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 Harlow Jacobs

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Harlow Jacobs

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Posts : 58
RP Reward Points : 54
Join date : 2012-10-24

PostSubject: Harlow Jacobs   Thu Oct 25, 2012 1:36 am



Jacobs, Harlow



      D.O.B: 04/21/1986
      AGE: 26
      GENDER: M
      STREET ADDRESS: 16 Pennwood Drive
      TOWN/CITY: Camden
      STATE: Delaware
      HEIGHT: 5’10”
      WEIGHT: 165
      ETHNICITY: Caucasian
      DISTINGUISHING MARKS: One mole on his left bicep, one on his left buttocks

I, Dr. Marilyn Kensinger will be completing the application for Harlow.
_____________________________________
Medical History

Do you have any ongoing medical issues for which you require treatment or medication?:
Harlow was diagnosed with Aspergers Syndrome at the age of seven. He has required cognitive behavior therapy and special education in communication and skills training. He is high functioning academically and completed both high school and college, with a degree in History.

Are you aware of any allergies? If so, please list allergy, age of onset and any medications or treatments you require or recieve:

Harlow is allergic to pine nuts.

Have you had any surgeries or invasive procedures in the past? If yes, please list reason and approximate age of procedure:

No previous surgeries.

Do you take any medications or supplements daily? Do you follow any treatment plans? Please list medications or treatments, and reasons below:

Harlow takes Aripiprazole and Luvox to curb certain behaviors related to his Aspergers Syndrome. He tried to commit suicide at the age of fifteen and spent several weeks in a juvenile psychiatric ward. Between the ages of fifteen and seventeen he continuously saw a therapist to treat behavioral problems as well as his depression. While attending Pennsylvania State College, he discontinued his sessions and opted out of receiving help while at school. He drifted in and out of therapy in his years following college, continuing on medication as well. When his depression worsened, he sought help (after convincing of his brother) and began having bi-weekly session with me. After a major depressive episode I do not believe that I can continue serving Harlow as he needs.

Do you use tobacco, consume alcohol, or use any other drugs including street drugs and/or prescription medications not prescribed to you? If yes, please list number of packs a day, number of drinks a day, and/or drugs consumed below:

Harlow has not admitted to using any form of narcotics but has admitted to drinking more steadily over the past two years. He consumes three to four drinks in one sitting, approximately four times a week.

_____________________________________
Psychiatric Screening

Please describe, to the best of your ability, your emotional and mental state of wellbeing:

Harlow is incredibly sensitive, and appears more fragile than when I first began seeing him a year and a half ago. He went from a moderate understanding of the world around him to complete dejection. He complains regularly of feeling listless, out of touch with the world, and alone. He questions the meaning of life often, and that he felt his job as a sales associate at a large company was a waste of time. After the death of his sister and her daughter, he did not often feel compelled to show up at work or get out of bed in the morning. He stated that he would much rather sleep all day than spend an afternoon with anyone. He appears to have lost the “drive” to live for something more.

Have you been diagnosed with any psychiatric or psychological ailments? Please list any diagnoses below, and the treatments or medications prescribed to you. Please include name of medications, dosage, and number of doses per day:
Harlow has been diagnosed and treated with:
• Major Depressive Disorder
o Wellbutrin, 150mg 2x daily
• Primary hypersomnia
o Modafinil, 100mg 2x daily
• Generalized anxiety disorder
o Effexor, 75mg 1x daily

Have you ever been hospitalised or referred to regular outpatient care due to these ailments or associated incidents? If so, please note where, and at roughly what age:

When Harlow was fifteen years old, he was admitted to Kent General Hospital after a suicide attempt. He slashed his wrists but called 911 before losing consciousness. He was admitted for psychiatric treatment to Christiana Medical for two weeks of observation and treatment. Following this, he began a regimented dosage of antidepressants and continued to see psychiatrists and therapists.

