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Introduction:

Chapter 1 – Opening Gambit
“Doctor, your three thirty is here: Ms. Millen.”
“Do I have her chart?”
“Yes doctor, I put it on your desk.”
“I see it. Give me five minutes to review it, then send her in.”
“OK doctor.”
Doctor Carl Hague released the button on the intercom and leaned back in his overstuffed leather chair opening the blue folder containing Dawn Millen’s chart and began to scan the contents.

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Green Oaks Psychological Assessment Center

PSYCHOSOCIAL ASSESSMENT

Prepared by: David Leeding PhD., LMSW-ACP, LPC, LMF, LCDC
Prepared for: Dr. Carl Hague
Patient release of information signed? YES
Reason given? Continuity of Care

Name: Dawn Millen
DOB: 21 April 1963
Height: 5’4”
Hair: Brown
Eyes: Green
Weight: 115 Lbs

Physical presentation: Patient presents as somewhat younger looking than her 40 yrs. Patient is dressed provocatively in an opaque white halter-top, and a short leather skirt. Patient’s appearance and demeanor suggest that it would be unwise to conduct this interview in a closed room. I conducted interview in room directly across from receptionist with door completely open, and informed receptionist Carly Baker of my intention to do so, that she might be aware of interview and act as a visual witness in case of negative occurrence.

Possible Diagnosis:

V71.01 Adult Antisocial Behavior: Patient has history of sadistic-sexual relationship patterns since before the age of 15 and possible intermittent cult involvement: cult fits no known pattern. Was member of “Rogue” biker gang from age 16 to age 32. Arrested numerous times for incidents involving biker gang. Significant arrest:
Possession of a Controlled Substance.
Assault with Intention to do Bodily Harm.
Co-conspirator Racketeering (Car theft ring).1
Patient has not held gainful employment for longer than three months at a time, with the exception of working in a topless bar as a dancer (302.4 Exhibitionism), and prostitution. Currently, Patient works as an independent “escort,” specializing in sadomasochistic role-play. According to patient’s own account, her clientele are mostly men, and are evenly divided between submissives and dominants. She self-divulges that she enjoys her work, and gains sexual pleasure from playing both the dominant or submissive role (301.50 Histrionic Personality Disorder). Patient self reports sexual arousal from object insertion, vaginally, anally, and orally during role-playing (302.9 Paraphila). Patient has been hospitalized on numerous occasion related to injury suffered during this type of sexual activity. Her last hospitalization was approximately six months ago on January 29, 2004. She required a blood transfusion because of sever internal bleeding from wounds received vaginal and anally. She was hospitalized for ten days, at which time she was released, and instructed to stay bedridden for the next week; she was then scheduled for a follow-up. She did not go to the follow-up, but appears to have made a full recovery, and states she is experiencing no current pain or problems related to the injuries. 2

Presenting problem: Patient states that she has realized that her behavior has become progressively more self-destructive. She states that she nearly constantly feels the need to be hurt, and no longer just for sexual arousal. For the last year and a half, patient reports that she has been “cutting” on herself (301.83 Borderline Personality Disorder) as a way to control these urges, but she is now becoming frightened because she feels she is losing control. She reports that she knew that she was being hurt badly during the incident that precipitated her last admittance to the hospital (see above), but did not want to stop the abuse. Patient reports suffering nightmares most nights, and being unable to sleep unless she takes some form of sleep aid, usually of the Benzodiazepine class, which she acquires from an illicit source. Currently she reports needing 20 mil. valium, or the equivalent to induce sleep. Patient states that she rarely gets more than three hours sleep a night.

