I started working at a charity organization known as H.I.M.H in March 2017. I was truly enthused or inspired by the tremendous as well as inimitable work the charity organization was doing. The work supported men and women from different ethnic groups which are victims of human trafficking, domestic violence as well as persons suffering from chronic mental health and physical needs. The London’s H.I.M.H is sub-divided between twofold centres; one unequivocally encompasses ethnic minorities’ including Arab communities, African, and Afro-Caribbean and the other section involved everyone. The care provided in the two situations appeared to stem from a basis of inspired hope and caring. The Centre is full of life and colour, and I affectionately recall the feelings of wonderment the first spell I walked into the organization. It is important to note that it explicitly deals with ethnic minorities groups and cubicle emanates culture, a setting I have never experienced in any place.
I encountered my first customer (Jane) while working at the H.I.M.H. Jane’s devastating needs as well as a history of substance abuse touched me in a way which I never projected. Jane is a 42-year-old woman and has mostly lived in London. She fluently speaks Italian and English, therefore, identifying her as heterosexual. Jane elucidates that her mother was very spiritual in front of other people. As a result, many people had a perception or insight that Jane’s mother was putting on a false persona to the Italian group associated with religion. In reality, Jane did not feel as however, her mother lived by what she discoursed or was being truthful to church. This consternation and realization appear to have resulted in Jane neglecting religion and developing a negative attitude toward religion.
In contrast to Jane, I am a 25-year-old female of African descent but Asian appearance. I live by religious and spiritual values and attend church services so often, therefore, very distinct from Jane. I have considered the comparison in the entire therapeutic relationship.
The Client’s Presentation
I first impressed of Jane because she was an exceptionally spectacular young woman who never looked upon her age but took inordinate pride in her physical physique or appearance. She was tall and curvy and dressed her figure with skirts and high heels. She at all times had face make-ups and never left her household without the application of a bright red or purple lipstick. I conjectured how she could perceive me who was dull dressed plain therapist sitting in her opposite. Generally, I remember Jane had a very fascinating or appealing presence from my initial session with her.
During my first session with Jane, I thought that her outward appearance didn’t match her communication skills. As a result, I reported this observation to my superintendent and it clear that she had a learning disability that was perceived by the supervisor to have resulted from strong medication. Surprisingly, Jane had not been diagnosed for the disability. It is important to note that in several instances, the prowess of a society to spot and address an individual’s disabilities and shortcomings may significantly change that individual’s life, resulting in serious concerns such as relationship issues. Furthermore, this particular concern came up during the therapy when Jane talked about online dating. She narrated how some men relish writing to her messages online however immediately she talk to them in person or through the phone the men put off and precipitously drift and adjourn chatting. She was distressed that a prospective online suitor told her that there is something wrong with her. This stuck in her mind and always feels highly judged by other people due to her disability. She thinks that she is not wanted and would never get a potential suitor.
Client’s Eye Contact and Communication
During the first session, I realized Jane generally keeps eye contact. I failed to notice her struggling with keeping eye contact. However, as she kept on talking I noticed that she experiences difficulty in maintaining eye particularly when she felt vulnerable, that is when she said that she would never find a potential suitor. At the same time, it becomes hard for her to understand particular concepts and interpretations and so I had to patient with her. She occasionally uses this as a ploy or trick to shun some topics which she is not comfortable with and quickly goes ahead to speak other things. This form of ricochet appeared to make other persons feel as if Jane is not considering their position on a matter under discussion or not listening resulting in a need to get another individual who communicates for her. In several instances, I had to be firm and careful to identify and understand what she found difficult to talk about. I was always mindful not to force her to follow my agendas or ask her particular things she might not be ready to offer an answer.
The Client’s Body Language
Jane’s body language was at times fidgety. She would sometimes take large water gulps and sporadically moved the chairs around if they appeared or seemed distinct from what she is used to seeing before. Jane visits me on a Sunday morning and since we were the first people to use the counseling room, it seemed left dull, with the lights off and the blinds low nevertheless the large windows allowed sufficient day-light to shine via the windows. Jane would still stand up and switch on the light on noticing it appeared darker than usual. Her body language reveals that she experiences some problems. She needs to feel as nevertheless she has had an impact on her instant setting even if the effect isn’t completely anticipated or implicit.
Jane first visited a therapist when she reached at the facility. Nevertheless, Jane says that she never got the first conferences beneficial and finally ended go to the sessions. She made up her mind to come back to a therapy after receiving shocking news of the death of her foster mother. It is Jane’s outreach worker who spoke to my supervisor about in regards to the need for Jane to get therapy. Notably, this was after she became extremely bruised, and scarred about the kinds of treacherous sexual activity Jane was taking part in.
My supervisor at the facility was very honest. He always encouraged us to do work in a manner which most suited us. It is easy and I felt free to work at H.I.M.H in such a setting because before coming to the organization I counselled people at Maudsley hospital for one year. I adored the notion of not looking at past notes or assessments written about my customers. I simply ask the patients to let me whatever they are most contented with. Remarkably, this tactic worked for me in that particular locale as I it provided I much time with the customers.
On my initial slated session with Jane, she got into the room and began looking for my manager. I recall waiting in the room pondering whether to simply wait or collect her. After limited minutes my manager brought her in counseling room and I presented myself to her. Jane was well dressed having her hair, make-up as well as face done. Jane sat down on the chair looking perchance a little unsure and uncomfortable with me. She tightly held her glass of water during the session. Nonetheless, as the meeting went on, I felt that the supervisor was testing me whether I was worth for Jane’s case. I felt that I had to win the supervisor and therefore I had not to disappoint her.
The Presenting Problem
H.I.M.H is a health organization that provides customers therapy depending on the clients’ needs. Due to Jane’s evaluation, my manager and I established that an open-ended psychodynamic psychotherapy was appropriate for Jane because of her nature issues presenting issues explained under.
Jane has a lengthy psychiatric history. Many drugs have prescribed for her including Lorazepam (1mg), Zopiclone (7.5mg), Omeprazole (20 mg), and Valproate Sodium and she is presently under Lithium medication.
Jane was in 2007diagnosed with Borderline Personality Disorder (BPD) and clinical depression up to 2016, June. She attended a clinical evaluation or assessment in the year 2010 which stated that, “since moving to the municipality, there have been no incidences of depressive or hypomania. Nonetheless, Jane has shown some symptoms or behaviours which indicate on-going personality difficulties. Jane experiences problems in impulse control, maintaining positive interpersonal relationship as well as regulating her emotion.”
Jane has been referred to several health services since her first diagnosis comprising Hospitals, social services, and charities. She has received a lot of support from H.I.M.H since her arrival in the institution in 2008. The institution provides her with professional workforce who supports her in the management of finances and housing. She is also provided with an outreach worker who supports her with social needs such as encouragement and counselling. She is satisfied with the H.I.M.H‘s services and love the staff.
Jane told me that she was having relationships with four men during our initial session. I challenged this because she said that she always engages with them in only sexual activities for a maximum of two hours per weekly. Most of these men are in relationships or married. However, Jane said that she did not want real relationships with them. She admitted that never had never had real relationships with any man, and would like to have one, however, men only want her for sex. Jane has lived alone since she left her foster mothers’ homestead.
Jane comes from a large family; however, it was hard to understand what part of the family she meant. Jane made a drawing of a family-tree on a paper during the session. This was enormously helpful to me.
Jane’s father divorced her mother before she was born. As such, she had not seen the father until she was 15 years old. After the divorce, Jane’s mother got into another relationship and gave birth to two children; a girl and a boy. Jane was physically raped by the stepfather and due to that ran away from her mother. She joined foster carer at 13 years. The foster mother took care of her until she was18 years after which got her own residence while studying. Jane flew to the U.S. at 16 years to meet her father for the very first time. Jane found that the biological father had entered into a second relationship and had sired two children.
The biological father didn’t want to know her and admitted he was embarrassed to refer to her as his biological daughter due to her disability and outlook. She came back to London and got another chance to meet her biological father once more due to her thirties. She tried to maintain a relationship with him however the father was not interested, making her give up.
