Preston was concerned over his aggressive behavior towards other males in and outside of the home. He had frequent altercations with his brother, both of whom lived with their parents. Preston was adopted at a very young age. This was a major cause of his recent issues. He feared that his emotions would progressively get worse, and that something detrimental would happen. In accordance with psychoanalysis, Preston was allowed to explore these issues through free association. Preston was shown that his subconscious had been concealing issues related to his early adoption. Preston was shown constructive ways to deal with these issues. Preston continues to make progress in this area, and is exhibiting less signs of his previous issues.
Psychoanalytic Case Study of: Preston A Conceptualization and Treatment Plan The individual in this case study presents a multitude of symptoms that are affecting his daily life. The individual has many factors from his childhood that would contribute to these issues. This study goes to show how the subject’s childhood has a direct relationship to the issues that he is currently experiencing. The identification of these issues is necessary in order for treatment to be successfully implemented. Presenting Concerns
Preston presents himself as suffering from multiple issues that affect his daily life. He claims to have issues with forming any relationships with other males. He states that he is overtly competitive when dealing with these other males. His biggest issues arise when dealing with his brother. Preston was adopted at a very young age, and has always had issues getting along with this brother. This aggression has moved from just dealing with his brother to all males in general. There have been instances where the police have been involved in altercations that Preston has had at home. He fears that this will continue until he is arrested outside of the home. Preston still lives with both of his adopted parents and his brother.
Preston has stated that he is constantly vying for his parents’ attention, and his aggression increases whenever someone else is monopolizing their time. He does not feel that he will always become violent, but that his anxiety is constantly increasing in situations such as this. He is afraid that his frustration and need to outdo others will end very negatively.
Case Conceptualization It appears that one of Preston’s main issues is that of Displacement. According to Murdock (2013), this occurs when a subject shows anger towards someone who is less dangerous than the real cause of an issue (p. 40). Preston shows that he has issues in dealing with the fact that he still lives at home with his parents. He verbally abuses those that he sees as “better” than him. Preston does not wish to abuse himself over this issue. So, he abuses others that he believes will accept the abuse. He seems to blame others for whatever failings he has in life. He takes his frustrations out on whoever is the most convenient to him. This involves rage towards his brother, as well as friends of his parents.
The fact that Preston was adopted as such an early age raises the issue of attachment bonds as well. It appears that Preston may have become overly attached to his adopted parents. Much of this may have to do with the way that they raised him. His parents were very protective, and would cater to his every need. This seems to have created a kind of subconscious reliance on his parents, and the need for their constant approval. This leads to the constant need for their attention as well as the need to outdo peers.
The aggressiveness towards peers does not seem to have started until Preston was old enough to identify that was adopted. He seemed to be displacing fear that his current parents would abandon him onto others. This is the main subconscious issue that is affecting Preston. His fear of abandonment has caused him to irrationally fear any force outside of his parental relationship, including his brother. This affects his appraisal tendency, which is the way his brain perceives threats and relates to his aggression and depression (Gilbert, 2007, p. 47). This is the disconnect that is causing most of Preston’s issues. He feels threats that just are not there. He remains living with his parents, constantly vigilant of anyone that will take them away from him, including his brother. This has manifested itself in a sort of hyper-masculinity. Preston’s ego identifies no other way to express these abandonment issues other than with aggressiveness.
Also, the fact that Preston’s aggression has continued to increase could be directly correlated with his parents aging. Perhaps he fears that not only could people take his parents away, but the fear that death is closing in on them. This could also be manifesting itself in Preston’s fear and frustration.
Treatment Plan Goals for Counseling The goal for psychoanalytic therapy is to get Preston in touch with his subconscious. This serves to identify the root causes of his present issues. Preston will need to identify specific defense mechanisms that he created in childhood. The material that has shifted from the subconscious to the conscious will need to be readily identified (Murdock, 2013, p. 37). Once these mechanisms and thoughts are out in the open, it will be easier to discuss them and change present behavior. Interventions
The fundamental intervention to employ with Preston will be “free association”. According to Murdock (2013), free association encourages the client to reveal whatever he is thinking even if it seems irrelevant or offensive (p. 49). This will be particularly helpful for Preston, and can reveal what his thought process is when he has these aggressive bouts. It seems that Preston has not been totally honest with himself. Free association can help him to bring out deep-rooted ideas for analysis and discussion. This intervention can provide logic and reason to the seemingly illogical thoughts he is experiencing. Establishing the Relationship
I realized that Preston had issues in dealing with other males. I asked him if he would feel more comfortable dealing with a female counselor. He indicated that he did not react the same way to me as with other males. He stated that he realized that my sole purpose was to help him with his issues, and this made him not feel anxious or aggressive. I relayed that I was glad this was the case, but that I needed to be immediately notified if these sentiments changed.
Whenever I felt that Preston was actually getting anxious or aggressive, I made him aware. I explained to him that he was projecting these feelings onto me, and that it was harmful to the counselor/client relationship. He quickly calmed down, and apologized. He seemed to genuinely understand my concern for his well-being. Analysis of Transference
The occasions that Preston did display anxiousness/aggressiveness, he did seem to understand that he was doing so after it was brought to his attention. He realized that I was not causing his issues, and I attempted to apply this to his other personal relationships. We would analyze why he was feeling this way, and how it related to his childhood and parents. He came to the conclusion that if he did not get these feelings under control in session, then he was never going to get them under control outside of it. Insight
Preston came to realize that he had subconscious issues regarding his adoption as a child. He understood that he was so shocked by learning he was adopted that he was afraid it was going to happen again. He learned that he was very afraid of losing his parents. He acknowledged that his aggressive outbursts were not about the people he was dealing with, but about his fear that his parents would somehow like them better and abandon him.
Preston identified that this is not considered normal behavior for someone his age. He picked up various calming techniques, and needed to constantly remind himself that the issue was him, not others. I was able to assist Preston in identifying the root causes of different scenarios and emotions that he discussed. His visible anxiety and aggression seemed to be kept to a minimum. With his understanding of why he was experiencing these emotions, Preston seemed to be doing better in his daily life. He reports being able to hold a discussion with other males without feeling the need to be dominant. He has also taken steps in explaining his fears and issues with his parents.
Conclusions The next main milestone for Preston will be to find a home of his own. This will take time and adjustment, but will be a great leap forward. Also, he is noticing some of the same issues he is dealing with in his brother. Hopefully, Preston can persuade his brother to seek the same sort of help that he has received. This will have to be gradual so as to not induce any sort of separation anxiety. However, if Preston continues with treatment and making positive choices, then he will be continuing on the path to recovery.