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Themes
2. Accept the loss and increase social interactions and contact with family
Initially, Jack presented with F43.23 due to the recent death of his wife and his adjustment to this. He reported increased anxiety and depression since her passing and a sense of "loss of meaning."
After working wtih Jack over the course of nearly a year, therapist has identified narcissistic behaviors and transferences. There are themes with Jack of manipulation and control, sense of superiority, lack of boundaries, splitting, and fear of rejection.
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Object Relations Theory
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Attachment Theory
Works upon the belief that because our unconscious mind is directly in conflict with our conscious mind, anxiety and defense mechanisms are created.
Psychdyamic Therapy is generally a longer term process that mostly uses what happens in the "room" between the therapist and the client as the foundation for assessment. Using a "here and now" philosophy, what the client brings to session (transferecen), and the countertransference from the therapist provides insight in regards to how the client relates in their world.
1.
Since past experiences and relationships (starting with the "mother") leave a residue within an indivuals psyche and predetermines how the individual will relate to others, the "inner objects" that become internalized continually manifest in current relationships. "Individuals interact not only with the actual other but also with an internal other, a psychic representation that might be a distorted version of some actual person," (2004, p. 2).
Client: You know the most comforting image to me is a beautiful woman.
Therapist: What about that is comforting to you?
Client: I saw the most beautiful woman I had ever seen on the street one day, then, I got closer, and she wasn't so beautiful after all. And I was confused. It was like, I was dissapointed because I thought she was so special. I felt sort of exposed for thinking she was so cool.
Therapist: Who did she remind you of?
Client: (big pause). Well.... my Susan. That's who.
Therapist: Who else?
Client: (big pause). My mother. I was always dissappointed by her. I didn't trust her. I didnt' trust that she loved me - that I was special and good and wanted. I think she lied to me a lot. Also you, I think. It's hard for me to trust you.
Session #16 Continued
Session #30
Client: I've realized that its not just an infatuation with you, it's that I"m in love with you. I want and wish to be in session every week, with you, and I dream about it in between. I feel lovesick. I want to know you. I want to know you're thinking about me, too.
Therapist: We've talked about transference before. We've talked about that when you feel vulnerable, you use your percieved feelings about me to evade the vulnerablity. What do you feel is happening now? I'm wondering how you want me to respond to you, Jack.
Client: I know you think that this is all an unconscious projection, but I disagree. I've never met anyone as brilliant or as perfect as you.
Therapist: I'm wondering if this is a test - a test to see if I reject you -I wonder if you are testing my rejction of you, my potential abandonment of you, as your wifes" death was an abandonment in itself perhaps. Perhaps I'm your connection to the way you find your grief.
Session #30 Continued
Change occurs when the therapist can first create a frame for the client that is consistent, including the time, place, day, fee and room of where therapy takes place. A strong frame equals a strong therapeutic alliance. When there is trust and strong alliance, deeper transference and countertransference can occur. The tracking of what the client shares and identifying the theme that is present in the clients material is one of the steps for creating change.
How Do People Get Better?
How do we resolve traumas and make meanings? The therapist is the containter for the client. We are the container through which we make experiences palpable to the client. Therapist is about helping clients speak the truth. We can't move on without the truth. We are the courage to name things that the client can not.
Working With Transference
Since Session #30...
I must be Jacks' object as a "secure base" from which he can experience attachment differently than he did as a child. This will allow him to freely explore his conscious and unconscious mind, to uncover desires and projections, interalizations and envious feelings. To have a secure base to return to, we are actively healing the attachment wound of trusting other emotional bonds and therefore truly experiencing love and self love.
I remain nonjudgemental, curious, consistent, and empathetic while also interpreting the latent content in sessions and giving it voice. I am provacative as well as intutive. Therapy is not linear. It is an intuitive process that requires thinking, processing, and connecting. Ultimately, when client is able to re-experience difficult, painful situations in the context of an emotionally contained space, client can experience change.
The therapist will become "good" and "bad" objects (mother) for the client and this will allow processing of the client's past experiences. If the client is able to securely attach to the therapist, there is also a starting point for change.