Mr. Alberts, a 28-year-old unmarried accountant, seeks consultation because â€•I feel I am going nowhere with my life. Problems with his career and girlfriend have been escalating and are causing him increasing distress. Mr. Alberts recently received a critical job review. Although he is reliable and his work accurate, his productivity is low, his management skills are poor, and he has conflicts with his boss over minor issues.
The patient’s fiancée recently postponed their wedding date. She said that, although she respects and love him, she is ambivalent because on many occasions, he tends to be remote and critical and he is often uninterested in sex.
Mr. Alberts describes himself as a pessimist who had difficulty experiencing pleasure or happiness. He says that, as far back as he can remember he has always been aware of an undercurrent of hopelessness, feeling that his life is hard and not worth living. Mr. Alberts grew up in a suburban community and attended public schools. His mother is a quiet person, periodically â€•moody, remote, and depressed. Shortly after the birth of Mr. A’s sister, 3 years his junior, his mother became very depressed and was hospitalized. She responded well to ECT and had no further psychiatric care. Mr. Alberts’ father, now deceased, was successful in business but was also overbearing, critical, and intimidating and drank to excess. Mr. Alberts says that he respect him but never felt they were close.
The patient did well academically in high school and college. He participated is some social activities but was shy and was considered gloomy and not fun to be with by most of his classmates.
In college, Mr. Alberts benefited from counseling after breaking up with his first girlfriend. During this time, an internist gave him amitriptyline for migraine headaches, which provided good relief from both the headaches and the feelings of hopelessness. In retrospect, he feels that this was a very good period of his life. He began a new job and relationship, functioned well, and almost seemed to enjoy life. However, when he discontinued the medication after 3 months, he seemed to slip slowly and insidiously back into his previous state of pessimism and hopelessness.
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Although he is usually depressed, he has never had depressive episodes that met criteria for a Major Depressive Disorder: He has never been suicidal or had prominent suicidal ideation and has not experienced significant problems with weight loss, insomnia, or psychomotor activity. For months at a time, however, Mr. Alberts’ energy levels are diminished and his ability to concentrate impaired. He views himself negatively, feeling he has little to offer. He is always surprised when others like and respect him. When he is depressed, his sex drive is reduced and he has difficulty maintaining an erection, which frightens him.
Mr. Alberts has periods when he withdraws from friends and social activities, but with effort, he always goes to work. Some weekends, he stays in bed in a state of profound inertia. In the past, he would sometimes drink excessively but now has only an occasional glass of wine. He does not recall every having periods of excessive energy or elation. Mr. Alberts says that he recognizes his strong need to please others, to obtain approval, and to avoid conflicts. He feels extremely anxious when forced to deal directly with a hostile situation. He takes pride in his acknowledged perfectionistic traits.
Mr. Alberts appears early for his appointment, is conservatively dressed, and initially appears outgoing and affable. As the interview progresses, however, he becomes tearful as he discusses his problems and acknowledges his depressed mood. There is no evidence of a thought disorder or of hallucinations or delusions. His insight is impaired by his tendency to deny and repress emotionally laden material. His judgment is intact, as are his orientation and recent memory. His intelligence appears to be high-average.
Case Summary (Essential Information)
Mr. Alberts is seeking counseling as he finds himself at a point in his life where he seems to be lost. “I feel I am going nowhere with my life.” Problems at work and with his girlfriend are causing Mr. Alberts increased distress. He is seeking counseling to help.
Facts about Mr. Alberts:
28 year old unmarried accountant
Engaged, wedding date recently postponed
Grew up in Suburban community attending public schools
Successful academically in high school and college
Did participate in some social activities
Mother – quiet, periodically moody, remote, reports history of depression with good response to treatment
Father – (deceased) overbearing, critical, intimating, reports issues with drinking
Oldest child – has sister 3 years his junior
Previous positive experience with counseling
Mr. Alberts is early for his appointment, conservatively dressed
Insight is impaired due to repression or denial of emotional issues
Intact judgment, orientation, and recent memories
Intelligence appears to be high-average
Issues as related by Mr. Alberts:
Recent critical job review – reliable and accurate but reported low productivity, poor management skills, and conflicts with supervisor
Fiancée recently postponed the wedding, as she feels “ambivalent” about marrying Alberts. She reports he is critical, remote, and often uninterested in sex.