Family History:
Patient reports that Father (William Carl Millen, age 62) was a violent and abusive man. He is currently serving a life sentence in the state penitentiary for the beating death of the patient’s mother (Patty Anne Millen nee, Wilkerson). Patient states that her mother died in 1985. Patient has one sibling, a younger sister (Shelly Anne Millen), who is in a continuing care facility. Patient reports that her sister suffers from a catatonic state, brought on by sever abuse when she was kidnapped, and subjected to sever physical trauma. Patient reports that when her sister was found outside of the county hospital, she was nearly dead. Patient relates that her sister was in the hospital for six months, the first six weeks in ICU. She had deep laceration, bruising and burns from what appeared to be marks from ropes used to tie her. Her vagina had been burned or scarred in some way, as to make sexual activity completely non-functioning. Patient states that her sister was bleeding internally and anally when admitted to the hospital. 3
Patient reports that she began having sex with her father when she was around nine years old, and that he began “whoring her out” when she was twelve. Patient relates that she generally enjoyed having sex with her father, who she reports as being a handsome and robust man. Patient states that her father continues to be the only man with whom she has had sex and also felt she was “in love.” Patient visits her father every three months, and writes him several times a week. Patient states that although she had, and continues to have feelings for her father, she knows she had to leave home before he did her harm. Patient also states that she was trying to “get back” at her father by leaving home because he had sexually abandoned her for her younger sister. Patient reports that she had intense feelings of hatred for her sister for “taking her father away from her.”

Final Diagnosis: 301.72 Anti-Social Personality Disorder with Masochistic features.
As noted above this patient could be categorized under a number of different diagnoses. However, after reviewing and comparing the results from the DSM IV 4 and other personality test given the patient at both this clinic, and from other sources (past testing through the Criminal Justice System, Juvenile Criminal Justice, Department of Health and Human Services), as well as numerous case histories and evaluations, this seemed the most comprehensive diagnosis under which to evaluate this patient. One telling note is the extremely high scores on section 4 of the DSM IV and the Bloom Anti-social Scale (99% percentile). This patient also scored in the extreme preternatural range (97% percentile) of the Wilkenson Sexual Behavior Inventory. 5 Because of Patient’s self-mutilation, masochism, and seeking out help without outside pressure, doubt is cast on using anti-social as the sole diagnosis. Although the Patient’s History and Psychological testing support multiple diagnosis, the evaluation team still feels that this diagnosis best fits the overall picture of the patient as reveled at the current time, and throughout this evaluation. 6

1. See attached criminal history. Millen, Dawn.
2. See attached medical reports. Millen, Dawn.
3. See attached medical reports. Millen Shelly.
4. DSM IV, Keirsey Temperament, Murray Inkblot, Tiebole Archetype Test, Wilkenson Sexual Behavior Inventory, and the Bloom Anti-social Scale.
5. Raw score results for Psy-test 4 series. See attached documents.
6. Team members, specialization, and summary of evaluation # D9401R-3 PSY.

Note: Dr. Hague, although I am sure you are familiar with most of our nomenclature, the dash three in the above Evaluation Number may be unfamiliar to you. The 3 and the PSY preceding it refer to the fact that this patient has had two previous Psychological Evaluations at our facility, and that all of the previous inventories/test were re-taken.

If we can be of any further help, please let me know. We look forward to working with you in the future.

Dr. Kenneth J. Reed, Jr., MD, PhD., Clinical Director Green Oaks.



