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Character Analysis: Morton Rainey

DSM IV-TR Diagnosis and Treatment Plan

Brian Noble

on 23 February 2011

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Transcript of Character Analysis: Morton Rainey

Character Analysis: Morton Rainey
The Secret Window Brian Noble, Karen Naumann, & Risa Cagnoni-Jacobs
The Adler School of Professional Psychology Background Information Heterosexual Male in his late 30’s

Successful writer

Recently separated from his wife pending divorce finalization

Lives in seclusion in upstate New York

Some history of alcohol abuse and nicotine dependance Background Information Discovery of wife’s infidelity prompting his retirement to seclusion

Avoidance of divorce finalization, and severe writer’s block.

Depressed mood and lack of personal hygiene practices

Reduced social interaction and withdrawl. Wife's Infidelity: Appearance of a stranger named John Shooter who accuses him of plagiarism

Mysterious disappearance and death of dog and two friends, arson of his second home

Paranoid and suspicious behavior of Mort

Eventual realization that Shooter is an alternate personality within himself Background Information Major Plot Components: DSM IV-TR Multi-Axial Diagnosis: Axis I: 300.14 Dissociative Identity Disorder

Axis II: 799.9 Deferred Diagnosis

Axis III: None

Axis IV: Discovery of infidelity, pending divorce,
reclusive living situation, lack social support.

Axis V: GAF = 10 Presenting Symptoms: Presence of two distinct identity states

Memory recall impairment

Posttraumatic symptoms (nightmares, flashbacks, startle responses),

Hypo-somnia, paranoia, fatigue,
A. The presence of two or more distinct identities or personality states (each with its
own relatively enduring pattern of perceiving, relating to, and thinking about the
environment and self) .
B. At least two of these identities or personality states recurrently take control of the
person's behavior.
C. Inabi lity to recall important personal information that is too extensive to be explained
by ordinary forgetfulness.
D. The disturbance is not due to the direct physiological effects of a substance (e.g.,
blackouts or chaot ic behavior during A!cohollntoxication) or a general medical co n ~
dit ion (e.g ., complex partial seizures). Note: tn children, the symptoms are not attributable
to imaginary playmates or other fantasy play. Diagnostic criteria for 300.14 Dissociative Identity Disorder Phase Oriented Treatment for Mr. Rainey 1. Safety, stabilization, and symptom reduction

2. Working directly and in depth with traumatic memories

3. Identity integration and rehabilitation Theraputic Relationship: Focus on Mr. Rainey as a whole person, rather than a collection of two individual people inside one body
regardless of the client’s subjective experience
treatment goals:
- moving the client towards improved and integrated functioning
- incorporating the two personalities into a single self concept Phase 1: Stabilization & Symptom Reduction: Focus on the development of a strong working relationship to assist Mr. Rainey in establishing stability, safety and symptom reduction
emphasizes managing and controlling symptoms - development of a stabilization and symptom reduction plan
- Variety of strategies can be used: e.g. detecting problematic thought patterns & beliefs (CBT)
- Client will begin adapting to the pending divorce and unfaithful actions of his ex-wife Phase 1: Stabilization & Symptom Reduction: If therapeutic alliance is strong, therapist will be able to: - map the client’s alternative personality states (alters)
- determine their roles and functions
- establish an effective relationship with the specific alter who appears to be the source of self-destructive or violent behavior, with the goal of controlling this behavior
- establish communication among the alternative personality states Phase 2: Working with Traumatic Memories focus on reclamation of painful memories and traumatic experiences

DID believed to have its onset in early childhood years, mostly caused by child abuse

therapist’s work with client: - recollection, toleration, and integration of life stressors and overwhelming events Phase 2: Working with Traumatic Memories Goals: disclose dissociated aspects of the traumatic experience - includes: feelings the client associates with finding his ex-wife in the hotel room
- the somatic and physiological reactions to it
- identifying sequence of circumstances of event to assist client in reconstructing & understanding the role of himself and others with an adult cognitive awareness Client will gain control over hurtful experience
increase his ownership of his history and sense of self
decrease experience of themselves as separate & distinguishable identities fusion Phase 3: Integration & Rehabilitation therapist will assist client in: fusing alters
- rehabilitate and improve client’s functioning in an increased and integrated manner
- support client developing a more rational and logical outlook on his personal history & past events
- when client is “unified”, therapist may begin teaching coping skills for dealing with everyday life stressors, emotions, and disappointments in non-dissociative ways References: American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington, DC

International Society for the Study of Dissociation. (2005). [Chu, J.A., Loewenstein, R., Dell, P.F., Barach, P.M., Somer, E., Kluft, R.P., Gelinas, D.J., Van der Hart, O., Dalenberg, C.J.,Nijenhuis, E.R.S., Bowman, E.S., Boon, S., Goodwin, J., Jacobson, M., Ross, C.A., Sar, V, Fine, C.G., Frankel, A.S., Coons, P.M., Courtois, C.A., Gold, S.N., & Howell, E.]. Guidelines for treating Dissociative Identity Disorder in adults. Journal of Trauma & Dissociation, 6(4) pp. 69-149. Definition of identity alteration- a “sense of being markedly different from another part of oneself”

Identity alteration can be observed when a person uses different voice tones, range of language, or facial expressions”
International Society for the Study of Trauma & Dissociation
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