Introduction
The race, ethnicity, age, gender, sexual orientation, religion, marital status, etc.
S. L. is a Romanian immigrant living in one of the disadvantaged areas of New York, renting a one-room apartment there. The client is 24 years old. They arrived from Romania to study in the humanities direction. L. is not married, but they claim that they maintain a relationship with their girlfriend, who moved from Romania to another European country and expects to legitimize them in the future. L. speaks quite fluent English, in addition to their native Romanian, has little knowledge of Latin and Greek. S.’s socioeconomic status leaves much to be desired – they have just enough money for food, renting an apartment, and buying books and scientific papers. They work as a pizza delivery man in their spare time from scientific activities, and their parents also send them a small amount of money every month. S. migrated to New York not only to get an education but also to try and establish a life in a more fulfilling place. S.’s acculturation in New York is quite high, but the level of social alienation is just as high due to a number of psychological complexes. The hero of this case has a complex relationship with the Catholic religion. At the same time, they is drawn to this religion and observe irresolvable contradictions in it.
The client’s self-identification
The client experiences a contentious relationship regarding self-identity – L. states that they would not like to be tied to strict identity parameters. They do not like the idea of ​​national self-determination and would not like to feel like a migrant or a full-blooded Romanian. L. believes that national preconditions only limit human potential.
The family culture
This culture had a conflicting influence on the formation of S., especially in their teenage years. The L. family was quite conservative and traditional, adhering to the standard gender models of a male earner and a female homemaker. S. was required to follow in their father’s footsteps and get a job related to civil engineering. However, S. managed, through long disputes, to convince their parents to allow them to choose a specialization.
The intersectionality of the client’s identities and its role in the client’s current situation
L. is currently writing a dissertation in sociology describing the transformation and diversity of contemporary gender and post-gender roles. Their rebellion against gender predestination is clearly shown in their behavior and self-identification – they are tolerant of pronouns but prefers to be addressed as “they.” S. does not consider that innate gender is proof of a specific identity and positions themselves as a non-binary person.
The client’s substance abuse history
L. admits that they took antidepressants and antipsychotics on their own, trying to solve the problem without the intervention of a doctor. However, the uncontrolled use of fluoxetine seemed to be effective for the patient only in the first week, increasing activity and sociability. As a result, self-treatment resulted in uncontrollable anxiety, and socialization was colored by sudden fits of irritability and irascibility. The patient needs careful selection of the appropriate medication.
The clarify with the client
The sexual preferences of the patient with their emphasized pansexuality remain not entirely clear. There is a possibility that L. may be embarrassed about their own bisexuality or homosexuality, sublimating it in choosing a non-binary gender model for representation.
The client’s strengths
The strength of the patient is their academic education and a fairly high level of erudition. The patient is an empathetic and sensitive person who really wants to get help from therapy. There is a high probability that S. will understand and intellectually understand those concepts that will be invested in their psyche during the sessions, which will speed up and strengthen the treatment.
The presenting problem
The client’s feelings (depressed, anxious, stressed, etc.)
The patient complains of a number of symptoms that indicate the presence of a depressive disorder and general anxiety disorder. S. has problems with motivation and communication. They has difficulty entering into an ordinary dialogue, worrying that their thoughts will distract them from making a successful exchange of remarks. Usually, this is exactly what happens, which makes them disappointed in themselves and avoid communication. Failure to attend classes in the magistracy in this way leads to the fact that S. does not keep up with the curriculum and loses motivation in writing a dissertation. They are under a lot of stress as depression and anxiety prevent them from moving forward with their scientific research.
The client’s procrastination, getting into bad situations, etc.
S. is having trouble completing their dissertation on gender roles, as their personal life and future prospects seem blurred. They sees no point in finishing the job, worried that they won’t be able to feel fulfilled in New York. Financial uncertainty leads to anxiety and stress, which is expressed in inaction. S. admits that they often sit in their rented apartment doing nothing, and at night, when the anxiety becomes too strong, they leave to wander the streets of the city.
The client’s reason for coming to therapy
The patient came to the sessions because they wanted to find ways to work through the psychological pressure they were experiencing. Psychoanalysis can help L. find the confidence to stand up for their identity, to be more confident in their decisions, and to feel their identity but not exclusion from society.
The perception of the client by their family and the larger society
The increasingly aggravated antisocial tendencies displayed by L. plunge them into an even more depressive state. L. is an agitated and sensitive person who reflects and worries a lot about how other people see them. They worry that their family will end up seeing them as a weak person who embodies feminine traits in their negative gender connotations. S. is also worried that their girlfriend will be disappointed in them – she does not fully believe in the new self-identification of her boyfriend and hopes that they is able to successfully realize themselves in America. The expectations of loved ones and the fear of disappointing them have an overwhelming effect on the patient’s ego.
