Posted: December 3rd, 2022

Clinical Practice

Clinical Practice
First Scenario
Question 1
Michaela uses ego defense functions to determine who she is based on her actions, thoughts, and perceptions towards others and how she treats them. She is overusing the ego function of self-directness and the degree of agency. In this regard, Michaela tries to be in control of every aspect of her life, and she feels responsible for the outcomes even though they might be beyond her control. For instance, after realizing that the partner she thought she loved and ‘pushed away’ had married one of her old friends, she feels a tremendous sense of regret and loss. This shows that she is significantly invested in controlling the turn of events in her life.
Moreover, she feels guilty about ending her relationship with Laura even though she knows that the relationship does more harm than good. The sense of responsibility of being in control also makes her think that she can change everyone who is in her life, which is the reason for not leaving Laura and also the reason why she felt the burden of being a parent during her childhood instead of allowing her mother to do the same. It can be deduced that Michaela is a low agentic individual who views life as one that is happening to her and not for her as she seems to rely on the whims of fate.
Question 2
The object relations theory focuses on psychoanalysis as it is structured around interpersonal relations, especially between directly related family members. According to Holmes (2015), the approach emphasizes on the inner perception of self and others while also determining how such images manifest in the respective individual’s interaction with others. The theory relates to Michaela’s case in the sense that her relationship with her dad, despite being an absent father, was based on Michaela’s frequent need for his approval. However, it seems that he often rejected her. Such a relationship affects Michaela’s intimate interactions, whereby she appears to be more focused on seeking the approval of others and meeting their needs despite them being abusive or toxic to her. She goes to the extent of feeling remorse when things do not turn out the way she would want them to.
Question 3
To address the predominant needs arising from this clinical case and improve my work with Michaela, it is imperative to incorporate the approach of shared trauma. According to Tosone, Nuttman-Shwartz, and Stephens (2012), is an effective and reliable multi-modal approach that I could use as a clinician from the dual exposure experienced as the collective Michaela’s trauma from childhood. Since I share a similar childhood scenario with her where the father was absent, and my mother was physically and verbally abusive, I can be more empathetic and compassionate towards her. This would lead to the substantial establishment of the core issues and the implementation of effective strategies for handling them.
Second Scenario
Question 1
In the case of Gregory, transference and countertransference are prevalent throughout the sessions. An example of countertransference is the prioritization of the client’s needs offering advice to Gregory rather than listening to his feelings and experiences. According to Comas‐Díaz and Jacobsen (1991), transference occurs when the clinician redirects their urge to tell Gregory that they feel the same way about their uncle and understand exactly what Gregory is talking about. Although it is difficult, the clinician focuses on the feelings and experiences of the client instead of their personal experiences, which are similar to those of the client as they grew in the same environment while sharing the same culture and experiences from childhood.
Question 2
Self-psychology relates to the gradual recognition that some of the challenges a client experiences are based on the development of a solid sense of self and self-esteem regulation over a certain period and space. This explains Gregory’s lack of adherence to the timelines and schedules of our meetings and his perception that I understand the importance of his priorities, although they might tamper with the development of our sessions. He excuses himself to pick a call during a session and hopes that I understand, which means that he has a strong sense of self-cohesion that determines his responsibilities and priorities.
Question 3
Based on the class readings, I would describe Gregory as a ‘difficult’ patient. This is because he understands the contexts of his situation and the source of his problems, which would require some time to reach a mutually agreeable approach towards finding a solution for his troubles. Considering that he has a strong measure of self-recognition, it would be challenging to work with him towards changing some of the ideas, values, and beliefs that drive him and determine his behaviors and actions. Some of these values he may have adopted for a long time, which makes them part of who he is as an individual. To address Gregory’s resistance, I would ensure that I have managed to convince him that I share his childhood experiences without compromising the clinician-client relationship. This would help me reach his vulnerability to promote an effective and successful psychoanalysis and intervention session.

References
Comas‐Díaz, L., & Jacobsen, F. M. (1991). Ethnocultural transference and countertransference in the therapeutic dyad. American journal of Orthopsychiatry, 61(3), 392-402.
Holmes, P. (2015). The inner world outside: Object relations theory and psychodrama. Routledge.
Tosone, C., Nuttman-Shwartz, O., & Stephens, T. (2012). Shared trauma: When the professional is personal. Clinical Social Work Journal, 40(2), 231-239.

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