Assessment and Treatment of a Psychological Disorder

Case: Jane

Jane is a 32 years old lady, separated from her husband and homeless. A closer examination reveals that she has a mental health condition which requires an immediate response in order to ensure her full recovery. Raised in a family of four, Jane recalls that her parents divorced when she was five years old. She was taken custody by her mother who was to die three years later from breast cancer. Additionally, her father was involved in drug trafficking and gang activities that eventually earned him a lengthy jail term at a local penitentiary.

On the other hand, Jane’s three elder brothers followed on the footsteps of their father leading to a murder of one of them from gangster territorial conflict activities. The rest are facing numerous charges related to drug activities and murder. With such a dysfunctional family, the death of Jane's mother, when she was 8 years old, led to her adoption by her mother's sister Mary. However, Mary’s family had its woes either; with her abusive husband coming home late and drunk and at times physically abusing Mary and her two children. Other times, he would physically abuse Jane, the adopted child too. A notable extreme case that is recalled by Jane is that when she was 11 years of age, she was forcibly raped by Mary’s husband. The inhuman activity was subsequently followed by a life threat to Jane in case she discloses the barbaric act, especially to Mary. Therefore, for years Jane withheld the dark secret with difficulty. Remarkably, she has been experiencing dreams and nightmares concerning the events that took place during the rape and the subsequent rape threat.

To dissolve her woes, she would abuse drugs such as bhang and cocaine. Also, she became a regular smoker and an alcoholic. By 20 years, she decided to undergo a self-initiated transformation, which took her painful and lengthy three years. When Jane was 26 years of age, she had a brief marriage period. The marriage did not last as she found out that she could not comfortably have sex with her husband. Most of the times, the sex act turned to be full of trauma on her part, as she had a psychological notion and a mentality that her husband was replicating the act that his step father did decades ago. Jobless and with no family to go to, Jane resorted to a street lifestyle ever since she separated with her husband. Notably, her husband has remarried. Jane further says that she has on several occasions thought of suicide as a possible solution to her recurrent mental problems.

Part 1: Assessment of Jane using Psychoanalytic Theory

            Psychoanalytic theory is mainly focused in exploring the overall organization of personality possessed by an individual subject. Furthermore, the personality development dynamics is analyzed by the theory in order to provide a direct guidance to psychoanalysis that is usually applied in offering treatment for psychopathology. It should be noted that the theory was designed during later years of the 19^th century by Sigmund Freud. However, the theory has undergone periodic refinements as a result of advancements that have recently been witnessed in the medical research field (Eliott, 2015).

            From a therapist point of view, it is clear that Jane endured various psychologically traumatizing events during her childhood years. Most notable of these include the molestation by her stepfather that she had to endure from her father. Remarkably, Jane carried this secretive burden for decades before she could make a disclosure to me as her therapist, but only after assurance and a guaranteed state of confidentiality on my part. Others include the family instability as well as the tragic end of her mother, who raised her single-handedly for years before she passed on. Consequently, the death of her mother opened a darker chapter in her life, which meant that she had to be self-dependent at such an early age. To further complicate her psychological healthy situation, Jane received a life threat from her step-father, which left her traumatized.

            Psychoanalytic Theory has a main focus on the analysis of childhood events that could possibly trigger the mental effects observed during the adulthood period of most of the patients. In this regard, the case of Jane possesses all the qualifications to be assessed with reference to this theory. Besides, the psychoanalytic theory is highly favorable in a proper analysis of possibly lost memories that have the ability to shape current thoughts, behavior or feelings observed in most of the patients. 

To fully assess Jane’s case in accordance to this theoretical model, three elements regarding childhood personality of Jane have to be determined and keenly analyzed. These include her id, her personal ego and finally the superego that she possesses.

1.      Id

Id refers to the personality aspect that is mainly contributed by the person's needs and other basic wants. These needs are usually instinctive especially to humans and they include the need for food, water due to thirst and individual level of sex drive. Research conducted in this field has unanimously concluded that id always act in accordance with the principle of pleasure. Therefore, it is imperative to say that id always seek pleasure by avoiding the pain. Essentially, the instinctive nature of the Id makes it impulsive, in that there is total unawareness action implications and consequences (Gabbard et. al, 2012).

            Jane’s id personality was distorted by the lack of provision of personal needs such as food, love and care by her parents that resulted from the divorce. Additionally, the age at which she was raped was a tender age in which her sex drive was at a developmental stage. Given that her brain was also developing at such time, the inhumane and terrific act was imprinted in her subconscious portion of mind, therefore, the observed long-term effects to her psychological state.

2.      Ego

Ego is a personality aspect that is mainly driven by the principle of reality and seeks to provide a balance in the co-existence of both the id and the superego. To ensure the balance is achieved, ego ensures realistic achievements of the instincts of id through their rationalization and encouragement of the personal drives leading to long-term benefits. Usually, ego helps in providing a clear distinction between the reality and the realistic nature of personal drives at the same time considering the standards that are set by the super-ego for personal benefit of the subject (Gabbard et. al, 2012).

