Psychotherapy: approaches, applications, and clinical practice

¶ … CCRT method, as used to analyze the case of Ms. A would proceed as follows:

P: Boyfriend does not pay enough attention to Ms. A.

W: Ms. A wants to be accepted and to receive assurance of unconditional love from her boyfriend.

RO: The boyfriend withdraws from her advances and becomes even more distant as Ms. A becomes more demanding.

This pattern has occurred and reoccurred in the patient's life. According to Kassaw and Gabbard, the therapist must be on guard that a similar relationship pattern is not recreated with the therapist (in other words, the woman might be very needy and demanding of the therapist's attention to the point of unreasonableness, then break off the therapeutic relationship if the therapist is not 'there for her.')

The patient's insecurity, according to the psychodynamic approach to therapy, will continue to manifest itself again and again in Ms. A's romantic relationships. However, by reframing the nature of her reaction to what she says is her boyfriend's inattentiveness, a more successful outcome can be realized. For example:

P: Boyfriend is not spending enough time with Ms. A or giving her reassurances of his love.

W: To spend more time with her boyfriend.

RO: Ms. A gives a specific, reasonable request to her boyfriend (such as spending the weekend together to go out to eat and to the movies) rather than constantly demands affirmations of his love.

Q2. The psychodynamic approach to therapy suggests that patients tend to recreate past traumas. In Ms. A's case, she was sexually molested by an uncle, but neither her mother nor her father confronted the uncle (Kassaw & Gabbard 2002: 721). Her father said he was too upset and might be physically violent while her mother did not react with a great degree of emotion. This created a sense of insecurity in Ms. A. Ms. A no doubt interpreted her parents' response as a lack of love. She felt that people would not 'be there' for her when she needed them the most, based upon both parents' failure to react to her molestation.

This lack of a secure sense of self causes Ms. A to seek validation from other people. When her boyfriends do not pass the 'tests' she creates for them, as she becomes increasingly more demanding about apparently inconsequential things, they pull back. The fact that they treat her concerns for validation as inconsequential mirrors how her parents reacted to her sexual abuse. Her boyfriends' refusal to reassure her feels like a great betrayal, rather than a minor argument.