Assess this client's prominent ego defenses and at least two other noteworthy aspects of ego functioning.
The client shows denial and sublimation as his primary ego defense mechanisms. His drug use started during his teenage years, and it was not until his late 30s that he acknowledged it was a problem. He was traumatized by the abuse from his elder brother in his childhood, an act that led to migraine development. The denial defense mechanism involves thoughts and feelings that alienate a person from the cause and effect of something (Cramer, 2015). The client denied that the prescription medications were harmful to him in his teenage years and developed hard to quit habit until 24 years when he realized he was addicted to them. Through the sublimation defense mechanism, the client did not seek timely help resolving his traumatic life experiences but rather used drugs to escape the reality and feelings from the encounters (Crenshaw, 2010). For instance, he held a grudge against his brother from his childhood until his brother died without resolving the issue. He directed his feelings to prescription meds until he attained legal age and could buy alcohol and other conventional narcotics.
The client shows low agency and believes his life is controlled by external factors. He thinks he has a low level of control over his life and many of his experiences came from external factors beyond his control. The client inhibits immediate feelings and shows no focus on the long-term (Freud, 2018). He perceives his life as dependent on the whims of fate as opposed to the consequences of his actions. The client shows different purposes and degrees of integration to life values. At 24, he changed his life's purpose and won himself off the opioid's addiction. At 35 he reverted into frequent intoxication and used stronger drugs. He does not show an overarching purpose in life or any efforts to integrate with social values leading to a state of incoherent ego functioning.
Create a half-page of dialogue (single-spaced), imagining "Bruce" as your client, and in which you demonstrate a psychodynamic intervention
(e.g., expressing empathic attunement; connecting of here-and-now patterns with earlier developmental experiences/events; positive validation and mirroring).
Me: What do you think about your current drug use? Do you consider it a problem?
Bruce: Yes. I consider it as a problem. I thought I could quit when I wanted to, but I realized it is not that easy. I keep breaking the goals that I set regarding detox.
Me: What do you think causes you to use drugs?
Bruce: My life is sad. I have lost people that I cared about, a job that I loved and two of my marriages.
Me: Bruce, all those things happened for a reason, and they were beyond your control. For instance, your first wife died of pulmonary embolism.
Bruce: I get your point but why do bad things keep happening to me?
Me: Bad things happen to all people Bruce. As much as we try to live a fair life, our expectations end up hurting us when reality presents us with frustration and sadness. We cannot control what the future has in store for us. However, we can rejoice at present and plan for an uncertain future. Your issue with drug abuse only serves to escalate the problem.
Bruce: Yes. The thoughts have on multiple occasions led me to develop suicidal antics, to die and escape it all.
Me: There is always hope Bruce. Your daily alcohol consumption is bound to lead to more problems such as liver cirrhosis and loss of the little social life that you have. I acknowledge the progress you have made in heroin detoxification. Continuous improvement is the key to attaining success. 65mg of methadone is quite a fete that many reforming addicts never achieve. I propose that you reduce your alcohol intake by both amount and days. Set goals and with time, your body will adapt just like it has done with heroin. There is a happy life out there, and you can only achieve it by believing in yourself and moving on from past traumas.
Bruce: I will do my best.
Explain how your assessment of his ego functioning (in at least one realm) informs your decision to use this specific intervention.
The assessment of the client's ego functioning revealed his low sense of self-direction and purpose in life. The specific intervention discussed above is centered on enabling the client to develop an internal locus of control (Heller & Northcut, 2011). Many of the problems leading to the client's state of depression are external and beyond his control. For instance, he was helpless as a child and fell victim to his elder brother's abusive antics. Due to lack of self-directedness and purpose, the client sought no help, and the condition elevated him to a troubled state of mind. The empathic attunement intervention helps the client in understanding his past experiences and accepting them. Acceptance is the principal step towards moving on and achieving a coherent self-state.
Reflect on how you would attempt to assess the impact of your intervention.
The impact of the intervention can be assessed by observation of the client's behavior. The empathetic attunement on which the intervention is based was meant to cause positive behavior change (Beck, 2011). The client is bound to minimize his alcohol intake as he comes to terms with his past experiences and finds purposes in life. The intervention's impact could be assessed further by monitoring the level of alcohol in the blood of the patient. Urinalysis and blood tests could be used in to quantify the alcohol. However, biological tests might cause discomfort in the client and work against the principles of mirroring and positive validation (Cabaniss et al., 2011). Therefore, a psychologist would consider interviewing the client on progress to be the perfect way to assess the impact of the evaluation. A guided conversation with the client would shed light on his environmental tuning and the associated state of mind after the therapeutic session.
How do you anticipate the client's early history might show up in her/his working relationship with you, the team, etc.?
The client's early history is laden with abuse and sad experiences that unfortunately shaped the client's worldview. His early history of abuse might show up in a heightened state of awareness of rights, freedoms, and vigilance while working. The client might be unable to trust other people due to betrayal from his blood brother. The client shows a significant degree of loyalty to those that cause him happiness like his daughter and first wife. He even quit drugs while he was living with them. His early history might be manifested in his treatment of situations. He is not solution-oriented, and thus teammates might find it difficult engaging him in constructive problem-solving. However, he shows understanding of self and appreciates the value of forgiveness. The client waited for his brother to apologize so that he would forgive him. However, he did not receive any apology even as his brother was on his deathbed. He is bound to show great emotional awareness and conceal his thoughts until a significant amount of time passes, and trust develops.
Anticipate transference and counter-transference responses and how they might impact your interactions with this client.
The client has a history of relapsing after completing a rehabilitation program. The lack of trust in the therapy and demeaning perception on the intervention used are some anticipated transference. The client lacks consistent autonomy in his decisions and changing attitudes towards drug abuse. These transferences might lead him to conceal vital information or demean the impact of the intervention on his life. An anticipated transference is a general discord on the stance of alcohol abuse. The client is notorious for driving under the influence posing a danger to other people. He at times denies the claims amid extensive breathalyzer evidence of intoxication. This countertransference might lead to avoidance of the subject or premature projection of the client's explanations.
Beck, J. S. (2011). Overview of treatment. In Beck, J. S. Cognitive therapy: Basics and beyond, Second Edition (pp. 17-28). New York, NY: Guilford Press.
Cabaniss, D.L., Cherry, S., Douglas, C.J., & Schwartz, A.R. (2011). Psychodynamic psychotherapy: A clinical manual. (pp. 43-50). New York, NY: Wiley-Blackwell.
Cramer, P. (2015). Understanding defense mechanisms. Psychodynamic Psychiatry, 43(4), 523-552.
Crenshaw, D. A. (2010). "Stitches are stronger than glue": A child directs the healing of her shattered heart. In Gil, E, (Eds.), Working with children to heal interpersonal trauma (pp. 200-219). New York, NY: Guilford.
Freud, A. (2018). Ego and id. In The Harvard Lectures (pp. 21-35). Routledge.
Heller, N. & Northcut, T. (2011). The integration of Psychodynamic and Cognitive Behavior. In Berzoff, J., Flanagan, L. M., & Hertz, P. (3nd ed.), Inside out and outside in (pp. 208-221). Lanham, Maryland: The Rowman & Littlefield Publishing Group, Inc.
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