A psychological assessment on Edelmiro Brian Deleon written by his previous therapist. After a year, Brian discontinued therapy and has shown no interest in returning.
"I'm sorry you're so damn fragile. I'm sorry everything I say somehow hurts your feelings. I feel like I can't talk to you about anything! You get upset all the time. You used to be so cool. Now you're always mad at me." The words escape Brian's throat like moths fleeing a flame. They bounce around the office before settling at the rims and everyone waits for something.
May's body suddenly jerks to attention, the edges of her mouth yanking back in a feral snarl. "Maybe you should try a little harder, bitch."
After continued efforts from his younger stepsister in achieving closure from her abuse, Brian was convinced to attempt therapy with the hope of reaching the same outcome. Despite May and Anthony encouraging further sessions, Brian eventually decided to stop attending therapy after realizing the work it required. This would be the first and last attempt Brian took in regaining control over his behavior.
With age, Brian has become increasingly venomous on the topic of therapy and psychological help. Despite the progress he once admired in May, he now envies her achievements and is offended her capabilities outshine his own. While his therapist tried fervently to keep in contact with him, Brian had no longlasting interest in recovery to begin with and it is unknown whether or not this will change.
I will be either updating this article or archiving it soon in response to a shift in setting.
Psychological Exploration of Edelmiro Deleon
HEALTH INSURANCE: ACCEPTED WITH $20 COPAY
May 8 (90791)
Paperwork Notes: Small handwriting. Did not complete paperwork when asked to elaborate on family and past drug abuse. Admitted to having done cocaine once or twice before but refused to confess to currently using anything. Brought paperwork with him at the time of appointment (23 minutes late). Did not sign updated office policy agreement and had to be prompted via text three separate times by receptionist. Has since avoided outside contact after receiving further paperwork to continue therapy.
Physical Assessment: Quiet and approachable. Tall. Latino. Seems to be in decent health/muscular/average weight for his height. Drug use apparent despite attempts at hiding. Receptionist had a crush on him and Brian did not hesitate to engage her in inappropriate conversation even after her discomfort was made known.
Mental Assessment: Was overly talkative and surreptitiously flirtatious. Asked where he could sit despite knowing the answer. Brian attempted to create small talk in order to evade serious discussion and when confronted had difficulty deciding whether or not to be combative with me. Covert narcissist(?). Had a decent grasp of reality and was able to answer prompts on current events/personal information but later contradicted himself with the intention of disarming.
Chief Complaint: "You tell me." Brian seems to have only appeared in therapy under the direction and expectations of those he wishes to please.
Session Notes: Could not maintain his composure when met with disagreement. Accused therapy of being "intrusive" and "for crazy people"; did not answer questions truthfully and actively pursued convoluted/pointless topics. Brian thinks of himself as interesting and expects others to at least silently appeal to his needs for attention and sympathy. Has a strong sense of helplessness, learned or not. Talked at length about his childhood in regards to his mother abusing him. When offered validation, Brian became overstimulated/animated and had difficulty halting his train of thought. Attention Deficit. Avoided eye contact by staring at the clock/implied disrespect by glancing toward the door. Was hesitant to set future appointment.
Diagnostic Code: F43.2
Diagnostic Notes: Adjustment disorders with absent father and unattached mother. Issues with stepfather and stepsister. Claims to have no surviving extended family.
Clinician's Notes: Has underlying narcissistic traits and no sense of personal/emotional/physical boundaries. Brian often came up with distracting scenes or noises to draw attention back to himself. Held aggressive eye contact and broadened his shoulders/leaned back in an attempt to appear domineering. Expresses learned behavior that appears pathological in nature. May benefit from CBT/CSC.
November 23 (90837)
Physical Assessment: Bathed. Cooperative and had a firm handshake. Was talking loudly in the reception area without care for volume. Sat near the center of the couch instead of further away. Unusual pupil size; put on sunglasses halfway through session as discretely as possible.
Mental Assessment: Showed awareness of unusual behavior. This shame did not endure. Needed excessive prompting to focus on topics. All of Brian's speech was defensive/designed to emphasize himself as the victim. His answers to questions were not to be relied upon even on the most mundane of facts. Excessive avoidance of accountability.
Chief Complaint: Anthony (older brother)
Session Notes: Brian explained a recent argument he'd had with his older brother that ended violently. When asked what the argument was over, Brian used vulgarity and aggressiveness to prove his point with little factual evidence to support it. Brian explained the situation in a way that assumed I knew more than I did and had to be asked multiple questions for messages to be clear. "He's a fucking idiot. You know he knocked up a girl in high school? I never ratted him out for it, either. He should know not to mess with me." Purposefully explained threats as if they could be applied to me. Nearing the end of session became increasingly agitated and speech became vociferous/uncontrollable. Was told to leave if he did not feel capable of having a respectful conversation and slammed the door on his way out.
Diagnostic Code: F60.2
Diagnostic Notes: Brian has shown many symptoms of APD with no signs of bipolar or schizophrenia/schizoid behavior. I am concerned over his degree of empathy and whether or not he is at risk of hurting others or himself. Brian has spoken at length on ways he differs from people, some factual but most purposefully absurd. Has a repetitive behavior pattern in attachment most apparent within his sexual/romantic pursuits. Has claimed to love many women at many different occasions. It is impossible to tell he is lying with voice and appearance alone. Has described criminal/destructive/antagonistic behavior before the age of 13.
