The DSM estimates that between two and three percent of the adult population in the United States are compulsive gamblers.  Male compulsive gamblers often begin during adolescence.  However, women tend to start to gamble later in life.  By the time a compulsive gambler seeks help, clients generally have an average debt running from $55,000 to $92,000.

For Factor #2 and #3 go to Pathological Gambling Course

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Need #1: Preventing Humiliation
The first concept related to a narcissistic client’s need for power and control is preventing humiliation.  As stated earlier in the track, narcissistic clients often control the emotions of sadness and fear as a prevention against vulnerability.  This desire to remain seemingly powerful and in control often results as a defense mechanism developed in early childhood.  As children, I have found that these clients suffer a severe narcissistic injury or a blow to self-esteem that scars and shapes their personalities.

This injury most often entails humiliation, specifically the experience of being powerless while another person enjoys the exercise of power.  Often, this other person is a parent or guardian who uses physical strength to force the child into submission.  To regain their own sense of power, narcissistic clients will use their inability to feel in order to control others around them.

Holly, age 26, described many repeated instances of feeling powerless in her early childhood and adolescence.  She stated, “My parents were contemplating putting me in a mental hospital without telling me.  This was when I was seventeen.  On another occasion, when I was fourteen and away at camp, they changed my high school without asking me.”

When I asked about her parents, Holly stated, “My father is a bull!  He’s a person who controls people.  He always appears as a nice guy, and most people see him that way, but he causes so much disorder!  In business, he is ruthless.  His only trip is power—power and money.  He is rather handsome, but big and burly.  When he was angry, he was very frightening.”

From her description, I could deduce that Holly’s father was a narcissistic character who valued power and control.  Because of his own need for power, he took the control away from Holly in making decisions for her.  This left her feeling powerless and to regain that power, she suppressed her own feelings of sadness and fear.  Think of your Holly.  How has his or her own need for power affected his or her emotions and feelings?

For Need #2 & #3  and Technique : Rage Control go to Narcissism Course

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Manifestation #1 – Behavioral
The first type of depression in relation to PTSD is behavioral depression.  As you know, behavioral theory states that depression is the natural result of inadequate reinforcement, inadequate rewards, or inadequate recognition.  This kind of depression can also occur when clients aren’t loved or supported enough by others or themselves.  Trauma survivors, those clients most in need of both, sometimes do not get the amount of either love or support that they require.

Many times this may be a recurring circumstance yet other circumstances, it may be a direct result of the nature of the client’s trauma.

Luanne had been raped by her uncle at the age of 12.  When Luanne promptly reported the uncle to police, he was convicted and sent to prison.  Although the prosecutor had sufficient DNA evidence to support Luanne’s charge, her family refused to believe her and shunned Luanne from all activities, gatherings, and vacations.

Without the love and support of her loved ones, Luanne quickly slipped down into depression.

Think of the level of love and support you PTSD has received.  Would this be an appropriate topic in your next session and how they can acquire this love and support now?

For Manifestation 2, 3 , and 4 go to PTSD Course

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However, my client Andrew found a way to observe his daughter Lacy’s behavior when he drove Lacy and her friends home from soccer practice.  Andrew stated, “I heard Lacy plotting with her friends to tease another girl in the class.  When I told Lacy later that I disapproved of her behavior, she just laughed and said that the girl was annoying and deserved to be teased.  I was horrified!”

Step Two: Watching
A second step is for parents to watch how their child treats his or her siblings. I explain to parents that if their son or daughter teases or bullies his or her younger siblings, chances are he or she acts the same way in the classroom.  My client Max had two boys, Larry, age 12, and Simon, age 8.  Max stated, “I never picked up on it before, but the other day I noticed Larry demanding Simon lend him his CD player.  When Simon said no, Larry started to push him around.”