Self appraisals from Mr. Alberts
Pessimist, difficulty experiencing pleasure or happiness
Strong need to please others, get approval, and avoid conflict
Proud of his perfectionist traits
Lifelong current of hopelessness “life is hard and not worth living”
Low energy levels
Inability to concentrate
No issues reported such as weight loss, insomnia, does not meet clinical definition for depressive episode
Withdraws from friends and social activities, always goes to work with effort
Some weekends, stays in bed
Negative view of self
Reports feeling he has little to offer
While he did well academically in school, he was shy, considered “gloomy and not much fun to be around by most of his classmates.”
Axis I: Axis II: Axis V:
Sigmund Freud – Psychoanalytic Therapy
The personality theory as developed by Sigmund Freud is the cornerstone to psychology today as well as a major contributor to how society thinks about mental processes. The psychoanalytic approach argues that a majority of our actions are controlled on an unconscious level. The goal and focus of this approach is to make the unconscious conscious through talk therapy.
Freud argues that most of our behavior is controlled on an unconscious level through the psychic structures of the id, ego, and superego.
ID – The id is the child of the psyche. It is governed by the pleasure principle; basically, if it feels good then I want it now. There is not regard for consequences or affect this behavior might have long term on us or those around us. If we deny the Id, what it desires tension is created. This tension is highly uncomfortable and creates anxiety. The Id’s desires are based mostly on our instincts. A tiny baby operates solely on ID. The baby cries and screams when it is hungry, tired, sleepy, or wants attention.
EGO – The ego is the “executive” of the psychic structure. The ego is governed by the reality principle, delaying gratification until a more appropriate time or in some case replacing the desired gratification with a more acceptable and safe version of gratification. This release of tension is referred to as cathexis. The ego functions consist of thoughts, memories, perception, and cognition. It is logical. Ego employs the many different defense mechanisms when necessary to help reduce anxiety and allow a person to return to a state of balance.
SUPEREGO – The superego is the “angel on our shoulder” as often depicted in cartoons arguing for an ideal or our conscience. The superego is governed by morality as defined by our culture, our family, and our viewpoint of the universe. The conscious defines our actions as right or wrong telling us what we cannot do. Whereas, the ego ideal determines our goals and tells us what we can do. Superego is where guilt is created.
Freud argued that each person is born with a certain amount of psychic energy. This energy is diverted and shared among the Id, Ego, and Superego. As each of us is born with a set amount, it is the job of the ego to keep this energy balanced. This creates the state of balance referred to above. If there is an imbalance or if the ego does not retain enough of this energy to keep control, abnormal behaviors will persist. For example, if a person is controlled by the Id, then they are controlled strictly by impulse and instinct. This can be highly dangerous both psychically and psychologically. If a person is controlled by their superego, then that person is likely to be moralistic, wooden, and extremely uncomfortable with pleasure of any kind. A healthy person will remain logical with the ego in charge balancing all the instincts and needs.
There are three types of anxiety in this model, Neurotic, Moral, and Realistic Anxieties. These three represent fears that the energy balance will not be maintained properly.
Neurotic Anxiety – fear that the Id will take charge. This is a fear that the person’s behavior will be dictated by instincts leading to becoming an outcast or some other form of punishment.
Moral Anxiety – fear that the Superego will take charge. This is a fear that the person’s behavior will be dictated by a strict conscience leaving the person suffering from excessive guilt or shame.
Realistic Anxiety – Fear based in reality and typically controlled by the ego. This is a fear of actually events and dangers in an individual’s environment.
