Conceptualization and Treatment Plan - Case Study Example

Conceptualization and Treatment Plan of This case study examines a patient suffering from a psychological disorder. A closer look into the life and history of the patient is provided so as to help with the understanding of this disorder and to devise the treatment plan. Julian, a young womans case study is presented with a detail insight in her life and history. After a detailed case summary, case conceptualization is provided that is studying what has been drawn by the clients interaction to infer specific intervention strategies and counseling goals. The study, hence, proposes and focuses on the psychoanalytic and object relations theory. Different interventions and treatment or counseling techniques of the psychoanalytic theory are discussed as the plan to treat severe and multiple problems that characterize the disorder. This paper will provide an insight to the clinical findings and then link those findings effectively with the strategies and other measures. The expected goals of treatment would be discussed with their prior difficulty in practical approach. Keywords: Case Summary, Case Conceptualization, Intervention Strategies, Treatment plan, Counseling goals. Psychoanalytic/Object Relations Case Study of Julian: A Conceptualization and Treatment Plan The underlying purpose of this paper is to apply a theory and to devise a treatment plan through a careful study of the patients life and history. The case study of young women, Julian, is thus provided that gives a thorough background of the origin of the disorder and aggravating elements. Presenting Concerns Julian presents herself as somewhat cynical or critical of her own self. She lacks self confidence. Julian recognizes that after her graduation from college, she had not been achieving good grades. Julian revealed in the interview that she belongs to a family that values academic and career success at the top of everything. She considers herself as not being able to delight her family with her higher academic results, and that is the reason why she has developed hatred for her own self and her family. She feels lonely and unworthy. After her unsatisfying academic result, her family was strict and harsh to her. Her social interactions saw a vast drop following the familys rebuttal. Throughout the interaction with Julian, she was depressed and reluctant. She would interpret her depression and hopelessness as “I am a cause of shame for my family". She had a limited and negative view of herself. In the interview, she would frequently say "Im useless". She admitted of having low self-esteem and limited self-concept of herself (Shaffer & Kipp, 2009). According to Julian, she thinks she is an embarrassment to her parents. She revealed in the interview that her parents were always busy in their professional lives. Busy with business trips and meetings, they had no time for Julian and her siblings. The children grew up under supervision of strict governess (Pastorino & Doyle-Portillo, 2012). Case Description Julian, a twenty-one year old white woman, belongs to an upper class family. She is the third of the five children. She was a high school graduate. Her family had no strong bonds and relations within themselves. On top of that, great emphasis was laid upon academic and career success. Julian was hardworking and a good student throughout her schooling period. She was shy, self-critical, and had few friends (Kingdom & Turkington, 1994). After her graduation from high school, she went out of state for higher studies. In the first year, she managed to get passing grades. Soon, she was unable to cope with the amount of pressure put in by her family and started to retreat in terms of poor results. She began to isolate herself from the world and society. A lot of times, she was found acting in bizarre ways due to social interactions absence. She was dropped out from college after her first year. Since then, she has been unable to work at all. Whenever asked for something to do, she would become so anxious. She would think that the work was way too much and difficult for her and restrict herself to her room. She would spend too much time alone in isolation that later, at the age of 20, she used to spend most of her time smoking, drinking and sleeping (Guerin & Guerin, 2009). There is no history of such psychological disorder in the family. Julian was the only one experiencing such disorder for the first time in their family history. She would have faulty cognitions such as "I am not good", "I cannot do anything", and "I am always going to be like this". Her morale was very low which was, in turn, affecting her interpersonal skills. She was completely isolated and socially or emotionally withdrawn. Her psychosocial functioning was impaired as well. Her self-care, even, was very limited. Increase in the negative symptoms such as apathy, avolition, and anhedonia would consequently increase her anxiety, negative thinking, and psychotic attacks (Ainsworth, Blehar, Waters, & Wall, 1978) (Brannon & Feist, 2009). Case Conceptualization Studying the case in detail reflects the reason why Julian may have started experiencing depression and social isolation. It seems that due to the pressure of her family and the amount of value they put on academic and career success, Julian started feeling too much of the pressure. Although she has always been an exceptional student throughout her schooling period, somehow when she graduated from the college, the