Jane never mentioned her mother until a few weeks into therapy. It seemed hard for her to talk about her relationship with the mother. She noticed that the mother never thought of her even after the father’s open abandonment. The mother currently resides in Italy with her stepfather and she sometimes visits. She says that she hardly visits her because she found it difficult to deal with her mother due to her anger.
Jane has a history of men who she slept with. She says that her initial boyfriend at the age of 19 was very obnoxious and would sometimes sexually assault her. She had several foul relationships and her behavior tended to get her out of one and hand her over to another dangerous relationship. Three years ago, Jane’s ex-partner endangered her with a knife injuring her.
Jane is an entrepreneur. She has very successful business of buying as well as selling trade in alcohol, cigars and cigarettes. As aforementioned her stepfather and mother live in Italy and she visits when she goes to purchase the products to sell domestically.
Jane struggled at school due to her learning snags; however, the difficulties never stopped from joining the college and finishing certain courses. Jane recalls finding academics challenging. On leaving college, she struggled with her mental health and sometimes she could not stand on her feet. On overcoming the difficulties, she noticed that her mental health would not allow cope with a full time job time of 8am to 5pm making her to venture into own business. Inasmuch as this was important for her life as well as confidence, she recalls feeling isolated or segregated from the rest of the people as she had minimal interaction or association with others.
I will utilize the Lemma’s (2015) psychodynamic formulation aide memoire as a template to structure this case study.
STEP 1: Describe the problem
Jane only mentioned her foster mother’s death during the first two sessions even though her primary reason for therapy was to talk about the issue. During the subsequent sessions she opened up concerning the various difficulties in her relationships with different kinds of men. Even though, she was very open about her relationships with several different men, she depicted a light-hearted attitude unremittingly during the relationships. She says that she is only happy to see the men for one hour every week for sex since that is what she needs. She says that she does not want them to either text or call her so often. Jane has characteristics of a masochistic customer because she gets engaged in perilous sexual activities including bondage, beating, and whipping which results in suffering and humiliation which more often leads her excruciating pain.
Step 2: Define the cognitive costs of the problem
Jane concedes that she experiences problems in getting into more formal and healthy relationship, although she prefers such kind of abusive relationships. Jane suffers from fear of isolation, segregation, and loneliness and struggles with establishing boundaries with others. She says that rather be badly treated than remain lonely.
Step 3: Contextualize the menace or problem
Jane has an ill-fated history of shock dating back to infancy. The father departed with the kinfolk when Jane was 3 years of age. At that time Jane had no brother or sister at until her mother re-married one year later giving birth to two children. Her biological father later re-coupled giving birth to two daughters. Jane craved to obtain her biological father’s love and attention but got rejected by the father several times. Jane as well had a bad relationship with the stepfather due to her bad treatment which later resulted in her physical abuse and psychological neglect.
At the point when Jane was only 14 years of age, she was encouraged by a solitary parental she referred to as Grandma as she may perhaps never again live inside her family household with the consistent manhandle as well as contending among her. Jane was particularly annoyed that her mom didn’t once attempt to inspire her to return or get some information in regards adaption.
Jane had a background marked by men utilizing her for sexual activities, she had exceptionally awful relationships when she was only 17 years of age, she recalled her accomplice being extremely regulatory and always sexually assaulting her. From that point forward Rosa has ended up in numerous associations with males. When I started to see Jane, she had this sort of association with five men, three of which were either hitched or in submitted relationship. Jane seems to experience depression because she appears bare for setting up a friendship with any person who is not of a sexual sort.
Step 4: Explain the patient’s most recurring and dominant object relationships
Jane feels that she been abandoned by everyone. She, therefore, wants persistent reassurance all through any relationship, which is clear in her all close relationships with men. Jane firstly claims that she never minds if the man is married or not because she only wants sexual relationships.
Jane encounters others as inaccessible to her, she it at first enjoyed till others find out about her unsafe way of life and steady stories loaded up with dramatization. For example, with her mom Rosa needed to battle for her consideration after her dad left and her mom began another family, putting Jane second. Because of this Jane likes to realize that she is imperative and continually considered, she solicited me on a number from events on the off chance that she can see me two times per week, upholding her foresight at the forefront of my thoughts.
Step 5: Defences Identification
From my initial meeting with Jane, I have discovered that she had only 3 key barricades which have been extensively discussed by Freud (2014). Acting out is the first main defence. Jane has been in a relationship with a specific man that she has nicknamed “Mr Robot”. She refers to him by this name because she says that he has no feelings. Additionally, Jane discloses that she on several occasions she failed to secured what she wanted from the man therefore causing unpleasant scenes at his workplace. She reveals that failure of the man to reply to her messages is one of the main reasons for that behaviour. Therefore, this is not concurrent to her claims that during the week various men do not distract her.
Subsequently, splitting is the next defence. Klein utilized this name to make a reference to the partition of an object or item into ‘bad’ and ‘good’ (Axelrod, Naso and Rosenberg, 2018). Likewise, Jane frequently shifts from romanticising and overly adoring a friend, partner or family member to hate them the in the subsequent week. For instance, in the case of ‘Mr Robot’, she will get into a sexual activity with him at his work or her house one day. However, she will be extremely violent towards him the next day. As a counsellor, this situation has made me review our relationship and consider if I will be the bad and good object or item interchangeably during the course of our work.
Notably, it is clear that Jane has been developing the characteristics of a dismissive attachment style (Ainsworth, 2015). Dismissive attachment style can be comprehended through her emotional dismissal of vital relationships, for example, the relationship between Jane and her mother. It is evident at the beginning of the therapy session that Jane idealised her biological mother. However, her mother constantly accused her for causing her father’s departure and failed to enthusiastically try to stop the frequent abuse caused by her stepfather. Therefore, this does not appear to be the standard mother-child attachment. I was able to confirm this by inquiring from Jane if she remembers any earnest memories with her biological mother, which she took time to recall (Lemma, 2015). Jane story disclosed her dismissive attachment style as she was hesitant about communicating her pain.
Jane’s situation made her to dissociate. Dissociating is another important defence that was advanced by Freud (2014) which Jane uses for protection. Jane can be in the therapy or counselling room, entirely participating in the conversation and precipitously lose concentration and track of thought therefore getting into a pre-occupied state.
Yalom relies on Maslow (2013), to summarize important personality traits and defences, related to existential isolation. They include less independence, neediness for affection and praise, and sacrificing happiness and joy for the illusion of one’s belonging. They also include enduring unpleasant relations because the perception of being lonely is unbearable. The author refers to this a ‘deficiency-motivated individual’. In the course of this case study, I will continuously make references in regards to how Jane utilizes this paramount defences.
Identify the aims of treatment
Jane clearly struggles with intimacy and establishing healthy sexual relations. Despite Jane seeking support from the therapy sessions, it soon became evident to both Jane and I that she only wanted to concentrate on her many intimate relationships. However, this is not what she longed for. Most of the therapy session will particularly focus on aiding her to develop the ability to manage and control her loneliness devoid of meeting men weekly. In the same token, I perceived that it would be appropriate to use the psychodynamic approach in Jane’s case. Although Jane lacked reflection and consciousness, I thought that it would be advantageous to enable her be conscious of things she was unaware of.
During the course of the therapy session with Jane, I strived to motivate her to remain safe. However, when she engages in sexual activities she would be at risk of encountering dangerous activities, for example, being beaten which would leave her seriously wounded. I intended to make sure that she keen concerning her safety. I did this by using safe words and being able to comprehend why she keeps on engaging in such dangerous activities. It is imperative to note that in this contemporary society participating in any activity is one’s choice (Altbach, Arnold and King, 2014). Throughout our session, I am determined to comprehend Jane’s behaviour and allow her make to the decision of choice herself.
