Transference the Miracle Question and the Ideal Self

Case Study: Colin

Introduction

Colin is a 54-year-old male seeking counseling for what he describes as being in the “benefits trap”: he has gotten used to having free time and pursuing hobbies due to time off work related to a physical accident. He is reluctant to return to work, citing issues of stress and anxiety, but he also knows he needs to return to work in order to enhance his income and repair his relationship with his wife. The most important psychological issue within the case study is the gap between Colin’s cognitive understanding of his situation and his behavior, which he wants to modify so that it is more positive and less harmful. He cites drinking, depression, a difficult relationship with his wife, and social anxiety as the main problems he faces. The general issues raised within the case study are his lack of self-confidence and motivation to return to work in spite of the apparent recognized need to return to work. The primary issue affecting Colin is depression.

This paper will discuss how counseling psychology theory might be used to explain Colin’s current psychological experiences by focusing on a cognitive understanding of depression, a psychodynamic understanding of depression, and a humanistic understanding of depression. It will then provide the recommended counseling psychology interventions for Colin.

How Counseling Psychology Theory Might Be Used to Explain Colin’s Current Psychological Experiences

1. Cognitive Understanding of Depression

As Ellis shows, the cause of unhappiness and negative thinking patterns are important in establishing a cognitive understanding of a client’s condition (Cruickshank, n.d.). Common irrational thoughts that hinder a client’s progress include performance perfectionism, fear of failure, and conflict phobia. Colin exhibits each of these irrational thoughts, as he avoids going back to work for fear of the stress he might experience when the work becomes too challenging for him. He also fears that he lacks the social skills needed to interact effectively with others. These fears underline his lack of confidence in himself. What has to be remembered for a cognitive understanding of Colin’s depression is that a person creates his own world view. People have free will, responsibility and control. Colin has the tools to move forward in a positive and healthy way; he only needs to recognize them and implement them.

2. Psychodynamic Understanding of Depression

As McLeod (2013) notes, “The aim of psychodynamic counselling is to help clients to achieve insight and understanding around the reasons for their problems, and translate this insight into a capacity to cope with current and future difficulties” (p. 81). While this is the aim of all counseling, psychodynamic understanding places special focus on the idea that behavior is deterministic and shaped by experience. Unconscious thought, as Freud notes, is repressed because it is considered unacceptable. Selfish needs are often a character of the unconscious. In Colin’s case, he desires time to pursue his own hobbies and interests. He is in his mid-50s, which is often when one begins to dream of retiring from work and pursuing a life that is more his own. Colin fears returning to work because he believes he will be unable to manage a balanced work-life ration wherein he can work but also have time for personal hobbies. According to Freud’s structural model of personality, the EGO, which is governed by the reality principle, must govern the needs and wants of the ID, which is the pleasure principle. Colin’s EGO is unable to govern the ID effectively from the standpoint of this model. The SUPEREGO, which is the moral angel that uses guilt to regulate behavior, is working to make Colin feel guilty, which is why he is pursuing counseling. However, the SUPEREGO can lead to perfectionism, which can be harmful to one’s behavior, as it leads to excessive punishing. The EGO must maintain a balance between the ID and the SUPEREGO in Freud’s model (Introduction to Pyschodynamic Theory, n.d.). For Colin, this balance is the ultimate goal that he would like to achieve, but he is uncertain of whether he can or how to achieve it. This is the primary cause of his depression, which he attempts to treat through avoidance and drinking.

3. Humanistic Understanding of Depression

Person-centered therapy provides a humanistic approach to promote self-actualization. The existential model does as well by focusing on the whole person, interpersonal relationships and self-awareness. The goal of this approach is to understand the client’s world view and to help him to see that anxiety is normal, everyone has desires and fears, and that some things are beyond one’s control but this should not be viewed as a deterrent. Colin is anxious because he believes he cannot get back to the way things were when life was good. He needs to understand to accept life as it is now and work towards congruence between his actual self and his ideal self-image. Colin’s ideal self would be able to work and bring in the money he needs to make the necessary maintenance at his home; this would also facilitate a better relationship with his wife, who sees his reluctance to work as a problem. At the same time, he likes the idea of being able to pursue his own hobbies on his own time. A balance can be achieved by applying the humanistic understanding of depression; all it requires is for the counselor to put himself in Colin’s shoes and experience the world through Colin’s eyes. By demonstrating empathy, the counselor would help Colin to understand his own life more deeply and feel justified in finding the appropriate balance that he seeks.

Recommended Counseling Psychology Interventions

The 5 P’s model allows counselors to assess and intervene at the same time by promoting client individualization. The presenting problem for Colin is his inability to manage his anxiety about returning to work and the depression that he experiences as a result. Predisposing factors include his tendency to drink, his desire to live a retired life, and his social anxiety. Precipitating factors are his relationship with his wife, which has deteriorated. Perpetuating factors are his lack of confidence in his ability to manage any positive change. Protective factors are his willingness to seek counseling so as to make improvements.

CBT

The counseling psychology interventions to be recommended are cognitive behavioral therapy, psychodynamic therapy and the humanistic approach of person-centered therapy. Cognitive behavioral therapy (CBT) will help Colin to identify the triggers that cause him to want to drink and avoid the society of others. Once these triggers are identified, he can then focus on identifying on behavioral and cognitive strategies that can be implemented so as to counteract these triggers and keep him in a positive frame of mind. The goal is that over time these strategies will become habitual for him and he will no longer feel defeated by the negative triggers that were previously weighing him down and preventing him from moving forward in a healthy manner.

