Psychological Analysis of of Nancy - Case Study Example

PSY3013 Case Study Spring Term Assignment 2 Counselling Psychology Asad Chughtai 16 March Case of Nancy Introduction This work analyses the caseof Nancy and then considers how knowledge of the theory and practice covered by the transpersonal, humanistic and existential perspectives to psychotherapy can be of assistance to the therapist who is working with Nancy. Firstly, a brief overview is given of the aforementioned theoretical perspectives to provide background information on their nature and what their associated approaches entail. Theoretical perspectives Humanistic approaches have had a pervasive influence on psychotherapy for many years (Walley, 2010b). These are client centred, and as Carl Rogers saw it, the goal of the therapy is to form a relationship that challenges self-concept. Gestalt therapy, is an example of the humanistic approach although it differs from other humanistic approaches (Gillon, 2007: 89). It is also holistic as the other two described below and shares the idea of cultivating self-awareness with the transpersonal approaches (Gillon, :90). The existential approach is grounded in philosophy, and is primarily concerned “with the understanding of people’s position in the world and with the clarification of what it means to them to be alive” (Dryden, 2007: 195). This requires searching for truths related to existence with an open mind, and is therefore a rational approach to attempt to understand the world. Transpersonal perspectives are spiritually oriented and work with the higher self. Core process therapy for example, which is based on this, integrates western psychological theories with ‘mindfulness’, a concept derived from Buddhism. Transpersonal therapies are now becoming a leading approach to psychotherapy. At the heart of this, is the need to become aware of one’s inner world and thereby grasp the meaning of life as well. As such, this approach has an affinity with all mystical paths for attaining enlightenment. However, it is also seen as embedded in some other therapeutic approaches such as Jung’s analytical psychology (Walley, 2010a). Case of Nancy Nancy was depressed. She had been exhibiting self-injurious behaviours, and had suicidal tendencies. Her physical symptoms were weight fluctuations, eating disorder since she was thirteen, and she had abused alcohol in the past. Problems of self-identity could also be the case as indicated from her dressing, rejection of femininity and not fitting in at school. The latter suggests she may also have been bullied. A large part of her condition is explainable given that her background was unstable and problematic. At a young age (of ten), her parents’ divorce must have upset her deeply. They were also violent towards one another yet they both loved Nancy but failed to satisfy her needs. She was an only child so was unable to share her feelings with any siblings. All this made her feel “invisible, unseen, unloved and uncared for” (ibid), and this feeling and her father’s affair is what led to her overeating, and moreover vulnerable due to hating herself, feeling hopeless, and having the desire to take flight. Given that her mother had recurring multiple sclerosis and was often depressed, this no doubt affected Nancy too. Nancy’s fear of rejection stems from when she started to have the eating disorder and felt rejected by her peers and teachers alike. This led her to hide her depressive state from her family and friends, and she felt the same rejection would happen with the therapist. Her reason for not being open with her parents was also that she wanted them to avoid conflict. Her anger and suicidal tendencies were a consequence of feeling trapped so she wanted to relieve her inner pain, her feeling to ‘scream inside’ through tolerating it physically. “She spoke of felling half-dead, judged and rejected” (ibid). The suicidal tendencies resulted from unable to control her anger. There is a strong need to create trust between the therapist and Nancy because she has been reluctant to cooperate during three treatments in the past and considers all therapy to be “useless” (University of Northampton, 2010). Her present therapy sessions are being conducted at the hospital where despite initial resistance she is showing signs of engagement. It is helpful for the therapist to be very clear on the patient’s profile. Therefore, the salient points are summarised in the table below. Physical symptoms Psychological problems Underlying issues Weight fluctuations Eating disorder Alcohol abuse Inflicting self-injuries (self-destructive) Suicidal tendencies Fear of rejection Inhibited feelings Repressed anger Lack of self-identity Instability Feels isolated; fears rejection Deficient motherly role model Not easily trusting Fortunately, during this therapy, Nancy has been expressing her internal feelings, and there has been noticeable improvement in “her level of comfort with herself, the therapist and the milieu” (ibid). This has lessened her urge to inflict self-harm, to binge and is leading to her desire to get well. The therapy has made her feel safe again, and she is attached to the therapist although this has led to fearing being discharged as it might make her resume her previous state. Possible approaches The humanistic approach could help Nancy to feel better about herself and shrug off the negative images so that she can value her life. Her desire to