One month ago, Harlow explained that he had harmful thoughts about himself and was worried that his depression was deepening. He expressed that he just didn’t understand why “some people had to be taken from this world" if he "couldn't go with them," and that he’d never see them again. He complained about the pain of his loss and the immense grieving that he had experienced in the year since his sister’s death. I asked if he had thoughts of killing himself and Harlow admitted that he liked to think about jumping out of his office building window (he works on the tenth floor). He imagined that “at the very least the pain would go away.” I told him that I did not believe that we were making progress through his depression, and that there was no more that I could do to help him. I also explained that he was a danger to himself—to which he admitted that he had thought about committing suicide for several weeks—and that he needed to seek further treatment for his depression and anxiety.

How have these ailments affected you and your life? Are there any major life instances you feel have been directly affected by these ailments, such as suicide attempts, criminal activities, etc?:

Anxiety can cripple Harlow from completing tasks during the day. He hates anything to do with large groups of people, especially those with which he’s unfamiliar. Panic attacks are not irregular and can leave him out of commission. His depression has led to one unsuccessful suicide attempt, and appears to constantly hover over him like a weight. He remarks that the depression has led him to think less of life, of what he should be doing, of what he is capable of, and how other people view him.

The most criminal thing that Harlow has ever done is shoplift a stick of gum (which he admitted feeling incredibly anxious about). His intentions are usually good natured, and his incredibly stubborn nature prevents him from being taken advantage of by most.

What is your social life like? Do you have many friends or relationships? How are your family relationships?:

Friendships have been few and far between for Harlow. Up until High School he felt as though he were drifting through the world as an observer, still trying to understand how people functioned the way that they did. While he admits to “not fitting in” and consistently being teased for his behaviors at the time, he was given a helping hand from his more than devoted sister. It was his sister that protected him throughout much of his life, and helped him to make friends and understand what was going on around him. He also admits that there were a few people that paid attention to him, teachers especially, that encouraged him to “get out” of Delaware and make something of himself. Harlow stated that it pained him greatly to see his sister go when she graduated from school, and determined that he would follow her wherever she went.

His time in college was well spent, and he made a few friends despite his social awkwardness. He grew more attached to his sister, who continued to act as a guide. He had one sexual relationship, but refuses to talk about this under most circumstances. He states that he began drinking in his second year of college, around the same time that he stopped seeing a psychiatrist regularly. His drinking became progressively worse, and he states that this is about the time that he began to once again feel isolated from his peers (around the same time that Melissa graduated from school). He completed college with a respectable (3.5 GPA) but admitted that he tried to manipulate professors based on his disability for higher grades and second chances on academic projects. He moved back to Delaware after graduation, where he began a job as a sales associate for Astrazeneca.

He rarely speaks of his relationship with his family unless pressed, but grew up with his mother (Jennifer), father (Brian), brother (Ray), and sister, now deceased (Melissa). His sister helped to convince him to get back into therapy and even attended a few of the beginning sessions with Harlow. His father is a member of local government (a state senator) and his mother is a vice principal of an elementary school. His brother is a lawyer. He stated that “they are the type of people that like fancy things” and that they always “have an image” to keep up.

Do you believe your life circumstances have contributed to any ailments? If so, what circumstances, and why do you feel they have contributed?:

If anything, the death of Melissa and her child has proven to be the single most difficult thing for Harlow to understand. While incredibly attached to his older sister, he admits to growing depressed having been separated from her after her graduation from college. He could not quite come to accept that he needed to live life on his own, and that there were other parts of his life that he needed to explore. When she became engaged to Scott, her fiancé, it was Harlow that proved the toughest sell on why he deserved his sister. He never truly warmed to Scott but conceded that the only thing that made him happy was to see his sister happy. He says that it “killed” him to see her move to Vermont but planned to visit often.

This marked the return of his depressive episodes and anxiety. He would break down into fits of anxiety and be unable to do anything at all. His only reprieve appeared to be the knowledge that he would be an Uncle. When it was announced Melissa was pregnant, she also made clear her intentions to move to Philadelphia, just forty-five minutes away from Harlow. He was ecstatic and could not wait for her return. Complications arose from the pregnancy, however, and just two months prior to being full term—having just moved into their new home—Melissa was rushed to the hospital.

