Less Than Zero Tolerance

To see my kids unsupervised, I needed to get a psychiatric evaluation, and I assume pass. I met with the psychologist who interviewed me and had me take a bunch of assessments–shown in the table–that included answering hundreds of never/sometimes/always-type questions. It seemed more like a test of mental stamina to keep answering what appeared to be the same questions asked in many different ways. I have included the complete evaluation below for transparency, but it recounts much of what I discussed in earlier chapters and summarizes each assessment.  I “passed,” and the psychologist said there was no reason to think I was any danger at all to my children; see the sidebar for the recommendations provided. However, Rita and Tonia continually accused me of being mentally unstable in petitions and court with absolutely no evidence that my mental health would put anyone at risk.

Fortunately, the court seemed satisfied with the psychological evaluation results, and I was allowed to have “unsupervised” visits. I put this in quotes because I believe my father was required to be there. At that point, I was in no position to fight a custody order, so I accepted it. My attorney kept telling me to be patient as it would take time for the court to give me more access to the kids.

DOE:2/23/13

Reason for Referral: Dr. Mockensturm was referred by Judge Ruest to determine the advisability of visitation with his children. Reportedly there was a protection from abuse filed against him and he texted his daughter that he loved her. He was arrested and went to jail overnight. Several days later he got a new phone and he texted Ms. Mockensturm the new number. That time he wound up in jail for 30 days. The specific referral question as conveyed by Attorney Rose Kaufman is whether or not, given his recent ill-advised behavior, it is safe for him to see his children.

History: History was gathered by client interview. Dr. Mockensturm reported that he currently resides in State College, PA, which is the home of Penn State University, and therefore is populated by people of a wide diversity of cultural, ethnic, and religious customs. There are opportunities to engage in a wide variety of past times and there is a wide range of cultured entertainment available. Activities for Dr. Mockensturm include science camp in the summer and hobbies like reading or blogging. Dr. Mockensturm was born full term with no complications. His early history indicates no medical or developmental problems.

Currently, a review of his medical status indicates a generally healthy male with high cholesterol and high blood pressure, both of which are controlled by mediation. He takes Simvastatin and Lisinprol. Educationally, Dr. Mockensturm earned a PhD at Berkley (sic). He reports he had no learning difficulties and did well throughout his education. His degree is in mechanical engineering. Current friendships consist of people near his age with similar interests. He reported that they go out or communicate on line once or twice a week. A MISA (co-occurring drug or alcohol problem) screening indicated that other than social drinking, Dr. Mockensturm does not use drugs or alcohol and no referrals are necessary. Dr. Mockensturm was interviewed about abuse and trauma in his past. He reported he was never neglected or abused and he has not experienced any trauma.

Regarding his legal history, Dr. Mockensturm reported that until this recent situation which occurred subsequent to the divorce proceedings, he had never been in legal trouble. Prior to this evaluation Dr. Mockensturm did received Mental Health Services. Dr. Mockensturm elaborated by reporting that he has a history of anxiety and depression. However this is treated by Dr. John DeCarle with Zoloft and is well controlled using that medication. Dr. Mockensturm is also receiving therapy.

Methods of Assessment:
Client Interview
Woodcock Johnson Tests of Cognitive Abilities (WJ-III)
Minnesota Multiphasic Personality Assessment, Second Edition, Revised Format (MMPI-2-RF)
OMNI IV Personality Disorder Inventory
Firestone Assessment of Violent Thoughts (FAVT)
Stress Index for Parents of Adolescents (SIPA)
Parenting Stress Index (PSI)

Assessment Results:
Client Interview: Dr. Mockensturm presented as an alert, middle-aged gentleman with normal speech, who was oriented to person, place and time. Other than the recent incidents with violating the PFA, his judgment appeared to be good and his perception appeared to be normal. His mood was calm and his attitude was congruent. His cognitive ability appeared to be above average which is consistent with results on the Woodcock Johnson, Third Edition. His long and short term memory were both intact. His insight is good and his thought processes, normal.