Thoughts on Freud
The psychoanalytic approach argues that a majority of our actions are controlled on an unconscious level. This initial argument is fascinating in that it proposes that all of a person’s behavior is in essence determined based on previous experience. This scientific determinism takes away to some personal responsibility and states that human behavior is a byproduct of our mental processes. To think that each action has corresponding reaction is very comforting in that it allows for an explanation for all human behavior. For example, this approach makes criminal profiling seem more like science allowing us to ignore the somewhat artistic approach or talent that is necessary in most successful profiles. While it might be comforting to believe human behavior would be that predictable, I think this is also a tad unreasonable, as humans, have proven repeatedly, can at times surprise and devastate even those that know them best.
I will admit that Freud’s approach is a good big picture way to see the world and how to explain personality. I find it weak in several ways. It is hard to say that the analysis of what occurs unconsciously can ever be accurate. Once the therapist defines the unconscious to a patient and gives then a framework and way to analysis this information, a great risk is created that the unconscious thoughts might very well be transformed in the process of obtaining sought after cathexis. From a personal standpoint, I find that there is a great mercy in some repressed memories. I am not sure that reliving the details of that event could ever be helpful. Understanding the cause of an irrational behavior, while it might be helpful, is not a strategy on how to correct or avoid the behavior going forward.
Another weakness of this theory is that the environment and its impact on a person’s functioning is not included as part of the equation. The person may be suffering from insomnia because work has gotten extremely stressful. The client might be dreaming of cheeseburgers because they forgot to eat before dinner with no latent meaning. It is just as the old saying goes, “Sometimes a cheeseburger is just a cheeseburger.” If we do not take into account the current events and environment, then a huge piece of the mental puzzle maybe missed.
Analysis of Mr. Alberts
Mr. Alberts presents with increasing anxiety due to problems at work and with his fiancée, leaving him feeling “I am going nowhere with my life.” He seems to have lost some of his motivation in life. According to the recent critical job review, Mr. Alberts is doing his work reliably and accurately. He is however struggling with those aspects of his job that require he interact with other individuals i.e. management skills and conflicts with his boss. This pattern of social anxiety and fear of others is a consistent pattern in Mr. Alberts’ life.
He tends to be remote and critical with his fiancée. He is also often uninterested in sex.
He did well in school but was “shy and considered to be gloomy and not fun to be with by most his classmates”.
He views himself as “having little to offer” others.
He is always surprised when others like or respect him.
He has long periods where to avoid the stress of others he withdraws from them. This defense works with peers but as he still forces himself to go to work, he is unable to completely withdraw from others.
He states he has a strong need to please others while also admitting that he feels he is incapable of doing so.
This conflict of Mr. Alberts need for people verses his perceived reality of being unacceptable to them is creating great stress and anxiety for Mr. Alberts leaving him feeling lost and having a hard time enjoying his life.
In Freudian style, one would need to analyze Mr. Alberts’ past to determine where this anxiety began. He describes his mother as being remote and quiet. She does not appear to have been a strong reassuring presence for him. She also seems to have been suffering from depression. While treatment worked after the birth of Mr. Alberts’ younger sister, this does not mean that her habits of depressed thinking would have been altered. ECT treatment after all does not help one learn new strategies to approach the world. Through modeling and his desire to be acceptable to his mother, Mr. Alberts may have learned her gloomy thinking patterns. This would explain while his classmates viewed him as a “downer and not much fun to be around”. This may also account for his self-described negative views of himself, pessimistic attitude and difficulty experiencing pleasure of happiness.
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Now why did Mr. Alberts’ associate himself more with his mother than his father? It appears by Mr. Alberts accounts that his father was “overbearing, critical, and intimidating and drank to excess.” All of these traits are characteristics that Mr. Alberts does not see in himself. While the client did at one time drink to excess, he has stopped that behavior and limits himself to only one glass of wine. It would appear that Mr. Alberts did not see himself as having anything in common with his distant father. Perhaps Mr. Alberts inability to relate or feel close to his father has an opposing effect in his life and in defense to his inability to feel that he is “manly” like his father, he choose instead to become like his mother. In effect, the Oedipus Complex was not completed. Mr. Alberts was never able to learn to identify with his father. This leaves Mr. Alberts stuck fixated in the Phallic Phase.
