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Lars and the Real Girl

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Lars and the Real Girl Steve Franklin, MSW, LCSW 6829 Gravois Ave St. Louis, MO 63116 SteveFranklin_at_JUNO.com www. Steve FranklinMSW.com 314-517-8383 – PowerPoint PPT presentation

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Title: Lars and the Real Girl


1
Lars and the Real Girl
Steve Franklin, MSW, LCSW6829 Gravois Ave
St. Louis, MO 63116SteveFranklin_at_JUNO.com
www. Steve FranklinMSW.com 314-517-8383
2
  • Difference between
  • eccentricity and disordered
  • What kind of problem?
  • Mental illness, other or none?
  •  
  • Does Lars need treatment?
  • Doctors approach?

3
  • Family and community response?
  •  
  • Community Mental Health movement
  • How do you think
  • you might have responded?

4
(No Transcript)
5
What is the problem?
  • People will laugh
  • Attachment to objects
  • Doctor interview
  • ADLs? Violence? Psychosis?

6
DSM-IV
  • The disturbance causes
  • clinically significant impairment
  • in social, occupational, or
  • other important areas of functioning.

7
  • Differential
  • Diagnosis

8
Avoidant personality disorder?
  •  
  • Social inhibition
  •  
  • Feelings of inadequacy
  • Extreme sensitivity to negative evaluation
  • Feel socially inept, unappealing
  •  
  • Excessively monitor reactions of people

9
Schizoid personality disorder?
  • Lack of interest in social relationships
  • Solitary, secretive, and emotionally cold
  • Little interest in having sexual experiences
  • takes pleasure in few, if any, activities
  • lacks close friends or confidants other than
    first-degree relatives
  • appears indifferent to praise/criticism
  • Dependency and love are dangerous
  • Psychodynamic Diagnostic Manual

10
Panic disorder with agoraphobia
  • Remains at home,
  • or in just a few comfortable places
  • fear of having panic attack

11
Social Anxiety Disorder Social Phobia?
  •  
  • Persistent, intense, and chronic fear
  •   of being judged by others and
  • of potentially being embarrassed or humiliated
    by one's own actions.
  • Physical symptoms often accompany social anxiety
    disorder
  •  
  • including Panic attacks.

12
Aspergers Disorder?
  • Involves an impairment in social interaction
  • Such as
  • impaired in the use of multiple nonverbal social
    behaviors
  • such as eye-to-eye gaze, facial expression, body
    postures, and gestures to regulate social
    interaction
  • failure to develop peer relationships
  • lack of social or emotional reciprocity

13
Aspergers Disorder?
  • B.Restricted repetitive and stereotyped patterns
    of behavior, interests, and activities
  • preoccupation with an area of interest that is
    abnormal either in intensity or focus
  • Adherence to routines, rituals
  • Stereotyped/repetitive mannerisms
  • Preoccupation with parts of objects

14
Aspergers Disorder?
  • They may be unusually sensitive or insensitive to
    sound, light, touch, texture, taste, smell, pain,
    temperature, and other stimuli

15
Delusional Disorder
  • Delusion that doesnt fit another disorder
  •  
  • Tactile or olfactory hallucinations if related to
    theme
  •  
  • Functioning and behavior otherwise normal.
  •  
  • Ignore information that contradicts belief

16
Delusional Disorder
  • Types erotomanic, grandiose, jealous,
    persecutory, somatic, and unspecified.
  •  
  • Psychodynamic protective response to stress  
  • Behaviors Extremeness/inappropriateness
  • rather than the simple truth or falsity of the
    belief, indicate its delusional nature

17
Developmental analysis
  • Lars afraid of manhood
  •  
  • Saw dad sad in the responsibility
  • Note family difficulty in discussing emotion
  •  
  • Recent change? Afraid of Karins childbirth

18
Developmental Analysis
  • Doctor
  • Hes been decompensating for some time.  
  • Mental Illness can be a communication, a way to
    work something out.
  • Compensate for
  • lack of a mother/ fathers distance/blaming. 
  • Embraces his loneliness/withdrawal
  • Others need for connection is weakness. 
  • Karins pregnancy arouses unconscious
    loss/abandonment feelings

19
Jungian
  • Bianca as anima,
  • the projection of disowned female self
  • projection of disowned idealized self
  • Missionary, Doesnt care about superficial
    things, Cant have babies (or die in
    childbirth),Has nurses training
  • Like him left-handed her mom died God made her
    to help people Doesnt feel sorry for self-just
    wants to be normal..

20
Treatment
  • Is his difference something to be treated or
    pathologized?
  •  
  • Lars doesnt seem to experience being treated so
    much as being in relationship.
  • Ethics of doctors approach?

21
Treatment
  • Typical approaches 
  • Antipsychotic and antidepressant medication
  •  
  • Cognitive-behavioral therapy top help challenge
    the delusion.
  •  
  • Insight-oriented therapy develop a sense of
    creative doubt in the internal perception of the
    world

22
Treatment
  • Community can provide support and encourage the
    patient to regain his or her abilities.
  • If goals not seen as attainable, person feels
    pressured/criticized, probably increasing stress
    worsening of symptoms.
  •  
  • Avoiding direct confrontation of the delusional
    symptoms (When confronted by brother, Lars simply
    doesnt hear.)

23
Disability Embracing strength
  • Minister From her wheelchair, Bianca reached
    out and touched us all..
  •  
  • (Lars sees her difference as an expression of
    her disability.
  •  
  • Its not that Bianca was artificial.
  • She was just. Realness challenged)

24
Community
  • Finds ways for Bianca to contribute
  • in ways she can be helpful/productive model,
    help at nursing home.
  •  They project themselves they believe that
    Bianca, like them, would want to help

25
Community
  • Minister in church scene
  • There really is only one law..
  • the lord has told us what to do
  • Love one another.
  • That, my friends, is the one true law.
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