My supervisor frank concerning how I worked when I first arrived at H.I.M.H. After conducting few therapy sessions with our clients, we deliberated on which approach we thought was the most relevant for that specific customer. Based on my training and education, I considered psychodynamic approach, person-centred, CBT (cognitive behavioural therapy). I decided to utilize the psychodynamic technique with regards to Jane’s case. The information I had concerning Jane revealed that she had just lost her step-mother. She also formerly had numerous defence issues which were already discussed in the facility’s staff portal. The manager informed me that the discussions were associated with Jane getting involved in masochistic behavior with different men. Lowen (1958, p. 195) states that a masochist is one of the most challenging and complicated health problems that a psychiatrist encounter. Kernberg, 2013, (p. 245) claims that a psychotherapist deals with after discovering different aggression levels. Subsequently, it is quite useless to try to diagnose masochistic presentation. However, it is probable to utilize an analytic model. Notably, I have adequate experience to diagnostically treat patients. Therefore, I resolved that Jane’s masochistic presentation and Borderline Personality Disorder will be appropriate to use psychodynamic method.
According to the approaches which are relevant to my health practice, I had an intention of utilizing the psychodynamic approach. However, I couldn’t disregard my background as well as subsequent Cognitive Behavioural Therapy education. It is essential to consider an array of methods to develop an efficient and probable treatment procedure. Moreover, the psychodynamic model entails primarily motivation, defences as well as how they relate to people’s childhood experiences (Shefler, 2014). It is important to note that person-centred approaches mainly concentrate on conscious focuses as well as consequent inspiring the customers’ urge for self-satisfaction especially via the utilization of the key conditions of Rogers (2013). Lastly, Cognitive Behavioural Therapy focuses in transforming behavior via concentrating on the present situation, that is, on the here and now. Both the person-centred and Cognitive Behavioural Therapy approach focus on the current situations. Nevertheless, psychodynamic method greatly intends to uncover a person’s unconscious thoughts which range from childhood experience to how it impacts people’s thoughts as well as behaviour currently. Notably, I was feeling that Jane’s concerns were based on her unpleasant history. Furthermore, the most appropriate way to attain our objectives would be via discovering certain forgotten memories specifically from her babyhood or infancy and trying to link memories to the present difficulties.
I accept that the techniques conflict in a variety of ways. According to Altbach, Arnold, and King (2014), in epistemology these approaches can swiftly be integrated. For example, it becomes easy to facilitate the maintenance of strict and clear boundaries as well as make significant transference interpretation. Moreover, this can be done using the person-centred approach’s core conditions, for example, remaining congruent, empathy and letting therapy to be predominantly customer-led. Having used psychodynamic approach I was unable to completely steer clear my CBT and person-centred training. Therefore, I involuntarily relied upon Yalom who considers a more existential psychotherapy. In every scenario, there is effort to remain impartial and balanced therefore providing the case study with the most suitable material to be used.
CONTRACT WITH THE PATIENT
After the initial therapy meeting with Jane and consulting with the manager, I concluded that Jane ought to see me at least once every week. Approximately, 40 minutes will be enough for psychodynamic works. Moreover, the charity organization does not charge customers as they are a charity organization. The organization offers support freely and neither did I charge Jane. Jane knew that I was delivering my services voluntarily. Furthermore, I was just carrying out my medical hours for free.
Jane was already a frequent client to H.I.M.H. She also knew the organization’s other staff and had been receiving help from her outreach employee. H.I.M.H endeavours to separate counselling support and other activities. However, this is usually difficult as the organizations’ staff works from the same office. I had earlier described our confidentiality and privacy agreement to Jane before the commencement of the therapy. Jane had numerous questions concerning the dynamic between support workers and counsellors. I further clarified that the work we conduct is entirely confidential. However, this is not applicable when she is or any other person was at a severe risk. No other information concerning the therapy session would be communicated to any other member of staff except for the supervisor who is usually an external member to the organization. Despite having kept strong boundaries in regards to this, it was however sometimes challenging whenever I would be questioned concerning Jane’s improvement or regarding any safeguarding issues. As Jane developed relationships with the different men, she failed to understand clearly therefore got involved in some dangerous sexual activities. There were numerous safeguarding concerns raised by other members of staff which I could get from the organization’s shared portal. To begin with, I was requested to give additional safeguarding concerns online so that other members of staff could access and read. Nevertheless, after an extensive discussion with the supervisor, we agreed on completely keeping outreach and counselling work entirely separate. I was only supposed to consult with my supervisor in regards to any concerns that arise. Consequently, this aided in maintaining confidentiality and privacy and I feel customers became more at ease to convey issues knowing that they would not be shared with other team members.
Generally, Jane and I met each other for forty seven therapy sessions. The sessions occurred from 7th May, 2017 to 20th July, 2017. An assessment session was vital after every eight weeks even though we summarized and subsequently conducted reflection all through the course of our work. The evaluation and analysis sessions were significant in confirming with Jane concerning the counselling and what aspects were helpful or unimportant. I maintained a record of the discussions regardless of such sessions being unstructured. We normally revisited what Jane had learnt or discovered concerning herself. Additionally, this included any new information together with what she wanted us to concentrate most on. In every scenario I discovered key information which enabled me to develop a better, more appropriate model that Jane would utilize to enhance her communication.
These evaluation and analysis sessions were precisely helpful while working with my client Jane. She developed a tendency to disclose every aspect which occurred with any partner or something else memorable which happened during the course of the week. I could utilize what we had discussed in the previous sessions to help maintain our work focused. Furthermore, this helped me to link her present experiences to her past encounters or more importantly, make a reference to a particular goal to ensure that she clearly understands what occurred to her.
I now believe that Jane only wanted someone to talk to. She never disclosed that it would be paramount that she works on something concerning herself or more important try to comprehend both her present and past. She only needed me to listen to the story that she provided. Similarly, she only required someone who would stop, listen and evaluate or analyse devoid of getting something else in return. I discovered this when I noted that Jane’s major difficulty was loneliness. She has several men around her that only require sexual encounters with her and many females that only seem to get bored to constantly listening to her uninteresting dilemmas which happen when she sleeps with married men. On account of this, I resorted to keeping her company and slowly aiding her to gain awareness. However, I evidently comprehended that everything would progress slowly. I needed to be patient because of Jane’s naïve perception of the world and probable learning difficulty. Therefore, this meant that it would be not possible to consider that I could make any significant transformations in her life.
As stated by Ainsworth (2015), Jane reveals that she has a timid attachment style. The goal of the meetings was to attempt to utilize our counselling relation to give her a safeguarding foundation which she never experienced in her childhood life. Therapeutic relations are useful in helping to heal adult’s unpleasant early experiences with their respective caregivers (Holmes, 2014). According to Holmes (2014), “The objectives of therapeutic process is to offer a setting which fosters treatment. Additionally, Yalom’s approach is thoroughly related to attachment researchers like those of Holmes (2014) and Fenichel (2014). He discusses the essence of having a safe attachment during babyhood as well as the potential adverse results of experiencing unsafe attachments. Yalom elucidates that, “A dissatisfying state of fusion-existence or too early or too tentative emergence leaves the individual unprepared to face the isolation inherently in autonomous existence” (2014, p. 362). Therefore, it was part of my work to aid Jane deal with the situation. Yalom further claims that this generates anxiety but eventually leads to personal growth. He explains, “It is the facing of aloneness that ultimately allows one to engage with another deeply and meaningfully” (2014, p. 362).
The other main aim to concentrate on in this therapy session with Jane is endings. Jane clearly understood that our work would come to an end although it was open-ended. In the same token, this would be a significant aspect of our work having in consideration her dismissive attachment style and subsequent experiences of abandonment. I deemed it essential to consider our ending early. Therefore, I had to conduct adequate preparation for it and attempt to reduce any related feelings of avoidance or abandonment.
Generally, I strived to aid make the unconscious things conscious through adopting insight. As Jung proposed. “Until you make the unconscious conscious, it will direct your life and you will call it fate.” Consequently, this reveals the necessity of trying to make the unconscious conscious. Lakhani, A. (2013) explains that 85% of the verdicts that we make are controlled by the unconscious structures and more so content, for instance, desires, emotions, memories and instincts. Therefore, I also endeavoured to inspire a reflection and awareness concerning Jane’s behaviour patterns to help her comprehend her present situation.
Foremost, Jane stated that she enjoyed sex from these men. We developed a routine where Jane would explain to me what occurred during the week. Additionally, this happened for the beginning 3 months of the therapy which consisted of 13 sessions. It was completely difficult to remain assertive during this sessions. Whenever I inquired anything from Jane, she was not willing to answer. She only continue talking and pretending not to hear me. I frequently got upset by the drama and constantly felt like we were not making any progress. Likewise, this occurred up to the 12th session. Jane continued explaining what these different men required from her whether it was beating, being blindfolded, biting, leaving scars or bondage.
