Case Studies in Mental Health Treatment

A Cross Section of Journal Articles for Discussion & Evaluation

Robert Kalina

• Publisher: Routledge
• Year: 2021
• Print ISBN:
  9781138287648
• eBook ISBN:
  9781351971164
• Topic: Psychology
• Subtopic: Research & Methodology in Psychology
• Index: Psychology

The key aims of this text are to illustrate the use of various types of mental health treatments and to provide in-depth examples of common psychological disorders supported by case studies. The 34 journal articles in this book— authored by practicing psychotherapists, psychiatrists, psychoanalysts, and counselors— describe the treatment of individual clients. In most cases, the authors discuss a client's psychological problem , the treatment used w ith the client, and the outcome. This book is designed for use in courses in clinical, counseling, and abnormal psychology, each article is followed by (1) a list of psychological term s for classroom discussion and (2) questions that call for students' opinions on various aspects of die case.

Case 1

Changing Mistaken Beliefs through Visualization of Early Recollections*

Mary Ann Lingg

Terry Kottman

There are no chance memories: out of the incalculable number of impressions which meet an individual he chooses to remember only those which he feels, however darkly, to have bearing on his situation. Thus his memories represent his “Story of My Life”; a story he repeats to himself to warm him or comfort him, to keep him concentrated on his goal and to prepare him by means of past experiences so that he will meet the future with an already tested style of action (Adler, 1958, p. 73).

(1) Early recollections are traditionally used in Individual Psychology to facilitate the investigation into a client’s life style. While early memories do not determine behavior, they do reflect the client’s current self-image, views of the world, and style of interaction with others. When asked to describe specific incidents that took place during the early years of life, the client selects, alters, or imagines events that express the central issues and interests of his or her life (Ackerknecht, 1976; Bruhn & Last, 1982). Gathering early recollections can help the counselor begin to understand the client’s struggles, attitudes, hopes, and behaviors (Papanek, 1972). They give the counselor clues about the direction of the client’s strivings and the ways the client gains significance. Early recollections indicate the values to which the client ascribes and the dangers the client wishes to avoid (Adler, 1937). Basic mistakes, illuminated by the early recollections, represent the client’s basic convictions about self, the world, and others. These ideas, which govern behavior, may or may not be within the client’s awareness (Manaster & Corsini, 1982).

(2) Basic mistakes are basic because they are the original ideas a child develops to fulfill the needs of belonging and significance. They are considered mistakes because they are faulty conclusions drawn from a child’s perspective while the child is engaged in the struggle to establish a place in the world. As Dreikurs and Soltz (1964) indicated, “Children are expert observers but make many mistakes in interpreting what they observe. They often draw wrong conclusions and choose mistaken ways in which to find their place” (p. 15).

(3) One of the goals of counseling is to identify basic mistakes and bring them to the client’s awareness. It is the counselor’s responsibility to discover those early, erroneously developed convictions and to help the client see how those ideas are false and how they can interfere with effective social and personal functioning. Manaster and Corsini (1982) refer to the process of psychotherapy as uncovering the basic mistakes and correcting them.

(4) Sometimes simply talking to the client about mistaken beliefs and bringing them to the client’s awareness is enough to bring about changes in the client’s self perception. However, at other times, mistaken beliefs and private logic are so ingrained in the client’s way of looking at life and self that talking about them does not bring about a change. When this happens the counselor must introduce creative ways of helping the client reexamine basic convictions in order to bring about changes. Early recollections have been used to help the client gain insight into his or her life style. By interpreting an early recollection or series of early recollections to the client, the counselor can hold up a “mirror reflecting the patient’s present attitudes and intentions” (Ackerknecht, 1976, p. 54). Since early recollections represent a microcosm of the client’s mistaken beliefs and private logic, active interpretation and visualization of early recollections may be an excellent tool for helping the client reconsider mistaken beliefs. It may then be possible for the client to substitute positive convictions for negative beliefs.

The Technique

(5) Before initiating the visualization process, the counselor reviews any previously presented early recollections and asks for any others the client may remember. The counselor is then free to choose the early recollection which best typifies the basic mistake currently under examination.

(6) The counselor begins the visualization process with some basic relaxation techniques such as asking the client to close his or her eyes, take a few deep breaths, and get as comfortable as possible. The counselor then asks the client to visualize the specific incident chosen to represent the particular mistaken belief. It may facilitate the process if the counselor suggests to the client to think of the early recollections as a scene in a play or television show to be watched from the perspective of an audience. The counselor then asks the client to describe the scene as it is unfolding. With eyes still shut, the client is asked to describe the feelings experienced during the interaction. In order to begin to change the mistaken belief, the counselor asks the client to visualize himself or herself as an adult actually entering the scene. The client is asked to visualize the adult self comforting the child self, telling the child self how valuable, important, and lovable he or she is. Then the counselor suggests that the visualized adult begin to help reconsider any mistaken beliefs about what is necessary to achieve significance and belonging.

