Case Study Final Paper – Cover PageDirectionsStudents will .docx

Case Study Final Paper – Cover Page
Directions
Students will conduct a case study pertaining to a fictional or
nonfictional character in a book or movie. Please note that all
characters and topics must receive prior approval from the
instructor. The following information should be provided
within the case study: demographic information, presenting
issue, assessment methods utilized, diagnosis (or possible
diagnosis), family history, social history, educational history,
intellectual functioning, mental health history including
treatment history, developmental history, medical history, and
substance abuse history. Within the paper, students will
conduct a two to three-page literature review of the presenting
issue/disability related to the character utilizing a minimum of
five (5) research-based references (only one reference may be
from Google Scholar). The paper should also include
multicultural considerations, treatment/rehabilitation
recommendations, and/or academic and school recommendations
depending on the nature of the issue. All citations should be in
APA format. Students should download this page and attach it
as the cover page to their paper.
Assignment Checklist
Was your character approved by the instructor?
Did you use the Case Study Template located on CANVAS?
Does your case study contain a two-page literature review with
at least five (5) research-based
Is your paper in APA format?
Does your literature review contain a Works Cited page?
Did you download this page, write your name, and attach it to
your paper?

Student Name:
_____________________________________________________
____
Case Study Final Paper – Cover Page
Directions
Students will conduct a case study pertaining to a fictional or
nonfictional character in a book or movie.
Please note that all characters and topics must receive prior
approval from the instructor. The following
information should be provided within the case study:
demographic information, presenting issue,
assessment methods utilized, diagnosis (or possible diagnosis),
family history, social history, educational
history, intellectual functioning, mental health history including
treatment history, developmental history,
medical history, and substance abuse history. Within the paper,
students will conduct a two to three-page
literature review of the presenting issue/disability related to the
character utilizing a minimum of five (5)
research-based references (only one reference may be from
Google Scholar). The paper should also
include multicultural considerations, treatment/rehabilitation
recommendations, and/or academic and
school recommendations depending on the nature of the issue.
All citations should be in APA format.
Students should print out this page and attach it as the cover

page to their paper.
Assignment Checklist
Ö Was your character approved by the instructor?
Ö Did you use the Case Study Template located on CANVAS?
Ö Does your case study contain a two-page literature review
with at least five (6) research-based
Ö Is your paper in APA format?
Ö Does your literature review contain a Works Cited page?
Ö Did you print out this page, write your name, and attach it to
your paper?
Student Name: “Kimberly C.”
“Kimberly C.”

RHS 302-???
Case Study
Demographic Information
Name: Kevin Khatchadourian (Movie: We Need to Talk About
Kevin)
Gender: Male
Age: 17
Height: 5’9”
Weight: 129 lbs.
Race: Caucasian
City/Hometown: Nyack, NY
Presenting Issue
At the age of 16, Kevin shot and killed his father, his sister,
seven of his high school classmates,
an English teacher, and a cafeteria worker. The weapon Kevin
used was a crossbow. His mother,
Eva Khatchadourian, describes Kevin as always having been
callous, cunning, and manipulative,
even as an extremely young child. She also characterizes his
emotional response to others as
shallow, and shares that Kevin has never displayed any feelings
of guilt at any point in his life.
A few weeks before Kevin committed the murders, his parents
reportedly agreed to divorce.
Family History
It is reported that Kevin spent the first 16 years of his life
growing up in an upper-middle class

household, first in New York City, and then in Gladstone, a
neighborhood of Nyack, NY.
Notably, Nyack is an affluent and artsy village located 20 miles
north of Manhattan, and the
family enjoyed the benefits of having a significant amount of
disposable income.
Eva Khatchadourian is Armenian-American and was reportedly
born in August 1945. She
describes her own beginnings as “apocalyptic,” based solely on
the chronological proximity to
Hiroshima and Nagasaki. She also categorizes her son’s birth
year, 1984, as ominous in its own
right, feared by many as a result of George Orwell’s classic
novel. Being of Armenian heritage
comes up as a frequent theme in Ms. Khatchadourian’s
conversation, and she shares that,
generally speaking, Armenians never truly have a sense of
safety and security as a result of their
ancestors having been slaughtered by the Ottoman Empire.
Though a native of Racine,
Wisconsin, Ms. Khatchadourian indicated that she never felt a
sense of belonging anywhere and
relished the chance to leave the United States whenever possible
and explore new cultures and
countries. She expressed that she never felt that she belonged in
the United States or had much
interest in the country, due to its perceived lack of exoticism. In
contrast, Kevin’s mother
describes her husband, Franklin Plaskett, as being a “full-
blooded” American, a person who
brimmed over with idealism, happiness, and the drive for what
she deemed to be an “imaginary”
American Dream. He is said to have been blindly devoted to
Kevin, and was known to regularly
“triangulate” Ms. Khatchadourian, aligning himself and his son