She died from these complications, and Harlow has not recovered. He fixates on his sister, her unborn child, and her decision to come closer to home. He thinks about what it would have been like if she hadn’t decided to move—blames himself for the constant pestering that she live closer—and imagines she might still be alive. He is absolutely heartbroken, and has not been himself since her death.

If you could change one past event that has happened to you, what would it be, and why?:

Harlow wishes that he had been smarter about getting into a car with a man that he did not know when he was nine. He was abducted not far from his home and forcibly raped and molested. This marked his first period of depression—one that continued into adolescence and through puberty.

Do you wish to rehabilitate from your ailment(s)? If so, how do you feel this would best be accomplished?:

If Harlow is not given a chance to rehabilitate, I fear that he will try to take his own life again in the future. He is prone to trying to swallow anything that might hurt him, to cut himself, to run scalding water over his body. He also will shut down if the world around him is “too difficult”, meaning that his anxiety overwhelms is thought processes. Presented with too many choices or a difficult decision, Harlow may decide instead to retreat inside his own mind and devolve into a panic attack. He has a deep sadness that he says is sometimes alleviated by not sleeping. I believe that if he comes to understand that death is a natural part of life, and that his sister would not have wanted him to mope, he might better understand how to live with his depression. His anxiety, however, appears to be crippling him from many day to day activities.

_____________________________________
Environmental History

Where did you grow up? Please list the location(s) and describe what it was like growing up there:

Age 0 – 18 Camden, Delaware
Harlow was the third of three children. His parents were (and still are) a large part of the Republican party in this area. Before going into politics his father was a business analyst and earned a considerable sum of money. They are members of the old guard, and have considerable influence in their small town. This did afford his family the ability to pay for the necessary tests, special classes, and therapies. All the work appeared to pay off as Harlow adjusted as much as a boy with his condition could.

When he was nine, however, Harlow was approached by a man after getting off his school bus and taken in his car. He went missing for two days before being found three miles from his house, wandering without his clothes on. He recollects that he was abused by the man, and that he managed to escape through an open window.

His sister proved an immense comfort to him upon his return home. His parents refused to “coddle” him and instead turned to “professional” help. She paid extra attention to her brother, making him feel less ashamed of himself. His immense fear of strangers created from the incident seemed to lessen with her coaxing. He did better in school and proceeded to make friends. Issues arose again when she went off to college. Left to his own devices, Harlow grew exceedingly depressed, as well as anxious, around those that he did not know. His thoughts of being “foul” and “worthless” contributed to his desire to attempt suicide at the age of fifteen. He stated that he felt “broken” and continued to think about what had happened with the man in his car. His brother was already out of the house at this point, and his parents offered little solace in the way of understanding his pain. Having no one left to talk to, Harlow attempted to take his own life.

Age 18 – 23 Penn State University
Nothing made his parents happier than getting into college. Harlow feels that this was the happiest time in his life, but also readily admits that it was too much for him to handle at once. His trajectory plummeted after the first year on-campus; he simply could not handle the size of the university nor the complex interactions with classmates. Melissa attempted to stabilize this and was moderately successful. The academic rigor was demanding and contributed to his anxiety. His loneliness was drowned out with alcohol and what he only remarks as “bad decisions.” He had several panic attack episodes—moments when he would be overwhelmed by the world around him and shut down—over the course of time here. He took one semester on Medical Leave to address his problems with extreme anxiety. He states that this was done through visualization techniques and a heavily increased regimen of medications. He was more than happy to return home after feeling there was nothing left at Penn State.

Age 23 – Present Wilmington, Delaware
Harlow stated that he received two job offers, one in Baltimore, Maryland and the second in Wilmington, Delaware. Wishing to be closer to his parents and disliking the city, he settled into Wilmington. He often regrets this choice, saying that there have been “fewer places more disappointing than Wilmington.”