(7) For instance, in one early recollection, a client was frightened for appropriate reasons, but her father pushed her aside and called her a baby for being fearful. By interpreting this to mean that her father would not accept her feelings, she formulated a mistaken belief which stated that in order to be loved and belong in her family she needed to deny her feelings and be someone other than who she really was. The visualized adult version of her self comforted her child self and reassured her of the appropriateness of her feelings and encouraged her to express those feelings. The adult self also expressed a willingness to accept her as she was, without a need for pretense.

(8) The counselor then asks the client if there is anything else in the visualized interaction that needs to be changed or if there is anything else the child self needs. If the client answers affirmatively, the counselor guides the client through the process of visualizing the adult self making those changes, doing whatever needs to be done in order to help the child self feel comfortable and safe. After bringing the client back to the present, the counselor asks the client to reexamine mistaken beliefs and to consider other more useful ways of gaining a sense of significance and belonging. At this time, the counselor also helps the client change the wording of selected negative self statements.

A Case Study

(9) A 32-year-old female entered counseling after the breakup of a love relationship. The client was experiencing extreme sadness at the disintegration of the relationship and was having difficulty letting go of her investment in the relationship. After establishing rapport with the client, the counselor began to explore her mistaken beliefs. They identified these mistaken beliefs: (a) “it is my responsibility to make and keep others happy”; (b) “I must control others’ behavior to feel important”; and (c) “I must hold things together in the family.”

(10) For several sessions the client repeatedly stated that she wanted to change her mistaken beliefs, but that she could not change the way she interacted with others. The counselor decided to employ the technique of early recollection visualization as a possible method of helping her get past this impasse. The counselor asked the client to close her eyes, sit comfortably in the chair, take several deep breaths, then recount one of her early recollections and she related this memory:

I remember one day my mother was supposed to visit an old friend who happened to live on the other side of the city, near an amusement park. My father was going to drop my mother off at her friend’s house and take my younger brother and I to the amusement park while my mother visited her friend. Some time before we were getting ready to go, my father was nagging my mother about something and before you knew it, it was a huge argument with my father nitpicking at my mother over anything. This happened quite often. Finally, my mother was so upset that she decided not to visit her friend. My mother was standing at the front door looking out the window crying. My father was standing in the dining room telling my mother there was no reason to be upset and she should get ready to go out. I was running back and forth between the two of them trying to interpret what the other was saying and trying to smooth things over. I was trying to get my father to stop harassing my mother and trying to get my mother to feel better. I wanted them to stop so things could go as planned.

When the counselor asked about feelings the client replied:

I remember feeling helpless and pulled in two directions. I wanted them to stop arguing because I didn’t like my mother to be upset or my father to be angry. I felt responsible for making things better between them and making everyone happy. I wanted things to be OK so we could still go to the park and I felt selfish about that.

(11) The counselor guided the client through the early recollection visualization process described above. The counselor asked the client to visualize herself entering the scene as an adult and encouraged her to hug and comfort her child self. The counselor coached her through a process in which her adult self told the child self that she did not need to always take care of other people nor did she have the power to control others’ behavior. The counselor prompted the adult self to tell the child self that she was not responsible for resolving the parental conflict. The counselor also prompted the adult self to hold the child self and reassure her that she was lovable and significant even when she was not taking care of others. When the counselor asked the client if there was anything else she wanted to change in the visualization she replied “I want her to know (child self) that she is really loved.” After the adult self told the child self how much she loved her, the counselor brought her out of the visualization.

(12) The counselor and the client processed the early recollection visualization and discussed changes she wished to make in her basic convictions. They talked about how this early recollection illustrated all three of the basic mistakes they had identified. They discussed the client’s feelings of sadness and hopelessness in trying to live her life in accordance with these mistaken beliefs. The client said she would like to change her erroneous convictions to the following: (a) “although I can contribute to others’ happiness, I do not have the power to make or keep them happy”; (b) “I do not have the power to control others’ behavior”; and (c) “it is not my responsibility to hold things together in my family.”

(13) After this session, the client reported a release of responsibility from a job that was not hers in the first place: taking care of her parents’ relationship and happiness. The client continued to examine her basic mistakes and to look at how these ideas interfered with her present functioning. With the help of the counselor she was also able to relate the basic mistakes highlighted in this early recollection to her continuing investment in the recently ended love relationship. She had experienced difficulty in letting go of the relationship because she believed she was solely responsible for its continuance. She replaced this belief with one that allowed her to stop being responsible for the happiness of others. Thus, she could let go of the illusion that she must control all of her relationships.

