RUNNING HEAD: The Soloist

Mary Catherine Collins

CNS 744b FG FU 2015
Assignment 1.2-The Soloist
August 30, 2015

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Nathaniel Ayers Jr., the lead character in the film, The Soloist most definitely meets the
criteria for Schizophrenia (295.90) per the DSM-V. After viewing the film, Nathaniel meets two
or more of the following significantly for a significant amount of time (DSM-V, 2013 p.99).
Nathaniel experiences rapid/disorganized speech (frequently and incoherently), delusions, and
hallucinations (auditory & visual). In addition, Nathaniel looses time and comes in and out of
lucidity throughout the day. It seems as if he is significantly out of touch with reality and often
has trouble relating to others-paranoid.
For example, Nathaniel does not like going to the homeless shelter, LAMP, because he
feels as if the individuals there throw their cigarettes on the ground to, torment him. At one
point in the film, Steve finds Nathaniel in the middle of the street (during heavy traffic time in
LA) picking up cigarette buds in between the cars zooming by him. Nathaniel wanted to keep the
city clean and wasnt even aware of the imminent danger he had placed himself by standing in
oncoming-busy traffic.
During the clips of Nathaniels childhood, it seems like the voices started in his early
adolescence which further progressed and eventually caused him to leave Juilliard School of the
Arts in young adulthood and eventually become homeless. The voices would often be obsessive,
in multiples, repetitive and paranoid. I believe that Nathaniel meets the criteria and specifiers of
Schizophrenia B-E (I was unsure about F due to the nature of the film). Nathaniel has had
schizophrenia for most of his life and his level of functioning have been affected areas like work,
interpersonal relationships, self-care, and occupational functioning (homeless) (DSM-V, 2013 p.
99). It is apparent that these symptoms have been occurring for more than 6 months and are

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consistent and persistent. He does not appear to have major depressive or manic episodes and the
disturbance Nathaniel experiences is not related to substance abuse.
The relationship between Nathaniel and the reporter, Steve Lopez is very interesting and
fragile. I think there are elements of healthy, but also unhealthy undertones throughout the
development of their relationship. From the beginning, it is pretty apparent that Steve is simply
using Nathaniel for a hit story in the LA Times (which he later goes on to publish a book about).
It is pretty obvious to see that the only one benefitting from this relationship financially is Steve;
however, their relationship seems to develop/evolve throughout the film. I think that Steve was
also going through his own interpersonal struggles (perhaps depression) and used Nathaniel as an
outlet to channel his energy and avoid dealing with his own issues (unhealthy aspects of their
relationship).
I think that Nathaniel was also confused about the nature of their relationship and often
was forced into situations that he did not want to be in. For example, Steve enticed Nathaniel to
come to LAMP because the cello would be waiting for him there instead of on the street. While
this was a great idea by Steve and made perfect/logical sense, it was a tactic used by Steve to get
Nathaniel to do what he wanted. In addition, he obtained a city funded apartment for Nathaniel
without knowing his history of where is symptoms worsened. From the previous clips, Nathaniel
was often in places of isolation (basement, apartment, etc.) where his obsessive thoughts and
voices increased tenfold. Thought the streets of LA are not the safest, Nathaniel seemed happy
and healthier in his own place in the streets. Steve often made decisions for Nathaniel instead of
asking what Nathaniel wanted to do, etc. Lastly, when Steve got him cello lessons and ultimately

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set up a performance for Nathaniel when he was in a very un-well and unhealthy place mentally,
was absolutely selfish and unhelpful for Nathaniel.
After meeting David Ellis in the film, it was clear the vast differences Steve and David
had about the well being of Nathaniel. Steve wanted to use tricks/tactics to force Nathaniel to
stay at LAMP, the apartment, etc. Steve also wanted David to force Nathaniel to meet with a
Psychiatrist and take medication. David enforced that it was completely up to Nathaniel and his
wishes and that they never force a client to do anything, they are merely there for education,
support and available resources. They are similar because ultimately they both want to help
Nathaniel become healthy and get off the streets.
I believe that David Ellis is more correct in the non directive approach in working with
Nathaniel. I think that ultimately you have to do what the client wants, when they need it. David
also was not quick to give Nathaniel a diagnosis and label; I found this to be very interesting due
to the diagnosis controversy that takes place within counseling, even today. I believe that it can
be very important for a client to know what kind of diagnosis they are experiencing so they can
better manage it and educate themselves about medication, etc. However, David felt as if, the
last thing Nathaniel needs is another diagnosis. However, I can see how this approach could be
helpful in Nathaniels case. At this point in Nathaniels life, a diagnosis will not enlighten him
nor will it bring him closer to treatment. As we saw later in the film, Steve tried to get Nathaniel
to sign some documents regarding his welfare and care into the power of his sister. On the
documents it listed Nathaniel as having a schizophrenic mind. Once Nathaniel read that it
ultimately broke his spirit and he had a mental breakdown, physically assaulting Steve. With the

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severity of Nathaniels symptoms, I think it would be best to discuss his diagnosis at a much
later dater within his treatment where he is much more lucid and self-aware.
Based on my observations of Nathaniel, I believe that it would be helpful to conduct
several interventions with him over time. I think it would be important to hospitalize Nathaniel to
get him off the streets and regulate his medications safely. Treatment for schizophrenia usually
entails a combination of medication and psychosocial interventions that target both the acute
psychotic phase of the disorder and the debilitating residual symptoms (Seligman &
Reichenberg, 2014 p. 413). In addition to medication, I think it would be helpful to then
transition to a day hospital or partial hospitalization program to slowly integrate him with more
people with more responsibilities. I believe that Nathaniel would benefit form a couple of
psychosocial interventions like: cognitive behavioral therapy, social skills training, and family
education (Seligman & Reichenberg, 2014).
CLIENT MAP (Seligman & Reichenberg, 2014)
Diagnosis: Schizophrenia 295.90 DSM-V
Objectives of Treatment: Create a safe and encouraging environment for Nathaniel. Reduce and
eliminate the most prominent symptoms: auditory/visual hallucinations, delusions, and
repetitive/incoherent speech. Restore Nathaniels awareness of reality and work on establishing
interpersonal relationships with family/friends. Improve Nathaniels coping mechanisms and
behavioral adjustments. Prevent relapse and engage Nathaniels family/sister in his treatment to
help them better understand his illness.

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Assessments: Medical, neurological, and psychological. I would also like to conduct a physical
wellness check for Nathaniel since he has been living on the streets for sometime. Assess suicidal
ideation or self-harming (if any) while establishing level of functioning of Nathaniel.
Clinician Characteristics: Supportive, empathetic, compassionate, and optimistic of Nathaniels
treatment plan and growth. The clinician needs to establish a trusting relationship with Nathaniel
and establish a long-term relationship. This clinician needs to be well versed in the disorder of
schizophrenia and be able to collaborate with a psychiatrist and medical personnel. Lastly, this
clinician needs to provide long-term support for Nathaniel and his family.
Location of Treatment: Hospitalization (initially) then Day Hospital (long-term).

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References

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders
-DSM-5TM (5th edition). American Psychiatric Publishing, Arlington, VA. Referred to as
DSM for reading assignments.
Foster, G., Krasnoff, R. (Producers), & Wright, J. (Director). (2009). The Soloist [Motion
picture]. United States: Paramount Pictures.
Seligman, L., & Reichenberg, L.W. (2014). Selecting Effective Treatments A Comprehensive,
Systematic Guide to Treating Mental Disorders (4th edition revised). Hoboken, NJ: John
Wiley & Sons, Inc.