Frankieseems to have lacked the opportunity toresume her former close relationship with Charles and only seems tobewrapped up in herself. She also seems to have a presenting problem ofwhich I would prefer tackling using a psychodynamicapproach ofcase conceptualization. Multiple forms of case conceptualizationexist, each using different models to describe how information fromthe patient is organized and interpreted. Case conceptualizationdescribes the process of taking interview data from a patient tocreate a model describing the patient`s symptoms and determine a planof action for treatment.
Inthis case, Frankie has a problem presenting herself, whereby she hasa negative view of herself and her own emotions, as she tries toavoid the real pain. This makes it difficult for her to develop anemotionally sustaining close relationship with Charles since she isunable to balance her free time. At some point, it is almost as ifshe senses that she does not have something to offer apart from hispain and anger, which seems to be overwhelming and scary since itmakes her cry at times. The deficiency of sufficient emotionalbacking and care as a child had a bearing on the sense ofself-fixation Frankie gained since she was not able to resolve theissues linked with the normal stage experienced by infants whilegrowing up.
Thepsychodynamic theoryfits and explains Frankie’s problemssince the counselors will assume that these symptoms are not justmerely shallow and they are likely to dig deep using experiencescases that happened in Frankie’s early life starting from herchildhood to the current sense of self. From this particularperspective, the counselor will gain progressive information toconfirm the hypothesis concerning the ancestry of her concerns. Inreference to Frankie’s case, this progressive evidence will helpthe counselor form proposition regarding the sense-of-self theindividual developed from the time when she was young.
Frankiestates that her parents were alcoholics and have limited resources tosupport her financially and that during her younger years, shewitnessed loud arguments between her parents involving shouting andpushing. This way, Frankie may be responding to not only who and whatthey are, but according to the unresponsive and uncaring significanceof others that she internalized in her early life from her parents,thus developing a sense of self. It seems that the client feltscared, helpless, and conflicted about how to deal with Charles,which makes her feel angry.
Hypothesisbased on Frankie’s presenting problem
Thepaper tries to prove that lack of adults in Frankie’s early lifemade her develop the poor relationship skills and transferring toanother school will help her reduce the pain she is going through.Following history, it appears that Frankie lacked other adult figuresin her environment with whom to form significant relations with sinceshe did not mention her sibling offering her some guidance. Becauseof this deprivation of any significant nurturing relationship as achild, Frankie might have sensed great pain, summed with the pain shelikely experienced, therefore, developing great anger towardsherself. Her boyfriend Charles had concluded that she was spoilt,dumb and unattractive and that no one would treat her as well as hehad over the past 1 ½ years and this has made her develop a negativesense of self.
Frankie’s’story indicates that she did not have the opportunity to formsuitable attachment bonds with her parents since she reports thatboth parents were alcoholic and even secretly wished that her motherwould leave her father who was psychologically and verbally abusivetowards everyone. In order to evade this pain, it is likely thatearly on, as a defense mechanism, Frankie disengaged herself to acertain level from her emotional self by utilizing her time indrinking during the weekend. This disconnect from her own emotionshas made it difficult for her to connect with others, feel empathyand develop a new intimate relationship.
Frankieseems to have just encountered her first relationship. This form oflinking to others most likely arose in the setting of her having noother former relationships. The anger she experiences now may haveoriginated earlier in her life as a way of managing the intense paingenerated by this early emotional deprivation. Her letdowns in thepresent relationship make her feel angry towards herself for notbeing impeccable on convincing Charles that she was the same goodperson he met in high school. The client stated that she was feelingfatigued, having a cold for the past few weeks, spending most of herfree time alone, frequently crying "for no apparent reason"and considering transferring to another school, so she does not haveto see her former boyfriend who refuses even to speak to her.
Interms of defense mechanisms, Frankie appears to be undergoing somedegree of splitting between her cognitive and emotional selves, whichcauses intellectualization, and communication of contradictory ideassince she is not able to cope with opposing information aboutherself. Frankie is likely to feel unworthy of Charles’s kindnessand care, which are likely very painful feelings. She thinks she isnot good enough and that she is ultimately responsible for Charles’misery, making her think she messed it all up. To compensate thedefensive behavior for her negative perception of herself, Frankiehad found the “perfect match” that would lead to the perfectrelationship. One method to protect herself from this pain is toresult in the defense mechanism of considering transferring toanother college so she can have a "fresh start," which letsher not to connect with these feelings of low self-worth. Accordingto the psychodynamic theory, lack of appropriate attachment or anearlier relationship has likely impaired her ability to form anautonomous self, which may contribute to her fear of closeness.
Froma psychodynamic perspective, the goal of therapy is to help Frankieconnect with her emotional self. Using the approach, Frankie willeventually identifyand change the faulty views about the belief of having Charles as herperfect boyfriend. The counselor will help her recognize and stop herself-demoralizing behaviors concerning her difficulty inrelationships. Itis expected that by forming a close emotional bond with thetherapist, Frankie may acquire how to be familiar with fulfillingcloseness in relationships, while sustaining appropriate boundaries.
Paradoxicalinterventions- Given Frankie’s privation of substantial nurturinginteractions in her life, issues requiring arguments will apparentlybe difficult to her. This should be addressed, in an empathic way andFrankie should recognize and understand that it would likely bedifficult for her to trust the therapist and should communicate tothe therapist about how she felt regarding being or not being able totrust. In some of these instances, the therapist should point out herbehavior and ask her what she feels about herself. Sometimes, insteadof asking, the therapist should reflect on the very symptom theclient wants to resolve in this case, moving on.
Analysisof transference – psychodynamic approaches will need the therapistlooking for transference because it will help Frankie identify theskewed expectations and unmet needs. She should understand thefeelings she was experiencing – which often included fear of beingexcluded, pain, and anxiety.
Iwould consider the following multicultural counseling issues whenusing this theory with FrankSelf-Awareness:There are many things to consider when treating one with a connectionto the family. This will allow the counselor to determine to whatdegree the client is aware of differences between themselves and thefamily, and may give the counselor some insight as to the level ofacculturation.
FamilyStructure:It is also useful to assess the family structure: is it egalitarianor hierarchical? Assessing the level of acculturation for each memberof the family is also important in order to determine if there areconflicts due to acculturation rates.
ChildRearing:Another major area of consideration is child rearing whereby physicalpunishment may be prevalent. Thus, it is very important to discusslimits of confidentiality. Furthermore, counselors must consider howthey address these issues with parents. The problem should also bereframed as “helping children with problems” rather than“altering poor parenting.”
ConcerningFrankie’s case, when the psychodynamic approach is employed, shemay project her deep fears of seeing her former boyfriend who refuseseven to speak to her and even reconsider transferring to anotherschool. She will soon enough stop bulging the feelings of negativeself-worth onto herself since she has not even acknowledged major orcareer goals. In addition, Frankie’s difficulties with intimacy maystem from her great emotional neediness and thus directive counselingwill be very efficient since it will fully assess her by experienceto the extent that she is unable to cope with her crisis. A properassessment will make her draw conclusions about her situation and herresponses, thus helping her to plan and define the level of risk andany threat of self-harm.
Berman,P. (2012). Caseconceptualization and treatment planning: Integrating theory withclinical practice.Thousand Oaks, Calif: Sage.