On account of this, I inquired from Jane what she really needed from the men. At first she answered as usual “I want them to have sex and leave me alone for the rest of the week.” She then proceeded with her story. Subsequently, I asked “But what is it that you really want?” However, she ignored this question and continued talking. I proceeded, “I know this is difficult to answer but what is it that you want?” Jane started crying and constant said “I don’t know” up to the end of the session.
The session was significant as it reminded me precisely of something that I read from Yalom (2012). I read concerning a group exercise that Irvin Yalom conducted by asking the group members to inquire from each other what they wanted. In the same token, this question aroused numerous responses including “I want the childhood I never had”. Similarly, the question evoked pain especially for Jane. At first, I didn’t think that this question would bring forth any feelings. Nonetheless, after reflecting on it I realized that the session was essential for the entire therapy period.
After this specific session, I confided to my supervisor that I did not think that Jane would return. I was however relieved when Jane came back the following week. I immediately realized that something was unusual. Jane did not have any make up at all. She told me that she had been critically thinking about the most recent session. Similarly, she told me that the experience she was having is not what she wished for. Therefore, she dumped all the five men. Nevertheless, she re-united with one of the men later on. She started crying why frequently saying “Why me.” Afterwards, Jane completely changed. She became very truthful and keenly listened to the interpretations that I gave her. She was also willing recall her past and subsequently link it to her present life experiences.
Notably, this session might be comprehended through the use of Stephen M. Johnsons (1994) book called ‘Character Styles’. Stephen explains about specific character styles. The chapter called ‘The Defeated Child: Social Masochism’ is helpful is in understanding Jane’s presentation. Throughout this particular chapter, Stephen Johnson makes reference to his earlier work of 1991. He utilized Fairburn’s (1974) model that is of intrapsychic structure to suggest four examples of internal object relationships. These models can be used to comprehend symptomatic behaviour. Johnson, (1994) claims that this specific model is particularly utilized as a way of “mapping the internal dynamics of the masochistic person all along the continuum from character style to personality disorder” (p. 202). Of the four prototypes, I am convinced that Jane mostly fits Prototype III. Stephen labelled Prototype III as “Resistance-Rebellion”. He further defines it as “behaviour that can be explained most accurately by the aggression of libidinal self and object against the antilibidinal object.” (p. 207). Correspondingly, he clarifies that a child is fighting back. In Jane’s scenario, she is actively demonstrating rebellion against the restraint which was as a result of her mother’s silence as she was mistreated by both her biological and step-father.
Importantly, in the masochist’s scenario, Johnson (1994) explains that any opportunity to rebel or resist had been prohibited. In this case, Jane was inappropriately controlled by her father, submitted to different men because of fear and silenced by her biological mother. Therefore, this meant that Jane’s self-expression was only through display and exaggeration of self-defeat. Johnson (1994) notes that it is this impossible state which causes the oft-note extreme rebellion to transformation of the masochistic character. Notably, this is one of the core elements of the therapeutic relation with Jane which I actively struggled with since my original intention was to attempt to “cure” her from allowing men to abuse and mistreat her through sex. However, after numerous unsuccessful attempts and consequent relapses I changed my strategy. Therefore, I helped her comprehend what made her feel that way instead of how to stop. It is arguable that this defeat has been caused by Jane’s character style as Stephen Johnson quotes “the client will defeat the therapist the way he was defeated” (p.229).
The major thematic concerns throughout the course of our work were Jane’s relation to men and masochism. I spent a considerable amount of time talking to Jane concerning abandoning her mother that deserted her, abusive step-father and biological father. An unfortunate situation occurred during the course of out therapeutic work. A building which is close to H.I.M.H caught fire. Jane lost several friends and also other service users which we knew at H.I.M.H. Therefore, this tragedy necessitated that we move relocate our therapy sessions to another centre that was far away. Finally, last theme that was dominant in our session was endings. I motivated Jane to review her relation with endings from the commencement of our work. I have included an extract from our last ending below.
Jane become less rebellious and more truthful to any discussions concerning her past. Additionally, this happened by our 22nd session. Jane attempted to become less vulnerable or emotional before this session. Prior to this session, Jane was only discussing past relationships with men. For instance, a few years ago Jane’s boyfriend become extremely aggressive and subsequently threatened to execute her if she failed to be submissive. The following tape starts with us discussing about this experience and the reason Jane is unable to say no to the different.
Transcript Process comments
J1 My sexual experience with the men was awful. One of the men even put a knife on my throat but I did not engage him in the fight. This shows that the controlling abuse relationship that Jane was undergoing could lead to her death
J2 I think failing to engage him saved my life. I think beginning to fight him could result in more problem. she was precluded to resist because she feared for her life, therefore, remained defeated
J2 Mmmmm Hmmm
J3 Typically, failing to fight him assisted me a lot more so in regards to my personality.
S3 Because you were afraid or? ... I was not sure whether she was afraid. However, her body language showed she was scared.
J4 Yes, I was. The man wanted to pierce my throat.
S4 Did you become the submissive I was trying to associate this particular experience to her present role.
R5 Yes, I was very exceptionally submissive. I think saying ‘no’ helped me to overcome the situation. This shows her defeated character
J6 I was really taken aback to see the guy holding a knife.
S7 So what is that thing which makes you occasionally want to become the leading one? At this instant I needed to reconnoitre both sides of Jane’s character because she frequently says she is dominant both.
J7 Do you mean dominant in the bedroom? The Yalom’s (2014) existential segregation defence outline that ‘compulsive sexuality’ refers to promiscuous sexual activity act which is a powerful relief for a lonely person who does not truly engage with the sexual partners. This basically defines most of Jane’s relationships and it has become custom to this kind of relationship. So I had to challenge her on this kind of relationships or coupling.
J8 Yes. I am actually dominant in the bedroom. However, I do not want to take much time in the bedroom after my experience with Mr Obedient. This evidently exhibits Johnson’s III prototype because in this case Jane is fighting back as Johnson elucidates in his theory. The masochist’s is the only way of expressing self-defeat particularly via libinal self-expression.
S7 Would like to get them back? This is a quite significant point to aid mirror out Jane’s situation as she is saying she would like avenge. Advising her on the impacts of revenge was important. I believed it would help to widen her awareness on revenge.
Notably, this extract shows Jane’s major difficulty, that is, isolation. My client agrees to meet the men weekly since she is entirely lonely and therefore cannot overcome the situation. Overcoming the condition will not be ease for her. For people to ‘cure’, Yalom argues that “There is no solution to isolation, it is part of existence; we must face it and find a way to take it into ourselves.”
S28 So I think about whether there's a piece of you that doesn't generally or need is devoted of a cozy relationship Yalom outlines a ‘constant searching down affection' as a key guard for the insufficiency roused singular Smith (2012) cites – "via hunting down adoration, the hypochondriac individual escapes from the faintly perceived feeling of disconnection and void at the focal point of being. The arrangement is bound to come up short since one misidentifies the issue. One thinks of it as that one is included, while in fact it is that one can't love."
J30 Yes I fear close relationships and I do not know the reason why
S31 Because there's a part of you that says that you want more from him but you've accepted that he gives you this one hour a week for nearly two years I believe that this somewhat resembles Rosa, although she
Thinks that she is capable and willing to love, her traumatic childhood and abuse from her fathers have tarnished a healthy way of her loving another man.
R31 (pause) yeah yeah that's (laughs) one hour a week ahh one hour week for 2 years ermm but yeah.
S31 I maybe going back to us talking about you you may be not wanting a real relationship with a man and you know you only have an hour a week with Mr Robot man you have an hour week here with me maybe that's all you're capable of accepting ..as part of a relationship only because it's too scary to think about having a relationship like that with your stepfather I clearly had my own agenda here as I went back to discuss this further– I also shouldn’t have nearly said ‘capable’ even though I quickly changed this to ‘capable of accepting’ it sounds harsh to say one is incapable of having a relationship and this may have been too difficult for Rosa to hear.
