Task 1 - Case Studies - Case 1 Individual Psychology (Adlerian) PDF

Preview

Summary

The subsequent report adopts an Individual Psychodynamic (Adlerian) approach to discuss the case of Louise, a 20 year old university student who has self-referred to the counselling service due to anxiety and stress over her academic work. 2:1 achieved...

Description

Task 1 - Case Studies Case 1 Individual Psychology (Adlerian) By submitting this work, I certify that it is my own work and that the work of other people is duly referenced and acknowledged in accordance with the University’s Academic Misconduct Policy.

Intro – The subsequent report adopts an Individual Psychodynamic (Adlerian) approach to discuss the case of Louise, a 20 year old university student who has self-referred to the counselling service due to anxiety and stress over her academic work. Adler’s approach views the person as a whole rather than breaking them into parts (holism) and sees the family as a system; therefore Louise’s personality will be looked at in depth in relation to her family and will scrutinise her family’s behaviour. The report will examine the pertinent issues encountered by Louise, with reference to the relevant theoretical underpinnings of the Individual Psychodynamic (Adlerian) approach. The theory states that people strive for superiority which is clearly visible within Louise’s family. The interactions she has with her family and with the bullies in her early life might be what makes Louise feel inferior. Parenting styles and birth order will also be examined, to see how these play a part in Louise’s feelings of inferiority. The types of inferiority which Louise shows signs of will be discussed as well as her life style, which can be used to understand her feelings and anxiety. The report will highlight the importance of encouragement in the therapy, whilst focussing on the therapeutic relationship. It will also draw attention to family constellation as a form of therapy, and justify how suitable this is for Louise. Finally, specific ethical and legal considerations will be discussed.

Relevant Background – Louise is the younger of two daughters in a family with a mother and father. Having gone through a chaotic childhood which has had lasting impacts on her in her later life, she is now struggling physically, academically and emotionally at University. She comes from a family who have high expectations and has a lot of pressure on her to do well, particularly from her father. This is partly due to her high attaining sister, creating competition between the two, which has in turn caused the two to distance. They rarely spent time together and increasingly argued with each other. The parents ‘explicitly encouraged the girls to do try out new experiences’ and ‘take part in extra-curricular activities’ such as swimming and tennis lessons, creating competition in the activities she took part in, alongside the competition she has with her sister. Being bullied at school caused Louise to have anxiety, which lead to hair loss. This was a cyclical issue as the hair loss would then lead to more anxiety. Louise’s relationship with her mother was fine but her controlling father spoke to his wife and daughters in a belittling manner, treating his family the same as his work colleagues. He is a successful senior manager at an interior design company. Perhaps his job has had an impact on the way he views his life in general – an interior designer trying to design the perfect child. Louise’s father says he doesn’t want her relying on the family as she’s ‘less than perfect’, making Louise feel unwanted. The constant criticism from her father will have had an emotionally negative impact on Louise. She found academic work to be increasingly challenging; she missed lessons at school due

to the reoccurring episodes of anxiety and as a result failed her A-Levels, which knocked back her confidence. Her parents then paid for her to resit her A-Levels so that she could go to University, which she doesn’t appear to be enjoying. Since being there she has ‘constantly worried’ about achieving the grades she needs for a good job which has resulted in a relapse of anxiety and led to hair loss again. It would seem that Louise is just doing what her parents want her to do - the pressure to be something that she doesn’t necessarily want to be. She resat the A-Levels as her parents paid and went to University as she was expected to do so.

Applied Therapeutic Orientation – The Adlerian approach states that people strive for superiority, which is clearly evident within Louise’s family, due to the father’s behaviour. He has high expectations of the elder daughter, Sophia, and would frequently compare her achievements against Louise. He asked Louise "Why can't you be more like your sister… you need to work harder!" The constant comparison between Louise and Sophia caused to two to distance and created a lot of jealousy and arguments. Not only did Louise struggle with relationships in her family, but she was also bullied at school, causing a great deal of anxiety for Louise and leaving her with no safe haven to escape to. As a result of these behaviours by Louise’s father and interactions with others in early life, this may be what led to Louise feeling inferior. There are different kinds of inferiority in the Adlerian approach; Louise appears to display biological inferiority and personal inferiority. According to Adler's analysis, ‘the inferiority reaction appears in individuals who start life with some organ inferiority’, which can be seen by Louise’s hair falling out in large clumps, and as a consequence they develop a feeling of inadequacy; she compares herself to others rather working together with humans (Bagby, 1923). The main type of inferiority which Louise appears to display is personal inferiority. This is where the individual feels undervalued, powerless and not part of the community. It also inhibits social interest. Louise shows two responses to personal inferiority; positive and negative. She shows a positive response by striving to be valued; working hard in school, joining a local swimming team and attending tennis lessons and piano class. She also displays a negative response to personal inferiority by avoiding effort and connection with others; she didn’t seem good at socialising as she rarely spent time with her sister and left school to avoid dealing with the bullies. This suggests that the life style which Louise most prominently displays is the avoiding type, displaying psychotic symptoms by avoiding life and social connections. Louise also shows evidence of the learning type life style, which is when people are too dependent on others. It could be seen that Louise depended on her parents for her education, as when she found it increasingly difficult to be seen in public, her parents paid for home schooling, and when she failed her A-Levels, her parents paid for her to resit them. Louise’s father worried that she would always be reliant on the family. This life style could contribute to Louise’s anxiety. Adler also suggested that birth order in the family had an effect on personality characteristics. He stated that as an adult, the youngest child in the family would have high dependency needs and feels the need to excel and achieve, which could also be explained by the early parenting styles and over encouragement to do everything. She will also see her older sister, Sophia, as competition and her development will depend on the way she treats

