Psychodynamic case conceptualization: Intake assessment and presenting problem themes

Psychodyanamic Case Conceptualization

Intake

The client is a 55-year-old European-American male named Gary, who is divorced from the only woman he had romantic involvement with 20 years ago. Gary raised three children when his wife left after 16 years of marriage. Gary's life is stable and predictable and due to very little changes in his life, the threat of change makes Gary anxious enough to contemplate suicide. Gary has lived on family property all of his life that the family has held since the 1800s and he has worked at the same job for 35 years, driven the same car of 20 years. His home is dusty and neglected and the house has not been properly cleaned in years. As well, the client does not eat properly and avoids addressing the issues in his life that result in the client caring little for his own needs.

Themes/Clients Presenting Problems

Gary's complaints include low levels of energy and lethargy and he does not sleep but four hours at a time and is experiencing tension in his jaw as well as frequent headaches. The client is very focused on a lean subsistence because he does not know any other way for himself being the youngest of six children. The client does not expose himself to porn, violence, abusive speech and he does not do drugs. The client does not appear able to be assertive or aggressive and is polite and passive in his encounters with others.

III. Statement of Likely Defense Mechanisms

Gary is attempting to preserve the 'status quo' in his life by ensuring that nothing in his life changes, including the dust and dirt in his home. It appears that when his wife left him that time stood still for Gary and that he was unable to move forward both literally and symbolically. Gary is highly fearful of any type of change.

Cognitive behavioral therapy would serve well in treating Gary's issues through gaining his acknowledgement of what he is doing and how these actions or inaction is serving to stall his life out and keep him rooted in the past. The client is likely to present in therapy with issues about his own self-worth and he is not likely to openly address any issues he may have with the treatment regimen.

The client is likely to watch the clock during his sessions because he will be attempting to avoid using more time that he is allotted because he does not want to be a burden to the therapist. As well, the client does not appear to be overly concerned with his own well-being in that he does not keep his home clean and he does not eat as he should both of which are a cause for concern due to the physical ailments that the client presents with.

IV. Statement of Potential Transference and Counter-Transference Issues

The client is likely to believe that the therapist is not as concerned with him as with other clients and that he is not important to the client because of the way that he felt as the youngest of six children. Gary is likely to feel that he is 'in the way' of the therapist and that, his issues are not important to the therapist.

Feelings of counter-transference on the part of the analyst is known as subjective countertransference and involves any unresolved issues of the therapist while objective countertransference has to do with the feelings that the patient induces in the analyst that provides information about the patients feelings and transferences and enables the therapist to feel how the patient felt toward himself and how his mother felt toward him and how he felt toward his other and how he wished his mother felt toward him." (Rathe, 2008, p.1)