against whatever salient
concerns his wife had about Kevin’s behavior. This dynamic
was reported to have continued up
to the point of Mr. Plaskett’s death. Franklin Plaskett’s parents
are reportedly described as upper-
middle class and live in a custom-built house in Gloucester,
Massachusetts. Their daughter-in-
law describes them as refined, brittle, and formal, with a
profound distaste for leisure time.
Eva Khatchadourian reportedly owned her own business and
worked as the head of an
international travel guide franchise. When she was working full-
time, she traveled several
months out of the year to research travel destinations. Kevin’s
father, Franklin Plaskett, was a
film location scout and worked on a freelance basis.
Ms. Khatchadourian states that, prior to becoming pregnant, she
thought that she truly wanted a
child. She describes her pre-parenthood relationship with her
husband as solid and very loving,
and she reports that she thought a child would be a positive
addition to their lives. When she
actually became pregnant, however, Ms. Khatchadourian
reportdly felt dread rather than
happiness, and no longer felt that having a child was a
particularly appealing prospect. She
expressed that she did not appreciate the re-organization of her
life that having a baby would
inevitably bring. Ms. Khatchadourian reports that she felt
nothing for her son when he was born,

apart from profound disappointment over not feeling anything.
Bonding reportedly never took
place, and Kevin is reported as having displayed a decidedly
strong preference for his father
versus his mother within moments of birth. It was reported that
Kevin never took to nursing and
consistently refused to breastfeed.
Regarding extended family, Ms. Khatchadourian’s mother is
reported to be severely agoraphobic
and continues to live in Racine, Wisconsin. Her husband
(Kevin’s maternal grandfather) was
reportedly killed in WWII when his plane was shot down by
Japanese fighter pilots. Ms.
Khatchadourian reportedly has one brother to whom she is not
close.
Kevin had a sister, Celia, whom he shot and killed with a
crossbow. When she was 6 years old,
he was reported to have poured Liquid-Plumr in her eye,
resulting in the loss of sight and a
prosthetic replacement. As mentioned previously, a few weeks
before Kevin committed multiple
murders, his parents reportedly had agreed to divorce.
Social History
Kevin did not reportedly have any friends as a young child. Ms.
Khatchadourian explained that
children rarely asked him over to their houses more than once.
In high school, he reportedly had
a few acquaintances who are said to have been obsequious
“followers” more than friends.
Educational and Employment History

While in Pre-K, Kevin was reportedly enrolled in an after-
preschool playgroup. It was note dthat
after a few weeks, all the mothers in the group pulled their
children out and formed a separate
group without telling Ms. Khatchadourian. Kevin attended a
Montessori kindergarten, where his
mother reports that many children quickly developed a deep-
seated fear of him. Though he was
never officially assessed as being a genius, Kevin is categorized
by teachers and his mother as
being disturbingly bright. In fact, he is noted for being
calculatingly so.
Developmental History
In terms of appearance, Ms. Khatchadourian describes her son
as always having been
underweight as a small child; a characteristic that gave him a
“ferret-like sharpness from his
earliest years” (E. Khatchadourian, personal communication,
December 25, 2000). She also
describes him as always having had a flat affect, disinterest in
any activity that children normally
enjoy (i.e. toys, games, and game playing), and a distinctive
“sobersided wariness and disturbing
self-possession” (E. Khatchadourian, personal communication,
December 25, 2000).
As an infant, Kevin’s mother reported that he regularly
screamed for 6-8 hours straight while in
her company during the day, only to stop immediately when in
the presence of his father. She
acknowledged that babies generally have a variety of
dispositions and crying habits, but notes

that Kevin’s always had distinct overtones of deliberateness,
genuine outrage, and wrath. As a
baby, he reportedly only ever slept after passing out from
exhaustion.
Kevin’s birth was reported to have caused marital strife, with
each parent having a diametrically
opposed view of Kevin’s habits, tendencies, and personality
type. Two nannies reportedly quit
taking care of Kevin in his early years, due to the child’s
alarming behavior, and the family was
blacklisted from at least one childcare agency. It was reported
that Kevin promptly ceased his
hours-long screaming habit once the second nanny left her post.
In Ms. Khatchadourian’s words,
he “stopped cold” prior to turning two years old. It was reported
that he subsequently became
mute, sitting in complete and utter silence for hours at a time.
Throughout this period, Kevin’s
mother and doctor describe him as being “floppy” and
physically “slack.”
It was reported that Kevin did not speak until he was nearly 3
years old, but when he did, he
spoke in clearly discernible, full sentences. Everything he
uttered was reportedly in the negative,
i.e. “I don’t like that. I won’t do that. Not if I don’t feel like it,
etc.” Kevin’s mother indicated
that he had serious issues surrounding toilet training, and did
not begin using the toilet until he
was 6 years old. She stated that this only occurred after she
used violence against him. Kevin, in
turn, reportedly used the incident to gain leverage and power
over his mother. Notably, both
Kevin and Ms. Khatchadourian indicated that they are in
agreement over what happened and