R32 yeah it's just I don't know I mean I do want to have a relationship it's not like I don't It's not it's not like I don't I believed her when she said this I think Rosa began to really want more for herself and in her relationships. It is also important to note that Rosa is comfortable with disagreeing with me or sharing her interpretation of what's happening to her and this is great for our work as we are comfortable with ruptures and challenges.
S32 but it's how much of a relationship you're willing to have maybe an hour week is more comfortable maybe more than that is too much
It is vital to include this extract although it is extremely short. The extract reveals considerable growth and the steps Jane has already initiated to improve her condition and start the process of transformation. During the previous session prior to this one, Jane conveyed her excitement because an agency had accepted her. The agency aids in match making couples specifically for a well renowned show called the Undateables. Jane involvement will be private and therefore not included in the Television show. At first I was very astonished that she chose our agency for care and support (Major, Whelton and Duff, 2016). I assumed that the show would only air singletons which had particular disabilities. I did not classify Jane in this category although she has learning difficulties and even mental or psychological health diagnosis.
After consulting with my supervisor, my doubts were greatly reduced. Moreover, this step was really helpful to my client and I told her that as indicated in the extract below. My supervisor specifically had some experience with an ally who had earlier on used our agency. The friend commented positively in regards to the organization. Likewise, this aided me realize how significant this was for the therapy sessions that I had with Jane.
At the end of this precise extract Jane confesses that she was never connected to any man emotionally. Furthermore, I believe in the meaning and essence of masochism. It is the inability of connect or empathise with other people. Therefore, it was critical that my client became conscious of this aspect. It would be imperative in aiding her comprehend the reason that makes her fail to connect emotionally with other people which is the key cause of the struggle she experiences.
Transcript Process comments
R34 Because like you know because of my age and stuff so it's not like like I'm gonna send the form in next weekend and I'm going to get a phone call within about I could hear changes in Rosa’s narrative here. When we began therapy she would have really struggled with this and it was probably what put her off doing this sort of thing sooner. Now she has prepared herself for how difficult this process may be for her especially if she is rejected.
Rosa is also a woman that knows how to get men very easily and this is usually through engaging in sex with them straight away. This shows that she is willing to wait and not use her usual tactic of seducing men and this may mean that they reject her.
S34 so it can take some time
R35 yeah yeah because she did say to me like and the men might not like me they might turn around and say no she did warn me about it I could have explored this a bit more as Rosa has a past full of rejection - we did at a later stage, but I believe she mentioned this hear because of her anxieties around putting herself out there and potentially being rejected again.
R36 so basically, no so I just need to kind of take that first step and This was great to hear, and I was genuinely very happy for her
R37 need to take that first step and
S37 it's it's a big step to you because it means that you're putting yourself out there for someone to connect to view I'm more than a sexual in more than a sexual way I wanted to express my thoughts as I didn't get a chance to as our session had ended. When she told me the week before She may have noticed my confusion and I wanted to acknowledge how big this was for Rosa. She was finally saying no to one hour a week and yes to a committing long-term relationship.
R38 yeah yeah because because when it comes to the emotional erm when it comes to men on an emotional level I don't think I've ever connected to a man on an emotional level I wonder if Rosa has connected to anyone else on an emotional level before
Could this unconscious coupling be one of her first experience of real emotional human connectedness?
Although I had adequately prepared for my ending with Jane, I confided to my supervisor that I had difficulty in informing her that I would soon leave. Nevertheless, during the last 4 weeks of our counselling sessions I opted to inform my customer, Jane, about our ending. The previous 2 weeks were before I told her were difficult for me as I could not find the appropriate way of telling her. Nonetheless, I could easily inform other customers that I was leaving. Jane failed to show up for week five’s therapy session therefore had to communicate to her in regards to our endings four weeks before. Having analysed this situation in my supervision, I constantly expressed my thoughts concerning our ending. I, therefore, was sure Jane would not attend our sessions. Despite being adequately prepared for this situation I was however amazed when Jane rang the buzzer. Working with Jane made me reviewed our relationship concerning endings. Although I had previously not had difficulty with endings, in this scenario I became extremely conscious about Jane difficulty with our imminent ending therefore postponed telling her which is not my nature.
During the last session, Jane came to the counselling session with a piece of paper. As she placed it on the table adjacent to us, I inquired why she had come with it. Staring at the paper, Jane said “this is my preferences form for the undateables, could we complete it together”. I appreciated her effort that she valued every aspect concerning our sessions. It a very good way of concluding our work. Making frequent inquiries about what was the necessity of a relationship to her and what she needed from the various relationship had formed the basis of our therapy sessions. I strive to educate and inform Jane that a weekly session of masochism is not an effective relationship (Stokes, Pogge and Zaccario, 2013). Additionally, this was also aimed at transforming her perception in regards to what a relationship ought to be. We used approximately 30 minutes to answer the queries provided in the Undateables form. We also conserved more concerning Jane’s opinion on our ending and the entire therapeutic journey. The following extract begins us discussing Jane’s past experiences and how and why she steers clear endings.
Transcript Procedure comments
S38 So you continue...
J48 I just steer clear it
S39 So you clearly observed this particular ending or completion Jane steered clear conversing in regards to completions all through the year. It is imperative to link endings or completions to something. As an experienced therapist I can evidently conclude expertly. In addition, the counselling period with my customer, Jane, would certainly end. Nevertheless, Jane would agree and consequently proceed communicating concerning another element. It, therefore, became difficult to convince her that it is vital we discuss endings or completions. Reviewing this experience, I ought to have been more cautious when doing that so that our encounter becomes prosperous.
J3 Yes and I am even convinced that it is true.
S41 Wow. That is great.
J50 Yes. Yes. Yes because like
S41 How do you manage to successfully mitigate the fear of completion and even continue coming to the counselling sessions like today?
I thought I was conversing with myself. I subsequently discovered that this precise completion was one of the most challenging or difficult part of counselling period. In the same vein, this is because we had spent a lot of time with my client, Jane and I constantly felt comfortable being with her..
J52 Errrrrrrmmmm certainly sad
J44 Extremely sad. (Jane sniffs). Yes completely sad. Yes since like mmmmmmmhhhh. Unhappy since I am not comfortable when experiencing situations which are related to completions or endings.
S54 Certainly yes.
J45 Yes. I completely dislike anything feeling that is associated with endings. I entirely hate conclusions. I realized that both my customer and I hate completions. On the contrary, as an expert I ought to be more relaxed in regards to issues that are associated with conclusions or endings. In addition, it is certain that there is some trait in me which overly makes me constantly dislike or entirely hate endings.
S45 It is alright
J46 My personality makes me fail to like endings. In general, most people do not like the notion of being related or associated with bad, unfortunate or unpleasant situations and occurrences. For example, yesterday was my step-mother first death anniversary.
S46 Yes since we have been together for over one year. I completely forgot that Jane primarily sought our organization’s services because she was experiencing sorrow and grief.
J48 It was basically one year. However, I was not entirely surprised when my granny passed on. I clearly comprehended that she would eventually die. Additionally, this because she was visibly weak. You also understand that she was extremely old. The situation provided me with an opportunity to become knowledgeable about such situations. I feared the ending or completion since I was the only person that she was close to. The ending or completion would not be unpleasant had I been seeing her less frequently.
S46 Yes. The experience was really hard.
J48 Typically, my behaviour was aimed at maintain a considerable distance. I constantly ensured that there existed a significant distance between us. Furthermore, when my granny passed away I was entirely shocked. It has been challenging for me to adjust to the situation. Nevertheless, one of my relatives experienced a completely different situation. My cousin would frequently go to the health facility to check on her. She actually visited our granny daily. She would have wished to be with her much longer. Jane evidently put much emphasis in regards to distance. At this point, I thought it would be essential to review the various relationships she had been in. Therefore, I discovered that all of them had an element of distance. Jane visits different male friends at least for an hour every week. Therefore, this reveals that there exists a considerable distance.
S48 Yes. We dealt with matters differently.
J49 Yes. However, I had decided to do what I perceived to be right.