Carl Jung – Analytic Psychology Therapy
Carl Jung is the founder of Analytic Psychology. He argued that the goal of life is to seek self-actualization (the realization of the whole self) using psychological process to integrate the ego, collective unconscious, archetypes, and personal unconscious. Jung differed from Freud in that he saw our energy as being less driven by sexuality but instead more of a generalized life energy or libido. In addition, Jung argued that our behavior was moving forward rather than being dictated solely by our pasts.
The process by which an individual creates a whole self is taught by Jung in the context of the “hero’s journey”. This is the personal fable and myths of our own lives that we create as we attempt to navigate the challenges of life allowing us each an opportunity to grow more into the idealized version of our best self. Jung argues that the most fundamental human conflict is between the Personal Unconscious and the Collective Unconscious.
The collective unconscious is made up of the memories, archetypes (universal ideals) and stored experiences of previous generations. The personal unconscious is made up of the individual’s memories and stored experiences. An individual is created during the process of separating the ego (consciousness) from self. The self is an unconscious force from which we are able to organ framework for our entire psychological system. This process begins at birth and continues throughout life. The first half of life is spent trying to separate the ego from self and the second half of life is spent trying to reunite those forces through strengthen consciousness of the ego-self axis. Self-acceptance of faults, strengths, and a realistic sense of a person is what strengthens this process and allows for successful living. The success of this process depends on integrating both the conscious and unconscious while still keeping conscious autonomy.
During the development of Self, we create personality types. Jung cited six different personality types. These are the framework for how a person sees and relates to the world and others.
Introversion – Orientation inward, toward self
Extroversion – Orientation outward, toward others
Thinking – logical or reasoning
Feeling – based more on emotion
Sensing – direct perception, not judgmental
Intuiting – Seeing future possibility, hidden meaning and symbols
Thoughts on Jung
Jung viewed individuals in a much more optimistic way than Freud. He focused on each person’s capacity to move toward individualization and wholeness through self-realization. He was not deterministic in his approach. Each person has the ability to choose his or her response to challenges and become the victim, survivor or thriver. As a long-time thriver, I very much appreciate the notion through my internal wisdom that I am not limited just because traumatic events occur. I have the power to interpret how those events will affect my future growth by creating my own story. This allows me to cast myself as the heroine and also to share some of the wisdom gained with others suffering through similar experiences.
As with Freud, Jung’s approach was based on analysis of internal thought processes. It is impossible no matter hours are spend with another person, to truly know all their experiences and what they are thinking about a particular event. I do agree with Jung in that, all we will ever truly know about another is the story created and honed by that individual that one chooses to share with the world. Jung’s approach does take the environment and the influences of others more into account. The people in one’s environment serve as catalysts to help the hero along with each journey.
It is comforting to know that we are able to find patterns and Archetypes that appear to be similar for everyone. The notion that each person retains a piece of the previous generations’ knowledge is interesting. I like the notion that I am tied and grounded to past generations. I do not know that this is something we can empirically prove.
Jung does leave room for the realm of spirituality, arguing for intuition and the unconscious mind. He seems to argue that world relies too much on science and logic. This is intriguing to me as he also argues for the need of balance in life to be healthy. It is ironic that one of the founders of the science and study of Psychology would argue for less science and logic.
Analysis of Mr. Alberts
In Mr. Alberts’ personal story, he has cast himself as the victim. He is trapped by his perceived perceptions of an overbearing father and quiet and remote mother into the belief that he is somehow inadequate to receive the love and respect of others. This is demonstrated but his surprise when “others like and respect him. To reinforce this role and view of himself, Mr. Alberts has failed to answer the call to adventure. He seems to complete the needed tasks with little to no enthusiasm. For example:
He completes his job in a reliable and accurate manner, but with low productivity, poor management skills, and conflicts with a boss who is asking for more.