Clinician's Notes: I am concerned for the wellbeing of Brian and those living within the same environment as him. Brian has shown a repeated dismissal of others' boundaries for minimal gains and emotes remorse poorly. His guilt does not affect future decisions and does not remain long after an incident has ended. Seems to be incapable of experiencing nostalgia even over childhood.
April 5th (90837)
Physical Assessment: Bloodshot eyes. Leg jittering while he talks. Has gained between 5-10 pounds since last month's visit. Commented on getting his hair cut and ignored obvious bruising on his arm. Complained about mother when pointed out. Has not bathed. Continual flexing of the arm in question after being noticed. Self-stimulated by rubbing his hands often. Deliberately dropped his hat upon entering and leaving so he could retrieve it.
Mental Assessment: Manic due to assumed NA drug usage. Had trouble paying attention and staying on topic without continued guidance. When asked about his birthday last week, stated, "My birthday is in November," despite his paperwork saying otherwise. After being confronted, ignored the fact he had attempted to lie. Pressured speech. Defensive when asked about his current mood's origins.
Chief Complaint: Argument with SF April 3rd
Session Notes: Had an argument with Jerry (SF) two days prior and is "processing the conversation". Avoidant toward personal assessments of his behavior during the argument. Has difficulty presenting historical material to explain his current predicament. Brian's recollection of the fight was illogical and does not agree with prior notes he has written himself. Brian was questioned extensively and creatively, but he was incapable of further describing the argument and instead focused on his mother. Brian seemed convinced she was the cause of this issue despite her having no involvement.
Is a willfully poor historian and became frustrated when asked for further details on how the argument made him feel. "I hate her. She's a cunt and a whore and she kept making me pay more rent every month." It was difficult to talk him down after approaching the topic of mother.
"Jerry is a bitch." Brian had no further thoughts on Jerry and showed anxiety when Jerry's name was said. Flashbacked to his memory but did not elaborate on it.
Scheduled next appointment with hesitancy. Made light of desiring to leave without bringing "it" up.
Diagnostic Code: F301.81
Diagnostic Notes: After seven meetings with Brian, it has become apparent to me that the issues he focuses on are symptoms of an underlying narcissism heavily spurred by blatant and apparent drug abuse and a coexisting diagnosis of APD. He refuses to initiate any conversations pertaining to his behavior and habitually victimizes himself by explaining the complexities of his absurd logic. Refuses to be honest during sessions and becomes verbally aggressive when told he does so. Brian attempted numerous times to engage with me on unprofessional and arbitrary topics (discussing politics, religious preferences, personal hobbies of mine) toward the beginning of our sessions to try to control dialogue. When this did not work he resorted to humor. Avoidant personality was soon overshadowed by continuous antisocial tendencies paired with multiple relatives and a former partner complaining of narcissistic-like tendencies (see attached notes). It is apparent that his mother is in a similar position and at this time unwilling to enter therapy to support Brian's recovery.
Clinician's Notes: After several meetings with Brian over the span of a year, I have come to the decision of ceasing treatment until he has taken the appropriate steps toward managing his addiction to alcohol and drugs. I have written and walked through the criteria necessary to continue individual therapy with Brian and he has since continued to undermine our sessions and his mental health. I have written a letter addressing my decision with the appropriate contact numbers for inpatient treatment centers and will be continuing to provide help for no longer than a month.
Wow, for a short entry, i really love this article! The document really does feel like a scientific journal and medical journal to me. I do want to know though, what was its legacy? How accessible is the document? Is it legal or publicly avialible? I am sorry if this comment was bad but still, i do hope you found it at least remotely good. Congratulations and keep up the great work!
Hey, thanks so much! It's a medical document, so it's under HIPAA. I figured I wouldn't bother explaining since most medical documents are typically under lock and key, but I may add it in later if it bugs me enough. You put time into commenting and I appreciate the feedback! No need to apologize. :)
Super dark, in a personal way, really well done! I felt almost guilty reading this. Like I accidentally found a doctors notes, or some very very personal files, and decided to read them over. The article does a great job of really imparting that feeling. I'd love to know a little bit more about Brian, before jumping into the doctors notes regarding his therapy -- make the therapy notes even more impactful!
Aw, thank you so much! I was hoping it would be realistic enough to sound miserably private, haha. As for Brian, I was wondering if I should add more info and I'll give that a bit more thought. His bio is pretty fleshed for now and offers enough backstory to give some firm groundwork, but I appreciate you alerting me to feeling a disconnect with his character! Will absolutely try to work on expanding the therapy notes and giving more backstory prior to the sessions! :") Thanks again so much!
I have to say, your writing is amazing!
Really love the unusual take on the "exploration" part of the challenge.
Keep up the great work!
This was a great article! The behaviors described here feel very real, and the style of the document really makes it feel like you'd find this when stumbling on a therapist's notes. Even though the document is a medical journal and thus neutral, the dark patterns of behavior that are described make the whole description very dramatic. Thank you for this article!