1. Case conceptualization/ assessment
• Based on the case, write an assessment through the lens of your chosen theoretical model. Include evidence from the case for your application of the theory/model.
Give an introduction to the Psychodynamic theory. Focus on Ego: describe.
In the psychodynamic theory, the focus is the mind, and in the mind, there is both a conscious and unconscious part. The impact of human development is developed with their life experiences. At the start of a human’s early childhood experiences and relationships are shaped by the development of their personality, which interacts with the present reality that shapes the adaptation in current life.
In Ego psychology, the main factors in having a sense of who you are, having a sense of I/me, your organized structure, and knowing that “you” who thinks, feels, and acts in a reasonably consistent manner is responsible for negotiating between your internal needs and your demands of living.
Write a brief summary of the case and how it applies to the ego. (Crisis: mother-daughter crisis)
In the case of Sandra, a 39-year-old heterosexual, cisgender black American female, she was currently living in her rural central Florida home with her husband and teenaged stepson. Sandra is on temporary disability shown when she walked in her first meeting with a walker but otherwise looking healthy.
The ID’s primary function is the basic impulses of sex and aggression, which seek immediate gratification on the irrational and impulsive; the ID operates on the unconscious level of the mind.
The Ego is at the executive mediating between the id’s impulses; the superego’s inhibitions test reality, are rational and operate mainly at the conscious and preconscious levels.
Connecting Sandra’s case to Ego psychology, ego development occurs as a result of meeting basic needs, identification with others, learning, having a mastery of developmental tasks, effectively problem-solving, and successful coping. For Sandra, she lacks an emotional connection with her family. In Sandra’s eyes, she describes her parents as being in a verbally and physically violent relationship with her father, who was affected by significant alcoholism. Sharing a memory, Sandra remembers being 12- years old when her father pushed her mother through a plate glass window. Sandra had to help her mother, who was barefoot at the time, remove the shards of glass embedded in her feet. While Sandra has no recollection of either of her parents being physically violent towards her, she does remember that neither of her parent being emotionally available towards her. Sandra states, “it’s like they wanted me there because they wanted to be this kind of family, you know? But they didn’t like it when I was there.”
The relationship between Sandra and her brother was physically violent. Sandra describes her brother doing things such as slamming her head into furniture, slamming a door on her arm, finding ways to humiliate her in front of her friends and family, and making up stories to get her in trouble with her parents. When going to her parent regarding these injuries or situations, her parent would punish her brother, but that didn’t give her any comfort because she was told that she should not cry, and if she couldn’t control it, she would be sent to her room
(ID’s) There is a lack of nurturing, comfort, and care experienced by her parents, which Sandra reports being in various sports and school activities over the years. She states “that her parents were not present for a single game or activities.
During her late teens, Sandra, Sandra’s mother and brother were sitting in the kitchen having an argument when her mother blurted out “well what do you know? You’ve never had to give up a child for adoption before!” in this moment Sandra and her brother were made aware that their parents had given birth to a child that was given up for adoption earlier in their relationship. Sandra starts to feel sad for her sister, this causing her think about that the family is cursed. “None of us can get away from the Brennan curse” (why does she think her family is cursed?)
When it comes to Sandra mental health, she suffers from depression due to being medically discharged from the military due to a fall that caused her to damage her spine. Sandra’s symptoms had gotten worse after a few years, she began having flare-up from the injury which had caused her to walk with either a cane or a walker. Because of her physically limitation Sandra became upset. As Sandra’s physical symptoms worsen, she disclosed during a screening that she was having suicidal ideations and had developed a plan. The veterans Administration Medical Center which is where she received care for her injury asked Sandra to sign a safety contract, but she refused (ID) she states, “I always keep my word when I make promises, and I didn’t know if I could keep my word on that.” “I mean I didn’t plan to kill myself that week or anything, but I didn’t want to be put in a position of breaking my promise to someone.”
The ID is based on when the person basic impulses such as sex and aggression seeks immediate gratification , Sandra starts to seek gratification when she was diagnosed as borderline and she was told she was being manipulative when she asked for more intensive services . she states “ it felt crazy, they wouldn’t even listen to me” she suspected that she was getting treated differently as a black women.
Sandra was asked to resign from her job as teacher due to lack of medical clearance because she wouldn’t sign the safety contract and was to sent to an outside community mental health facility. She was given medication and told to attend one group per each day, but did not receive no individual therapy.