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Doctor Hague looked up from reading the chart as Dawn Millen walked through the door of his office. She looked to be a woman in her early thirties, and could possibly pass as being in her late twenties. She was a short woman, but wearing high-heeled pumps, four inch spikes, causing her to look taller than she was. She was wearing a very short dark blue skirt, with a fluffy trim at the hem. She had on a sheer light blue cotton shirt, which buttoned in the front, and clung to her breast tightly. The dark purple-pink ring of her areola was clearly visible through the light material, showing that she had small, up turned breast. Every now and then the gold and diamond ring that hung from her pierced left nipple would catch the light and make its presence known. Dawn Millen like the fact that men could not keep from staring at her, she was generally so horny from the ring that was through her pierced clit, that she was ready to fuck every man she met.
“Reading all about me doc?” The woman said as she walked into the room and sat down in one of the two overstuffed leather chairs that sat opposite Doctor Hague’s desk. She crossed her right leg under her left, and began striking the side of the chair that protruded out at the level of her head.
“I’m afraid it might scare you away from taking my case. That Dr. Leeding that did my interview seemed a bit nervous. He looked like he thought I might either assault him or rape him,” she said grinning boldly as she stared at Doctor Hague with penetrating emerald green eyes.
Doctor Hague could not remember ever seeing anyone with eyes that color. “Excuse me Ms. Millen, I don’t mean to appear to ignore what you said, but do you wear contacts?”
“No doc, why do you ask?”
“Well,” he hesitated, not sure how much he wanted to reveal. “Throughout my practice I have made a study of my and other psychiatrist’s patient’s physical features, such as face, mouth, and eye shape and placement, to see if there are any correlation between that and their psychiatric problem. I guess it has become habitual for me to notice such things. In all of that time I cannot recall seeing anyone with eye color like yours. So I was curious if you might be wearing colored lenses.”
“Well, that’s sweet of you to notice my eyes doc, of course most men notice my other features more.” She said, bringing her left hand up to cup her right breast, then using her left to trace out the colored circle around the increasingly harder nipple.
“Yes, I understand that is probably the case, but I would ask you to refrain from inappropriate behavior while you are in my office, Ms, Millen.”
“Sure doc, sure,” she replied, removing her hands from her breast and putting them in her lap. “But, I’d like to ask you a question out of curiosity also, if you don’t mind?’
“Go ahead Ms. Millen,” the doctor responded.
“Well, you got some nice leather chairs here doc.” She said as she ran her hands suggestively over the chair she was sitting in. “I was just wondering what you would do if I were to suddenly throw a leg over each arm, and start going after my cunt right here, you know I’m not wearing underwear?”
“Ms. Millen,” the doctor responded. “I understand you are in a great deal of emotional pain, and I would like to help you to find and rid yourself of that. However, should you do something like that, I’m afraid I would no longer be able to work with you. Despite the fact that I understand that it is a defense you use to keep others at arms length. Should you actually do something like that, I would have to ask you to leave my office.”
“What if I didn’t want to stop, what if I wouldn’t stop, what would you do then doc?”
“Well, we do have a security force in this building, I would regrettable have to call them to escort you out of the building.”
“Hey, that’s pretty good doc, you’re the first shrink that has stood up to me,” she said as she straightening up in her chair. “Most of the time they don’t know what to say.”
“So you have sought psychiatric help previously?” the doctor asked, making a note in her chart.
“I don’t know if you would say I sought it out,” she replied with a grin. “It was more that the judge requested that I go as a condition of my probation a few times. I always received a good review from all of the shrinks, except for one time.”
“And why did you not get a good “review?”
“Probably because that was the one shrink I couldn’t get to fuck me,” she said as she grinned and licked her lips with her tongue. “Nothing like saving some of the evidence to see that I get a passing grade.”
“Would you like to give me the names of those doctors so that I can report them?” he asked, as he wrote some more notes in her chart. “You may not realize this Ms. Millen, but you were taken advantage of by those doctors, and that is against the law.”
“Oh, they took advantage of me good, doc. But, I don’t won’t to report them, they did what I asked, and I got some good fucking out of it. You shrinks know some kinky stuff. Do you learn that in school?” She said as she leaned forward, putting her elbows on her knees and resting her chin in her hands. She stared at the doctor across the top of his desk.