how Kevin used the incident to his advantage.
Client Medical History
It was reported that as a young child, Kevin had a noticeable
disinterest in nearly everything, and
carried himself with an air of boredom and extreme apathy. Ms.
Khatchadourian reportedly had
him tested for various illnesses and spectrum disorders, but all
results were negative. As
mentioned previously, Kevin was reportedly resistant to toilet
training and stayed in diapers until
the age of 6. Then, following a changing table incident in which
it was reported that his mother
accidentally broke his arm, Kevin immediately began using the
toilet. Aside from a flu-like
illness he contracted for two weeks at the age of 10, Kevin was
never reportedly sick. It was
noted that food was never an interest, and his weight has always
been on the low side of
height/weight averages.
Family Medical History
Ms. Khatchadourian was reportedly diagnosed with Postpartum
Depression, a condition she
categorizes as actually having an aversion to Kevin in
particular, rather than to motherhood in
general. It was reported that Kevin’s maternal grandmother is
agoraphobic and lives on her own.
When his sister was 6 years old, Kevin reportedly poured

household cleaner into her eye,
blinding her and causing permanent facial scarring.
Mental Health Treatment History
Prior to committing multiple murders, Kevin had no history of
mental health treatment or
diagnosed mental health issues. It was reported that Kevin
asked to be placed on Prozac a few
weeks before committing mass murder at 16. This was not due
to any diagnosed or observable
depression, but rather was a detail Kevin wanted used as part of
his legal defense. In an
interview, Kevin openly discussed his pleasure at the Prozac
ploy’s effectiveness.
Substance Abuse History
There was no reported history of Kevin having engaged in
substance abuse and he has never
shown any indication of interest in alcohol or drug use.
Intellectual Functioning
Kevin has never reportedly underwent a psychoeducational
evaluation or any kind of intelligence
testing. That being said, his mother reported that a number of
Kevin’s teachers always
considered him to be quite smart, although manipulatively so.
Ms. Khatchadourian also
considers Kevin to be quite smart and extremely calculating.
Any developmental delays that
Kevin displayed as a child (see Developmental History) are
considered to have been acts of will
rather than ability.

Multicultural Considerations
Although Ms. Khatchadourian is proud of her Armenian
heritage and tried to engage her son in
multicultural pride, it was reported that he has historically
abhorred that part of himself, claiming
to be “American,” rather than Armenian. Kevin reportedly has a
tendency to use racial
derogatory terms with ease, including “gook” and “negro.” At
one point shortly before the
murders, Ms. Khatchadourian was reportedly called into school
for a meeting with one of
Kevin’s teachers. During the course of the conversation she
commented that perhaps Kevin
suffers from some form of “affluenza” because he lives very
comfortably in a large, well-
appointed custom-built home, where all his needs are met. The
teacher surmised that he might be
“bored” as a result and feel that he does not have much of a
purpose. His solution, therefore, is to
destroy his surroundings.
Suggested Methods of Assessment (or Methods of Assessment
already used)
Kevin appears to require a full mental health and forensic
evaluation that includes a psychiatric
evaluation to determine his overall treatment needs and risk of
future violence and aggression

towards others. The following instruments and methods of
assessment would be appropriate for
use with Kevin:
- Clinical Interview with Kevin as part of a forensic evaluation
- Collateral interviews with Kevin’s mother, teachers, and other
individuals who have
knowledge of him and his behavior
- Hare Psychopathy Checklist-Revised (PCL-R)
- Millon Adolescent Clinical Inventory (MACI)
- Jesness Inventory – Revised (JI-R)
- Personality Inventory for Children, 2nd Edition (PIC-2)
- Parenting Stress Index (PSI)
- Child Behavior Checklist (CBCL)
- Youth Self-Report (YSR)
- Cognitive testing (i.e. Wechsler Intelligence Scale for
Children – V)
*Upon his arrival at Claverack, Kevin was screened by the
psychiatric team for specific levels of
psychopathy using the PCL-R. The PCL:YV was not introduced
as a screening tool until four
years after Kevin’s conviction and so was not used.
The clinical interviews and inventories would be helpful in
gathering information related to the
extent of his antisocial thought processes and behaviors. The
personality inventories, such as the
MACI and JI-R, would be helpful to identify maladaptive
personality patterns and determine the
extent of Kevin’s psychopathology. The Parenting Stress Index
(PSI) would be used with
Kevin’s mother to obtain information about her own level of

