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Case of Deidre: Conceptualization of Problem through Psychoanalytic Theory

A case conceptualization is a report that is written to explain a client’s presenting problems, establish goals as they relate to a theory, plan interventions, and explain the rationale for the interventions and expected outcomes for the client. The interventions chosen will reflect the theory being focused on this week and will include citations from a minimum of two of the week’s resources.

Presenting Problem

From a psychoanalytic perspective, Deidre appears to be experiencing anxiety because of unconscious conflicts originating from her early childhood experiences (e.g., parents’ divorce and mom’s moods), her complicated family relationships, the untimely death of her father, and her abortion. Additionally, Deidre is experiencing a high level of guilt indicating that her ego is struggling to balance between the instinctual drives of her id and the drives of her superego (i.e., the aspect of self that looks at the morality of choices) (Johnson, 2016). It could be that Deidre is experiencing unconscious psychological conflicts surrounding the secret of her abortion, her desire to feel safe with her boyfriend, Tom, and her need to remain loyal to the values she learned from her childhood (i.e., to kill is wrong).

Deidre is using some defense mechanisms—including repression, which blocks these conflicts from her awareness, avoidance, and rationalization—that help her cope with her fears of abandonment. According to Johnson (2016), these defense mechanisms, unconsciously employed to bolster Deidre’s fragile ego, could be linked to Freud’s concept of death instincts that might be related to her father’s early death and her fear of losing Tom.

Goals

According to Johnson (2016), the primary goal of a psychoanalytic approach is to bring Deidre’s unconscious processes into her conscious awareness to illustrate how she is blocking past experiences to help herself cope with her present experiences. The overarching goal of psychoanalysis is to help the client gain self-awareness, so she will be able to understand how past experiences and relationships are causing emotional and cognitive distortions (Johnson, 2016).

In addition to the overarching theory goals, one clinical goal the counselor will work on with Deidre is reducing the overall frequency, intensity and duration of her anxiety so that her daily functioning is maximized; this will be accomplished with the use of psychoanalytic interventions.

Interventions

Free Association

During the counseling session, clients are encouraged to state any thoughts or feelings that come to mind without censoring them. Then, in a nonjudgmental way, the counselor assists clients to analyze the underlying unconscious feelings associated with these disclosures (Johnson, 2016). The goal is not to uncover specific memories, but rather to encourage self-exploration with the counselor to achieve balance between the clients’ id, ego, and superego.

Analysis of Resistance

Resistance in psychoanalysis is considered to be an unconscious reaction by the client to keep unpleasant or perceived negative experiences hidden (Johnson, 2016). These acts interfere with the ability to accept changes that could lead to a more satisfying life. Common types of resistance are changing the topic, refusing to talk, or giving up on counseling. These types of behaviors imply that a client is unconsciously trying to avoid thoughts and feelings that are perceived as threatening. Using analysis of resistance, the psychoanalytic counselor encourages the client to consider what these thoughts and feelings might be as well as how they are an important influence on the client’s mental health (Psychoanalytic theory and approaches, n.d.).

One example of Deidre’s resistance is keeping secrets from her boyfriend, Tom, and using drugs as a way of coping with her anxiety.

Rationale and Expected Outcomes

The goal of psychoanalysis is to bring unconscious thoughts into the conscious to deal with them (Johnson, 2016). Repressed feelings, experiences, and/or ideas can surface in the shape of neurotic symptoms and disorders such as the anxiety that Deidre is experiencing

Therefore, a Freudian/psychoanalytic approach asks clients to integrate consciously what they are rejecting from their conscious mind. According to Johnson (2016), anxiety is a feeling of dread resulting from repressed feelings, memories, and desires that develop out of conflict between one’s id, ego, and superego.  

