Presenting Problem: Deidre, a 22-year-old college senior of mixed African American and Latina heritage, was referred by her MD for symptoms of anxiety. She practices meditation but does not identify as religious. Her parents divorced when she was 9 and she reported a stormy relationship with her “moody” mom. Her dad was a calming presence but died suddenly 5 years ago of a heart attack. Deidre reported using drugs (marijuana preferably) and alcohol to cope. When she was 18, she became pregnant at a party and chose to have an abortion. This complicates her present relationship with Tom, her boyfriend of 4 years as he is prolife and they are considering marriage.
Hypothesis: Deidre’s anxiety is rooted in her early childhood experiences, her lack of secure attachment to her mother, the sudden death of her father, and her abortion. Much of her distress comes from unconscious struggles as her ego tries to balance her instinctual drives (her id) and her superego (Johnson, 2016). Deidre’s defense mechanisms of repression, avoidance, and rationalization help cope with her fear that if she tells Tom of her abortion he will abandon her. This is an unconscious attempt to bolster her fragile ego, likely linked to her early childhood experiences, her father’s death, and her fear of losing Tom.
Goals: The primary goal for Deidre is to increase awareness of unconscious drives and past experiences (Johnson, 2016) as related to her anxiety, drug and alcohol use, and feelings of guilt. Bringing deeply buried feelings and thoughts into consciousness will allow them to be examined and worked through building insight.
Free Association: Deidre will be encouraged to state any thoughts or feelings that come to mind in response to a word prompt, without censoring them. The goal is not to uncover specific memories but uncover patterns of thought. Then, she will be assisted to analyze the underlying unconscious feelings associated with these disclosures (Johnson, 2016).
Analysis of Resistance: When Deidre unconsciously reacts to keep unpleasant or perceived negative experiences hidden by changing the topic, refusing to respond, or giving up on counseling, her resistance will be analyzed (Johnson, 2016). These behaviors indicate that she is unconsciously trying to avoid threatening thoughts or feelings. These acts interfere with the ability to accept changes that could lead to a more satisfying life. Deidre will be encouraged to consider what these thoughts and feelings might be as well as how they are an important influence on the client’s mental health (Psychoanalytic theory and approaches, n.d.).
One example of Deidre’s resistance is keeping secrets from her boyfriend, Tom, and using drugs as a way of coping with her anxiety.
Expected Outcomes: Deidre’s anxiety will diminish because of her increased insight into her unconscious drives. She will be empowered to make decisions based on the insight she has gained. Her id, ego and superego will be more balanced and healthier.