Counseling Case Study Developmental Issues

Counseling Case Study

Developmental Issues of Potential Concerns

Relationship Intimacy, Communication, and Fulfillment

Psychodynamic Perspective

The subject clearly expresses a lack of intimacy, communication, and fulfillment in his primary intimate partnership with his wife. He indicates that he has little contact with his relatives and is dissatisfied with his marital relationship which he describes as lacking emotional intimacy. From a psychodynamic perspective, the counselor would want to understand whether this dissatisfaction and lack of emotional intimacy (from the subject's point-of-view) is attributable to classical psychodynamic conflicts relating to repressed negative emotional reaction to early emotional rejection, the repetition compulsion as regards rejection of emotionally intimate relationships, projection of negative self-concept, and other classic concepts outlined in great detail by Freud (Gerrig & Zimbardo, 2008).

From a psychodynamic perspective, the counselor would want to consider, primarily, whether the subject's complaints about his marital relationship and his lack of intimacy and fulfillment in his other relationships are attributable to issues in his personal psychological profile and development or to issues that are specific to the relationships rather than to the personal psychological profile of the subject (McWilliams, 2004). In that regard, the counselor would want to explore the friendships that the subject refers to as being "close friendships" to consider the evidence of intimacy issues in those contexts.

Specifically, close friendships characterized by good communications and (especially) the absence of trust issues would contradict the psychodynamic origin of the intimacy and communication problems described by the subject (Gerrig & Zimbardo, 2008). Naturally, factual circumstances that suggest similar lack of intimacy and communications quality within the context of friendships would support the psychodynamic origin of those corresponding issues in the context of marital and family relationships (McWilliams, 2004). This distinction would seem to be a crucial focus of counseling inquiry, particularly since the subject indicates that he has never experienced much happiness in any intimate relationship, that he would love to have an intimate partner, and that he does not know what do to help improve his current relationship.

Dialectical Perspective

The counselor would want to consider possible issues in the realm of dialectic issues in conjunction with the identification and analyses of possible psychodynamic issues. Specifically, the same lack of intimacy and lack of intimate communication in the subject's marriage could be manifestations of the classic conflicts described by dialectic theory (Mitchell & Black, 1995). In that regard, the subject could be describing the manifestations of his much higher need for privacy than for transparency within relationships. The subject's description of his marital relationship could also be a manifestation of excessive predictability and insufficient novelty. Finally, the subject's description and complaints about his marriage could be a manifestation of his personal high need for autonomy over connectedness within relationships (Mitchell & Black, 1995).

The fact that many of these possible origins for the patters described by the subject could be indicative of and attributable to psychodynamic conflicts or, alternatively, to dialectic interpersonal communications dynamics highlights the importance of understanding the potential relevance of both schools of though. Naturally, the outcome of the preliminary distinction between these fundamental perspectives would dictate the subsequent approach that would be most appropriate for continued professional treatment.

Issue # 2 -- Purpose in Life

Existential and Biological Perspectives

Several statements made by the subject strongly suggest that the existential perspective may be helpful to his counseling. Specifically, he complained that he believed that his life was lacking in both a direction and meaning or purpose. Similarly, he indicated that does not know how to enjoy his life (Gerrig & Zimbardo, 2008). Certainly, the counselor would want to rule out psychodynamic origins of these perceptions as well as biological origins such as chemical imbalances associated with clinical depression (Gerrig & Zimbardo, 2008).

That consideration of possible biological factors would also include a review of the information of the subject's parents and other ancestors (if it is available) to identify possible genetic components responsible for any depression-related symptoms. Naturally, the subsequent direction of counseling and treatment would differ substantially depending on whether they have a physiological or genetic basis (Mitchell & Black, 1995). Furthermore, the biological perspective would also consider possible influences of untreated post traumatic stress disorder (PTSD) in connection with his statements about depression-related symptoms and difficulty establishing intimate social relationships (Frain, Bishop., & Bethel, 2010).

To the extent the counselor can rule out psychodynamic, dialectic, and biological bases for the subject's expressions of his inability to experience fulfillment in life or to establish a sustained and meaningful direction in his life, the existential approach might be critical. More specifically, the existential analysis would challenge the subject to recognize his personal responsibility for determining his intellectual interests and for identifying the possible directions that he might take toward establishing direction in his life.

Finally, with respect to the biological perspective, the counselor would want to determine the origin of the addictive behavior exhibited by the subject previously in connection with his alcohol dependence. Substance abuse and other dependencies can be indicative of inherited neurological and other physiological elements that are known to increase tendencies toward addiction and substance abuse (Gerrig & Zimbardo, 2008). That analysis would also have to determine whether those addictive behaviors were symptoms of biological influences or merely manifestations of behavioral responses in the form of self-medicating to relieve the anxiety and depression attributable to underlying psychodynamic issues (Gerrig & Zimbardo, 2008).

Spiritual Perspective

This subject also indicates that he is struggling with faith issues. He expresses an intense dislike of organized religions but is less sure about whether or not he believes in a higher power of "God." He's not sure whether or not he believes in God or a higher power, but is certain that he hates organized religions. On the other hand, he indicates an apparent desire for greater spiritual connectedness in his recent interest in Eastern philosophies and in his anxiety about understanding the purpose of his life.

The counselor would want to explore any early experiences that the subject associates with organized religion. In principle, it is not the counselor's role to steer the subject either closer to or further away from organized religion (Adler, 1927; McWilliams, 2004). However, it is fully within the counselor's role to help the subject understand the extent to which his current rejection of organized religion may be a function of specific early experiences that presented organized religion in a negative light (Adler, 1927; McWilliams, 2004).

