiosity in that he is exerting overconfidence in the beliefs of who he is (a famous song writer) and what he is owed (royalties from Robbie Williams), this may be an unconscious protection of his self-esteem.


When Jack was 10 his father was an alcoholic and violent towards his family. At age 14 Jack was sexually abused by the male boss and at age 15 Jack’s father left the family and no contact has been made since. Once Jack continued to go off the rails, his mother threw him out of the family home. It seems understandable that Jack will now have difficulty trusting anyone, with broken care-giver relationships and abuse from a figure in authority Jack does not trust that anyone cares about him and is now experiencing delusions that his friends want to kill him. It could be hypothesised that Jack has disorganised attachment with his confused feelings for his father, this hypothesis may help to form a care plan for treatment (Bowlby & Ainsworth, 2013).

Defence Mechanisms include:

Jack has disassociated by using increasingly regressive defence strategies. By disconnecting unacceptable thoughts and feelings from current reality. Projective identification, projecting rape on to his sister. Denial, acting out with drug and alcohol abuse and finally resorting to manic and paranoid psychotic delusions.

The evidence suggests Jack has considerable weakness in his sense of self with difficulty sustaining a sense of reality and utilising severely regressive and psychotic defence strategies to deal with life pressures.

(Note: Sub-headings would not be used in the actual assignment)

Cabaniss, D. L. (Ed.). (2013). Psychodynamic formulation. John Wiley & Sons.

Bowlby, J., & Ainsworth, M. (2013). The origins of attachment theory. Attachment Theory: Social, Developmental, and Clinical Perspectives, 45.