Sep 15, 2009

Marvel.com Psych Ward: X-23

Laura Kinney is an adolescent female who appears to be of average to above average physical fitness. She presents as composed to the point of lacking affect most of the time. However, when her emotions become too much for her to process, she is prone to wild displays of temper that involve the destruction of property and can often prove dangerous to those around her and, indeed, herself. Due to the circumstances of her early childhood, she speaks what can best be described as "nearly flawless English" and therefore might often be considered to be of a very high degree of intelligence. While she is undoubtedly of above average intellect, it is important that her academic abilities be viewed accurately and not assumed purely on the basis of her rather unique speech patterns.

She is associated with the mutant rights group the X-Men and has served with them under the name X-23. Currently, the client claims to spend

most of her time with their black ops unit, called X-Force. This affords her an opportunity to work with the mutant known as Wolverine, from whom she was cloned. While she claims to have no particular feelings on this, body language and changes in tone would seem to indicate otherwise. This collaboration and its effect on her will be revisited throughout therapy in a manner that is least likely to upset her or the therapeutic relationship.

Currently, Kinney has no formal diagnosis present in her chart. This writer, however, feels justified in suggested that she should have an Axis II diagnosis of Borderline Personality Disorder (BPD) as she fulfills at least six of the nine symptoms laid out in the DSM-IV and will, most likely, be shown to fulfill them all as our therapy sessions progress.

As with most individuals who have BPD, Kinney was raised in an emotionally invalidating environment, in this case a lab attempting to create the perfect killer. Her "mother," Dr. Sarah Kinney had to be careful not to show affection to the client so as not to endanger her role on the project, but did attempt to raise the client in the best possible way, given the circumstances. Unfortunately, this may have made a difficult situation all the worse. The client was able to sense a bond between herself and the doctor and the existence of love between them. However, any and all attempts to confirm this connection were squashed immediately, the doctor believing that it was best she stay on the project and help Kinney in as unnoticeable a way as possible as opposed to confirming Kinney's emotions.

The result has been that Kinney is largely unfamiliar with emotions of any kind, positive or negative, and therefore distrusts and ignores the way her body interprets the physical sensations of feeling. This is why she often indulges in wanton destruction when experiencing intense emotions, including in acts of self-harm, because violence, against people, objects,

or herself, is something she understands and therefore gives her a feeling of control over her environment.

Additionally, the client has shown some of the poor decision making that is hallmark for individuals with BPD. She has often been attracted to people or tasks that would exploit her, including prostitution and, the writer would argue, her current role as a black ops mutant rights activist. She is seeking love and acceptance by making choices that will ultimately further harm her. By reaching out in these ways, she is actually further stunting her emotional maturation.

Typically, the client's self injurious acts would be the first target behavior to be tackled in session as it can endanger a client's life. However, since Kinney has a physical healing factor as a result of her mutant physiology, it is considered more of a lifestyle-destroying behavior, not a life-destroying one. Therefore, we are instead focusing first on how the client deals with overwhelming emotions.

As such, Kinney has agreed to join a Dialectical Behavior Therapy group at the start of the Emotion Regulation unit. She has committed to complete at least this unit and consider staying in the group for the subsequent units.

In session, the client and the writer will be working on building a crisis survival kit full of objects and techniques that she can use in the moment to overcome stressors. We will also be using weekly diary cards to record incidents of self-harm, incidents of harm to others, incidents of property destruction, and so on. Finally, on the occasion that Kinney does act out,

we will use chain analysis documents in session to figure out what triggered her vulnerabilities and what could have been done differently when to reach a preferable outcome.

Laura Kinney's next session will be with Doctors Craig Kyle, Chris Yost and Mike Choi on October 14. To prepare for the session, one should read over the file marked X-FORCE #20.

Tim Stevens is a Dialectical Behavior Therapy Consultant and Doctoral Intern at a college counseling center currently pursuing his Psy D. who has had extensive experience working with individuals with BPD and instructing them in the use of DBT skills.

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