She was again admitted for self inflicted cuts that were found on her upper thigh and again she refused to sign the safety contract to commit to not hurting herself or killing herself. Due to these events she believes that the reason for her losing her job or being asked to resign was because someone found out that she involuntary was admitted and they we using her lack of medical clearance by a medical provider as a way to get rid of her.
In the Ego which adapts drives to socially acceptance outlets. Sandra shows this by her strengths. Through successful coping skills Sandra is a compassionate, self-aware and actively seeking help. An example of this is when Sandra signed up with an online DBT support group that she located on her own, was seeing a psychiatrist regularly, and was journaling. She was able to report her self-care coping, which including photography, a hobby that she’d begun while working with her first VAMC therapist. She states “ when things are too much, I can just put in my headphones and sorts of zone out.” “ No one talks to me and I go to my park, and I am just there, with the trees and the animals.”
Ego developments occurs as of result of meeting basic needs, like mention before Sandra lack support from her family. An example of this, is when Sandra entered into a VAMC art contest. She went to a photography studio in west Florida to have some blown up prints made of her work, and was met by her mother while there. Sandra shared that her mother spent most of the day complaining about parking, the employees at the photography studio, and about Sandra’s choice of photographs. Her mother insisted that Sandra blow up two other photos on top of the one she had originally planned to print but when she had told her mother that she didn’t have fund for that her mother paid. On the drive home, Sandra’s mother spend the entire drive complaining about the cost of the extra prints. In this situation Sandra reports feeling confused by the way her mother reacted but she starts to show growth by stating “ that’s just how she is.” It was the first time that Sandra had not taken her mother’s behavior personally she recognized that her mother might only have certain capacities and that this had nothing to do with Sandra. In the beginning Sandra would cry when speaking about her mother and ask why she her mother was doing this to her. But this time she just rolled her eyes about how her mother’s reaction. When sharing that story she shared it as just another annoying event in her past week instead of one more tragedy of her life. In this moment Sandra began to relate to other with there own minds and behavior she began not to take their choice so personally.. in this moment she learned how to identify with others.
Note any missing information from the case that would be helpful to know to assess this client through your chosen lens.
Go back to the case and find what information you would need to know based on ego lens
• Include client’s problems, barriers, and strengths as would be discussed according to the theory/model
• You may include an ecomap or genogram as an appendix
• Ensure you are writing a case formulation and assessment of client utilizing the language of the theory/model
• Problems, strengths, and barriers should be discussed in the context of the theory/model
2. Treatment model/Intervention
• Discuss how you would organize your treatment based on your theoretical conceptualization for this client.
• Treatment planning: Note specific goals that would be listed on your treatment plan, based on the model you chose
• Describe what your intervention would look like as you work with your client.
• Apply critical thinking to why this model would be a good fit for this client and what barriers might arise.
• Note any barriers or problems that might be encountered in using this model/intervention.
• Describe and critically appraise how selected intervention fits with best practices appropriate to your client.
3. Evaluation
• How would you assess treatment progress/efficacy with this client?
Ego – supportive- coping
Support (therapy) , education, some reflection ( journaling)
• How would you know if they are getting “better” according to the theory/model?
• Discuss how treatment outcomes might be evaluated based on selected intervention. What outcomes would you be looking for as evidence?
4. Evidence-informed research
• Is there any evidence base for this theoretical model and treatment model for this type of client? Cite at least 2 articles in addition to your text to support your argument.
• Discuss the research literature as it is connected to client’s presenting problem and/or identity, and the potential intervention.
• Describe findings of identified evidence-informed research
5. Diversity and Social Justice
• Thinking in terms of power, oppression, diversity, and social justice, how would you conceptualize this client according to the theoretical model chosen here?
• Has this theory/model been shown to reflect equity and social justice for oppressed and marginalized clients? Cite at least one article to support your argument.
• Would this client likely have access to this theory/model of treatment based on current modes of insurance coverage or available mental health institutions?
6. Therapeutic alliance/Ethics
• Describe the nature of the therapeutic alliance as well as any issues of diversity and social justice that might impact this client’s problem and treatment, using the information you have from the case AND assignment’s theoretical lens.
• How might transference, countertransference, bias, and potential therapeutic ruptures be understood according to this theoretical model and intervention?
• How are you and the client similar and different? How might this impact the therapeutic alliance? How might you utilize supervision around these issues? What recommendations might you make regarding social, economic, and/or environmental advocacy and empowerment efforts for this client?
• What ethical challenges are discussed in the case, and how might you understand them according to the theoretical lens and model you have chosen?
Last Completed Projects
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