Introduction – to the perspective you are using to construct the formulation, which should include the key ideas underpinning the approach (500 words).
There is no doubt that some of original Sigmund Freud’s psychoanalytic principles have been enormous miscalculations. However, his conviction that the dynamic of psyche depends on understanding of the adoptive significance of its components was, without a doubt, spot on (Nesse & Lloyd, 1992). Due to the scientific majority’s dismissal of all subjective data, psychodynamic approach and its treatments have been much criticized for their validity, or luck of it, from its beginnings to the present day. Even though those criticisms can be justified, this unique method still does provide a plausible explanation for different levels of mental organizations (Nesse et al. 1992). William E. Glassman (2004) rightly points out that the image of Sigmund Freud; “stroking his beard and pondering the meaning of his patient’s world and action” has become a caricature that represents psychotherapy. Since the approach originated Freud has been accepted as the father of psychoanalysis, nonetheless, this approach evolved and has been transformed by scholars such as Anna Freud, Adler, Jung, Klein, Fromm and many others. Although, these transformations shaped the classical psychodynamic theory to the whole world of diverse contemporary view points, the following paragraph will in brief describe the core feature typical to these views.
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Understanding behavior by analyzing development of personality shaped by its past experiences and what motivates the mind are the central focus of psychodynamic approach (Glassman et al, 2004). So, attention is placed on the mental processes within the person and those are not directly observable. By theorizing about inner drives (id) and their constant conflict against demanding, inhibitory reality, and the self evaluetor (super ego), in his theory Freud portrayed a complex process of personality development. Ego’s (Self) role is to balance previous two mental components for a personality to thrive. This is a demanding and often painful job. Avoidance of pain is achieved by use of defense mechanisms such as repression, denial, projection (Glassman et al, 2004). Since we are not always conscious about use of these defenses or about how successful they are, we often dismiss when their employment becomes damaging (Johnston & Dallos, 2006). Due to lack of awareness these futile defenses are used over and over again, shaping and maintaining psychological disorder (Johnston et al, 2006). Psychodynamic framework is utilized in many ways in order to be able to provide support to people with a range of psychological disorders. Anecdotal view is that psychoanalysis encompassed years of on to one session, but Freud really worked with his clients for more then a year (Messer &. Warren, 1995). Moreover, the approach and its core principles have been applied in a number of different psychotherapeutic settings such as with couples, small and large groups, families and children (Gelder, Gath & Mayou, 1989). The role of the therapist is to, together with the client make an attempt at understanding of the client’s psychodynamics, bring the client in touch with the painful feelings previously avoided, and help the client in relief of the problem/symptoms (Perry, Cooper, & Michel, 2006). Moreover, a therapy is lead by teams which are repainting across four psychodynamic perspectives. These teams are further organized to serve and guide a useful formulation (Johnston et al, 2006). The dynamic perspective considers personal difficulties in terms of meaning and motivations that an individual attaches to them; the developmental perspective looks at the past to understand the present; the structural perspective tries to understand the ways in which unconscious needs shape persons perceptions and responses to the world; and adoptive perspective looks at what is working in a persons life and use this identified strengths to brake maladaptive cycles (Johneston, 2006). The following paragraphs attempt to utilize all of these perspectives, as and when appropriate, for formation of appropriate therapeutic model.
Formulation – this is the main body of the text and should include references to further literature (e.g. if you make a claim that delusions are caused by systematic logical errors, then provide a reference to support this claim) (1500 words).
Bess, 19 year old girl from London was referred to a clinical psychology department. Referral was made subsequent to her admission to an acute psychiatric unite. Medication she was prescribed proved ineffective in lessening the voices she heard, and in improving her delusional beliefs that Michel Jackson is in love with her. From the above we can assume that besides being on the medication and suffering from delusional beliefs Bess is thought to be able to take a part in a psychological assessment. Potentially and in additional to her medication, she could participate in a psychotherapy. Talking therapy may not further threaten her equilibrium but help Bess beyond removal of the disturbances caused by the delusions and hearing the voices toward the gaining ability to truly overcome underlying concerns.
Based on a history that is revealed to us on an A4 page, nevertheless, an attempt will be made to provide some key points which could perhaps be useful in beginning to create a psychodynamic formulation. Above presented problems that are currently interfering with Bess’s day to day existence could bee seen as deeply rooted in her developmental history. Born in the Caribbean, to a Christian family, Bess moved with her parents to London, aged just 5. Due to both parents working long hours Bess, as the oldest child took care of her youngest three siblings. Still, she excelled at school and has been accepted and supported by her teacher who was there for Bess when she was bullied by other children. Despite a demanding life, Bess got on well with her siblings and had high and healthy ambition to go to University and study medicine. Over the course of psychoanalysis, Bess could perhaps understand that her choice of the career she desired was shaped by the events from her childhood (????). Leaving homeland and moving to another country, to different culture and for ‘better life’, perhaps motivated a reaction in Bess. Being a girl of a black colure skin, a child of parents who had work with no prospects, being bullied at school, all that may contribute to her feeling of helplessness and impotence. These feelings in themselves may have produced a trauma in Bess, which she unconsciously tried to control in any possible way she could; by doing well at school and eventually gaining a status which will then give her a sense of power.
At the age of 10, Bess’s family experiences further disintegration, this times amongst them self’s. Her parents, who chose to come to the UK for the ‘better life’, are dealing with the realization that they only encountered multiple losses on this quest. Each of them is coming in terms with these losses in a different way but each is leaving profound consequences on Bess’s wellbeing. After initial arguments between her drunken father and her ‘due to work’ absent mother, abyss between parents just grew deeper. Consequences of this reality hit Bess the most. Her father began his two year long sexual abuse of Bess. This was total betrayal by both of her parents. It is difficult to deduce any feelings that Bess may have without actually talking to her, but we can speculate that this was traumatically overwhelming. This trauma must have been worsened by the fact that her mother completely dismissed her. At the end of the day she was forced to work long hours just to ‘meet the ends’. This poses us to consider the abuse in a wider context. Family violence in African-Caribbean communities is still considered to be an area of tension in the UK (McClooskey & Hooper, ????). As much as the mentioning of racism is anecdotally disliked in this country, it can not be dismissed that racial sexual stereotyping may play a role in fostering child sexual abuse. This is a form of abuse in it self. McCloosky ( ) goes further by suggesting that racism has an effect on a child’s ability to seek or accept help from others when abused within the family. If we are to incorporate this notion into psychodynamic formulation we can speculate that Bess was totally dismissed by her parents and was left to her own devices to try to contextualize what happened.
Bess helplessly participated in this abuse. Her initial agreeing to take a part in the sexual contact to protect her sibling was substituted by enjoyable feelings of getting the attention and affection that accompanied this act. However, she was left to her own ‘inner silence’ and confusion after her father, eventually, stopped the abuse and left the family for another woman.
Delusions are believed to be disturbances of lessen severity
Psychodynamic formulation reveals, up to this point, that for this Christian girl delusions represent fear, loss of control
Structural perspective; how early trauma happened and how sever it was.
Integration – use this section to include any further information from other perspectives that you think might be relevant to the client (e.g. even though you may have concentrated on CBT, you could include issues relating to social inequality if you think they are relevant) (300 words).
Conclusions – use this section to critically evaluate the observations you have made or the approach you have used more generally. You may also add further comments on any unresolved issues (200 words).
By looking at mental unconscious events psychoanalysis offer a perspective on mental life that has not been incorporated in some other respectable approaches such as social constructionist. Although