S49 Are you comfortable attending today’s session? Are you much contented with completions or endings? Can you experience endings as well as get over them? As an experienced therapist, my purpose was meant to certainly reveal to Jane the improvement we had achieved. However, the question became very challenging to ask her. Honestly, it would be unrealistic to conclude that Jane had gained the ability to handle every completion or ending.
J49 Yes. Certainly, this is right. Yes. I can manage the situation. On the other hand, it will be challenging to mitigate the problem as I have not been experiencing goodbyes or endings prior to this scenario. In general, nobody likes goodbyes. Jane just told me anything that she perceived was right to inform me as her counsellor.
J50 Importantly, I realized that my mentor or counsellor was leaving.
S50 What motivated you to attend today’s session?
J51 I actually do not know.
S51 What has changed concerning this particular completion or ending? I was not certain of the information I wanted to convey to Jane. However, I was concerned that she was steering clear of completions or endings. I was completely contented that we would come to a successful ending after the therapy sessions.
J52 (Starts crying). I typically do not understand. I do actually not recognize the reason that made me come (cries).
S52 Hmmmmmhhhhhh endings or goodbyes are completely hard. I appreciate the fact that Jane noticed our completion or ending. The ending indicates that she realizes and appreciates the improvement or progress that we have made.
J53 Mmmmmmhhh. I entirely hate goodbyes. I even felt like crying.
S54 It is alright.
J54 I fail to understand the situation. It is just clear that I hate completions. Additionally, this is because no person likes an ending or goodbye.
I attempted to analyse and evaluate ending. I did this during the period that we have been with Jane. However, she failed to reply to my inquiries. I would have further analysed this situation if I had adequate time.
J56 I fail to comprehend endings or goodbyes. I dislike it whenever persons are leaving. Notably, this reveals Jane’s agonizing fear of isolation and loneliness.
J56 Typically, it is important to note that the main reason I was considering whether I should attend the session was because my friend was leaving. However, there was no reason of failing to attend the counselling session as it is paramount
S56 Did you critically consider attending today counselling session? I was completely convinced that Jane may show up to the last therapeutic session. More importantly, this situation was challenging for Jane. I made an inquiry because I was amazed that she actually came.
J57 No. I do not like the process
Maybe Jane failed to convey the truth?
S57 We ought to appreciate the time we have been together as well as the activities that we have performed or conducted. Likewise, it is important that you considered coming.
I was completely astonished that Jane showed up. Similarly, I made an effort to assure her that encountering endings or goodbyes is vital.
J59 Yes. Yes. Additionally, this because you have extremely aided me.
J60 Yes. In addition, this is because it is the first goodbye or ending. Wow! That is great
Foremost, I certainly had difficulty with my therapeutic association with Jane, specifically in the initial eight weeks of the sessions. Basically, I experienced challenges like dealing with Jane who was withholding and cold and brought sadomasochistic dynamic between us. Her extensive, dramatic storytelling period was characterized by victimization, seemed as an angry attack especially on me and a humiliation of our work.
Johnson (2013, p.218) clearly explains what Jane experienced during the initial stage of the therapeutic session. Johnson states that, this kind of an individual consciously sees herself or himself as perfectly well-intentioned, not-guilty or innocent, however unlucky, victimised, unfortunate, misused or unappreciated. The person sees the innocence of, for example,” Who, me?” as well the unfair treatment of “Why me?” So in Jane’s case, she is pervaded by the masochist’s conscious self-presentation and consciousness. Johnson states that the masochist will ask for aid or come to therapy but will not actually believe that the assistance will be upcoming or if something positive is forthcoming. The masochist will only present himself or herself because there is nothing or she can do.
During the counselling, Jane took me like a brick-wall that has does not have any purpose, opinion, or feelings. Jane would occasionally tell me long stories and at the same time flout or disregard any fundamental point or input that I provided. She also would refute having any reactions in regards to the therapy. On several occasions, Jane would ignore me by pretending that she is keenly listening then proceed with her story. The cycle continued making me feel worthless. Additionally, this is because I felt that the sessions were becoming tedious and frustrating. Yalom (2014) describes a client in one of his books called ‘Existential psychotherapy’. He argues “Yet how can he or she address me if I am not around” (Yalom 2014, p. 414) I recall my manager telling me to continuously remain hesitant to Jane’s drama and that it should not affect my work. Jane’s audio diary which progressively continued every week became useless. Instead of empathising with Jane, I frequently identified with the oppressors in her stories. Her female allies who do not like neither the stories nor the men leave Jane after obtain what they require. They do not keep her company therefore fail to connect with her emotionally. Therefore, I am convinced that Jane narrated her tales to maintain an emotive distance precisely amid us.
According to Blizard (2001, p.55) in any vicious transference a customer seems self-sufficient or autonomous and may even dismiss the specialist or therapist’s points. The patient takes up the role of the ‘specialist’ making the therapist to start feeling inept. It is important to note that this is because of the fear of being rejected. Therefore, the client strive to intimidate the expert or therapist. In Jane’s case, she achieved this by constantly failing to value my input and ignoring me. Blizard further suggest that this client’s behaviour can make the therapist angry. Therefore, the therapist loses objectivity, becomes incapable of making valuable interpretations and is unable to establish therapeutic boundaries. I experienced that this was the most difficult part in the course of my work. I felt that I had been doing nothing for the past three months making me frustrated. As evident in this case study, I was able to overcome this conventional routine. It is explicit that our rapport become stronger because I did not relent in Jane’s case.
Jane had a frustrated and revengeful tone due to her sadness. However, sometimes she was self-loathing and apologetic when conveying her distress. A notable thematic concern that was dominant in Jane’s life was her incapability to integrate and abandon the distinct parts of herself. Nevertheless, after concluding 3 months of the therapy sessions, Jane became less secretive and withholding. She was able to disclose to me her hidden character traits. Furthermore, she was now able to reveal her deep isolation, desperation, heartache and resentment. Primarily, Jane realized that she required my aid or help for a significant and considerable progress in regards to her situation.
Notably, after the 13th session, Jane now heard me as I inquired assertively what she actually needed from the relationships. Particularly, the session influenced several transformations in Jane which even surprised me. On reflection, I assumed the role of the aggressors. The frequent inquiry concerning what Jane needed made her change to a self-defeating submissive style (Breiter et al., 2015). Moreover, she dumped all the men that she had been having sexual relationships with. On the contrary, I doubted if this precise session caused any emotions to Jane. It is because she has been previously told what she needed in her life nonetheless I was treating Jane like a mature person. The numerous questions that I asked were aimed at making her cooperate and open up to make the therapy sessions successful.
After completing this therapy session, I wanted to assert myself but Jane was only attending them to acquire something useful from them instead of utilizing them as a record or diary. Jane discussed her family’s situation and most importantly her relations with her parents. She also described her precise childhood commemorations. In addition, this is evident in the extracts provided above where Jane answers questions, gives me an opportunity to talk and listens to my significant interpretations. Jane, therefore, had to connect with me emotionally. She explores her association or relation with other people in my conversation with her. She interacted with me in a manner she was not used to by attending the sessions and allowing me into her life. Similarly, this reveals the progress she has made.
Another change which occurred in Jane after evading the fire, observing building burn and witnessing her neighbours avoiding death, made her get stressed. After the fire, during the 14th session, Jane was communicating her existential opinions of existence and purpose in her life. My client stated that she needed transformation, move forward and obtain much from life. She realized that death actually exists. Yalom’s (2016) brings forth a lot concerning death nervousness. In (2014, p. 173), he explains that each nervousness nightmare encompasses death and terrifying imaginations encompassing such subjects as mysterious belligerents breaking into someone’s household, constantly when discovered, results in fright of death” He goes ahead to state that the wakening experience does not concern being an usual or curious happening or concept; in reality is the livelihood of medical or clinical practice. Accordingly, the author states how he spends ample time education therapists some of the ways of identifying and harnessing the wakening takes for therapeutic practice. The author is making reference to nightmares and it is important to note that Jane has had a personal experience and understanding of these kinds of dreams. I, therefore, used the aforementioned approach to motivate Jane toward transformation and becoming a person who loves herself irrespective of challenges or difficulties. Jane boldly started to make progress from the night of the fire when she escaped death. She had not earlier stated that she feared death or she would die despite now having a greater value of life.