During the client interview Dr. Mockensturm reported that his mental health issues started about three years after he started working at Penn State University. He was always “nervous” but that he never had any anxiety attacks up until that point. There were a lot of circumstances in his life which contributed to his anxiety. His son was born three months prematurely. Before that Ms. Mockensturm’s water broke at 21 weeks while they were move from Berkley (sic) to Penn State. They stopped at Ann Arbor, Michigan. She was told at the hospital to abort the pregnancy. She chose instead to remain on bed rest in a hospital in Michigan. Their son was born in Ann Arbor, 3 months prematurely. The baby was placed in the NICU and was not expected to survive, however he pulled through.

Three years later their daughter was born full term. However, she had lower abdominal defects. She was rushed to Hershey Medical Center, where she was in the NICU for four weeks. She is now 11 years old and has had 13 surgeries. She has had a bladder constructed for her. Her spinal cord was tethered and she has no uterus. Nothing in the lower part of her body functioned appropriately, initially.

Dr. Mockensturm started having panic attacks in the mornings. He was shaky and jittery and could not focus. He found he could not make decisions. He did little things to help himself, such as going for walks or spending time in the sunlight. Then his mother was diagnosed with cancer. Three of his nephews died in a house fire and shortly after that his mother passed away. Things settled down for a period of time. Four years ago his youngest daughter was born. Then Dr. Mockensturm had two minor strokes. After the first stroke the doctors told him it would never happen again. The second one occurred 1 1/2 years later.

The divorce was not Dr. Mockensturm’s idea. He thought the worst was past and that he and Ms. Mockensturm would start doing things together. However, Ms. Mockensturm felt things were not improving. In summer 2012, she and the children left for Michigan the day the children got out of school. Dr. Mockensturm was not able to go with them. They stayed for 6 weeks and filed for divorce when they returned home. He said he felt their interests were different because Ms. Mockensturm has a high school education and he has a PhD. However, they were together for 25 years.

In October, Dr. Mockensturm went to Mt. Nittany Medical Center. He had become overly stressed, for the first time in 7 years and did not know who to turn to. At one time, he was becoming stressed every fall, but Ms. Mockensturm was able to calm him. During the episode in October 2012 his physician switched his medication from Zoloft to Lexapro. Then the Lexapro was changed to Effexor. Finally his medication was changed back to the Zoloft.

Dr. Mockensturm reported that Ms. Mockensturm did not want to go for therapy. He began looking for a place to live but there was not much available so they all lived in the same house for 4 months. This forced them to try to communicate.

Over Christmas, Ms. Mockensturm took the children to Michigan again. In January 2013 Dr. Mockensturm found a studio apartment. Ms. Mockensturm did not want to discuss some of the difficult issues, such as financial problems posed by the divorce, and she did not want to go to mediation. She kept telling him she wants to move to Michigan with the children. Dr. Mockensturm moved on January 3, 2013 and that evening he received a PFA notice. Reportedly, Ms. Mockensturm said that he slapped her. Dr. Mockensturm reported that he did slap her but it was on the hip to wake her up. She also reported that he was continually making sexual advances toward her. These events culminated with Dr. Mockensturm admitting himself to Mt. Nittany again. He was somewhat suicidal at the time.

By this time the couple was involved in court-ordered mediation, Dr. Mockensturm reported that the children were listed on the PFA. He does not know what he was thinking but he texted his daughter and told her that he loved her. He said the police were there within half an hour and he spent the night in jail with 6 months probation. He was still not sleeping at this time and was having anxiety problems. Two or three days after his release he realized his phone had been turned off because Ms. Mockensturm had removed him from the plan. He had to get a new phone with a new number because his previous number was not released. Then he began to worry because no one had his new number. He was working late at Penn State one night and became panicked that Ms. Mockensturm did not have his telephone number. He sent her a blank message with his new phone number. The police arrested him and he got 30 days in jail.