He appears to be almost ambivalent towards his fiancée as he remains “remote and critical and is often uninterested in sex.” He seems to be completed just what he deems as necessary and no more.
He performed well in school but remained shy and participated in limited social activities.
By refusing to have close relationships with other individuals, Mr. Alberts does not allow the influence of a Mentor, Shapeshifter, or Trickster to encourage him forward in the goal of achieving self-actualization. Instead, he appears to be stuck aptly feeling “I am going nowhere in my life.”
Mentor – An internalized voice learned from another
Shapeshifter – An authentic voice challenging us, keeping us off center to allow us to gain more center.
Trickster – A reality check that allows us to retain a realistic view of ourselves, our situations, and the inconsistencies in life.
In the Psychic Life Cycle, Mr. Alberts experienced rejection from both parents as well as peers. This created alienation from Self resulting in frustrating low expectations from others and low expectations for himself. It can be argued as Mr. Alberts is finally reaching out for therapy, he will finally be able to find acceptance, be able to reconnect with self, restore some inflation and finally be restored to a more realistic view of what Mr. Alberts has to offer those around him. In a sense, the counseling will hopefully, be able to restore his self-confidence and give him the ability to relate to others in order to find his life’s call and be successful in the pursuit of his quest.
Alfred Adler – Individual Psychology
Adler presented the notion that people are primarily motivated by our desire to be superior. This is not in an arrogant sense. We are motivated to be the very best that we can be. We strive to reach our own capacity of superiority. The definition of this superiority will change from person to person depending upon their strengths and weaknesses. In contrast to our desire to be superior, we are also motivated by our fear of being inferior.
As each person is born as a helpless baby, we are each born experiencing inferiority. These feelings set the development of personality into motion. Jung argued two major factors influence feelings of inferiority, birth order and our environment. Whether we are born first, second, or third influences how we view the world and ourselves because this affects the most influential relationships in our young lives, the relationship with our parents.
Oldest child – did receive full attention of parents until newest child born, tend to be responsible, hard working, may have fear youngest child will steal love of parents
Second child – always shares attention of parents, tends to behave as if in a race, tries to outdo older sibling
Middle child – may feel neglected, view life as unfair as older and younger siblings seen as having more of the parents’ love and affection, or may be pushed into role of peace keeper.
Youngest child – baby of the family and may be spoiled, seen as having a special role in the family.
Only child – has sole attention of parents, high achiever, may have difficulty learning to share or be team player.
Our environment can also create inferiority feelings. If we have a physical weakness or defect in the eyes of those around us, we will have to compensate for this weakness by becoming superior in another manner. For example, my friend Keith was born with Cerebral Palsy. He will never play football, but he is an amazing and charismatic speaker. Taking Keith as an example, he used his fear of being physically inferior and became aggressive in learning how to speak and express his external will to make sure that his lifestyle matches the level of success and view internally he held for himself. Keith’s decision to be influential, well learned and dynamic is consistent with Adler’s premise that self is more than just instinct and need. Our behavior is purposeful in helping us obtain enough power and control to fulfill our desire to reach superiority.
Thoughts on Adler
Adler’s more humanistic approach is appealing. He argues that each person has the ability and capacity to live up to his or her own superiority level. This allows that every person is born with the ability to be successful in his or her own way. The very thing I most like about the theory is also its biggest limitation. In order for Individual Psychology to be successful, the client has to have the desire to want to change their behavior, the ability to accept responsibility, and the willingness to explore childhood and previous family history even if he or she does not truly see the relevance. A therapist practicing this theory runs the risk with some individuals seeing the therapist as better at making life decisions and may want to rely on the therapist rather than taking responsibility for his or her own life.
Analysis of Mr. Alberts
People learn how to balance other and our selves. It is the process of reaching a state of our own superiority and meeting the expectations of friends and family, in which we and create our lifestyle. The lifestyle or vision of what we are to become is established for the most part prior to us turning six. To be a successful adult, we have to learn through the influence of those around us to have to keep this vision (Fictional finalism or life plan) somewhat flexible to allow continued growth.