I thought of Jane’s reaction the most during the final week that I would announce that I will be departing from H.I.M.H service. I found it difficult to convey this information to her. Furthermore, this is because of strong countertransference and her being my longest client. We had all along worked towards achieving a successful ending during the course of the year. In the 43rd session, I informed Jane that I was planning of telling her something as I summarized the earlier discussion. However, she straightway said “Oohh nooo you are not expecting like me, are you?” then stared at me upsettingly. I just smiled as I reviewed what she had just said. I had been single for a long time though I was 26 years old. I informed Jane that I would be leaving to concentrate on finishing my studies.
More importantly, this triggered me to think of Jane’s relation with her biological mother. Her mother had previously neglected her after getting a new household. Likewise, this might have been a possible prognostication of Jane’s initial association with her mother as she alleged that I was also planning to leave her because of her child. Jane continued coming for the next few sessions but she suddenly became sad and tearful. She confided to me that some days she would lose focus and start doing silly activities. For instance, she would press the water dispenser button, however, not accurately therefore started forgetting vital things (Fenichel, 2014). As evident in the last excerpt, Jane needed me to observe how I had transformed her life. She needed me to partly hold and even try comforting her during her stressful moments. Moreover, Jane clearly explained she needed comfort because she was had not steered clear ending of her problems. I am sure that Jane might have regretted consuming her time to make herself comfortable and talking frankly to me. She was upset because I was leaving when she was working hard to get the most from the therapy sessions.
Generally, I am pleased and satisfied with the progress that we made during the course of the year. Jane transformed from sleeping with numerous men to becoming more aware and subsequently reflective as she overcame her initial ending. On the other hand, there are several issues which I feel that I should have improved and done better. As a therapist, I have for instance learnt that I could have handled the challenging dynamic that we had at the beginning of the therapy session (Linehan, 2018). I realized that Jane became cautious when describing the unfortunate fire incident. I was later informed that her outreach employee had told her that I witnessed a client who died in the fire incident. Additionally, this can be clearly comprehended through the use of Yalom’s existential defence, which requires a therapist to put the needs of his or her client first before considering other things’. According to Smith (2012), in a case like Jane’s, the therapist has to put the needs of the patient first perchance to the disadvantage of himself or herself to avoid the dismay of antagonizing existential isolation.” It is my belief that Jane was utilizing my loss as an avenue to steer her present existential catastrophe particularly the stress of losing several friends and neighbors and also her nearly dying.
After a thorough talk with Jane she agreed that we could discuss the events that occurred during the night of fire, she was still not willing to disclose more details. Nevertheless, there existed an element of her ‘trying to put my wants first’ because she presumed that I was experiencing a hard or tough time in regards to the loss of her friends and neighbors. Despite this being inevitable, I strived to make sure that Jane felt reassured and that she could comfortably describe the fire occurrence.
I constantly evaluated who I was to Jane in the transference during the time we had been together. It is evident that there existed a solid countertransference with Jane when I encountered her outside the therapy room during one night. On account of the intensity of the fire, I was required to control a night bus service to enable residents to come in and communicate. Moreover, this come up after the public had requested the board to establish a way of catering for people who witness inferno and struggle to have a sleep at night. I therefore supplied the bus with bottled water, coffees, and tea prior to leaving for work.
One night when I was stocking the bus and arranging sofa cushions and curtains prior to the night shift staff commenced work, I heard someone calling my name. I was on the deck so I had to go downstairs and I found out that it was Jane. She was coming from the silent march accompanied by her two neighbours. She introduced me to them as her therapist. The neighbours started laughing after looking at each other. Jane did not realize that as she was busy asking questions in regards to the night bus service. As this occurred I recall feeling somewhat uncomfortable. I failed to maintain boundaries in this case although I did not communicate with the neighbours and I felt the desire to protect Jane. I discovered that she was uniquely naïve and this might be the reason why the different men easily manipulate Jane. After this encounter I analysed this occurrence in supervision and discovered that the feeling to protect Jane is the same as that one that I feel in the same case with my younger sister.
During my work at this critical moment at H.I.M.H, it was impossible to maintain objectivity and distance as it is the norm in my psychodynamic work. I was continually aware of this and therefore made sure that I maintained boundaries. According to Yalom, Freud’s position is that the specialist or therapist had difficulty in maintaining objectivity. Moreover, this makes the expert to lose control and be swayed by what a patient wishes instead of what the patient needs. “In Freud’s opinion, if a therapist opens up to a patient and engages in usual human intercourse, he or she will forgo objectivity and, therefore, enhancing value or effectiveness” (Freud 2014, p. 412). Jane seduced me with excitement and enthusiasm of her lifestyle and ignored my questions making it impossible for me to assert myself and consequently take control. Through my personal reflection and supervision, I discovered just as Freud had proposed that this is what Jane wanted. It was to simply continue with her stories devoid of being vulnerable. She required me to take charge just like caregivers without mistreating her or suddenly abandoning her.
In the same token, this necessity to protect Jane was just an urge from my personal feelings in accordance to my family life’s context. As Yalom (2014) explains, this usually develops from childhood encounters. During my upbringing, my biological mother and sister experienced an extremely troubled relation. Additionally, this entails my mother’s experience of postnatal depression which happened after my sister’s birth. My mother excessively struggled to deal with the situation. Interestingly, I am informed that I actively endeavoured to aid her. Recently during one of the family gatherings, my younger sister remembered a story that she had been told by our mother. My mother narrated the whole story and other things related to our family issues to make my cousins believe it. Particularly, she narrated a story concerning the night that my younger sister was born. She said that when they got home she left the baby in the living room and went to sleep. Furthermore, she also recalled waking up the next morning and sat by her side waking her up shouting “the baby is crying wake up! The baby is crying wake up!” As my mom took care of my younger sister, she realized that her skin was becoming dark purple because of consistent crying throughout the night.
Notably, this is an explicit instance of my protective measures and concern in regards to my sister, starting from my early age. In spite of Jane being almost twice my age, I always felt as I was older than her. Similar to my younger sister, she would keenly pay attention to my personal interpretations. As such, she viewed me as being more knowledgeable. During one therapy session, I requested Jane to tell me how she viewed me but she did not comment, however, pointed at a table which was in the room and said “The tiny dot you in the table represents me while the entire table represents you”. I shared this imperative information with the supervisor because Jane seemed to be naive. It is vital to think developmentally concerning a child’s comprehension and perspective about the world. I realized that adults aid facilitate and develop a child’s awareness by joining the dots. Furthermore, this is revealed by the desire to support and help Jane in regards to safeguarding concerns. In one of the counselling sessions she was unable to sit properly because of pain. The pain was as a result of being intimate with one of the men the previous night. Jane made me actively perform my role of a protective mother. I continuously reminded her of the various things that can help keep her in a safe environment or state. In addition, this is a clear instance of my countertransference in the therapy room with Jane. Therefore, this was something which required supervision and to be aware of.
She once stated that I make her recall one of her Asian allies that she studied with in high school. Upon making further inquiries, my client disclosed that this occurred because the Indian friend was clever. Jane viewed me this way since my appearance made her feel that I was wiser and older. Subsequently, having discovered this information, I understood that I had to conduct my duties in an effective and hardworking manner. Likewise, I had to work extra hard to make sure that Jane reduces her reliance on me to provide her with answers. I strived to impact skills which would help her develop her own awareness. Therefore, this is in accordance with what Freud proposed as the key aim for a psychodynamic counselling or therapy.
On a similar note, my younger sister is undeniably needy and this was always my expectation and experience with my client Jane. She would attempt to utilize her extra time to test boundaries. She once observed me greet another service user in the waiting area. She later inquired if I was also providing the person with counselling. On account of this scenario she requested to that we organize more than one meeting in a week. Having a clear understanding of my countertransference with Jane, I became very careful concerning whether I should concentrate with “protecting her” during the course of our counselling sessions. Particularly, this would be vital and fundamental and this meant that we would not easily handle some of the ruptures. Moreover, this is a very paramount aspect in regards to my psychodynamic practice. I was extremely cognizant not to make Jane completely agree with all the things that I told her. I, therefore, challenge her to maintain a broader perspective towards various elements. In spite of Jane partly agreeing with what I told her, she was able to disagree with some of the elements which I interpreted in an inaccurate manner.