The main tenets of the theory to apply to the client
The client’s detailed childhood history
The history of the patient’s childhood will be required as the primary and most traditional psychoanalytic method to consider the formation of the patient’s psyche from the perspective of trauma. The shocking and transformative experiences experienced by S. are fundamental to the peculiarities of thinking and perception. Trauma works in such a way that it constantly requires re-reproduction – it is required to find these repetitive patterns in S.’s actions, thus revealing repressed memories.
The client’s psycho/sexual/developmental stages to take into account
The early stages of psychosexual development will be ignored in the analysis of the patient’s childhood. However, S.’s sexual interests during puberty require consideration. Teenagers tend to balance their sexuality with social preconceptions, making it both conformable and reasonably satisfying. S.’s sexuality is associated with their non-binary gender identity and probably largely comes from a protest against the way within the family. The formed ego and superego of the patient seeks to distance themselves as far as possible from the conservative attitudes of their parents, finding themselves in a break with the gender tradition.
The therapeutic choices based on the client’s symptoms
When choosing therapeutic methods, you need to be guided by your own experience and the tasks set by S. based on the logic of patient-oriented care. The goal of the client coincides with the main tasks of psychotherapy – to remove the neurotic state, giving the client greater comfort with their own personality.
The multicultural, sociopolitical context of the client in the theory
The multicultural aspect of this case is expressed in the opposition to modern Western culture and the conservative Eastern European tradition in the mind of the patient. S. was always afraid of becoming the same as their parents, but their greatest fear was that their parents were right and they was always part of a culture that they denied. The theory of patient-centered care will allow one to give a multifaceted, holistic approach to the client, considering them both as an independent person and as a product of cultural clashes.
The treatment via the theory
Specific techniques to use
Freudian and Jungian aspects of psychoanalysis will be used in this therapy. Narrative therapy seems to be the most effective because it allows the client to create a fictional identity against which they can confront their struggles and problems. A distinction should be made between what is S.’s true “I” and what is their persona, an idealized socio-cultural construct (Wilmer, 2018). The distribution of aspects of S.’s personality into archetypes will allow the patient to realize their “shadow” – a collection of fears and negative feelings (Wilmer, 2018). Such tactics, combined with an externalized narrative, will allow telling the story from a distance, but at the same time with the depth necessary to understand the problem.
Frequency of sessions
Given the patient’s extremely anxious state, the first month of therapy is required to see twice a week and then reduce the meetings to once a week with noticeable progress.
The steps to address the problem
Initially, through a free form, the patient will be able to express their feelings and reasons for seeking help. Through the analysis of the patient’s values, it will be possible to reveal the patient’s egoistic dissatisfaction. The root of this problem is traced through the analysis of childhood traumas reproduced by the patient. Through the personalization of trauma and role therapy, it is planned to work out the neurosis and resolve the internal conflict of L..
Homework for the client
The patient will be asked to record their dreams on paper or a tape recorder and then analyze them in terms of Jungian archetypal roles and symbols.
Course of treatment
Short- and long-term goals with interventions
The therapy has three main goals: to find a way to sincerely interact with the patient, to solve the problem of S.’s cultural and gender identification, and to allow them to distribute concepts within their psyche from the position of psychoanalysis, giving them the opportunity to operate with them.
Forming a therapeutic alliance using the theory
Forming a therapeutic alliance with a patient requires the use of Freudian and Jungian theories. As a sociology student, L. has a certain amount of confidence in these concepts and is willing to try them on their psyche, which gives them the confidence to apply them successfully.
Legal or ethical issues
Legal mandates to uphold
In the process of working with the client, the therapist does not encounter any manifestations of abuse that would need to be reported to the supervisory services. S. is a temperamental person who does not use violence as a method of solving psychological problems.
The need for consent from a parent
The client has crossed the threshold of adulthood and expressed a desire to conduct sessions of therapeutic work. The consent of parents and guardians is thus optional.
Prognosis
The strengths of the client helping in therapy
Familiarization of the client with the concept of social and gender roles gives hope for successful and productive work on sorting aspects of personality and combating traumatic memories.
Indicators of improvement
The education of the client and the progressiveness of their thinking allows us to count on the flexibility of the psyche and the rapid removal of neurosis. However, the pressure of parenting, tension with a demanding girlfriend, and the precarious socioeconomic status of a migrant in America may continue to put pressure on S.’s ego, making treatment difficult.
Reference
Wilmer, H. A. (2018). Practical Jung: Nuts and bolts of Jungian psychotherapy. Chiron Publications.