Dr. Mockensturm reported that Ms. Mockensturm wants him to have supervised visits. She is worried that, with his mental status, he will kill himself. His mental health issues were raised at the most recent history so it was determined that a psychological evaluation would be warranted.

Woodcock Johnson Tests of Cognitive Abilities (WJ-III): The Woodcock Johnson Tests of Cognitive Abilities was administered to determine an estimate of Dr. Mockensturm’s intellectual abilities. It yields a GIA which Is the equivalent of an IQ. On this administration Dr. Mockensturm earned a GIA of 133, placing him in the very superior range of cognitive ability. For purposes of this evaluation, these results indicate that Dr. Mockensturm has the cognitive ability to understand and implement any recommendations that apply to him.

Minnesota Multiphasic Personality Assessment, Second Edition, Revised Format (MMPI-2-RF): The MMPI-2RF, was administered as a test of personality to determine if any pathology is present. The MMPI II RF includes numerous validity scales. There are three scales devoted to content non responsiveness.
The first level of validity consists of the number of scorable items. Dr. Mockensturm’s profile produced scorable responses for all 338 items. On the variable response inconsistency scale there was no evidence of inconsistency.

On the true response inconsistency scale there was no evidence of content inconsistent fixed responding. The next set of validity scales is designed to measure atypical frequency of response. On the infrequent responses subscale,there was no indication of over-reporting of symptoms. The subscale measuring infrequent psychopathology responses was not elevated. Dr. Mockensturm was within normal limits for infrequent somatic responses. The symptom validity scale was within normal limits. The last two subscales are designed to determine if the client is presenting himself in a better light than would be accurate. These two scales indicate that Dr. Mockensturm was very truthful about his symptoms Based on these scales, Dr. Mockensturm’s profile is deemed valid and interpretable.

The rest of the MMPI-2 consists of 4 major scales and their subscales. The first is the Higher Order and Restructured Clinical Scales. This scale broadly covers the areas that would indicate issues and possibly lead to a diagnosis and is scored unless validity scores indicate otherwise. Not all of the other scales and subscales are scored for each examinee, depending upon other results. In other words if a condition has been ruled out, there is no reason to continue to examine It. Dr. Mockensturm’s results on the MMPI-2RF indicate that he is experiencing a mildly significant degree of emotional distress and a moderate elevation indicating a lack of positive emotional experiences. On the Profile for Somatic/Cognitive and Internalizing Scales, there is one critical item on the suicidal/death ideation subscale. This item indicates that Dr. Mockensturm is reporting that he has had suicidal ideation in the past. However there are no indications of repeated episodes of suicidal ideation nor has there been a plan to actually carry out the act. The only other elevation on that profile was the Stress/Worry subscale which indicated a mildly significant elevation. On the profile for Psy-5 Scales, there wasa mildly significant elevation for Introversion/Low Positive Emotionality. These results indicate that Dr. Mockensturm is experiencing the levels of stress that would be expected when going through a divorce and fighting for custody. He is honestly reporting his past suicidal ideation. However, there is nothing to suggest that he currently meets criteria for a diagnosis or that he has active symptoms.

OMNI IV Personality Disorder Inventory: The OMNI IV Personality Disorder Inventory is a test designed specifically to examine the possibility of an Axis II diagnosis of Personality Disorder. These particular disorders are characterized by maladaptive personality traits. The OMNI IV provides an indication of the likely presence of a personality disorder and an indication of the specific type. There are two validity scales for the OMNI IV. The first is the Variable Response Inconsistency Scale, which measures contradictory responses to items of similar content. The second validity scale is the Current Distress scale, which estimates the extent to which the client is currently anxious or depressed, because a heightened abnormal mental state can impact the results on the scale. Extremely elevated scores > 70 can mean that the scale should be interpreted with caution or can even render it invalid. Dr. Mockensturm’s responses yielded validity scores on the validity scales that were within normal limits, indicating that the profile Is valid and interpretable. Results indicate that he is within normal limits and is not displaying symptoms related to a personality disorder.