Moreover, the counselor would also want to explore whether and to what extent any early religious experiences may have contributed to the subject's tendency toward depression-like symptoms and to low self-esteem and self-worth. Specifically, if the subject's more recent lack of ability to enjoy intimacy in relationships is related to his underlying issues of low self-esteem, the counselor would want to identify any possible connection to explicit messages absorbed by the subject in a religious context. Certainly, religious orientation provides considerable benefit for millions of people; on the other hand, religious orientation is not necessary for personal happiness and fulfillment (Adler, 1927; McWilliams, 2004).

In this regard, the counselor's role would simply be to help the subject address any specific negative experiences in connection with early religious experiences that could have triggered his negative impression of organized religion. If the counselor determines that the subject's opinion reflects early internalization of negative self-concepts from religious influence, he would assist the subject address the erroneous and excessively judgmental ideas responsible for his experiences. Alternatively, to the extent the counselor determines that the subject's opinions about organized religion reflect genuine autonomous thought, the counselor would support the subject by helping him understand the existential analysis and, ultimately, his personal responsibility for creating his own meaning and purpose in life (Gerrig & Zimbardo, 2008).

Cognitive Perspective

He subject indicated that he is unsure about what he wants to do with his life because he does not know what his strengths and abilities are. From the cognitive perspective, the counselor would want to help the subject determine his greatest areas of cognitive abilities for the purposes of identifying likely directions of possible vocational fulfillment. (Gerrig & Zimbardo, 2008)

Issue # 3 -- Social Conflicts

Behavioral/Social Learning Perspective

The subject indicates that he does not trust governmental or authority figures and that he feels that he has been "fighting something" throughout the course of his life. These statements would have to be considered from the psychodynamic perspective to identify any possible root in the Freudian concepts addressed in psychodynamic analyses. To the extent that psychodynamic influences can be discounted, the counselor would examine the potential influence of social learning and behavioral responses to previous experiences. Specifically, the subject was involved in an extremely controversial war at a time when the nation was embroiled in bitter discord about the nature of civil liberties, personal identity and autonomy, equal rights, and the rightful role of the United States armed forces in overseas conflicts.

Those issues could potentially be the source of the subject's statements about being in a "survivor" mode (Frain, Bishop, & Bethel, 2010). In that regard, the counselor would want to explore any possible connection between the social turmoil that might have been responsible for generating his subsequent social disillusionment. To the extent the counselor determines that the subject's social disenfranchisement is attributable to his involvement or response to those social conflicts he would assist the subject evaluate the objective conclusions and expectations that have shaped his outlook as an older adult in substantially different social circumstances and living in a very different society than the one responsible for his feelings about government representatives and authority figures in general (Gerrig & Zimbardo, 2008).

B. Preliminary Hypotheses of Main Apparent Problems

Hypothesis # 1 -- Multiple Causes of Intimacy Issues

First, it is likely that there are multiple concurrent causes of the subject's apparent difficulty establishing and maintaining close intimate relationships and effective communications within his marriage. The psychodynamic perspective teaches that it is relatively rare for human beings to reach adulthood without at least some psychological influence from residual conflicts originating in classical Freudian psychodynamic concepts (McWilliams, 2004).

Second, it is also likely that dialectic dynamics play a role in the communication insufficiency in the subject's marriage. Specifically, it is a ubiquitous feature of gender-based differential socialization, social learning, and social expectations in relation to gender-specific expectations and communications patterns, particularly in intimate relationships between men and women (Gerrig & Zimbardo, 2008).

Hypothesis # 2 -- Typical (i.e. Non-pathological) Identity Confusion

The existential approach teaches that a significant percentage -- if not a majority -- of adults never reach the higher levels of self-actualization described by Maslow (Gerrig & Zimbardo, 2008). Likewise, many adults spend much or all of their adult lives either ignoring, or sublimating their personal insecurities and lack of genuine self-esteem into superficial means of overcompensating for internalized negative messages and poor self-image. In many cases, social learning, family-of-origin dysfunction, and negative religious influences (such as teaching that natural impulses, desires, and thoughts are sinful) are responsible for undermining the development of healthy self-esteem (Gerrig & Zimbardo, 2008). It is likely that some of this subject's reactions to relationships and his inability to maintain intimate satisfaction and communications have multiple concurrent origins in all of these areas, as is very typical throughout the human community (McWilliams, 2004).

Hypothesis # 3 -- Residual Psychosocial Trauma from Vietnam Era

Social learning and behaviorism teach that the individual is highly susceptible to the influences of the external environment in which he lives and interacts with his community (Gerrig & Zimbardo, 2008). Many of this subject's apparent conflicts with his society and authority figures, and his disenfranchisement and difficulty identifying a fulfilling direction in his life have connections to his experiences and circumstances during and immediately after his wartime experiences in Vietnam.

Frequently, soldiers and others who survive traumatic environments in which they witness the death of close friends experience confusion, so-called "survivor's guilt," and subsequent disillusionment in life (Frain, Bishop., & Bethel, 2010). It is likely, therefore, that much of this subject's difficulty in these areas relate directly to his experiences as a soldier. Those concepts would explain the difficulty that the subject has had establishing a vocational identity and a fulfilling direction in life as an adult.

C. Possible First Counseling Steps

Possible Counseling Step # 1 -- Exploration of Early Relationships

Since there is a good chance that at least some of this subject's complaints relate back to early experiences in connection with psychodynamic principles, the first possible counseling step would be to inquire into psychoanalytically relevant experiences and early relationships (McWilliams, 2004). I that regard, it would be particularly important to understand the family dynamics of his family of origin and his relationships with and feelings about his parents. Ideally, that exploration should also include an examination of the communication patterns that were modeled in the home as between the subject's parents as well as any explicit teaching about male and female roles and relations (Gerrig & Zimbardo, 2008).