Mr. Alberts appears to be trapped with his inferiority feelings that he cannot relate well with other. Adler argues that there are three basic universal life tasks we all strive to meet of building friendships, establishing intimacy, and contributing to society. With this in mind, it is not surprising that Mr. Alberts is seeking help. He is struggling to have close relationships of any kind. He is not close to friends who he can withdraw from for extended periods. He is struggling with his fiancée due to being remote, critical, and even fearful of the most intimate act of sex. Even his hope to contribute to society via his profession is in jeopardy due to his critical job review. Each of these factors contributes to increase Mr. Alberts’ fear of inferiority.
Mr. Alberts is the oldest child. He was three years old when his sister was born. At the time his sister was born, his mother experienced increased depression and had to be hospitalized for treatment. A first-born child will already be dealing with fears that the new sibling in his parent’s eyes has supplanted him, but this fear will be compounded and heightened to also have the mother increasing in her remoteness due to depression and eventual hospitalization. The case study does not speak to the relationship of the youngest to her parents, but Mr. Alberts does report that he did not have a close relation to either as he described his father as overbearing, critical, and intimidating and his mother as quiet, moody, remote, and depressed. This isolation in childhood within his own family dynamic contributes to feeling of inferiority and incompetence in learning to relate to his peers as life continued. With luck, the therapist will be able to address Mr. Alberts’ private logic and help to challenge any errors in his thinking to help him establish more meaningful relationships allowing him to accomplish the three universal life goals.
Existential Theory is founded on the belief that while we are essentially alone in the world, we all long to be connected to others. People want to know that we are important to the people around us. Unfortunately, the truth is that while we do need others, we cannot rely on people; we must come to understand that we are ultimately alone. The four ultimate concerns have to be understood, faced, and ultimately dealt with alone. While everyone faces concerns, each has to navigate his or her own path. The ultimate concerns are death, freedom and responsibility, existential isolation, and meaninglessness.
Death is not viewed as a negative force in life. Rather it is argued that death ultimately provides meaning to life. Knowledge of limited time on earth and the certainty of death serve as catalyst helping individuals see their time as valuable, important, and ultimate motivation to find meaning with the little time allotted.
Freedom and responsibility – Freedom is viewed as a part of being human. We are all responsible for the choices made and the resulting consequences. We are free to choose how we respond and what meaning we assign to any given event. While this freedom can be terrifying, it is something that we cannot avoid. If a person simple chooses not to make a choice, then that is also a decision. Once this is understood, then it becomes more apparent that each person has responsibility as well. Life and how successful we are at living is a direct result of the many choices both large and small that individual makes through each day. A person is responsible for the choices made, actions, and even for failures to take action. Ultimately, we are the masters of our universes based upon how we choose to approach life, other, and most importantly ourselves.
Another truth of the human condition is that we are ultimately alone yet constantly striving and in need of relationships. Through the acceptance of our freedom, knowledge of impending death, and the practice of responsible choices, a person can choose an authentic life where he listens to his own internal voices to determine a value system. To be truly authentic one has to understand that the only person who can define himself is himself. Only after a person finds their true inner self, accepts it and is able to find peace with the person they are becoming will he be able to reach out as a whole and complete person to form a healthy affirming relationship with another being. During this process, and perhaps as a catalyst to this growth process, a person must first experience Nothingness. Nothingness is the knowledge that possibilities beyond this very moment and the current circumstances exist. We are not yet all that we could and might become and so the process of finding our most true and authentic self begins.
The process of determining an inner core and belief system is not automatic. It takes time, courage, and a willingness to face anxiety. There is a potential for loss of previous friendships, strained family relationships, and internal struggle when one begins to analyze long held beliefs. As we are people under construction at all times throughout lives, constantly accepting and rejecting new ideas, striving for new goals, new friendships, new understandings, we must find comfort within ourselves. After all, the only person who will travel with you for the entire journey of life through all the changes, growth, and setb
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