CBT has been found to be a superior approach to using antidepressants because it focuses on structural changes within the lived-life of the client and is a tool for self-empowerment (Butler, Chapman, Foreman & Beck, 2006). One technique that could be used in CBT is to pose Colin the “miracle question,” which would allow him to consider his situation in a new light. The miracle question is a method in which Colin would have to answer how he would live his life if he woke up one day to realize his problem was gone: his depression was cured, he had no more anxiety, and he could go about his life without any of the troublesome feelings he has experienced in the past: what would he do now? The point of the question is to get him thinking about positive steps he would take if freed from his problems. For instance, he might answer that he would immediately return to work so as to be able to afford the maintenance required on his home. He might also answer that he would make time for himself to pursue his hobbies on the weekend, or cut out drinking, or focus on finding ways to make his wife’s life a little bit more pleasant. The idea behind the miracle question is essentially the same idea the drives CBT: it is about focusing on positive cognitive and behavioral steps that the client can take to supplant the negative thoughts and patterns of behavior that otherwise prevent him from living a satisfying life.

Guided discovery can be another technique that may help Colin to understand himself more fully. As he discusses his viewpoint, the counselor can direct Colin to explain why he feels that way. The counselor can ask questions that might challenge his beliefs or assumptions. The point is to get Colin to think about other perspectives that differ from his own. By considering his wife’s perspective, he may be able to develop a greater degree of empathy for her and for his own issues.

Psychodynamic Therapy

Psychodynamic therapy will help Colin to address his issues of avoidance, denial and alcohol misuse. Currently, his EGO is driven by the competition between his ID and SUPEREGO rather than being the driver in that dynamic. His ID compels him to seek his own selfish needs, while his SUPEREGO makes him feel guilty for this. The EGO is unable to keep a balance between the two. He does not realize how he is repressing the ID because of the SUPEREGO’s influence of guilt. He feels the guilt, which is why he is pursing counseling, but he also feels that he cannot manage the selfish desires to live a life of retirement or to balance those desires with his need to be responsible for his home and his wife. His EGO is under attack from two directions and as a result he has sought to avoid the problems facing him and to deny them by engaging in drinking.

The psychodynamic therapeutic approach can help Colin to understand that the job of the EGO is to maintain an equilibrium between the demands of the ID and the moderation of the critical SUPEREGO. His psychological problems are the direct result of his EGO failing to maintain that balance. Talking therapy can help Colin to bring this issue to light as it will enable him to recognize his own defence mechanisms and how he uses them to avoid his own troubles. This approach dovetails with CBT in that by recognizing these defence mechanisms, Colin will be better able to identify the triggers that keep him from responding in a positive manner to the issues he avoids.

Freud pointed out that everyone dislikes anxiety and will adopt a range of behaviours to avoid it. The problem for Colin is that avoidance exacerbates the problem. By presenting himself for counselling he is already taking the first step towards addressing these issues and he should be commended for that because it shows that he is ready to begin asserting his EGO in a more constructive manner. What needs to be done, however, is to help him cease from projecting his problems onto others. He does this by indicating that his wife’s anger towards him has led to an increase in his drinking and that he does not want to return to work because he fears the social situation there. He is projecting his own negative feelings onto others instead of taking responsibility for them. He is acting as though they are to blame when really he is the one responsible for his own actions.

Freud also notes that when one is faced with pain or discomfort or failure he tends to become immature and behave as a child. This is called regression. Colin has regressed in the sense that he is no longer acting like a capable adult: he has allowed his momentary set-back to derail him from leading an active and productive life. The counselor should be on guard against transference, wherein Colin might transfer feelings to the therapist. If it occurs, the counselor can be most helpful by establishing a helping relationship so as to unearth emotions that can then be worked on, leading to the formation of a strong working alliance with Colin. That approach will dovetail nicely with the humanist/person-centered approach in which Colin can begin to feel as though he truly has someone in his life who is empathetic towards him. Additionally, by releasing negative emotions, Colin may experience catharsis, i.e., the ability to process emotions and purge the negative feelings from within.

The purpose of psychodynamics in Colin’s case is to help him to make the unconscious conscious, so that he can understand and reduce the negative experiences of his life. It is consistent with the CBT approach in that it focuses on becoming mindful of the unhelpful behavioral patterns that prevent one from engaging with life in a positive manner. The aim is for Colin to take healthy control of himself and develop a sound adult relationship with his wife and those around him in the workplace.

Humanist/Person-Centered Approach

The humanistic/person-centered approach will help Colin because it will provide him with an empathetic relationship that can help him to grow and develop in a way that benefits him. Currently, the only relationship he has is with his wife, and she is antagonistic to his current state of mind. She does not empathize with his needs, and he requires empathy before he can proceed with any self-confidence. The goal of this approach is to provide Colin with congruence and positive regard as well as to collaborate with him in developing a path forward that helps him to bring his ideal self and actual self into alliance. Managing countertransference is important here and the counselor should provide self-disclosure and rely upon feedback (Asay & Lambert, 2002). By developing a positive relationship with Colin, Colin will feel more empowered to repair his own relationship with his wife. One suggestion that could come about during this approach is that family therapy be applied so that both he and his wife can receive counseling together. This way they will be more aligned in their relationship and will be able to appreciate the views and needs of one another in a manner that is empathetic.

In this approach, the counselor is there to act as a sounding board by engaging in active listening, reflecting back to Colin what he is saying and affirming his voice. By reflecting back what Colin has said, the counselor can help him to understand and clarify his own thoughts and feelings better. Before progress can be made in identifying problems, Colin has to feel secure in his perspective and in his person, and that can come by way of clarification and having a good listener.