Step Three: Talking to Teachers
In addition to listening when the student talks about his or her friends, and observing how the student treats siblings, a third step is for parents to talk to the student’s teacher, and to other parents. Clearly, teachers are good sources of information about a child’s social interactions.  Additionally, other parents may have information about children who may be involved in bullying.

Step Four: Monitoring the Media
A fourth step is for parents to monitor their child’s media diet.  I ask parents to notice if their son or daughter is hooked on violent video games or movies.  Could they be bringing the modeled confrontational attitudes to school.  Or, does their son or daughter spend leisure time watching shows in which characters frequently ‘dis’ each other?  Does she or he seem to admire these characters?  I encourage parents who answer yes to these questions to take an opportunity to make it clear to their child how they feel about the matter.

For 5th, 6th and 7th Steps for Assessing Bullying go to Risk Management Course

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#1  Schneider’s 11 Guidelines for Suspicion of Schizophrenia
In addition to DSM criteria for diagnosing schizophrenia, you may also find Schneider’s Guidelines for Suspicion of Schizophrenia useful as guideline for the elevation of suspicion regarding suspected schizophrenia.  Schneider’s list contains eleven Guidelines for Suspicion of Schizophrenia.  As I list the eleven symptoms, you might consider your schizophrenic client and evaluate him or her for one or more of the following symptoms.

1. Auditory hallucinations in which the voices speak one’s thoughts aloud.
2. Auditory hallucinations with two voices arguing.
3. Auditory hallucinations with the voices commenting on one’s actions.
4. Hallucinations of touch when the bodily sensation is imposed by some external agency.
5. Withdrawal of thoughts from one’s mind.
6. Insertion of thoughts into one’s mind by others.
7. Believing one’s thoughts are being broadcast to others, as in radio or television.
8. Insertion by others of feelings into one’s mind.
9. Insertion by others of irresistible impulses into one’s mind.
10. Feeling that all one’s actions are under the control of others, like an automation.
11. Delusions of perception, as when one is certain that a normal remark has a secret meaning for oneself

As you can see, some of Schneider’s Guidelines for Suspicion of Schizophrenia correlate to DSM criteria. However, studies show that while 75% of schizophrenic clients present Schneider’s symptoms, so do about 25% of manic-depressive clients.  Therefore, Schneider’s list is an informal guide to suspicion, rather than a guideline for diagnosis like the DSM.  Even so, you might consider your diagnostic interview process.  Would you find Schneider’s Guidelines for Suspicion of Schizophrenia a  helpful adjunct the DSM ?

For #2  Symptoms of Schizophrenia and #3  Subtypes of Schizophrenia go to  Schizophrenia Course

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# 1 – Violent Language & Presumption of Innocence
One of the first factors that may have prevented children from coming forward is the frequency of violent language and the subsequent presumption of innocence. As you know, violent language, especially among teens, is commonplace, and usually casual.  Sports teams, for example, will refer to a victory as “killing the other team.” There are two aspects of this which are applicable to the shootings we have so far discussed.

The first aspect is summed up by Stacey Hunt, a classmate of Mitchell Johnson. Stacey indicated that she had heard Mitchell referring to violent acts before the event. Stacey stated that Mitchell had talked about having a list, and that, “everybody was going to pay.  But he didn’t say that he was going to go and pull the fire alarm, get everyone outside and shoot them, you know? He was going around bragging like any other kid would when they were mad.” Clearly Stacey, like her classmates, attributed nothing out of the ordinary to such violent threats, rather normalizing them as a common expression of frustration and anger.

A second aspect is that students like Michael and Mitchell were widely known as pranksters, bullies, and prone to acting out. Many attributed these threats to the same behaviors, assuming that the shooters were merely looking for attention. In some cases, shooters may have made so many warnings beforehand that their classmates become convinced that nothing will actually happen. Even instances of a shooter bringing a gun to school may have been interpreted as this bluffing, show-off behavior.

For #2  and #3 Factors of Preventions and 3 Frames School Children Use for Identifying a Threat as Serious go to School Shootings Course

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