Jane's childhood problems lead to the imbalance in her ego and superego as she could the events led her to be unable to distinguish between the reality and the non-reality. For instance, human instincts dictate that young infants should not be molested by adults. Therefore the rape that Jane underwent at her young age lowered the level of functionality of her ego element, in the event having an effect on her psychological development and capability.

3.      Superego

Unlike ego which is driven by the reality principle, superego, on the other hand, is driven by the principle of morality. Therefore, its main role is to ensure that there is an establishment of a link between the higher thought morality and the action executed. Unlike id that acts as per human instincts, superego follows the path that is socially acceptable in the society. Therefore, to ensure morality, superego provides judgment of right and wrong senses by utilization of guilt in order to dictate socially acceptable code of conduct. (Gabbard et. al, 2012).

Jane's stepfather was supposed to provide moral guidance to Jane during her childhood that would have enabled her to live a morally upright lifestyle in the society. Furthermore, her parents' divorce and involvement of her father in drug-related activities had a direct effect on her superego through the poor foundation establishment. The result of this imbalance in personality elements is her engagement in drug-related activities and subsequent threat of a divorce in her own marriage.

The Unconscious Mind

The unconscious is a section of the mind that the individual is unaware of activities taking place. Researchers believe that the subconscious has the ability to make revelations of the true current thoughts and emotions of a person (Mlodinow et. al, 2013). Therefore, a significant number of analytic techniques have been designed to understand this mind section. The main analytic techniques include conducting a session of hypnosis to the patient and a detailed analysis of their dreams by a specialist in order to obtain clues that may provide crucial leads to their current mental situation. With Jane's disclosure that she has been experiencing dreams and nightmares, her medical condition can consequently be analyzed for further medical treatment recommendations for the possible mental disorders that she is suffering from. The probability that her ego and superego can be confirmed from the Freudian slips from the conversation. The observable parapraxes from Jane include the provision of wrong narrations during the subsequent counseling sessions.  Also, she periodically provides different names for her parents and stepfather. This signals her need for medical attention.

Other Possible Psychology Theories for Jane’s Case

1.      Psychosexual Development: It is clear that Jane was sexually molested by an adult at an age when her sexual energy and urge was at low levels, given that she was a child yet to undergo sexual development and hormonal changes (Chiocca, 2015). Therefore, her psyche levels were quite low for engagement in a sexual activity thus the observed negative psychological effects. The after effects observed during the attempt to have sexual intercourse with her husband further confirm that her sexual development and urge became fixated and stunted during the time she was molested.

2.      Neo-Analytic Theory: Focuses on the importance of the unconscious mind in deciphering the mental situation and also the role that dreams and other childhood experiences have on the overall mental development.

Part 2: Jane Treatment Plan as per Humanistic Model

Humanistic treatment model involves a treatment therapy that is especially based on theories of personalities majorly designed by humanistic psychologists; Carl Rodgers included. The distinct focus of the humanistic treatment therapy is to ensure that the entire therapy process results in patients becoming healthier and with higher levels of creativity (Schneider et. al, 2010). Moreover, the medical attention should involve the patients regaining their functional personality levels. Of keen to note is that the model acknowledges the role that human spirituality and aspiration play in raising the psyche levels of a depressed or a traumatized subject. Therefore, it is incorporated in the humanistic therapy package.

Essentially, the humanistic treatment model focuses on human phenomena including free will as well as exploitation of full potential as a human being. Such a treatment model encourages patients like Jane to view themselves as a whole person despite the humiliation and difficulties that they went through in the course of their childhood. In fact, it successfully manages to offer encouragement to such mental disorder patients to have a self-exploration session instead of comparing themselves with other people behaviors (Milton, 2010), for instance, the self-neglect and lack of self-worth that is clearly evident in Jane are possibly resultants from her comparison with others that seem to have normal lifestyle and families. Such comparison and  the feeling that the people show no understanding and care to her situations significantly lowers  her self-esteem, plunging her into depressions and her resolution to use drugs to clear her mind of such negative thoughts.

During the treatment process, it is a goal of every humanistic therapist to provide guidance to the patients in their healing process by ensuring subsequent elimination of attitudes, negative behaviors and beliefs especially those that encourages a negative state of being. As a replacement, the therapist attempts to ensure that the patient gradually integrate numerous components of their individualized personalities. As a result, the patient will emerge from the therapy as a more mature individual who possess higher levels of self-awareness as well as authenticity (Frankl, 2011).  Jane, for instance, has a negative attitude towards her parents. Additionally, it is possible that she believes that all men are capable of executing inhumane acts towards children and women, is revealed from the bedroom incident with her husband. Additionally, she believes that drugs such as cocaine and alcohol have the ability to drown her sorrows thus making her feel better and regain normality. However, her attitude and beliefs have led her to develop the more mental complication and to plunge deeper in depression. Therefore, the treatment and subsequent recovery of Jane is highly dependent on the therapist ability to ensure that Jane regains self-awareness through the positive thinking mentality.

