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Case Notes

Name: Walter Neumann

Session Number: 1

Comments: The patient has clearly been troubled for some time with an overweening sense of his own infallibility. He presents with a disturbing level of overconfidence in his own abilities. He has a grandiose self-image and is reluctant to concede the possibility that he might be subject to valid criticism.

When challenged, he appears offended and clearly has difficulty masking his indignation. He sees no need to defend himself, regarding it as self-evident that he is right, in spite of all evidence to the contrary. His capacity for self-analysis is clearly limited. A typical response to a question is to deflect it with a question of his own. He shows a marked reluctance to examine his own behaviour or the consequences of his actions.

He lacks insight and the concept of a wider responsibility. He has mastered the appearance of affect, but it is unlikely that this is more than a convenient mask.

Therapeutic Action: Altered state therapy initiated.