What was your family life like? Did you spend much time with your parents? Do you have any siblings? If so, what are your relationships like?:

Harlow regularly talks to his brother on the phone (once a week), and attends all major holidays at his parent’s home. All of them live in the tri-state area, and thus get together as much as time will allow. He believes that this is their compensation for the amount of time that they did not spend with him as a child. He does not fault them for this, however, he believes that there was no reason to put much effort into him saying that he was a “miserable” child.

What was school like? Did you have any problems? Did you enjoy school? What were your grades like?:

Harlow was put in special education classes up until the second grade. He continued to learn proper social and communicative structures through outside education, but was put into “normal” class and stayed here until schooling was completed. His grades were above average to stellar, and he did particularly well recalling historical information. It was good enough to get him into college. Academically he enjoyed school—social activities were almost non-existent.

Did you engage in any extracurricular activities, such as academic, artistic, or sporting clubs?:

As a High School student, he was involved in Cross Country Running, one of the few sports he enjoyed because it “helped” him think and alleviated anxiety. His sister convinced him to be part of the Quizbowl team, and he helped lead them to state victory three times. In college he was also a runner. He was not involved in any other social activities. He tried to rush a fraternity but was rejected.

What was work like? Did you have any problems? Did you enjoy your work? What were your coworker relationships like?:

Working for Astrazeneca was easy enough for Harlow, who described his position as that of a “glorified secretary.” He stated his boss would routinely criticize his mannerisms and his attitude, but because of his disability status, believes that he was afraid to fire him. He interacted minimally with his coworkers, though there were a few older women that treated him favorably. Generally “okay” with his job (remarking that he would work his way up) Harlow seemed content. The death of his sister seemed to stifle that thought. As time progressed he spoke of his work less frequently, and then, not at all.

Recently, he had an episode at work where he was given a project to oversee as a “test” of his management capability. This was six months after his sister’s death. He admitted to feeling overwhelmed and anxious. As time progressed and he realized he would not meet the deadlines or satisfy his boss’ wishes, Harlow began to panic. One morning at work, he stood up on his desk and began to scream at the top of his lungs in the office. I was called and met him outside his office, where he was already coming down from his panic attack. As his depression set in—already in tears—Harlow explained that he didn’t know if he could do any more than he did then, meaning he would never be qualified or successful ("like my sister"). The next two weeks he took medical leave and did not leave his house once. His brother informed me he found his brother soiled and in clothes he’d been wearing for several days. After washing him, we had an emergency session to discuss his problems. He stated that he had been overwhelmed and that perhaps "life was just too difficult" for him. I put him on suicide watch for the next few days, but his mood stabilized. He returned to work a week later and after changing his meds, appeared normal once again.

Have you ever been convicted of a crime or misdemeanour? If yes, please explain, list conviction, and list any sentences associated with convictions:

None.

Lastly, please tell us about yourself. How do you feel about yourself and what you have done with your life? If you have committed crimes, how do you feel about those now? What are your hopes for the future?:

Harlow appears listless and lost. He cannot let go of his grief and remains chained to thoughts of the past. He continuously references things his sister would approve or disapprove of, and needs to constantly be reminded that he needs to make his own decisions. He wants to forget what has happened to him and move on with his life, but he returns to the death of his sister or the moment when he was sexually abused. If overwhelmed by stimuli, overly embarrassed, or faced with a difficult choice, Harlow may have a panic attack and be overcome by his anxiety. These episodes spiral downward and into a state of depression where he has thoughts of ending his life and removing all feeling. He sees a very narrow view of the future and does not know how he’ll ever be able to move forward.

_____________________________________
Out of Character Section

What are they not telling us? What secrets do they have to hide? What back story are we not hearing? This is where you can tell us all the things your character wouldn't put on an application, or others don't know.:

((Remember, if you put all their back story as a secret, we won't be able to admit them to Hallowsgate! This section is for secrets only, not the entire character history. We need most of the info in the main app so we can process it!))

Harlow once tried to rape his sister while he was a sophomore in college. He considers it the moment where he changed the course of his life and can never forgive himself for it. It was a late October evening, and having attended a party—and abandoned by those that had invited him—his sister managed to meet him at the same party and realized that he needed to be taken home. She led him back across campus, and as she did so, Harlow proceeded to attempt to sexually assault his sister. Driven by a confusing mix of lust and drunkenness, he pinned her against the wall and proceeded to get his hand down her pants. Melissa managed to escape but not before the damage had done.