functioning. Finally, it would be
helpful to use cognitive testing to identify Kevin’s overall IQ to
further guide treatment planning.
Diagnosis or Possible Diagnosis
As mentioned previously, Kevin has never received mental
health treatment and does not have a
prior diagnosis. According to DSM-5, he does not appear to
meet all of the criteria for Conduct
Disorder despite exhibiting a history of callous behavior
towards his sister. However, he does
exhibit some symptoms associated with Oppositional Defiant
Disorder (ODD). Additionally, he
also appears to exhibit symptoms associated with psychopathy
and Antisocial Personality
Disorder.
Case Conceptualization & International Classification of
Functioning (ICF)
Psychopathy is a psychological trait considered to be made up
of four category facets
(interpersonal, affective, lifestyle, and antisocial. On the Hare
Psychopathy Checklist-Revised,
facet scores can range from 0-10, and the higher the score, the
higher an individual’s level of
psychopathy.
If Kevin was to be administered the Hare Psychopathy
Checklist-Revised (PCL-R) as a

screening tool, he would likely score very highly in all four
facets indicating a very high level of
illness. He exhibits many of the following symptoms associated
with the DSM-5 criteria for
Antisocial Personality Disorders with psychopathic features:
1. Moderate or greater impairment in personality functioning,
manifested by characteristic
difficulties in two or more of the following four areas:
1. Identity: Egocentrism; self-esteem derived from personal
gain, power, or
pleasure.
2. Self-direction: Goal setting based on personal gratification;
absence of prosocial
internal standards, associated with failure to conform to lawful
or culturally
normative ethical behavior.
3. Empathy: Lack of concern for feelings, needs, or suffering of
others; lack of
remorse after hurting or mistreating another.
4. Intimacy: Incapacity for mutually intimate relationships, as
exploitation is a
primary means of relating to others, including by deceit and
coercion; use of
dominance or intimidation to control others.
2. Six or more of the following seven pathological personality
traits:
1. Manipulativeness (an aspect of Antagonism): Frequent use of
subterfuge to

influence or control others; use of seduction, charm, glibness,
or ingratiation to
achieve one’s ends.
2. Callousness (an aspect of Antagonism): Lack of concern for
feelings or problems
of others; lack of guilt or remorse about the negative or harmful
effects of one’s
actions on others; aggression; sadism.
3. Deceitfulness (an aspect of Antagonism): Dishonesty and
fraudulence;
misrepresentation of self; embellishment or fabrication when
relating events.
4. Hostility (an aspect of Antagonism): Persistent or frequent
angry feelings; anger
or irritability in response to minor slights and insults; mean,
nasty, or vengeful
behavior.
5. Risk taking (an aspect of Disinhibition): Engagement in
dangerous, risky, and
potentially self-damaging activities, unnecessarily and without
regard for
consequences; boredom proneness and thoughtless initiation of
activities to
counter boredom; lack of concern for one’s limitations and
denial of the reality of
personal danger.
6. Impulsivity (an aspect of Disinhibition): Acting on the spur
of the moment in
response to immediate stimuli; acting on a momentary basis
without a plan or
consideration of outcomes; difficulty establishing and following

plans.
7. Irresponsibility (an aspect of Disinhibition): Disregard for—
and failure to
honor—financial and other obligations or commitments; lack of
respect for—and
lack of follow-through on—agreements and promises (American
Psychiatric
Association, 2013).
According to the ICF model, Kevin is experiencing impairment
in the following domains:
Body Functions (mental functions): Kevin has engaged in
antisocial behavior (mass murder)
and has demonstrated callousness and a lack of empathy toward
others. His mother, Eva
Khatchadourian, describes Kevin as always having been callous,
cunning, and manipulative,
even as an extremely young child. She also characterizes his
emotional response to others as
shallow and reported that Kevin has never displayed any
feelings of guilt at any point in his life.
At a minimum, Kevin appears to exhibit symptoms of
Oppositional Defiant Disorder (ODD) and
antisocial thought processes and further assessment is needed to
determine the full extent of his
psychopathy and other mental health issues.
Activities and Participation (learning and applying knowledge,
interpersonal interactions and

