Character analysis and development in literature

¶ … Person-Centered Therapy: Judy Garland

The phenomenological person-centered therapeutic approach to psychiatric patient care is an approach that says that which is perceived as being real for the patient is the patient's reality, and therapeutic approaches must be focused on the patient's reality. Resolving patient's conflicts from that perspective and from that therapeutic approach direction, any issues that are the reality of others, including those of the therapist are put aside, and conflict resolution is derived wholly from the patient's own consciousness and becomes a patient focused perspective.

The patient case study presented here is one of a well-known celebrity figure: Judy Garland. The idea is to follow the phenomenological therapeutic theory in treating

"Ms. G," to resolve her problems of: alcoholism, prescription drug addiction, and suicidal ideations (without a plan). Ms. G. presents for the first appointment. She is neatly dressed in a conservative and socially situational appropriate suit. Her case file history and physical (H&P) shows that she is physically healthy, although the primary care physician expresses concerns about her alcohol intake, and prescription drugs for pain and sleeping symptoms that may be psychosomatic in nature. The H&P also reports concerns with the patient's smoking habit, especially since the patient is a singing artist as well as an actress, and smoking is an of her physical skills and abilities contributing to her support, and that of her dependent children. The two dependent children are both young girls, the product of two of the patient's many failed relationships.

The patient appears nervous, shy, and anxious. She avoids eye contact when speaking, but is forthcoming in speaking about herself. She expresses a fear of new situations, new places and people she has never before met. She smokes while she talks, and it is noted that there is a tremor to her hand that is probably indicative of her alcohol use. She readily admits to her alcohol use, and expresses her own concerns about that use, agreeing that it is excessive. She describes her use of prescription pain medication as necessary to alleviate the excruciating pain of the migraine headaches from which she suffers. Sleeping pills, she says, are necessary, because she keeps odd hours due to the nature of her work, and she finds it difficult to sleep. The patient states she has insurmountable fatigue from her work schedule, but, then, especially after live performances, finds it difficult to sleep. The patient, when asked, states that she has no physical exercise routine, but that her live performance often involve dancing, and she thinks of that as physical exercise.

Asked to talk about her family, the patient has a noticeable physical action of withdrawal. She becomes defensive, explaining that her "girls" are well taken care of. That, for now, each one is spending some quality time with their father, because she is in between living arrangements. The patient states that she speaks to her children every day over the telephone, and that even though she misses them very much, she must work. She is quick to point out that in her line of work people who aren't seen are quickly forgotten. She must stay active in performing and filmmaking, she says, or the opportunities for work will not come to her. Efforts to take the conversation in the direction of her family result in evasiveness, and reluctance to talk about her children. The patient automatically redirects the conversation back to her work as a stage and film star.

The patient is less reluctant when speaking about the fathers of her children. They represent her failed marriages, but she has had numerous other failed relationships. The failed marriages, she says, had a lot to do with the fact that her work involved extensive periods of travel, and being away from one another. She states that the two fathers are good men, who love and support their daughters. This, even though the patient admits to being "in between" living arrangements at the present time, and says that she is having a difficult time financially, because she has not had work in film for more than a year, and it has been six months since her last stage work. She floats the idea that she is concerned that her drinking may be impacting her ability to get work. This is the extent to which the patient has so far admitted her behavior as a problem in life.

The patient states, too, that she has never sought therapy before, and that she really didn't believe in it. Today, however, she awoke to the strangeness of a friend's guest room, and began crying uncontrollably. She was not able to stop crying, and her friend, who is a patient, brought her here.

Asked to speak about her immediate family, mother, father, siblings; the patient says that her mother was a nervous woman. Her father, she says, was a hard worker, a good provider, but when he died, it left the family without their main source of support. At that point her mother and older sister and brother took work. She says she was left in the care of the grandmother, who was cold, unhappy, and often times mean to her. She says the maternal grandmother did not like her father, and often spoke badly about him, saying that he was worthless. She says her grandmother remarked on her father this way everyday, and that the more she remarked on him, the more she felt hurt by her grandmother's comments.

The session ended here for today, and it was agreed that the patient, who left saying she felt better, would return the following week for an hour long appointment. When the patient expressed concerns about paying, I reassured her, telling her we would work that out. I offered her once a week pro bono sessions until she got back on her feet.

Assessment found the patient forthcoming for the most part. There is much here to be explored and resolved before this patient can fully resume her responsibilities and role as a mother, or as a performer. Right now, however, she seems to have an improved outlook by just this first session, and appears relieved that she will have additional sessions of therapy.

The patient is minimizing her alcohol use, though it is an open subject as she admits that her alcohol use may be the reason why she has had problems being offered work. Her alcoholism is having a negative impact on her life, and needs to be resolved. At this point, however, the patient claims to experience migraine headaches, and claims to need the pain medication that has been prescribed for her. The way in which she describes her inability to sleep following periods of work, sounds very much like manic episodes that are often experienced by manic depressed individuals. The patient, however, remains in denial about many of the issues in her life.

Treatment Plan

The plan for this patient is to pursue her therapy from a phenomenological patient centered approach. This is to understand that the patient's level of perception emanates from her own level of consciousness about her environment and the world around her. The first step, however, is to help the patient modify her behavior in a way that causes her to be free of alcohol and prescription drug dependence. For this reason an effort will be made to explore with the patient her perceptions on these issues as it pertains to prescribed course of outpatient treatment, and Alcohol Anonymous for support in reaching and maintaining sobriety. The next session will be devoted entirely to exploring with the patient her own strengths that could help her find sobriety, and to maintain that sobriety in a business that involves a lot exposure to alcohol, prescription drugs, and other behaviors that are not necessarily conducive to maintaining sobriety. Although this is not to say that it cannot be done, but it begins with helping the patient to realize her own strengths in order that she can depend upon herself before she depends on alcohol or drugs.

The patient suffers from low self-esteem. Even after having accomplished much in her life and after having contributed the film and stage industries in remarkable ways, patient's perception of herself as worth of the success she has experienced as a result of her acting and musical abilities. This is not uncommon amongst people who suffer from manic depression, and while more work and tests are necessary to make that diagnosis, it is strongly suspected at this point.

Right now, the patient suffers from an inability to find value in herself as a parent, and feels that her children are better off with their respective fathers. It is important to help the patient modify that perception of her self. This can be accomplished through family therapy sessions. The patient's daughters are at an age where they able to understand at some level the problems their mother is experiencing. The children will be brought into the family therapy sessions, as will the ex-spouses, because even though they are divorced from the patient, there remains that familial connection through the children that suggests that their support of the patient would be useful in improving the life and well being of their respective children. This, however, will remain the choice of the patient, but the hope is that we can bring about a change in her level of consciousness such that she might recognize for herself a benefit in that involvement with the children's fathers.

Imperative to helping the patient realize her value in her abilities, skills, and other qualities associated with motherhood and her career that will help her to see her role and herself differently. This will help her with some of the confidence issues that she experiences in meeting new people and going to new places. There is perhaps some minimal issue of panic attack syndrome, but that, too, requires more in depth work and additional sessions to arrive at that conclusion. If the patient's panic about new places and people subsides as we address some of the self-esteem and family issues, then that will not be a problem. if, however, as work brings about positive changes in the patient's consciousness about how she perceives herself as a mother and performer, and the sense of panic continues upon meeting new people or going to new places, then we will have to address that as an aspect of the patient's therapy.