This was the beginning of their separation. They spoke of the incident to no one, but Harlow knew that this changed everything forever. This contributed to Harlow’s overall decline in mood and brought out a great anxiousness that one day he would be left to answer for what he’d done. He still doesn’t understand this confusing mix of feelings he had for his sister and blames himself immensely. They reconciled when she was pregnant—wanting him in her life was important, she said. But before she had an opportunity to fully forgive Harlow, Melissa died. He was left with the same bitter sadness and now an immense emptiness from her death.

Harlow does have immense hopes and dreams. When he sleeps, he dreams vividly and often envisions himself as a great traveler. He also has a desire to make something of himself—he believes that he should be something better than he is, always, and can never be good enough. His father was abusive to him as a child and tormented him privately for not living up to his standards. His mother openly admits he is not her favorite child, and if it weren’t for her “conscience” she would have cut off contact with him entirely. They would love for him to stay Hallowsgate indefinitely.

Your Nickname: Lukerson
Your Chatango Screen Name: Lukerson
Your Character's Playby: Jamie Bell


Last edited by Harlow Jacobs on Thu Oct 25, 2012 3:57 am; edited 2 times in total
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Ghost
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Join date : 2011-07-05

PostSubject: Re: Harlow Jacobs   Thu Oct 25, 2012 2:37 am

THIS APPLICATION IS PENDING

This application is currently pending. Below, you'll find the reasons for this pending notice. If you wish to continue the application process, please follow the points laid out below by a member of Hallowsgate's staff.
_____________________________________________________________

  • Thank you so much for joining us. We're really looking forward to seeing Harlow in play with the rest of the loonies. And the patients. Before we can jump right in, there's just a couple of quick things we'd like to work on with you. Don't panic though, as a lot of apps get pending notices! We think you have a great application here!

  • The first thing we'd like to touch base on is the Aspergers. I know we did some nattering about this in the chat box too. I'm perfectly fine with Harlow having aspergers syndrome, but I am concerned that this is where his mental illnesses seem to stem from. With his depression and anxiety as a result of his social problems, that leaves Hallowsgate's psychiatric team needing to work with him on the aspergers as well as depression and anxiety, or even before them. This makes aspergers his primary issue out of the three, and unfortunately we and Hallowsgate aren't equipped to really help him in that case. What I would greatly suggest is that his aspergers play a lesser role in the evolution of his depression and anxiety, so that treatment is not dependant upon resolving some of his social disabilities.

  • The quick second point is that we'd love to see a little more severity in his psychiatric problems. This will serve two purposes. Firstly, it will help establish those as the primary issues above aspergers, and secondly it will warrant an inpatient hospital stay rather than outpatient. Perhaps you could include some more recent incident, or even tie in another problem that is as a result of the depression and anxiety. He certainly counts as a suicide risk by his doctor's reasoning, so perhaps you could play up that angle a little more.

  • Other than this, Harlow will be good to go, and we're looking forward to throwing him amidst the wolves welcoming him to Hallowsgate! Wink


_____________________________________________________________

Please reply to this thread once you have edited your application, to let us know, and a member of Hallowsgate's staff will review your application again at our next possible convenience.

This app was reviewed by: Ghost and Nebby.
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Harlow Jacobs

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PostSubject: Re: Harlow Jacobs   Thu Oct 25, 2012 3:58 am

Modified... I tried emphasizing his depression & anxiety from events... hopefully that's better? Smile
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PostSubject: Re: Harlow Jacobs   Thu Oct 25, 2012 6:45 pm


________________________________________________________________________

JACOBS, HARLOW


    DIAGNOSIS(ES): Major Depressive Disorder/GAD/Hypersomnia
    WARD: Male
    DORMITORY: 02
    BED: 02
    THERAPIST: Dr. Finn McAlister


________________________________________________________________________

OOC - BEFORE YOU BEGIN PLAY

Before you begin play, you must complete the few steps listed below:

  • Sign up for the Hallowsgate Patient membergroup HERE.
  • Sign up for the who plays who list HERE.
  • Sign up your play-by on the face claim HERE.