relationships, and community, social, and civic life): Kevin
committed mass murder and will
most likely be incarcerated for a substantial period of time
(possibly life). He will not be able to
participate in community activities and his relationship with his
mother and others has been
severely impacted by his crime. He will not be able to
participate in meaningful and pro-social
activities within the community. At the present time, Kevin
possesses antisocial thought
processes and tendencies and does not have the ability to
empathize with others.
The Environmental Factors that help to facilitate positive
functioning for Kevin include his
upbringing in an upper-middle class of socio-economic
conditions and his parents’ support of
him despite his negative behavior. Additionally, the highly
structured environment associated
with incarceration in conjunction with his lack of access of
weapons will diminish the risk of him
harming (or killing) others.
The Personal Factors that help to facilitate positive functioning
for Kevin include his high level
of intelligence and overall good physical health. He does not
have a reported history of abusing
drugs or alcohol either.
The Environmental Factors that serve as a barrier to positive
functioning for Kevin include
isolation from family and friends due to incarceration, inability
to practice pro-social behavior
within the community due to incarceration, lack of meaningful
relationships with others,
disruption in his education, and interaction with others in prison

who have histories of antisocial
and criminal behavior.
The Personal Factors that serve as a barrier to positive
functioning for Kevin include his
antisocial thought processes, lack or regard for others, and lack
of meaningful interpersonal
relationships with others. Kevin’s mother has a history of
mental illness (Postpartum
Depression) and his maternal grandmother also has a history of
mental illness (Agoraphobia).
Kevin’s mother has also generally been aloof in their
interactions and the two have never had a
close, meaningful relationship.
It is obvious that Kevin has significant capacity for success
given that he comes from an upper-
middle class family and has experienced little trauma or
adversity during his childhood. He has
no reported physical disabilities or cognitive deficits and
presents as highly intelligent.
However, the major areas affecting Kevin’s overall performance
appears to be his high level of
psychopathy and antisocial thought processes. This has grossly
affected his relationships with
others, particularly his mother, and led to him engaging in mass
murder. Kevin will be
incarcerated for the remainder of his life and his ability to
develop a family as well as engage in
prosocial activities within the community will be severely
impacted.

Finally, assessment that includes an extensive clinical
interview, interviews with collateral
sources (such as teachers, parents, etc.), personality testing,
intelligence testing, and especially
testing for psychopathy is needed to determine Kevin’s level of
risk for future violent acts as
well as determining a comprehensive and appropriate treatment
regimen for him. He should also
be given a psychiatric evaluation to determine whether he could
benefit from psychotropic
medication.
Treatment/Rehabilitation Recommendations
● The major presenting issues to address in Kevin’s
rehabilitation are his psychopathic and
antisocial tendencies that include a lack of empathy for others,
his opinion that most
everyone and everything is “boring and stupid,” and feelings of
superiority while
processing his belief system that led to him committing multiple
murders.
● Kevin is recommended for intensive individual therapy to
address his major presenting
issues referenced above.
● Kevin is recommended for MST, or Multisystemic Therapy.
As such, therapy will
encompass close examination of Kevin’s personal systems,
including his peer, family,
school, and childhood environments prior to entering prison.
Kevin’s mother regularly

visits him at Claverack and has expressed noted interest in
being involved in the
therapeutic process. As part of the family systems aspect of
therapy, Ms. Khatchadourian
will be regularly included in sessions.
● Kevin is recommended for a psychiatric evaluation to
determine whether he could benefit
from psychotropic medication.
REVIEW OF LITERATURE
By current estimates, there are thought to be approximately 30
million psychopaths living
throughout the world today. When limited to the United States,
the number counts for about 1%
of the population, or 3.09 million people. When broken down
even further, it is estimated that
nearly 1% of all non-imprisoned American males aged 18 and
over are psychopaths (Kiehl &
Hoffman, 2011).
Historically speaking, psychopathy is a psychological disorder
that many in the field of mental
health view as having few effective treatment options. In the
last 30 years, progress has been
made in terms of the adoption and implementation of effective
screening tools, namely the PCL-
R, or Psychopathy Checklist Revised, and its derivatives.

According to psychologist Robert
Hare, having such tools available can only aid in the
development of effective treatment
programs for psychopaths, ones in which “their propensity for
offending and violence can be
managed, without futile attempts to produce fundamental
changes in their personality” (Hare,
2007, p. 22).
In writing about psychopathy and criminality, FBI expert Mary
O’Toole reports that this kind of
disorder is best described in dimensions rather than categories.
She goes on to state that the
psychopathic personality can be broken down into four different
facets. These include the
interpersonal, affective, lifestyle, and antisocial facets. Facets
are scored on a scale ranging from
0 to 10. The higher the score, the deeper the level of
psychopathy (O’Toole, 2007). The
interpersonal facet relates to how an individual interacts with
others. A high score indicates that a
person is manipulative, deceptive, dominant, and controlling
(O’ Toole, 2007). The affective
facet refers to a person’s emotional depth. A high score is an
indicator that the subject is unable
to experience feelings to a significant degree, nor is s/he able to
consider the feelings of others,
except in the abstract. The lifestyle facet is rather self-
explanatory and relates to how the
individual lives his or her life. A high score indicates a
propensity towards boredom, a tendency
to wander, and an inability to stay in jobs or relationships for
very long. Finally, the antisocial
facet describes the overall “rule-breaking” behaviors in which
the subject might engage. A high
score is an indication that the person regularly engages in social