Firestone Assessment of Violent Thoughts (FAVT): The Firestone Assessment of Violent Thoughts is a self-report that is based on research which indicates that violence stems from a pattern of thoughts and that people will accurately endorse Items that reflect their own thought patterns. Studies indicate that even extremely violent offenders will accurately reveal their thoughts. The FAVT has two validity scales, the negativity scale, which as the name implies, is used to examine responses that indicate an excessive amount of negative thinking, The second validity scale Is the inconsistency scale. This scale is used to detect responses that appear contradictory. The FAVT was administered to determine if Dr. Mockensturm adheres to a pattern of thinking that would lead to violence. Results on the validity scales were within normal limits. Therefore the profile is considered to be valid and interpretable. Results of Dr. Mockensturm’s responses on this scale indicate that he does not harbor thoughts that would lead him to resort to violence based on a perceived challenge from someone else.

Stress Index for Parents of Adolescents (SIPA): The Stress Index for Parents of Adolescents is a measure comprised of subscales that indicate the types of stress that parents usually experience. The scale is divided into two domains—the parent domain and the child domain. There is also a validity scale.
On the validity scale, Dr. Mockensturm’s scores were within normal limits,indicating a valid and interpretable profile. Because Dr. Mockensturm has three children, only the parent domain will be interpreted. The parent domain consists of parental feelings that relate to issues that could cause stress. On the parent domain, Dr. Mockensturm’s responses yielded an elevation into the borderline range for the isolation subscale, only. On all other subscales there was no indication of stress related to his role as a parent.

Discussion and Conclusions: Dr. Mockensturm is a highly intelligent middleaged man who has suffered from anxiety and depression, which appear to havebeen related to a series of circumstances in his life. His symptoms are currently well controlled by medication and therapy. He does show some signs of stress which would be expected for anyone in his current situation. He has after all,spent time In jail after being the kind of person who never expected to find himself incarcerated. Add to that the limitations on seeing his children, one of which has serious physical needs, and he is bound to be worried and concerned that he will not be able to be there for them. It seems reasonable that Ms. Mockensturm would be concerned about suicidal ideation. There is a difference, however, between being suicidal and having suicidal ideation. Mr. Mockensturm had thoughts but no plan of action. Currently he has neither the thoughts nor aplan. He reports that, in the past, when he did have the thoughts, he thought about what suicide would do to his children and those thoughts acted as a deterrent. Should the thoughts arise again, he has the coping skill of countering those thoughts with appropriate self-talk. In addition, he does not have a thought pattern that would lead to violence and he does not have symptoms of a personality disorder. His intelligence, use of medication, and positive self-talk are all resiliency factors that would support his current state of remission and allow him to function appropriately.

Diagnosis:
Axis I—Anxiety Disorder, NOS, in remission
Axis II—None
Axis III-High blood pressure
High cholesterol
History of stroke
Axis IV-Moderate/Severe
Divorce
Child with serious health problems
Recently incarcerated
Dispute over visitation
Axis V—Current GAF=75

I found the following things in the assessment interesting.  The Woodcock-Johnson test showed I have an IQ of 133; I seriously doubt it’s that high.  The Minnesota assessment consisted of 338 questions and “indicate that [I was] experiencing a mildly significant degree of emotional distress and a moderate elevation indicating a lack of positive emotional experiences.”  It also said that I’d had “suicidal/death” ideation in the past, and there were times during my worst depression that I felt like the world would be better off without me.  However, I never attempted to kill myself or made any plans to do so.  Thus, I’m not sure how this was determined.  Finally, “the Stress/Worry subscale…indicated a mildly significant elevation.” I think they got this wrong as I was highly stressed and worried when I took the test.  The OMNI inventory showed that I do not have a personality disorder, whatever that is.  The Firestone assessment showed “[I do] not harbor thoughts that would lead [me] to resort to violence based on a perceived challenge from someone else.” The Stress indices said my “responses yielded an elevation into the borderline range for the isolation subscale, only.”