Don't forget to familiarise yourself with the pertinent patient handbooks and other in character information that you'll need to reference for play, and have fun!
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Finn McAlister

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PostSubject: Re: Harlow Jacobs   Mon Dec 03, 2012 3:13 am

THERAPY NOTES
_____________________________________

    Date:December 2, 2012
    Attending: Dr. Finn McAlister
    Session With: Dr. Finn McAlister
    Session: Group Therapy


Therapy Notes: Today’s session was low key and involved helping Hallowsgate look more festive for the holidays. This involved setting up several Christmas trees in the dining room, decorating them and ending in Peppermint hot chocolate and gingerbread men. Each of the patients entered calmly, and I asked for each to introduce themselves starting with Moira who did not comply, however everyone else did state their name. I split the group into twos, with Janine Zeegar and Henry McAuliffe into putting up one tree near the door, Mallory Bates and Harlow Jacobs putting up the tree near the kitchen, and Moira Hanley and Myself separating garland to decorate the dining hall. Moira Hanley refused to get up from her seat to assist, and Dr. Benjamin Graham, Moira’s attending stepped in to assist. I then went about sorting ornaments for the group, as well as lights, divvying them up between the two groups setting up the tree. Janine and Henry worked well together, and Henry seemed in somewhat decent spirits. He stated that this activity was better than sitting in his room, or talking in a circle with a bunch of crazies. Janine also seemed in high spirits, especially when she realized we would be decorating for the holidays. During this discussion with Henry and Janine, an outburst occurred between Harlow Jacobs and Mallory Bates. As I did not see the altercation directly, I cannot place blame, however, Mallory did shove the lights at Harlow and into his chest. From my understanding, Harlow believed Mallory was attempting to take the lights from him, and expressed his frustration in a loud outburst. Harlow exclaimed that Mallory tried to take the lights, and then stated that Mallory threw the lights at him, and called him a name. However, because I did not witness the altercation face to face, I cannot back up or deny this. Due to Harlow's delivery and outburst, however, he did face punishment after a warning of calming down and working as a team, in which he refused to pick up the lights and help. Harlow also stated that he didn't like Christmas, and he didn't want to put together the stupid tree. He also stated that he told Mallory to leave him alone. Due to this, and his inability to calmly answer why he hollered and what happened,he was placed on dish duty for the afternoon in the kitchen for this outburst Mallory refused to tell his side of the story, however, he was not sent out. This will be discussed in a later individual therapy session, and I will check back up with Harlow again once he has calmed down. Towards the end of the session, I allowed the patients to enjoy gingerbread men and hot chocolate. Moira worked through the session with Dr. Graham and earned her hot chocolate and cookie, however, she did not take the cookie, and simply took a hot chocolate back to the table for Dr. Graham.


Additional: N/A

Follow-Up: Building teamwork skills and helping Harlow realize that close personal interaction isn’t going to harm him is in order. Also, I plan to discuss with him why he received punishment, as I do not place blame on either party in the upset at today’s session. If he can tell me calmly what happened, and we can discuss it, he may earn his hot chocolate and his gingerbread man.


_____________________________________________________

I'll never wear your broken crown.

But in this twilight how dare you speak of grace?
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PostSubject: Re: Harlow Jacobs   Tue Dec 04, 2012 7:47 am

Dr. Benjamin Graham wrote:


Nov 29, 2012

    Group Participants:
    Thaddeus Salant - Schizophrenia (Catatonic Subtype)
    Moira Hanley - APD/(Suspected OCD)
    Quincy Randall - Sexual Paraphilia (Vampirism)/Obsessive Love
    Joleen MacMahon - Stockholm Syndrome/Hypersexuality
    Harlow Jacobs - GAD/MDD/Hypersomnia


Therapy Plan: Today's therapy will be an exercise in sharing and relationship building, utilising the light-hearted nature of a game to foster communication about the self with others. The aim of the game (a customised jenga block game) is to encourage patients to talk about themselves openly, build rapport with others, and foster trust with others. The game functions in such a way that each block has a therapeutic question pertaining to the self written upon it. Patients (and therapist) play the game of jenga as usual, only players must answer the questions on the blocks they pull. At the end of the game, whoever knocks over the tower will have to answer an (appropriate) question from each of the other members of the group.