“Let me assure you Ms. Millen, that type of behavior is not condoned by the American Psychiatric Association or I.”
Leaning a little further forward, but continuing to rest her head in her hands she said, “You mean like having your patient lay across the arm of the couch were the rest of your patients lay pouring out their dark secrets, while you pound her up the ass, pulling a fistful of hair like it’s the reins on a horse you are riding?”
“Any inappropriate behavior is grounds for the doctor to lose his license and bring criminal charges. I would like to see that these doctors to whom you are referring do not molest any more clients, not just pay for what they have done to you.”
“Well, I don’t think I want to do that right now,” looking serious for a moment before pouting her lips, and then laughing.
“We can table that for the moment, if you wish, but I would like to revisit it later,” the doctor said, looking over the desk at the woman until she gave a nod of her head. “What is it you do wish to discuss today, Ms. Millen?”
“Well, for starters, you could drop the Ms. Millen thing, and just call me Dawn,” she said, as she sat up straight and smoothed her skirt.
“I do not think, considering your history, that would be appropriate at the moment,” the doctor responded.
“You sure are one tough cookie, doc. Well I suppose that chart on me that you were reading says why the Green Oaks shrinks think I am here, plus I told them enough times.”
“According to your chart, you are here to get help with recurring nightmares.”
The woman’s head jerked up, and an angry look crossed her face, but then was quickly replaced, with a grin.
“Ms. Millen, you seem very interested about what is in your chart?” questioned the doctor. “Would you like to read it?” He said offering the thick blue folder to the woman across the desk.
“Can I take it home?”
“No, I’m afraid that could not be permitted. By law I can not allow that record to leave my office.”
“Ok doc, I’ll read it here, but before I start, I wanted to ask you a question.”
“Sure Ms. Millen, go ahead.”
“If I told you about something I did years ago that hurt someone, but it was just that one time, would you tell the cops?”
“I’m afraid if you committed a crime on which the statute of limitation had not expired, then yes, I would have to report it.”
“Do you have any other questions, Ms. Millen?” the doctor asked, starting to rise from his desk.
“No, not now doc.”
“Very well. If you will step this way, I have a conference room where you can read the chart, and not be interrupted,” he said as he motioned her towards his door.
“I can’t read it in here doc,” she said, staying seated as she turn slightly to the side and pulled both of her legs up into the chair, “I like it in here.”
“I am sorry Ms. Millen, but I have another appointment shortly.”
“Oh, that’s OK doc,” she said as she slid out of the chair, then turned and bent over, straight legged to retrieve her purse, and in the process exposing everything underneath her short skirt. ”I appreciate your consideration.” She may have been forty years old, but her ass still looked liked it belonged to a teenager. One of the benefits to not minding pain was that she didn’t mind waxing her cunt and ass. Waxing gave her a nice smooth look, as though she still had not grown any hair down there. Nearly all of her male clientele got off on fucking and under aged girls, they really liked it when she called them daddy, and told them to fuck her hard before mama came home. That it got her off, pretending it was her father fucking her made it even better. She heard a quick inhale of breath from behind her. She pretended to be outing something in her purse, and over her shoulder said,
“Coming doctor.” She had to suppress a big grin as she stood up and turned around. She was completely aware of the view she had given the good doctor; after all, she had looked at herself in the floor length mirror at her apartment many times as she practiced bending over in just those shoes. She wanted to make sure when she did this move; it displayed her cunt lips just right. She had taught herself how to run her finger between her slit to make her lips fan out in back, between her slightly parted legs, in the most inviting way. The fact that she also kept a drop of scented oil on her asshole, making it glisten like a glowing beacon, let her know that she had given Dr, Hague quite a show. The doctor was already at the reception desk, and talking to the woman behind it as Dawn walked up. As Dawn approached the desk she heard the Doctor say,
“Ms. Millen will be using the conference room for the next several hours, please assist her in whatever she needs.”
“Do you want to make another appointment before you begin,” the doctor said as he turned to face Ms. Millen.
“That won’t be necessary doctor, said the receptionist. She has already scheduled and paid for a session a day for the next month.” Ms. Millen grinned as she walked by the doctor to the conference room, having to resists the urge to grab at the bulge she could see between his legs, instead, she patted him on the shoulder as she passed and said,

“Don’t worry doc, you’ll come through it OK.”

End of chapter one
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