Traditional Psychoanalytic Theories
Choose your case
MK is a 15-year-old Puerto Rican adolescent female living with both her parents and a younger sibling. Her parents presented with significant marital problems had been separated several times and were discussing divorce. Her mother reported having a history of psychiatric treatment for depression and anxiety and indicated that the patient’s father suffered from bipolar disorder and had been receiving psychiatric treatment. He was hospitalized on multiple occasions during previous years for serious psychiatric symptoms.
MK was failing several classes in school, and her family was in the process of looking for a new school due to her failing grades and difficulties getting along with her classmates. She presented the following symptoms: frequent sadness and crying, increased appetite and overeating, guilt, low self-concept, anxiety, irritability, insomnia, hopelessness, and difficulty concentrating. In addition, she presented difficulties in her interpersonal relationships, persistent negative thoughts about her appearance and scholastic abilities, as well as guilt regarding her parents’ marital problems.
Traditional Psychoanalytic Theories
MK’s medical history revealed that she suffered from asthma, used eyeglasses, and was overweight. Her mother reported that she had been previously diagnosed with MDD 3 years ago and was treated intermittently for 2 years with supportive psychotherapy and anti-depressants (fluoxetine and sertraline; no dosage information available). This first episode was triggered by rejection by a boy for whom she had romantic feelings. Her most recent episode appeared to be related to her parents’ marital problems and to academic and social difficulties at school.
- Using any of the theories in this unit, how can you explain why the student is struggling, and how you would approach intervention. Be sure to address any limitations based on site environment (school, agency, etc)
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MH Case Presenting Problem:
The client presented at the clinic with concerns of depressed mood, frequent crying at inopportune moments, panic attacks, and chronic pain. Ct is unable to function at his normal level in all areas of his life, and is facing forced retirement from his work of 30 years. The client has limited use of his arm due to injury followed by several surgeries, and he feels that this is the source of his problems. Moreover, he feels out of control, and unable to see an end to his misery.
Background Information:
The client is a late 40’s EA male who lives in the Duluth-Superior area.
Family. The client resides with his wife of 29 years and his son, younger 20s; his mid 20s daughter lives in the same city but not at home. According to the client, he has a good relationship with his family, a very understanding wife who supports him, and a positive relationship with his children. The client noted that several years ago his daughter received treatment for an eating disorder, but that the eating disorder was “her problem. She had us running around all over the place.” When asked, client indicated that his children do not know about his “problem,” and that at times they get frustrated with him for not participating in their lives more fully. The client noted that he was not very close with his father until his dad was dying. Reportedly, the client’s F would go to the garage work space and drink every night. The client described his father as just giving up in life in the end. The client has noted that he and his father are similar in many ways.
Traditional Psychoanalytic Theories
Work/Military Service. The client served in the military, but did not see significant direct combat. After that time, he remained in his position but was discharged and became a civilian employee. The client continues to be employed by the military as a civilian, and has been successfully advancing at the site; currently is a supervisor. At times, he has been called to Washington for his expertise in his particular field. However, currently the client has been off work for 6 months on a disability leave due to a recent surgery. Client described past five years of work as difficult.
Five years ago, the client fell in during a work trip and severely broke his wrist. Since that time, the client has been in continual pain and has had 7 operations on his arm. The most recent fused his wrist together; during this process they had to take bone from his hips and this has limited his mobility. Since the injury, the client noted an increased sense of depression and irritability (denies ability to express anger) as well as frequent experiences of extreme anxiety which would lead him to leave work for an hour to drive around. While working, he has trouble keeping track of where he is in a project – making computation, complex activities, and procedurally based work more difficult. When he realizes that he has lost his place, he becomes anxious and frustrated.
Client is a noted expert in his field, but due to his injury, he will have to retire at the end of this year. He describes proficiency in computer analysis, support, and programming; management of personnel, and applications of mathematical principles. He describes himself as a people person, but prefers work with his hands. Now that he is experiencing less anxiety, he is willing to pursue additional education.
Traditional Psychoanalytic Theories
Social. The client indicated that prior to the past years, he was a very social person – often attending social events with his wife and on the base. The client noted that since he began experiencing intense pain and anxiety/depression, he has limited his social activities, to near nonexistent, and spends much of his time alone in his workshop or in the family room. The client stated that it simply is not worth the panic that he experiences, but that since this has lessened, he is open to the possibility of increasing his interactions with others. However, he indicated that he doubts he will ever feel 100% comfortable functioning around large groups of people or in close interpersonal situations.
Support. The client stated that he has a good circle of friends but that they are very frustrated with him. The client indicated that he does not want to cause them discomfort by his disability, and that this has led him to isolate himself; leaving him with no one to discuss his pain/distress. The client noted that he knows he has support from his wife and children but that he does not want to be a burden to anyone else.
Upon entering counseling, the client would not go to coffee with his friends, but has started doing so in the past few weeks.
Traditional Psychoanalytic Theories
Activities. The client noted that prior to his decreased mobility due to the hip bone grafts, he ran marathons and spent considerable amount of time working. Since the decreased mobility, it is painful for him to walk further than one mile and extended periods of time on his feet in his workshop (hard floor) are difficult for him. The client noted a definite difficulty attending sporting events or arts events due to feeling like there may be no escape. However, he has attended some sporting events with his son and each time had to excuse himself to walk around the concourse for fresh air. In terms of leisure activities, the client has been doing wordworking for many years and finds considerable enjoyment in working in his workshop. He admits that his ability to do so is hindered by not only his decreased ability to stand for long periods of time, but both his functional range of motion for his arm and wrist as well as his difficulty keeping track of complex procedures make it difficult to work effectively on projects.
Psychiatric History. The client denied any past history of mental illness in self of family – except for father’s alcohol abuse. The client noted that for a few years he would go drinking after work, but when he realized that it was interfering with his family life, he quit. The client is currently on a medication for sleep, anxiety, and depression.
Mental Status:
Client presented as neatly dressed and well groomed with no apparent abnormalities in gait. Client appeared of average intelligence with coherent and goal oriented speech.
Client’s mood appeared dysthymic with affect congruent and appropriate for content. Client was oriented X3 with no manifestations of thought disorder. Additionally, the client denied experience of auditory or visual hallucinations. Although the ct’s thought processes were intact, he presents as very concrete with difficulty understanding abstract thoughts. His style is to remain very cognitive. Client’s memory for recent events appeared intact but client complains of an inability to concentrate well enough to complete job. Client denied active suicidal ideations, but did indicate thoughts of hurting himself, and has in the past come close – one occasion thought about driving into the bridge piling and on another went up to his sons room where the guns are kept and sat on the bed with a gun on his lap. The client noted that he would not kill himself because it would hurt his family.
Traditional Psychoanalytic Theories
Instructions:
Your Original Post is due by Saturday. There is no prescribed length for your posts, but they should reflect your own work, exhibit a high level of synthesis of course materials, and reflect a high caliber of scholarly writing. Citations and references are to be included in your responses. Your post should reflect APA 7 requirements.
By Tuesday please respond to 2 peers by:
Asking a probing question.
Share an insight from having read your colleagues’ postings. Offer and support an opinion.
Validate an idea with your own experience. Make a suggestion.
Expand on your colleagues’ postings.
Question 2: Read this article Links to an external site.
- As we consider Freud’s theory and approach to counseling:
- What do YOU think he got right, what do you think he got wrong?
- Do we still see his influence in counseling theories today, and if so, why?
- Finally, are his ideas appropriate culturally respectful and sensitive?
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