her. Sophia doesn’t treat Louise nicely, and has been known to highlight Louise’s failings, which would explain why problems and arguments arise between them. Sulloway (1996) states that firstborn children hold positions of dominance and parental favour in comparison to later born children and, as a consequence, develop personality characteristics that correspond with parental interests. Contradicting Sulloway's findings, Michalski & Shackelford (2002) find no relationships between firstborn status and conscientiousness or emotional stability. More recent research also contradicts lay beliefs and prominent scientific theories about birth order effects on personality, and only finds relation between birth order and intelligence, which has convincingly documented that performance on psychometric intelligence tests decline slightly from firstborns to later-borns (Rohrer et al, 2015). This could explain why Louise struggled academically in comparison to her Sophia. The early parenting styles which have lead to the development of inferiority in Louise is due to the fact that the parents were overly involved in the children’s lives and the father was permissive of Louise. Louise’s father has clearly had an an impact on how she feels – the over encouragement to do everything has negatively impacted her. Being dictated by parental expectations, Louise may not be living the style of life she actually wants – she’s at University now but is that where she actually wants to be?

Recommendations and potential goals for therapy – The Adlerian approach emphasises the importance of encouragement with clients. The therapist’s role is to help the client explore feelings of inferiority and consider how they might change this. Louise has selfreferred to the counselling service due to difficulties with her academic studies and increasing feelings of anxiety. Therefore she will need encouragement from the counsellor that she is doing okay, with an aim to reduce feelings of inferiority, which she feels because she is constantly reminded about her sister's academic achievements and is spoken to in a belittling manner by her father. The therapist will also need to promote feeling of belonging in Louise, which she currently will lack as she is criticised for being ‘less than perfect’. The approach involves making good life choices and looking at the positives. The first step is engagement; where the therapist encourages the development of warm, trusting therapeutic relationship, which can be defined as "the collaborative bond between therapist and patient" (Krupnicket al, 1996, p.532). A therapist-client relationship is arguably more important than anything else in a successful treatment, and this could be particularly important in Louise’s case as she hasn’t got the strong relationship with her family members. The more the therapist identifies with Louise, the more empathy that they will have (Maroda, 2009). If the therapist can empathise with Louise then a strong therapeutic relationship can be built. The Adlerian approach specifically aims to engage the therapist and client in a selfmotivated, lively & emotional encounter (Meier & Boivin, 2011). This will be beneficial for Louise as she has self-referred to the counselling service, suggesting she is willing to put in the effort in herself to get the most out of the therapy and reduce her anxiety.

The use of Socratic questioning should be employed by the therapist to encourage Louise to self-reflect and develop new perspectives (Braun et al, 2015). Socratic questioning is disciplined questioning that can be used to explore complex ideas and to open up issues and problems (Paul & Elder, 2007). There are contradictive findings on the effectiveness of Socratic questioning. Talking about negative life events can be distressing; therefore asking Louise questions like “and why did that make you feel unwanted?” could have either a positive or negative effect. The therapist should be wary of the potentially undesirable effects. However, experts have suggested that the use of this approach helps patients to be more active throughout therapy, take new perspectives and experience improvements (Neenan, 2009). The therapist will also need to explore Louise’s relationships to make an assessment on her life style. As previously mentioned, Louise displays the avoiding type and the learning type life style. The early parenting styles may lead to the development of inferiority as they were over involved with the children and permissive of Louise. Therefore, the therapist could seek to address these issues within the family by exploring family constellations, a psychotherapeutic approach founded by Bert Hellinger. This approach is useful as it’s designed to help reveal the hidden dynamics in a family in order to address any issues impacting these relationships and heal them. ‘Family Constellation’ means the client’s physical-emotional positioning and re-positioning of substitute family members in relation to each other, with help of a therapeutic group. It’s a one-session approach that addresses family-of-origin issues (Zollmann, 2002). The relationship Louise has with her family will be having an impact on her sense of belonging and outlook on life, so the aim should be to restore a sense of belonging and hope in Louise. The therapist must be careful what she asks Louise to do in family constellation. For example, if she asked Louise to do something like bowing to [the representative in the constellation of] her father. As the father already speaks to Louise in a belittling manner, this could have a negative effect and lead to therapeutic abuse (Hunger et al, 2015).