and legal violations (O’Toole,
2007).
The PCL-R was first introduced to the field of psychology in
1980. It has been revised twice
since then and is used to determine the course of treatment
programs for adult psychopathic
individuals. In recent years, more clinical attention has been
given to the presentation of
aggression and psychopathic traits in youth. In a study of
adolescent and child psychopathy,
psychology professors Ribeiro da Silva, Rijo, and Salekin write
about the need for more reliable
assessment tools for young people. In the early 2000s, the PCL-
R was adapted for screening of
child and adolescent psychopathy. In that iteration, it is known
as the PCL: YV, or the
Psychopathy Checklist: Youth Version (Ribeiro da Silva, Rijo,
& Salekin, 2012). It is considered
a full-scale assessment, replete with a structured interview and
a comprehensive record review.
Another youth-based screening method is the Antisocial Process
Screening Device, or ASPD. It
is considered “the most widely used and tested youth
psychopathy screening measure” (Ribeiro
da Silva et al., 2012, p. 72). Less frequently used tools include
the Child Psychopathy Scale, the
Youth Psychopathic Traits Inventory, and the Psychopathy
Content Scale.
Despite the significant growth in youth based measures, Ribeiro
da Silva et al. point out that not
all of them are precise in their findings, and many vary in what
factors they are assessing. In their
words, “the lack of agreement on the dimensionality of the
psychopathy construct is a major

issue that should be addressed in order to better compare results
from different studies” (Ribeiro
da Silva et al., 2012, p. 72). Not doing so most likely means
continued “misunderstandings and
mistakes” in clinical evaluations (Ribeiro da Silva et al., 2012,
p. 74).
Though it has proven to be an ineffective clinical intervention
for psychopaths, “one of the most
popular treatments for psychopathy has been the therapeutic
community” (Harris & Rice, 2006,
p. 556). In the 1970s, it was thought that the social construct of
a therapeutic community “might
alter the basic personality” of psychopaths (Harris & Rice,
2006, p. 556). Based on this theory,
an intensive study of a therapeutic community was conducted in
the early 1990s, a community
that was thought to be beneficial for patients with psychopathy.
The program took place in a very
high security psychiatric hospital and featured intensive group
therapy for up to 80 hours per
week. The study matched 146 treated offenders with 146
untreated offenders. Nearly all
offenders had been convicted of violent crimes, and variables in
the study were “related to
recidivism (age, criminal history, and index offense)” (Harris &
Rice, 2006, p. 556). All
participants were given the PCL-R, but not all scored high
enough to be considered a
psychopath. The results of a study follow-up showed that 10.5
years after treatment in the
therapeutic community, non-psychopaths demonstrated lower

violent recidivism. However,
psychopaths demonstrated higher violent recidivism. Since the
program was psychoeducational
in nature, and taught both psychopaths and non-psychopaths
alike about the feelings of others,
empathy, sympathy, social skills, and the importance of
people’s perspectives, it is thought that
psychopaths used this information to further harm others, but to
a greater degree.
Hecht, Latzman, and Lilienfeld of Georgia State, Emory, and
University of Melbourne
respectively, also write about the historical use of therapeutic
communities to treat psychopathy.
They state that, ideally, such communities should provide the
client with a supportive and
therapeutic atmosphere (Hecht, Latzman, & Lilienfeld, 2018).
The daily group meeting is
thought to be a key aspect to a strong supportive environment.
When properly formatted, the
group meeting is one in which all patients and staff are in
attendance and a cooperative and
democratic decision-making environment is created. In this
context, rules can be made, therapy
provided, and conflicts addressed (Hecht et al., 2018). To date,
though, general treatment in a
therapeutic community has not proven to be a clearly effective
intervention for psychopaths.
Cognitive Behavioral Therapy has historically been another
intervention recommended for the
treatment of psychopaths. However, it too, has not been proven
to be particularly effective. To
highlight this point, when a CBT and relapse prevention
program for sex offenders was
conducted in 1999, high psychopathy patients “were rated as