Group Observations: New patient, Quincy Randall, was in attendance for today's session after a morning arrival. He was first into the group room and displayed appropriate greeting behaviour and vocalisation. He did appear a little dazed, as to be expected for new arrivals, but was otherwise pleasant. Next to arrive to our session today was Joleen MacMahon. Her face was still bruised from a recent fight with roommate Jamie Gibbs, but she seemed in relatively well spirits despite this. However, her body language and tone of voice bordered on the inappropriate. Harlow Jacobs arrived shortly afterwards, seeming a little anxious though he nodded in greeting and took a seat without prompting. Thaddeus Salant seemed much unnerved, as his behaviour might be best described as skittish and evasive upon entering the group therapy room. Regardless, he also took a seat without having to be prompted. Moira Hanley was the last patient to arrive to the session, with little enthusiasm, but also was seated without being prompted.

Before introductions could be made Joleen MacMahon and Quiny Randall struck up an introductory conversation between themselves. Given Joleen's injuries and diagnoses, and Quincy's condition, I intervened and disrupted this private conversation by encouraging Quincy to turn his attention to the rest of the group and introduce himself. He was polite and compliant with this request. Thaddeus Salant continued to exhibit distancing behaviour and anxious body language during the introductory part of our session, which remained throughout, though he was supplied with some note cards and a pen, in order to doodle. Clearly having some activity eases some of his anxiety, though I will be discussing paying more attention to group activities with him in future individual therapy sessions.

Our group session went largely according to plan today, though I encountered some oppositional and defiant behaviour from Moira Hanley whenever it was her turn to select a block from the tower. Moira Hanley and Joleen MacMahon also engaged in a short-lived verbal altercation towards the end of our session, the precursor of which came towards the beginning, when Joleen seemed to attempt to defend me from one of Moira's outbursts.

In the middle of our group session, Joleen made inappropriate sexual contact with myself underneath the table, my reaction to which disrupted the game momentarily as I put distance between us. I did not verbally raise the issue during the group, in the interest of not derailing our activity, but this behaviour is entirely inappropriate and should be made special note of, with Miss MacMahon's primary therapist.


Session Report: I started our session today by choosing the first block, and answering the question upon it in very impersonal and general terms.

Moira Hanley was next, drawing a block which asked her to say what motivates her. She disputed that she had any motivations. When I questioned why she got out of bed in the morning, she eventually answered that going out to smoke a cigarette was her motivation for getting up. More on this in later individual therapy notes. It is my belief that Moira witnessed Miss MacMahon's inappropriate contact, and she attempted to bait me with suggestive questions after the fact, before she was derailed by the continuation of the game. Moira's second block was one that she refused to answer, and which I kept for a later session. It asked her to talk about a time when someone made her uncomfortable. She refused to answer and put the block back on the tower. Moira was kept after the session for an impromptu individual session, following her poor behaviour throughout the group. During this individual session, her cigarettes and personal affects were confiscated, only to be earned back by cooperation with her therapist and the other staff, and evidence of her behaviour and self control improving towards others.

Quincy Randall was relatively calm and polite in our session today. he did not make trouble, though I am cautious of allowing him to associate with Joleen MacMahon, given her diagnoses and Randall's susceptibility to romantic and inappropriate advances. he answered both of his questions from the game eloquently, beginning with being asked: How often do you incorporate what people think into what you do?[ He admitted that he didn't often give much thought to what other people thought, but that it did matter to him on some level. Though he admitted trying to give consideration to it, he also noted that sometimes the things that he wanted overrode this consideration. Individual therapy could focus on impulse control, and on healthy outlets for thoughts and frustrations, as well as healthy relationship constructs and interpersonal communication and listening skills. Mr. Randall's second block from the game asked: What are your plans for the future, and how do you hope to achieve them? He admitted to wanting to go back to Paris, and acknowledged that it would only be possible if he got out of Hallowsgate, further conceding that his discharge depended upon honestly and a willingness to cooperate. Efforts should be made to reinforce these thoughts for Mr. Randall, but also to build upon other things that will have to be addressed in therapy.

