The Margarita Case Study: An Application of Adlerian Theory and Therapeutic Techniques
Margarita is a twenty-six-year-old Puerto Rican woman who has lived in the United States since she was a teenager and is married to a thirty-six-year-old African-American male. The couple has two children, a three-year-old boy and a one-year-old girl, and Margarita has also recently been accepted into law school following earning her MBA. Both members of the couple hold prominent positions in their community. Recently, Margarita has been prone to bouts of depression and fits of inexplicable rage against her husband, including one incident in which she threatened her husband with a knife. No actual violence has occurred, according to Margarita, and she herself cannot explain why she has these outbursts against her husband -- she only knows that she feels a sense of relief after they occur.
The relationship between Margarita and her husband is obviously put under a great deal of strain by the current state of things, though her husband seems very accepting and forgiving (possibly to the point of enabling). In addition, the fact that Margarita is the mother of two young children has an impact both on the particulars of the case and the necessity of reaching a positive outcome in an efficient manner. Choosing the right theoretical model could be crucial in leading to an effective outcome. Due to the number of significant life changes that Margarita has experienced and is experiencing, the Adlerian approach to psychotherapy could be an effective theoretical and therapeutic approach in this case.
The Adlerian approach places some initial emphasis on sibling birth order (Corey 2009). Though his information is not explicitly given for Margarita, it is implied that she is an only child (there is a reference in the case first to her parents and husband, and then to them all collectively as "her family," suggesting there are no other nuclear relatives). Adler supposed that only children could become spoiled due to overindulgence, and though subsequent research has questioned this conclusion it has been demonstrated that certain social interactions can be more difficult for children without siblings (Eischens 1998). This, along with certain other specific Adlerian conclusions involving specific changes to lifestyle and to one's stations and roles in life, will contribute greatly to the development of an effective analysis of Margarita's situation and the provision of psychotherapy to her.
The goals in this therapeutic approach are of paramount importance, as it is a focus on outcome while making significant lifestyle and perspective changes that typifies Adlerian psychotherapy and the client experience during therapy (Corey 2009). Discovering the root of Margarita's anger and building her necessary self-confidence and sense of self-worth so that the energy funneled into this anger would find a new and more beneficial outlet would be primary goals for therapy in the Adlerian model (NASAP 2011). These goals will have the most immediate practical effects for Margarita and will also lower the degree of tension she is experiencing, making it easier to address other issues (Hazan 2001).
Other specific goals that will be set as outcomes for therapy will include addressing Margarita's underlying depression, and examining her relationships with each of the members of her family -- her parents, her husband, and her children. It is believed in the Adlerian perspective that increased confidence and a sense of gratification leads to a greater desire for cooperation and a greater ability to cooperate, meaning that certain relationship issues should start to mend as the central lifestyle and perspective changes are addressed through ongoing therapy (Adler Graduate School 2011). Specific attention would also be paid to these relationships both as instances of unhealthy patterns and as possibilities for building new networks of trust, confidence, and mutual benefit and satisfaction (NASAP 2011).
Application of Therapy
There are four distinct phases of Adlerian therapy, each building on the last and requiring truly successful completion of each successive phase for the therapy as a whole to be meaningful (Corey 2009). The first phase consists of establishing the proper therapeutic relationship, which includes person-to-person contact rather than immediately addressing "the problem" (Corey 2009). Especially for a woman like Margarita that has no friends and was likely an only child, establishing this initial contact, trust, and sociability can be very difficult, and may in itself be somewhat therapeutic for the client if properly achieved (Corey 2009). Next is exploring the individual psychological dynamics of the client, allowing them to frame the issues as they see them before the counselor addresses them (Corey 2009).
Phases two and three of therapy might prove highly difficult for Margarita at the beginnings of each phase. Phase three consists of encouraging the development of self-understanding; the introspection that is required both to frame the issues in phase two and to develop greater self-understanding in phase three is something that Margarita has already shown a resistance to in her life. Her inability to understand the source of her anger and frustration is a major part of her problem, and it is obvious that there are major issues Margarita is not being honest with herself about. Once these barriers are overcome, however, helping Margarita to make new choices should be relatively easy, as she clearly has a desire to change even if she is resistant to understanding her problems. This fourth and last step will include finding ways to ensure she receives the support she needs form her relationships, while understanding her own necessity and worth in these relationships (Corey 2009).
One of the key features of the Adlerian approach to psychotherapy is the imperative for the therapy to be largely client-driven (NASAP 2011; Adler Graduate School 2011). It is through the client's own framing and definition of their problems that these problems are identified and addressed, explicitly allowing for cultural perspectives, preferences, and values to emerge and become embedded in the therapeutic process (Adler Graduate School 2011). This will be of enormous benefit for Margarita, given that certain cultural and intercultural pressures might have a great deal to do with the fundamental problems she is experiencing.
The fact that Margarita grew up in a foreign culture (regardless of the fact that Puerto Rico is a territory of the United States) and is now art of an interracial relationship might have created the impression of certain pressures, expectations, and stereotypes especially given her rising status and considerable achievements. If Margarita feels that she is experiencing any such pressures or being held to nay such expectations, whether or not this is actually the case, it would necessarily place specific psychological strains on her relationships with herself, with her parents, and with her husband -- potentially with her children as well. If any such racial or cultural pressures exist, the Adlerian approach to psychotherapy will allow these issues to come to the foreground through examinations of Margarita's relationships as she views and describes them, without judgment or preconceptions (Adler Graduate School 2011).
There are also some definite limitations with the Adlerian approach to psychotherapy in Margarita's case, however. Because this therapy is built on changes to Margarita's basic understanding of herself and her relationships with others and with the world at large, there are very few quick fixes that can be suggested from the Adlerian perspective to help mitigate some of the more immediate issues she is facing (NASAP 2011). The outbursts of inexplicable rage against her husband, for instance, will be dealt with in this perspective by developing an understanding of where this anger is coming from and relearning methods for handling anger and other strong emotions, not with quick anger-releasing exercises.
Other limitations in the Adlerian approach to psychotherapy as outlined above include a lack of familial inclusion and a lack of effective planning for impending changes to Miranda's life.…