The humanistic treatment comprises of several counseling sessions that enable the therapist to have a detailed knowledge of the patient's situation and the observed response to the treatment process. A complicated case like that of Jane requires a higher frequency of counseling sessions, given the number of years that her mental situation has deteriorated. To ensure the total cooperation of the patient hence quicker response to the therapy, the therapist has to cultivate a strong relationship and a capability to gain the patient's trust. An experienced humanist therapist is aware of his/her obligation of consideration of feelings that the client has in its entirety. Furthermore, all the concerns of the patient should be duly considered. Finally, the therapy conditions should instill a subject’s feeling of warmth and subsequent acceptance by the involved parties. It should be noted that humanistic therapy is mainly aimed at the strengths that the patient possesses and thus the counseling session should not involve judgments (Payne, 2011).

Psychological patients like Jane require a display of empathy from the humanist therapist as one of the initial steps towards her recovery. Empathy is a crucial element offering the therapist the ability to view the society and the environment that the patient lives in a way that the patient will be convinced of the therapist understanding of the situation they are in. In addition, the therapist should not show the authority that they wield over the patient. In turn, the subject is able to disclose further information, which will in turn help the therapist to accurately diagnose the possible mental disorder that the patient may be suffering from.

Types of Humanistic Treatment Therapies

The following are the widely acceptable techniques applied in treating patients with psychological disorders:

Gestalt Therapy

The therapy mainly focuses on ways and techniques that will eventually enable the patient to gain a deeper understanding of their own feelings and thus be able to gain their control. Essentially, the therapy prioritizes on the patient’s feelings rather that their causes (Nevis, 2014). It is possible that over the years, Jane has lost her ability to understand her personal feelings and to control the. This is especially evident from her revelation that she has attempted ending her life by committing suicide. Suicide is usually associated with the inability by an individual to control their soaring emotions and feelings thus leading to the act. Additionally, the resort to abuse drugs is brought about by her lack of control of feeling that she has no self-worth. 

To help Jane recover from this situation, there is a need to ensure that she learns how to control and lower these feelings through engagement of positive activities and abandoning engagement in negative activities such as drug abuse and recalling her past life. She should be assisted to be focused on her future and the benefits that come with being alive.

Client-Centered Therapy

The main focus of the client-centered therapy is the provision of supportive environs that enables the patients to recover especially through a personal establishment of their true identity (Knight, 2010). From a psychiatric point of view, Jane loss of her identity was majorly contributed by the childhood difficulties and lack of proper parental guidance, especially during her growth and development period. Additionally, her lack of disclosure of the rape by her step-father further added a weighty secretive burden that she had to be the lone bearer for decades. Given her immaturity, the burden became too much for her to bear, leading to her development of a possible mental condition. A further sense of neglect and lack of support from her husband worsened the situation. Resultantly, the recovery of Jane is highly dependent on proper guidance and assistance by well experienced therapist to ensure that she has a proper understanding of her situation and an unwavering support for her activities that will ensure she fully recovers. Gradually, Jane will develop a sense of belonging and a feeling of care from the therapy.

Possible Diagnosis

From the analysis of Jane’s case as above there is a high probability that Jane is suffering from Post-Traumatic Stress Disorder (PTSD). This is a mental disorder mostly associated with individuals that underwent traumatic events during their childhood, for instance, loss of loved ones e.g. parents and rape. The symptoms of the disorder can take years to show off and they include depression and traumatic dreams and nightmares (Javidi et. al, 2011). All these are evident in the case of Jane.

References

Chiocca, E. M. (2015). Advanced Pediatric Assessment.

Elliott, Anthony. (2015). Psychoanalytic Theory: An Introduction. Palgrave Macmillan.

Frankl, V. E. (2011). The Unheard Cry for Meaning: Psychotherapy and Humanism. Simon and Schuster.

Javidi, H., & Yadollahie, M. (2011). Post-traumatic stress disorder. The international Journal of Occupational and Environmental Medicine, 3(1 January)

Knight, T. A. (2010). Client‐Centered Therapy. Corsini Encyclopedia of Psychology.

Milton, M. (2010). Therapy and Beyond: Counselling Psychology Contributions to Therapeutic and Social Issues. New York, NY: John Wiley & Sons.

Mlodinow, L. (2013). Subliminal: How your Unconscious Mind Rules your Behavior. New York: Vintage Books.

Nevis, E. C. (Ed.). (2014). Gestalt Therapy: Perspectives and Applications. CRC Press.

Payne, M. (2011). Humanistic Social Work: Core Principles in Practice. Lyceum Books, Incorporated.

Schneider, K. J., & Krug, O. T. (2010). Existential-Humanistic Therapy. Washington, DC: American Psychological Association.