having shown the most
improvement (as measured by conduct during the treatment
sessions, quality of homework, and
therapists’ ratings of motivation and change)” (Harris & Rice,
2006, p. 557). However, not only
were these same patients more likely than other participants to
reoffend, their crimes were more
likely to be violent.
In 2018, a study was conducted in the Netherlands, exploring
whether or not MST, or
Multisystemic Therapy, is a viable treatment option for
extremely violent youth. In the study,
extremely violent youth were defined as individuals who had
committed murder and/or used
excessive violence towards others. MST is derived from
Bronfenbrenner’s socio-ecological
model, and it states that “the development of all behavior, and
thus also the development of
antisocial behavior, is the result of the interactions between
individuals and the various systems
in which they find themselves” (Aascher, Dekovic, Van den
Akker, Prins, & Van der Lann,
2018, p. 959). The model draws heavily from both social and
family systems theories, as well as
research that has been done on the causes of antisocial behavior.
The treatment addresses the
various systems that make up adolescent daily life, including
peer, family, school, and
neighborhood (Aascher et al., 2018). The Dutch study included
a group of 71 juvenile offenders
who are classified as extremely violent. During a 5-month

treatment period, researchers found
that psychopathic behaviors initially increased in the first
month of treatment, but then decreased
in months two and three. The same non-linear pattern was found
in the quality of the
parent/adolescent relationship. The study concluded that MST
may be an effective treatment
option for at least some violent juvenile offenders.
REFERENCES
Asscher, J. J., Deković, M., Akker, A. L., Prins, P. J., & Laan,
P. H. (2016). Do Extremely Violent
Juveniles Respond Differently to Treatment? International
Journal of Offender Therapy and
Comparative Criminology,62(4), 958-977.
doi:10.1177/0306624x16670951
David, D., Lynn, S. J., & Montgomery, G. (2018). Evidence-
based psychotherapy: The state of the
science and practice. Chichester: Wiley Blackwell.
Diagnostic and statistical manual of mental disorders. (2013).
Washington, D.C: American
Psychiatric Association. doi:https://doi-org.ezp1.villanova.edu/
10.1176/appi.books.
9780890425596.AlternatePersonalityDisorders.
Hare, R.D. (2007). Forty years aren’t enough: Recollections,
prognostications, and random
musings. In H. Hervé and J.C. Yuille (Eds.), The
psychopath: Theory, research, and
practice (pp. 3-28). Mahwah, NJ: Lawrence Erlbaum.
Harris, G. T., & Rice, M. E. (2006). Treatment of

Psychopathy: A Review of Empirical
Findings.In C. J. Patrick (Ed.), Handbook of psychopathy
(pp. 555-572). New York, NY,
US: The Guilford Press.
Hecht, L.K., Latzman, R.D., & S.O. Lilienfeld (2018). The
psychological treatment of
psychopathy: Theory and research. In D. David, S.J.
Lynn, & G. Montgomery (Eds.).
Evidence based psychotherapy: The state of the science
and practice (pp. 271-298).
Hoboken, NJ: John Wiley & Sons.
Hervé, H., & Yuille, J. C. (2017). The psychopath: Theory,
research, and practice. London:
Routledge.
Kiehl, K. A., & Hoffman, M. B. (2011). The Criminal
Psychopath: History, Neuroscience, Treatment,
and Economics. Jurimetrics,51(Summer), 355-397. Retrieved
March 28, 2019, from
www.ncbi.nlm.nih.gov/pmc/articles/PMC4059069/.
O’Toole, M. (2007). Psychopathy as a behavior
classification system for violent and serial
crime scenes. In H. Hervé and J.C. Yuille (Eds.), The
psychopath: Theory, research, and
practice (pp. 301-325). Mahwah, NJ: Lawrence Erlbaum.
Shriver, L. (2005). We need to talk about Kevin. London:
Serpents Tail.
Silva, D. R., Rijo, D., & Salekin, R. T. (2013). Child and
adolescent psychopathy: Assessment issues

and treatment needs. Aggression and Violent Behavior,18(1),
71-78.
doi:10.1016/j.avb.2012.10.003
Student Name:
RHS 302
Case StudyDemographic Information
Name:
Age:
Gender:
Race/Ethnicity:
Height:
Weight:
City/Hometown: Presenting Issue
Provide a brief summary of the character’s disorder, disability,
and/or other problems. (What is reason why you would be
conducting an assessment on this character?)
Family History
Provide a summary of the character’s family history. The
following items should be included (if known): the family
composition, nature of the family relationships, conflict among
family members information about the character’s childhood
and upbringing, trauma within the family, trauma experienced
by the character, and any other information deemed to be
important especially as it relates to the presenting issue.
Social History
Provide a summary of the character’s social history. The
following items should be included (if known): peer
relationships, conflict with peers, romantic relationships, sexual
relationships, activities in which the character is involved, and
any other information deemed to be important especially as it
relates to the presenting issue.