After conducting a critical evaluation of our session’s objectives I discovered several things. Jane usually conducted little reflection and awareness concerning her relationship and herself. She originally utilized the fifty-minute sessions to convey her dramatic encounters and also fill her diary concerning events which occurred during the week. After two vital therapy sessions, a significant transformation happened concerning our therapeutic relation. Jane began noticing the essence of the counselling. She would now better tell her story. She started sharing more information in regards to her childhood experiences. She also expressed her feelings concerning the specific relationships that she had. Significantly, she became more frank during the course of our work.
As evident in the above extracts, Jane started to reflect herself devoid of requiring reminders from me, I reviewed one of the sessions in which Jane sat down and stated I had been considering dismissal this indicating how much development Jane had registered as far as her mindfulness and consciousness are concerned. She was additionally frank to connect together various parts of herself and subsequently comprehend and understand where they might have originated from as well as how she has turned into the manner in which she is at present. When we started therapeutic process sessions, I would make inquiries to trigger her to do as such. However, she would dismiss each invitation to further uncover more details of herself. Although, this turned out to be considerably less demanding for her, as evident all through the extracts, for instance she knew that her outrage in badminton was profoundly established and not just as a result of what her friends had said. Jane likewise recognized that she did not sincerely and emotionally associate with any man. She said that she always stayed away from all wind-ups.
As recommended by Holmes (2014) and Yalom (2014) it was critical that the therapeutic relationships becomes solid to make sure that Jane develops a self-autonomous account or narrative. Similarly, this was unquestionably not the situation for the initial months of counselling and it took numerous obstacles to keep up genuine relationships as evidently proposed by Yalom. As disclosed in the excerpts, my therapeutic relation with Jane was one in which Jane would become secure and comfortable in. We became comfortably ready to challenge each other while maintaining transparency and honesty.
Jane became capable of conquering her first appropriate ending as proposed by Messler Davies (2010, p. 85). According to Messler Davies (2010, p. 85), the process of mourning and termination of mourning encompasses the analyst as a ‘stand-in’ of sorts, which is a representation of part for all the separations suffered by the patient, unresolved abandonments, ungrieved as well as the unmourned.” . She discovered that our conclusion was troublesome in light of the fact that I spoke about the previous abandonments as well as divisions she experienced. She placed me on a platform because I was the only individual who remained with her or could help her in regards to her problems. It is vital to note that I keenly listened and never got exhausted of her stories in comparison to her companions. I also did not utilize her like men she had relationships with. I did not become furious with her the way her biological father did. However, I neglected her like her biological mother.
Freud anticipates that an examination will avert a repeat of troubles later on. He states that an analyst will assess whether repressed materials have been made sentient or not; so much that was indecipherable has been elucidated, and so much internal resistance conquered that there is no need to fear a repetition of the pathological processes concerned.” In spite of the fact that, Jane has just barely started demonstrating her defencelessness and opening previous injuries. It is my feeling that much of what was earlier subdued has been completed cognizant as Freud proposes. Nevertheless, Jane has barely been provided with the tools to overcome the difficulties. In spite of the fact that, Jane comprehended her masochistic conduct in a better way and did not have shielding concerns hailed throughout the previous four months of treatment. Similarly, this was as well a big reprieve despite the fact that my point was not to keep her participating in such activity, I needed her to be in a safe condition. In general, Jane began to reflect and connect parts of her life without a moment's hesitation and she became capable of conquering her first ending.
In conclusion, generally, I pick this contextual analysis as it showed me an extraordinary arrangement and indicated to me issues I might not have perceived so clearly previously. I am knowledgeable concerning my challenges with completions and to become conscious of such concerns as it might hinder me completely from making adequate preparations with customers in regards to our endings. In the same vein, as an experienced counsellor I have at no time been preoccupied in therapeutic work as I have felt in the initial few months with my customer Jane. In the same token, this was a great learning opportunity. The supervision and reading taught me an imperative lesson when I am in the same situation. Jane similarly preferred to test limits or boundaries. For example, she may keep conversing after we conclude the counselling period. As a counsellor, I desired to stay firm or assertive to efficiently maintain such significant limits that aim at supporting me in my development as a specialist. Additionally, this particular scenario constantly challenged me all through the counselling room because of the disaster that happened in the specific locality. More importantly, the precise situation implied that having seen Jane close to the counselling organization as well as failing to control or manage what my colleagues would inform Jane concerning me would be devastating. It is also possible that she found out more details in regards to my personality and character as opposed to what I actually thought she would get. Likewise, this would be through conversing with other customers and staff. At first I truly found it difficult to handle this situation. Nevertheless, I taught myself different techniques of managing it skilfully and subsequently maintain significant boundaries. Ultimately, I did not have any experience working with essential masochistic demonstrations previously. Continuously dealing with Jane's difficulties or complications made me attain incredible self-assurance and certainty. My critical skills as an expert were at first overpowered with Jane’s paramount scenario or case.
After starting this vital course, I felt frightened as most persons usually experience. Additionally, worrying about a substantial concern of insecurity in regards to my age, as far as being the most youthful and the most inexperienced among my friends. However, as I conclude my professional internship, together with the assistance of supervision, toiling tirelessly in practice and finishing the imperative medical sessions, I am assured I have gain enough experience as well as capacity to effectively treat customers and consequently keep on growing during the course of the next few years. From the current experiences I am sure that I may not have made a similar development as well as learn more concerning my personality. Beginning this critical journey implies opening or exposing injuries I perceived may have been ideally left closed. Nonetheless, the vital experience has given me a new sensitivity and understanding regarding feeling vulnerable and spending time with patients yet entirely believing in the perspective of therapeutic relationship.
Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. N. (2015). Patterns of attachment: A psychological study of the strange situation. Psychology Press.
Altbach, P. G., Arnold, K., & King, I. C. (2014). College student development and academic life: Psychological, intellectual, social and moral issues. Routledge.
Axelrod, S. D., Naso, R. C., & Rosenberg, L. M. (2018). Introduction. In Progress in Psychoanalysis (pp. 23-36). Routledge.
Berry-Smith, S. F. (2012). Death, freedom, isolation and meaninglessness and the existential psychotherapy of Irvin D. Yalom (Doctoral dissertation, Auckland University of Technology).
Breiter, H. C., Block, M., Blood, A. J., Calder, B., Chamberlain, L., Lee, N., ... & Stern, D. B. (2015). Redefining neuromarketing as an integrated science of influence. Frontiers in human neuroscience, 8, 1073.
Early, S., & Fincher, J. (2016). Consciousness of Self. Leadership for a Better World: Understanding the Social Change Model of Leadership Development, 43.
Fenichel, O. (2014). The psychoanalytic theory of neurosis. Routledge.
Freud, S. (2014). The neuro-psychoses of defence. Read Books Ltd.
Holmes, J. (2014). John Bowlby and attachment theory. Routledge.
Holmes, Jeremy. The search for the secure base: Attachment theory and psychotherapy. Routledge, 2014.
Lemma, A. (2015). Introduction to the practice of psychoanalytic psychotherapy. John Wiley & Sons
Linehan, M. M. (2018). Cognitive-behavioral treatment of borderline personality disorder. Guilford Publications.
Maslow, A. H. (2013). Toward a psychology of being. Simon and Schuster.
Rogers, C. R. (2013). A Theory of Therapy and Personality Change: As Developed in the Client-Centered Framework”. Perspectives in Abnormal Behavior: Pergamon General Psychology Series, 341.
Stokes, J. M., Pogge, D. L., & Zaccario, M. (2013). Response character styles in adolescents: A replication of convergent validity between the MMPI–A and the Rorschach. Journal of personality assessment, 95(2), 159-173.
Yalom, I. D. (2014). Momma And The Meaning Of Life: Tales From Psychotherapy. Basic Books.
Major, R. J., Whelton, W. J., & Duff, C. T. (2016). Secure your buffers or stare at the sun? Terror management theory and psychotherapy integration. Journal of Psychotherapy Integration, 26(1), 22.
Shefler, G. (2014). Time-limited psychotherapy in practice. Routledge.