For this discussion, you will apply psychoanalytic theory to the client Mary (se

Question

For this discussion, you will apply psychoanalytic theory to the client Mary (see case study below)

1) Discuss two specific interventions you would use with Mary

2) Identify a limitation of applying the theory to this case.

CASE STUDY IS BELOW:

Presenting Information: Mary is a 29-year-old white female. She is divorced with two children, a four-year-old daughter and a 10-year-old son. She is currently in a relationship with John; they have been together for about a year. John was recently laid off from his job with a small local manufacturing company. Mary presents to counseling with multiple concerns. She reports feeling tired and lethargic most of the time and does not sleep well. She feels decreased motivation in general and a discontent in her life, feeling like a dark cloud follows her around. She does not enjoy her life as she once did. She states, "I feel like every day is just a struggle, and I do not know where to turn." She also reports having a lot of relationship problems and challenges with her son. In her relationship with John, she feels that he ignores her and puts everything else first. She says that he just stays with her because he has no where else to go, and that he does not even want to talk to her about how she is feeling in her life or about her financial concerns. She says that she loves him, but she is worried about his lack of ambition, and she is not sure she wants to stay in the relationship. She states that she cannot trust John even though she has no reason not to trust him. She also reports that her son is getting in trouble in school and that she is at a loss for what to do. He has been sent home a few times in the past three months for fighting physically and verbally, and she feels like she is a bad mother because she does not know what to do to help him.

Social History: Mary has lived all her life in a small rural town outside a larger city. Mary was first married at age 19, when she and her boyfriend discovered she was pregnant. She was married to Mark for six years and got divorced just after having their daughter, her second child. She states that her ex-husband was controlling and says, "He kept me on a tight leash and never gave me any slack." She reports that he had bouts of using drugs and had an affair early in their marriage. She says she tried to get over the affair but could not, stating, "I could never get the image of catching them together in our bed out of my head." She states that the decision to divorce was mutual but that he made it very difficult as he helped minimally with the kids. He is now seeing the kids twice a month and pays a small amount of child support through the state, but she says that she worries about what is going on at his house when he has the kids. She reports that her son comes back angry and defiant after staying at his dad's house for the weekend. Mental Health and Addictions

History: Mary states that she used marijuana in her early 20s but has not used it in five years. She only drinks alcohol occasionally, having a few beers once or twice a month. She reports that she felt she was depressed while in her marriage but never sought counseling or treatment because her husband would not have let her. Family History: Mary is an only child. She states that her mother and father were divorced when she was 14, and she feels like she never got over that. She says, "I can just remember how they fought and yelled like I wasn't even there. I hated that time in my life and I hated my parents." She reports that she ran away from home several times during her early teen years and that there was never enough money for her to do the things she wanted to do in school or for extracurricular activities. She states that her relationship with her mom is supportive now, but she has little contact with her dad. Mary later found out that her dad was having affairs while he was married to her mom, and Mary states that she just cannot forgive him for putting them through that. Although Mary's mother is now sober and supportive, she lives about an hour away and works full time. Mary states, "I don't want to burden my mom with my problems or my kids."

Occupational and Educational History: Mary went away to college but dropped out when she got pregnant and married. She got a CNA license and started back to school a year ago to work toward a nursing degree. She works full time and lives paycheck to paycheck. She is worried about her job, saying, "I just can't get the motivation to do a good job … and sometimes I can't even get out of bed to go in." She is also ambivalent about being a nurse. She states that she should since she has been a CNA, but that she has no motivation to go to school anymore and her grades have been dropping.

Explanation / Answer

The patient Mary is suffering from depression and anxiety with personality disorder as mentioned in the diagnosis of the statistical manual of mental disorders under category 4 and 5. She is divorced and is a victim of harassement and abuse from her second husband. She feels lazy, lethargic with depression,anxiety and suicidal thoughts. She had a habit of taking marijuana drug during her childhood which has caused the development of hallucinations, hysteria and delusions with blurring of vision. Her parents were divorced when she was young ,this indicates the adverse conditions present at her home. She feels lack of care,love and empathy. She has two children and feels suffocated with depression.

1) The interventions for the treatment include the counseling for the patient from the doctor. The patient is a certified nurse assistant by profession by is facing serious depression. Behavioral therapy with the availability of a good environment should be provided to her and her kids in the rehabilitation room. The circumstances in the chidhood which led to the development of the personality disorder should be discussed with the couselor.She should be made aware of the harmful affects of the intake of marijuana which is extremely dangerous for the body. The treament was started by Foulkes in 1940 and is based on the psychoanalytical theory of Sigmund Freud. The psychodynamic theory can be implemented which discusses the inner feelings and emotions of the person suffering from anxiety and depression. She should express her feelings with someone close who can support her and show emotion, empathy,love and care with emotional support. The statistical tests of significance are used for checking the levels of the depression and scaling analysis is done to study the mood, emotions, fear, phobia, enjoyment and other physical attributes defining the nature of the patient under study.

2) The psychoanalytical theory involves the detail case study of the circumstances and evidences with the environemental factors prevalent for the occurrence of the personality disorder in the patient. The inner feelings are depressed, gloomy with suicidal tendencies and generation of anxiety, stress and lethargic behavior. The shortcomings of this theory is that 1) the patient does not express inner emotions and feeings easily in front of the doctor or counselor 2) The environment and the circumstances with adverse conditions do not change in the life-time of the person even if the character of the patient is improved with behavioral exercises, psychodynamic exercises, pattern development exercises, mental tests of color and perception. The adverse circumstances again reoccur leading to the development of the personality disorder even after the intake of sedative drugs. The statistical tests analyze the intensity of emotions, depression, anxiety with developement of the graphs to study the behavior of the patient.

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