It appears that Deidre’s keeping her abortion a secret from Tom (and possibly from herself) is her unconscious effort to defend her fragile ego (Johnson, 2016). By exploring Deidre’s thoughts and feelings that emerge through free association, she can begin to connect how this repression is manifesting in her life today. Then, by helping Deidre look at her resistance to changing her behaviors, she will see that her anxiety and drug use are ways of defending herself (her fragile ego) and holding her back from making changes that could enhance her overall well-being.

 

A very positive outcome would be that at the end of therapy Deidre would be empowered to make decisions based on a full awareness of her unconscious drives and her anxiety will diminish. Her id, ego and superego will be balanced and healthy.

 

References

 

Johnson, A. L. (2016). Psychodynamic theory. In D. Capuzzi & M. D. Stauffer (Eds.), Counseling and psychotherapy: Theories and interventions (6th ed., pp. 73-96). Alexandria, VA: American Counseling Association.

Psychoanalytic terms and concepts defined. (n.d.). Retrieved November 23, 2018 from http://www.apsa.org/content/psychoanalytic-terms-concepts-defined.

Psychoanalytic theory and approaches. (n.d.). Retrieved November 18, 2018 from       http://www.apsa.org/content/psychoanalytic-theory-approaches.

 

Week 8: Family Systems

 

 

The previous weeks focused on individual approaches to counseling. This week, you will take a slightly different approach by looking at family systems theory. Family systems theory provides various frameworks that can be used as guides to help couples and families obtain and maintain healthy family functioning. In working with couples and families, counselors focus on addressing systemic issues and view the entire family as “the client.” Additionally, there is focus on promoting change in those patterns and processes that contribute to dysfunctional family processes. Working with the entire family at one time allows counselors to see things as they may happen at home. When the whole family is in session, you also have the chance to work with everyone at once—coaching and supporting them throughout the change process.

Like the theories you have studied in the previous chapters, these theories provide the clinician with perspectives on how problems arise in families. They also give you ideas on how to promote change in family systems and what it takes to help restore the family to functionality. Keep in mind that this week is a broad introduction to systems theory. You have the opportunity to learn more about working with couples, families, and children in other classes in your program.

Enjoy this information and think of how an understanding of systems theory will enhance your effectiveness as a clinician. If you have any questions about this information, please contact your Instructor.

Learning Objectives

Students will:

  • Identify theorists, timeframes, and major constructs of individual theories
  • Analyze techniques/interventions associated with individual theories
  • Evaluate theories in relation to cases

 

Dykeman, C. (2016). Family theory. In D. Capuzzi & M. D. Stauffer (Eds.), Counseling and psychotherapy: Theories and interventions (6th ed., pp. 339–366). Alexandria, VA: American Counseling Association.

 

Required Media

Psychotherapy.net. (Producer). (1997b). Family systems therapy [Video file]. Mill Valley, CA: Author.

 

Discussion: Family Counseling: Case Conceptualization

For this Discussion, you will write a case conceptualization as though you were a family counselor.

As you review this week’s Learning Resources and media files, note techniques and interventions, and consider the role of a family counselor in planning treatment. Further, reflect on family therapy with respect to developing your own theoretical orientation. In what ways do you find that family therapy may resonate with your own point of view?

Note: These are not the full assignment directions! Be sure to read the entire Discussion assignment directions for how to prepare your initial post, what you are posting, and how to respond to your colleagues. 

To Prepare:

  • Review this week’s Learning Resources.
  • Review the family systems therapy video from this week’s Learning Resources. Take note of language and techniques used by the counselor that is specific to this theory.
  • Review the Psychoanalytic Case Conceptualization Example found in this week’s Learning Resources and use this document to prepare your initial Discussion post.
  • Select one of the four case studies presented in this week’s Learning Resources, and answer the following points as if you were a family counselor. Use your Learning Resources and the notes you took on language and technique from the family systems therapy video to support your conceptualization and integrate examples from the case to support your post. Include the following:
    • Presenting Problem
    • Treatment Goals
    • Identification and explanation of at least two techniques and interventions
    • Expected Outcome

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