amount of stress on her doubled leading to great stress and anxiety. It appears that she also lacked strong and healthy bonds with her family (parents busy with their own professional lives) because if she had some, she would have discussed the issues and solved the matter instantly. The matter would have not aggravated much (Ainsworth, Blehar, Waters, & Wall, 1978). Prior to this, not being able to fulfill the criteria of her family may have caused her to have a self-critical approach. Detachment from society, friends and relatives along with low self-esteem (defensive behavior), hence, was the result (Ainsworth, Blehar, Waters, & Wall, 1978). Also, her cognition and behavior were strongly affected. Hence, according to object relations theory, lack of adequate attachment has impaired her autonomous self. This is why we see Julian experiencing reluctance and fear of intimacy. Because Julian had never experienced good and friendly social relations with her family (due to their professional commitments) and had been brought up by a strict governess, she has thought to believe social relations as bitter and bad. This may be the reason why Julian has less friends and no serious or close relationships throughout her life (to avoid the reliving of trauma). This may be due to her internalization of negative concepts (Ainsworth, Blehar, Waters, & Wall, 1978). It seems that when Julian was undergoing the process of low morale and de-motivation, no other member of the family interacted with her or made efforts to enquire about her problem. Due to which, she made herself restricted to the room and went deeper and deeper in the isolation process. Because of isolation and depression, she started drinking and smoking a lot in the later years of her life (defense behavior) as when individuals are impacted with such great stress, anxiety and pressure, and are unable to cope with these, they start considering these substances as their only companions and sources of pleasure (internalization of bad objects) (Ainsworth, Blehar, Waters, & Wall, 1978). Not only this, she was unhappy and discontented with her life and academic failure. The negative self-concept and detachment from the world became her only defense mechanisms. This would make her even difficult to have interpersonal relations (Ainsworth, Blehar, Waters, & Wall, 1978). Lack of these skills would explain why we see Julian having difficulty to maintain healthy social relations (less friends and hatred for parents). Julian is probably guilty of her own self. She thinks she is a failure, a college dropout, and hence a disappointment to the family (internalization of bad concepts). She is probably fearful of having social relationships because she thinks this might interfere with her academic and career success (true intimacy is hard for her). Julian is seemed to underestimate herself and overestimate the power of others. These faulty attributions are related to the theory of self-efficacy. She is seemed to have no internal power in her life (external locus of control). She is seemed to have no control over her life. These faulty attributions give rise to negative thinking and cognitive impairment (Ainsworth, Blehar, Waters, & Wall, 1978). Thoughts like: "I cannot do it", "I have no control over things", "I am always going to be like this", and/or "I am a cause of shame to my family" became predominant in her case. Her constant experience of fear, fatigue, hopelessness, depression and anxiety was probably because of her experience of vulnerability, low-frustration tolerance, catastrophe and over-generalizing nature. Julians elder siblings were all academically sound and professionally successful; this might have led her to have a further profound self-critical and negative view of herself (internalization of bad objects). Her self-esteem and morale must have been adversely affected when she used to compare herself with the other siblings. Absence of appraisals and motivation from the surroundings, in addition, might have exacerbated the whole situation (Ainsworth, Blehar, Waters, & Wall, 1978). According to the psychodynamic or object relations theory approach, Julian is seemed to have the traits of narcissistic personality. Lack of emotional support and care as a child led her to not successfully came out of the normal narcissistic stage experienced by infants (as proposed by object relations theory). Treatment Plan Goals of counseling/therapy: According to the object relations theory and psychodynamic perspective, the goal of therapy is to connect Julian emotionally with her own self, eradicate her negative self-concept and image, develop positive concepts, identifying and modifying faulty logics and cognitions, encourage her to perform life tasks and break free the negative internalized concepts. She needs to get her confidence back. The object relations or psychodynamic perspective will be incorporated to make Julian socially active and free from apathy; most importantly to make her realize how her present situation is related to familial problems and familial pressure . An effective treatment plan would be discussed upon which would try and eliminate her negativities and make her socially active (Brannon & Feist, 2009). Interventions: Therapist-client relationship: Development of this relationship is vital in order to effectively work with the patients. Julian has to be more comfortable with me, the therapist. Measures like active interaction, respect, and friendliness will be used by me (the therapist) so as to promote Julian into discussing issues, be it private or personal (Ainsworth, Blehar, Waters, & Wall, 1978). Any point of interest would be touched upon and discussed. For instance, Julian revealed her interest in music in the interview. Frequent discussions upon music would, hence, develop the relationship, strengthen the communication process, and normalize the situations (Ainsworth, Blehar, Waters, & Wall, 1978). From this, it is predicted that she would be more comfortable in expressing her feelings to me and as well as her interpersonal and social skills will be developed (Pastorino & Doyle-Portillo, 2012). Insight: Educating Julian with the cause of the disorder is important. She should know that it was academic stress which put her in the situation where she could not manage to get good grades. Also, that it was not her fault. It was just the pressure and stress which she was unable to cope up with and as the result, she had to face the consequences. This will not actually make her feel better but also her self-critical approach would be minimized (Ainsworth, Blehar, Waters, & Wall, 1978). This process would include emotional as well as intellectual insight. Emotional insight would inculcate in itself the practices of emotional support which would try and make Julian believe that the feelings she is experiencing are all rational and reasonable. Furthermore, it is important that she communicates these feelings verbally and non-verbally to achieve emotional catharsis. I, the therapist, would make her believe how expressing feelings is the best way and that her pain, anger or fear would not over-whelm me. Hence, corrective emotional experience would be taught. Intellectual insight would focus on eradicating all the negative concepts and objects by evaluating each faulty cognitions successfully. Her faulty thoughts of "I cannot do it", "I have no control over things", "I am always going to be like this", and/or "I am a cause of shame to my family" would be eliminated (Ainsworth, Blehar, Waters, & Wall, 1978). Analysis of the transference: In psychodynamics, it is defined as the process by which the therapist would interpret the feelings expressed by the client. Whenever Julian will try to push me away, i would make her realize how important the process of expressing feelings is to the therapy. I would let her explore her feelings of fear, anxiety and pain openly so that she is able to recognize and label each of her feelings successfully. I would link her feelings to the previous instances where she would have felt the same way (Shaffer & Kipp, 2009). Interpretation: Another treatment would be to interpret Julians thoughts that are causing her difficulty with the current-day functioning. I, the therapist, would constantly make efforts to interpret her feelings and behavior to the best of my skills. Julians distorted perceptions would be tried to solve by following the psychoanalytic theory of "repeating, remembering, and working through". I would try to recognize all the elements which would make Julian reluctant or cause resistance to the flow of thoughts. Later interpretation and working upon those distorted concepts would make her feel better. Conclusions: The treatment and psychodynamic strategies are expected to be effective and successful to treat Julian to recover (Ainsworth, Blehar, Waters, & Wall, 1978). Julian is expected to overcome her anxiety and hopelessness. She is hoped to maintain good social interactions with a relative good self-image and concept. With time it is hoped that Julian becomes an active part of the society; building strong social relations and contributing in the day to day works. The parents and family are also hoped to develop good social ties with children and lessen the burden or value they put on academic and career success. Furthermore, Julian is expected to come out of her isolation and give up her bad habits of smoking and drinking. As the result of the interventions, it is hoped that Julian successfully recognizes her feelings, interpret them and express them freely. She would link the feelings to the correct responses. It is believed that Julian would understand that it was not her fault that she underwent such a depressing and failure academic year. It was the familial pressure and the lack of stress coping skills which affected her academic, emotional and social skills. I, the therapist, would assure him that she made no mistake nor her present condition was due to her fault. This would serve as corrective emotional experience. In the long-term, Julian is expected to give up her smoking and drinking, engage in social interactions actively, and successfully label the situations and her cognitions. Works Cited Ainsworth, M. D., Blehar, M. C., Waters, E., & Wall, S. (1978). Patterns of Attachment: A Psychological Study of the Strange Situation. Hilssdale, NJ: L. Erlbaum Press. Brannon, L., & Feist, J. (2009). Health Psychology: An Introduction to Behavior and Health. New York: Cengage Learning. Guerin, P., & Guerin, B. (2009). Lifespan: Middle and Later Years. In P. Barkway, Psychology for Health Professionals (pp. 42-60). New York: Elsevier Australia. Kingdom, D., & Turkington, D. (1994). Cognitive Therapy of Schizophrenia. New York: Guilford Press. Pastorino, E., & Doyle-Portillo, S. (2012). What Is Psychology?: Essentials. New York: Cengage Learning. Shaffer, D., & Kipp, K. (2009). Developmental Psychology: Childhood and Adolescence. New York: Cengage Learning. Read More