Next, the therapist should encourage Louise to think in different ways to have a more positive outlook on her life. The aim should be to get Louise to understand her motivations and then Louise can use these insights to form a healthier interpretation of the relationship she has with her family members. For example, she could try to view the pressure from her parents to succeed in a caring manner rather than a belittling one. She should also be encouraged to see that she has choices –if she doesn’t achieve the grades she desires, she will still have the potential to secure a good job. There are also other options if she is struggling academically and not enjoying University, to live the style of life she wants to. For example, she could find an apprenticeship in a sector which interests her. Seeing that she has these other options may help with her stress and anxiety. The therapist should seek reorientation by working with Louise to change her style of life based on her learning and encourage her to change her behaviour and think positively.

Ethical and/or legal issues – The contract should be discussed between the therapist and client in the first session so that they understand the rules of the contract and to know the extent and limitations of the confidentiality that they are being offered by the therapist.

There is a legal issue of confidentiality which the therapist would need to consider when working with Louise’s case here. Louise arrives at the session and asks if her friend is able to join. Since this is Louise’s session it should be used for the therapist to learn about Louise and discuss the therapy and what will happen throughout the process. The therapist is only contracted to give therapy to one client and may find it hard to keep up with both of them. The client’s confidentiality and privacy must be protected. This links to one of the BACP ethical principles, beneficence, which is acting in the best interest of the client based on professional assessment. The therapist should work within her own competence to decide what will be the best option for Louise and their therapeutic relationship, as the client is the primary focus (BACP Ethical Framework, 2018).

Conclusion – The case report adopted an Adlerian approach to contextualise the pertinent issues within Louise’s case. Consequently, the suitability of an Individual Psychodynamic (Adlerian) approach was evaluated, together with justifying the potential methods of therapy, such as encouragement and family constellation, for Louise’s case. Ethical and legal issues have also been considered. To summarise, the upbringing and parenting styles in Louise’s childhood have affected her in her later life and to this day she still has feelings of inferiority, which is contributed to by the behaviour of her elder sister. She still suffers with anxiety which she developed in school and the therapist should aim to address these issues and give Louise a more positive outlook on life and see that she has other choices.

Word count: 2513

References: 

BACP ethical framework. (2018). Available at http://www.bacp.co.uk/ethical_framework/



Bagby, E. (1923). The inferiority reaction. The Journal of Abnormal Psychology and Social Psychology, 18(3), 269–273. https://doi.org/10.1037/h0066946 Braun, J. D., Strunk, D. R., Sasso, K. E., & Cooper, A. A. (2015). Therapist use of Socratic questioning predicts session-to-session symptom change in cognitive therapy for depression. Behaviour research and therapy, 70, 32-37. Hunger, C., Weinhold, J., Bornhäuser, A., Link, L., & Schweitzer, J. (2015). Mid‐and long‐term effects of family constellation seminars in a general population sample: 8‐ and 12‐month follow‐up. Family Process, 54(2), 344-358. Krupnick, J. et al (1996). The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: Findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Journal of Consulting & Clinical Psychology, 64(3), 532-539. Maroda, K. J. (2009). Psychodynamic techniques: Working with emotion in the therapeutic relationship. Guilford Press. Meier, A. & Boivin, M. (2011) Counselling & Therapy Techniques: Theory & Practice. Sage.







 



  

 

Michalski, R. L., & Shackelford, T. K. (2002). An attempted replication of the relationships between birth order and personality. Journal of Research in Personality, 36(2), 182-188. Neenan, M. (2009). Using Socratic questioning in coaching. Journal of rationalemotive & cognitive-behavior therapy, 27(4), 249-264. Paul, R., & Elder, L. (2007). Critical thinking: The art of Socratic questioning. Journal of developmental education, 31(1), 36. Rohrer, J. M., Egloff, B., & Schmukle, S. C. (2015). Examining the effects of birth order on personality. Proceedings of the National Academy of Sciences, 112(46), 14224-14229. Sulloway, F. J. (1996). Born to rebel: Birth order, family dynamics, and creative lives. Pantheon Books. Zollmann, A. (2002). Family Constellation - A Therapy Beyond Words. Australian and New Zealand Journal of Family Therapy., 23(1), 38–44. https://doi.org/10.1002%2Fj.1467-8438.2002.tb00484.x...