change and value her capacity to direct her own life is evident from now fearing from being discharged. Nancy needs to take responsibility for herself and have the confidence to sustain her sense of self-worth in the outside world as well. Her dependency on others for her sense of self-worth is evident from her attachment to the therapist given also that she has been alienated from her parents at an early age. The gestalt approach can also reveal a lot through observing Nancy’s speech and body language. This form of therapy has the potential to make her more optimistic than other psychoanalytical approaches (Dryden, 2007: 4). It facilitates the change process from low self-esteem as she had at first to a “view of self more closely in accord with essential self-worth” (Walley, 2010). Now that she is no longer ‘self-loathing’ means that she has transformed a long way already. This approach can work successfully if trust can continue to develop, which the hospital therapist has managed to build, and if the therapist can also develop an empathic understanding of the case. Moreover, Gestalt therapy in particular can benefit Nancy by helping her to become what she is and speeding up her ‘evolution’ (Walley, 2010b). The existential approach is suitable for Nancy because she does appear to have an open mind and is trying to make sense of her life. Her disturbances were a result of her avoiding coming to terms with her own background, and showing signs initially of being unable to cope. However, her openness to possibilities was evident when she started to express and further interpret those feelings. She was clearly in a state of breakdown and the breakthrough was made possible by the hospital therapist’s trust and making her feel safe. Her recent changes in attitude following her period of crisis and constructive frame of mind show that an existential therapy can explain this process well. It could further help her to have a clearer purpose in life so that she can put the past behind her but learn from it, and strive for something more meaningful for herself. Existence is recognised as a suffering but humans have a choice to either face up to it, described as ‘living authentically’, or try and deny it, described as ‘living inauthentically’ (Gillon, 2007: 92). Her desire to live now means that she is definitely starting to face her own existential reality. A strong advantage of this approach for the therapist is that a solution to the complexity of Nancy’s problem can be worked out creatively. Moreover, the patient herself has already demonstrated the capacity to change through being given the opportunity to express herself instead of the therapist having to try to change her. Nancy no longer needs to feel insignificant or empty, as she can easily ‘reinvent herself’ having nothing to lose but a lot to gain. She is at a tender age and has a whole life ahead of her. The transpersonal approach can help Nancy further to get the bigger picture of her life and think about her future potential. At the same time, it can be very effective for the therapist as it deals specifically with the more fundamental spiritual aspects to the problem of suffering. Nancy’s initial state was dire because she could not relate to her background. Therefore, her ability to explore her inner self has demonstrated how she can effectively work towards healing her life and moving on. In fact, it was her own innate potential that she is tapping into and which is helping her deal with her suffering and access her deeply buried feelings. Contrary to taking a usually narrow perspective of suffering as a damaged ego in western psychology, the therapist would need to see the ego as the very cause of suffering itself and therefore help the patient to become fully aware through being ‘in the present moment’ (Walley, 2010a). This is similar to Gestalt therapy’s style to explore the ‘here and now’ except that it allows the client to be in greater control instead of having the therapist decide which aspects of the client’s experiences to identify and then apply various experimental techniques (Gillon, 2007: 90). As long as Nancy is receptive to opening herself up even further, she can benefit immensely from reflecting deeper. After all, there is no ‘monster’ inside her as she expected to find. The benefits will moreover assist Nancy not only to start a new lease in life, but also for her overall and long-term well being due to self-improvement, maturing spiritually early becoming wiser albeit the harsh way. Aspects of the three approaches can be combined well to enable Nancy to overcome her depressed state and move on in life. For the therapist, the humanist approach would particularly help to understand how Nancy is transforming into a more positive person, while the existential approach helps to understand is coming to terms with her reality, and the transpersonal approach to understand how the counselling is enabling Nancy to heal herself and transform her whole being. References Dryden, Windy. 2007. Dryden’s handbook of individual therapy. SAGE. Gillon, Ewan. 2007. Person-centred counselling psychology: an introduction. SAGE. University of Northampton. 2010. Case of Nancy. Walley, Malcolm. 2010a. The Transpersonal and Existential Approaches to Therapy (presentation). The University of Northampton. Walley, Malcolm. 2010b. The Humanistic Approach to Counselling/Psychotherapy (presentation). The University of Northampton. Read More