Contemporary Clinical Psychology - Essay Example

Case Study Part Steven’s behavior can best be explained using the humanistic-existential approach. A therapist will be able to understand a person’s feelings and behavior better if there is also an understanding of the person’s perception of internal and external reality.(Plante, 2005). In this instance, there are several indications that Steven’s behavior may be the result of a disparity between his own self image as opposed to the reality of his experience. In the first instance, as Carl Rogers points out, human beings have a natural tendency to strive towards their inner potential. (Plante, 2005: 63). They believe in themselves, but their perception of their own self image is also affected by the feedback from others. In Steven’s case, his father’s constant criticism and ridicule in childhood, coupled with a lack of the father’s love, time, care and support may have threatened Steven’s image of himself as a strong person and a real “male”, thereby affecting his self esteem. In effect, his father’s behavior was tantamount to rejection of Steve, especially when he failed to sympathize with Steve when he was bullied, further eroding Steve’s self image as a male through a failure to identify with the only male he knew as a child. This has only been compounded by his mother’s attitude to him. Abnormal behavior may arise when the spectrum of basic needs that an individual has, such as air, water, food, love, belonging and self actualization, are not satisfied. (Simson and Strauss, 2003: 178). Steven’s mother was too affectionate to her son, so when she abruptly refused to let Steve into her bed, it appears likely that the boy would have perceived this also as a rejection. The causal act leading to the rejection was his masturbation, but he is unable to control this, thus placing him in a position where masturbation in the presence of a real woman appears wrong – leading to feelings of anxiety and guilt, with an impairment in his sexual function, as evidenced in his failure to perform with his girlfriend. Steven’s anger at his mother for ‘rejecting’ him is expressed in his anger against women, and the only time he is able to allow his sexuality to thrive without associated feelings of guilt, is when he sees celluloid women being hurt and violated because this makes him feel powerful. The feelings of depression Steven has been suffering from can thus be attributed to the conflict between his self worth and the reality of his parents’ ‘rejection’, which has produced feelings of anxiety and dissatisfaction. This has affected his behavior in childhood, making him reclusive because he may have felt that he was not a loveable person. The humanistic approach suggests that humans then resort to self defense mechanisms in order to regain control over their lives. Steven’s defense has been his fantasy world and his membership in the Church of Satan. Such activities offer him a temporary release from his feelings of low self worth and have helped him to become more outgoing, because it offers him a justification for being an unloveable person, i.e, he has been possessed by Satan, so he’s not really himself. Steven’s feelings of anxiety and the still unsatisfied need for love, belonging and self actualization are being replayed in his relationship with his girlfriend. He needs her constant attention and resents it when she’s with her friends and sometimes forgets him, because such behavior only serves as a reminder of the dismissive behavior of his parents and their lack of love, attention and care for him. His lonely childhood did not offer him the opportunity to receive love and affection from others, thus his primary relationships are very important to him. The anger he feels against Linda is only the expression of the violent anger against his parents which has been locked up within him. It is they who have contributed to the development of a low self image in Steven, which in turn affects his perception of reality. The conflict between Steven’s effort to develop a positive image of himself, as opposed to his experiences in reality where the people he loves the most appear to be rejecting him, is the causal factor for much of Steven’s abnormal behavior. Part 3: On the basis of Steven’s symptoms, the best diagnosis of his case according to his current circumstances appears to be Bipolar Affective Disorder. Applying the specifications of this condition as spelt out in the DSM IV, the patient swings between episodes of mania and depression. The manic episodes are characterized by an unrealistic belief in one’s abilities or power, increased energy and a higher level of talkativeness. Steven displays all of these symptoms; he is exhibitionistic and outgoing during his manic spells and strongly identifies with characters perpetrating outrage, such as Freddy in the Nightmare Films and the man with the hacksaw in the Texas Chainsaw massacre films. He feels strong and powerful during these times and sees himself turning violent and hurting his mother and father. This may well be in effect, a desire in Steven to push away the memories of his father despising him for not being physically aggressive in childhood. With Bipolar Affective Disorder, the depressive moods on the other hand, are characterized by feelings of worthlessness, helplessness or excessive guilt, sad, irritable mood and recurrent thoughts about death and suicide, among other symptoms as set out in the DSM IV. Steve also demonstrates these tendencies. His feelings of worthlessness are clearly evident in his anger at what he perceives to be Linda’s ‘rejection’ of him when she spends time with her other friends. He has attempted suicide on two occasions by taking a drug overdose. Steve does suffer from delusions and hallucinations, but these have not evolved to the point where there is disorganized behavior or affective flattening as per DSM symptoms of schizophrenia. While Steve’s symptoms at present could also be classed under the category of Complex Post traumatic stress disorder, the stress in question being generated by his girlfriend leaving him, Bipolar Affective Disorder appears to be a more appropriate diagnosis bearing in mind, the long history and duration of Steve’s mental problems, which also existed before the current crisis. It may be noted that Steve has been almost ‘autistic-like’ in his childhood, but there has been a change during his adolescent years with mood swings from manic to depressive. Bipolar Affective Disorder typically develops in adolescence or early adulthood and it is a long term illness associated with a high suicide rate. Steve fits all these parameters and this appears to be the best diagnosis, which would have been even more applicable if he had been presented as an adolescent. Part 2: Applying the Humanistic approach, a therapist treating Steve must apply a client centered approach and provide “unconditional positive regard, congruence, intensive active listening and support to help individuals and groups to reach their full human potential.” (Plante, 2005:63). Steve’s sessions with his therapist over a few weeks have already helped him in expressing some of his innermost feelings, especially his anger against his parents. The aim of therapy under a humanistic approach is to bring the patient to a state of increased self awareness, heal past trauma and pain and help the patient to become emotionally competent. The best tool whereby this can be achieved appears to be therapeutic sessions where Steve is encouraged to talk more about his innermost feelings, so that he is able to vent all the pain, grief anger and guilt that may still be rampant in him, giving rise to the violent feelings. The violent streak that Steve is displaying is the expression of his anger at his parents, but it is the first step towards the patient regaining control of his own life. The therapist’s duty will be to slowly help Steve to develop a more positive picture of himself, an awareness and self actualization that is not connected to or dependent upon how others perceive him, or how he believes that they perceive him. The root cause of the abnormal behavior that Steve is displaying is the conflict between the self image he would like to have versus the self image that has been imposed upon him by the realities of his interaction with others. The fact that Steve is able to express his feelings of anger against Linda is an encouraging sign. This can be used as the basis to draw out Steve’s inner rancor and anger against his mother, so that he is able to speak out the stressful incidents of his childhood and rid himself of the inner trauma they still cause. Regular therapeutic sessions would also be beneficial to Steve in helping him not to turn that violence out on others, but rather to slowly arrive at a sense of his own autonomy and self worth. In addition, during the later stages of Steve’s therapy, he could also be encouraged to interact with support groups and to find new friends who will be more understanding about his special needs. References: * Plante, Thomas G, 2005. “Contemporary Clinical Psychology”, John Wiley and Sons. * Simson, Sharon and Straus, Martha C, 2003. “Horticulture as Therapy”, The Haworth Press, Inc. Read More