Are there any issues with regard to social family functioning
(i.e. relationships, spirituality, sexuality, recreation, etc.)?
Provide a summary of the character’s educational history. The
following items should be included (if known): schools
attended, current grade and school, academic grades, behavior
and attendance at school, relationship with peers and teachers,
learning disabilities and special education, extracurricular
activities at school, graduation status, college education,
previous jobs, problems with employment, and any other
information deemed to be important especially as it relates to
the presenting issue.
Are there any issues with regard to the character’s education
and/or employment?
Provide a summary of the character’s developmental history.
The following items should be included (if known): issues with
mother’s pregnancy and delivery, problems with developmental
milestones (walking, talking, toilet-training, etc.), medical
issues as a child, cognitive functioning, and any other
Medical History
Provide a summary of the character’s medical history. The
following items should be included (if known): illnesses,
diseases, medications for physical health issues, injuries,
hospitalizations for physical health issues, surgeries, and any
other information deemed to be important especially as it relates
to the presenting issue.

Provide a summary of the character’s family medical history.
The following items should be included (if known): illnesses,
diseases, medications for physical health issues, injuries,
hospitalizations for physical health issues, surgeries, mental
health diagnoses and treatment, substance abuse diagnoses and
treatment, and any other information deemed to be important
especially as it relates to the presenting issue.
Provide a summary of the character’s mental health treatment
history. The following items should be included (if known):
history of suicidal ideation and attempts, symptom history,
previous diagnoses, previous and current treatment (inpatient,
outpatient, etc.), medication for mental health issues, and any
other information deemed to be important especially as it relates
to the presenting issue.
Provide a summary of the character’s substance abuse history.
The following items should be included (if known): what
alcohol and drugs have been used, frequency and amount of
alcohol/drug use, history of substance abuse treatment,
problems caused by alcohol/drug use, and any other information
deemed to be important especially as it relates to the presenting
issue.
Provide a summary of the character’s intellectual. The
following items should be included (if known): IQ score, other
cognitive testing, history of intellectual disability diagnosis,
and any other information deemed to be important especially as
it relates to the presenting issue.
If applicable, provide a summary of any issues related to the
character’s age, race, gender, sexual identity, sexual
orientation, religion, socio-economic status, and any other

Are there any issues with regard to test bias or other ethical
considerations for this character?
already used)
What specific instruments and assessment methods could be
used for this character? Explain what you are assessing and
why you are using that method of assessment and/or instrument.
If applicable, what instruments and/or assessment methods
could be used to determine the presence of a mental health
disorder?
could be used to determine whether the character is at risk for
suicide?
could be used to determine whether the character has a
substance use disorder?
could be used to determine physical disabilities?
could be used to determine the extent of educational/vocational
problems?
could be used to assess the character’s intellectual functioning?
Are there any issues with regard to adaptive functioning? How
do you know? How can you assess the character’s adaptive
functioning?
Possible Diagnosis
What instruments and/or assessment methods could be used to
determine a diagnosis for this character?

** Reminder: You are not diagnosing the character! If the
character has a prior diagnosis, you can list it. If not, you can
discuss possible or potential diagnoses for the character based
upon the outcome of your assessment methods and
instruments.**International Classification of Functioning (ICF)
and Case Conceptualization
In which domains/components of the International
Classification of Functioning (ICF) is the character
experiencing impairment?
According to the ICF framework, what are the environmental
factors that are helping to facilitate positive functioning for the
character? (i.e. environmental protective factors)
According to the ICF framework, what are the personal factors
that are helping to facilitate positive functioning for the
character? (i.e. personal protective factors)
According to the ICF framework, what are the environmental
factors that are serving as a barrier to positive functioning for
the character? (i.e. environmental risk factors)
According to the ICF framework, what are the personal factors
that are serving as a barrier to positive functioning for the
character? (i.e. personal risk factors)
According to the ICF framework, explain the gap between the
character’s “capacity” and “performance.”
What is the character’s presenting issue/problem or disability?
What is the possible (or actual) diagnosis and why?
How/why do you think this character developed this problem or
disability?
What personal and social factors contributed to the development
of the problem or disability?Treatment/Rehabilitation
Recommendations

What areas of treatment/rehabilitation are required? Be sure to
address needs related to family and social functioning,
education/vocation, medical/health, cognitive functioning,
mental health, substance abuse, etc.
Review of Literature
Students will conduct a two to three-page literature review of
the presenting issue/disability related to the character utilizing a
minimum of five (5) research-based references (only one
reference may be from Google Scholar). All citations should be
in APA format.
Student Name:
RHS 302
Case StudyDemographic Information
Name:
Age:
Gender:
Race/Ethnicity:
Height:
Weight:
City/Hometown: Presenting Issue
Family History
Social History
Character Medical History

already used)
Possible Diagnosis
Case Conceptualization & International Classification of
Functioning (ICF)Treatment/Rehabilitation Recommendations
Review of Literature

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