Joleen MacMahon was willing and compliant with the group activity throughout our session, despite her obvious inappropriate conduct towards myself. She was upset by Moira Hanley's outbursts towards me, but responded favourably to attention during the group. Given her conduct towards me, I can assume that she harbours a sexual attraction towards me, which influenced her behaviour during our session. Regardless, she answered the questions she received from the game, beginning with being asked to list five things that made her happy. While largely inappropriate, she answered with the following, and was allowed to let it rest at that for the first round: "Well you make me happy Ben. Very happy. [...] And I like bright colors, like purple and pink and aqua. Singing makes me happy too. I liked going to the movies that was always fun...and sex. Sex makes me very happy." Joleens second block asked her If you were an animal, what would you be and why?' She answered that she would be a unicorn, because then she would be so special that everyone would have to care about her. Obviously, given her history and diagnoses, attachment issues can be guessed at throughout. I would recommend that therapy focus on creating appropriate and reliable relationships with others, and on boosting real self confidence and responsibility. Her sexual promiscuity may be compensating for a lack of real attachment in her interpersonal relationships. I would recommend exploring the possibility of a buddy system, with another female patient unlikely to give in to sexual advances, or even a female member of staff.

Harlow Jacobs was quite withdrawn and appeared anxious for a lot of our session. He seemed perturbed that he would have to answer questions at random from the jenga tower block, but he did manage to put forth some effort to do so, for the most part. He started off with a block which asked: Where do you want to be? How do you think you can get there? He struggled with this question, and answered that he didn't want to be anywhere, his tone unsure and anxious. Looking to me for a prompt, I asked Harlow if he would like to be outside of Hallowsgate one day. He conceded that he did want to, but that he didn't have any clear goals as to where he wanted to be so long as he was useful. Future therapies should focus on realistic goal building and self confidence, encouraging small steps towards small goals at first, and then building up to larger ones, as I expect he may be easily overwhelmed. Perhaps some activities involving personal responsibility and rewards for effort may help. Harlow did not have a chance to answer a second question, after Moira Hanley's conduct and Joleen MacMahon's reaction to her meant that our session needed to be cut short to avoid more conflict.

Thaddeus Salant was anxious and evasive throughout the group. She shows fear of his peers and hospital staff, and prefers distraction by way of drawing. I think that art therapy could be very good for him so long as it is fully monitored and the art work is actually guided and discussed. he should not just be left to his own devices, but should be eased into more social contact and communication instead. Though he struggled with comfort levels throughout the group, he was coaxed into participating in the game, wherein he drew a block which asked: What realistic alternatives are there to your current lifestyle? Thaddeus answered that he didn't know, and that he believes that being 'in here' [Hallowsgate] is better than being 'out there' sometimes. He lack any real self confidence, and is easily startled. Outside of guided art therapy, his treatment plan should focus heavily on safe socialisation and on self confidence building, as well as learning coping skills for his emotions, and working with medications more closely to find the best treatment for him.

Additional Notes: Socialising activities should be pursued for Thaddeus Salant, after individual sessions discussing social and life goals and considering medication options to control the symptoms of anxiety he is subject to. Guided art therapy should also be explored, as well as confidence boosting activities and communication skills, executive managing, and personal nutrition and hygeine skills.

Moira Hanley was kept behind after our session for an individual meeting which will be documented further in supplemental notes.

I will be filing an incident report concerning Joleen MacMahon's conduct and feelings towards me, in order to assure that this matter is entirely transparent and handled accordingly.




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Forty-Nine | Divorced & Single | Smoker | Psychiatrist | Stubborn | Damaged Goods
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