(14) A one-month follow-up found the client still experiencing the same release of responsibility and emotional disengagement from the defunct relationship. She reported an increase in her ability to concentrate on other matters and was no longer obsessing about the relationship. She was continuing to redefine her priorities for future relationships and her beliefs about how she could gain a sense of belonging and significance.

Conclusion

(15) Counselors can assist clients in belief reorientation through the use of early recollection visualization. This technique helps clients gain a clearer understanding of their mistaken beliefs and facilitates changes in the ways they gain significance. Early recollection visualization is an action-oriented method which is helpful with clients who have difficulty making a connection between their early decisions and their present behavior. Counselors may recognize this type of client as the one who frequently asks, “Why do I continue to do this?” or who says, “I do not understand why I do the things I do.” This technique is also effective with clients who resist examining their mistaken beliefs or persist in negative self-talk. Visualization may also help clients who have a cognitive understanding of their problem but seem to have difficulty changing their feelings and behaviors.

(16) However, counselors should be aware that this technique is not a magical cure. Early recollection visualization is simply one of many therapeutic tools to be used in conjunction with other strategies. It should never be used without a strong counselor-client relationship and an understanding of the client’s life-style. Following a visualization, it is imperative that counselors process clients’ experiences with them to insure client understanding and well-being.

References

Ackerknecht, L. (1976). New aspects of early recollections (ER) as a diagnostic and therapeutic device. Individual Psychologist, 13, 44–54.

Adler, A. (1937). Significance of early recollections. International Journal of Individual Psychology, 3, 283–287.

Adler, A. (1958). What life should mean to you. New York: Capricorn Books.

Bruhn, A. R., & Last, J. (1982). Earliest childhood memories: Four theoretical perspectives. ...

Table of contents

• Cover
• Title Page
• Copyright Page
• Table of Contents
• Introduction
• 1. Changing Mistaken Beliefs through Visualization of Early Recollections
• 2. Sexual Counseling with a Developmentally Disabled Couple: A Case Study
• 3. Reducing a Child's Nighttime Fears
• 4. Treatment of an Adolescent with Bowel Movement Phobia Using Self-Control Therapy
• 5. “Forbidden Fruit Tastes Especially Sweet.” Cognitive-Behavior Therapy with a Kleptomaniac Woman: A Case Report
• 6. Behavioral Treatment of Night Bingeing and Rumination in an Adult Case of Bulimia Nervosa
• 7. Decreasing Junk-Food Consumption Through the Use of Self-Management Procedures: A Case Study
• 8. Case Report of a Needle Phobia
• 9. Controlling Extremely Dangerous Aggressive Outbursts when Functional Analysis Fails
• 10. Linking Descriptive and Experimental Analyses in the Treatment of Bizarre Speech
• 11. Body Image Changes During Guided Affective Imagery
• 12. Self and Space
• 13. The Intruder: A Dream-Work Session with Commentary
• 14. A Look at the Self-Righteous Defense
• 15. Grieving the Loss of Narcissistic Entitlement: A Case Study
• 16. A Group Counseling Experience with the Very Old
• 17. Group and Individual Reactions to the Death of a Member of a University-Affiliated Women's Support Group
• 18. Multiple Severe Sexual Dysfunctions Resolved in Brief Sex Therapy
• 19. Childhood Neurotic Disorders with a Sexual Content Need Not Imply Child Sexual Abuse
• 20. Pubescence: A Psychoanalytic Study of One Girl's Experience of Puberty
• 21. The Psychoanalytic Treatment of a Preschool Boy with a Gender Identity Disorder
• 22. Identity Formation in an Adolescent Girl: Boundaries Between Psychotherapy and Counselling
• 23. Occupational Therapy Intervention for an Adult with Depression and Suicidal Tendencies
• 24. Extended Inpatient Treatment of a Refractory Heroin Addict: A Multidisciplinary Approach to Patients with a Dual Diagnosis
• 25. Alcoholic Women's Feminine Self-Concept and Mothering: The Importance of Reinforcing Self-Esteem in Treatment
• 26. Hypnotherapy for Agoraphobia: A Case Study
• 27. A Case Analysis in Human Sexuality: Counseling to a Man with Severe Cerebral Palsy
• 28. Treating Adolescent Satanism in Art Therapy
• 29. Summoning a Punishing Angel: Treatment of a Depressed Patient with Dissociative Features
• 30. Therapy for an Anxious Patient Who Believes His Symptoms Are Caused by a Medical Problem
• 31. Psychotherapy by Telephone: A Therapeutic Tool for Cancer Patients
• 32. The Longing for Nurturance: A Case of Factitious Cancer
• 33. Eight Cases of Patients with Unfounded Fear of AIDS
• 34. Bulimia Nervosa and Acne May Be Related: A Case Report