Who Is Sylvia? and Other Stories

Case Studies in Psychotherapy

Dorothy E. Peven, Bernard H. Shulman

• Publisher: Routledge
• Year: 2021
• eBook ISBN: 9781317711162
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

First published in 2002, in this innovative book two leading practitioners tell the stories of the people they have met as clients and how they, as therapists, tried to help them. Through compelling case studies, Peven and Shulman invite the reader into their thoughts and feelings about their clients, their processes and treatment techniques, and their subsequent successes and failures. The authors describe a cognitive, constructivist, interpersonal, dynamic approach based primarily on the principles of Alfred Adler's Individual Psychology. The case studies represent several different DSM-IV diagnostic categories, and the authors offer their own theoretical perspectives and treatment methods for each category. With compassion, insight, and skill, the authors take complicated material and present it in a clearly written and easy to understand fashion.

1

Psychodynamic Theory

The theory presented by Alfred Adler and elaborated by his followers views human beings as members of a social species who live in social groups and are socialized to be “human.” According to this theory, human behavior is best understood in a social setting. It is, in fact, through the establishment and maintenance of human relationships that people give meaning to their lives.

The early social scientists tended to seek the “cause” of social behavior in either biological, environmental, or economic factors. While Karl Marx (1818–1883) and William Sumner (1840–1910) attributed all human behavior to the influence of cultural institutions. Adler and others understood human behavior could not be explained in simplistic, mechanical terms. For example, Kurt Lewin (1890–1947) suggested in his Field Theory that:

The world, as experienced by the individual at a given point in time, is his life space, which always includes both the person and his psychological environment.… Behavior is always a function of this life space, which in turn, is always a product of the interaction between the person and his environment.… (Lewin, in Schellenberg, 1978, p. 70)

Horton Cooley (1865–1929) and George Herbert Mead (1863–1931) were among the early social theorists who considered that personality and behavior could only be understood as a product of the interaction between social demands and individual needs. They believed that behavior is subjectively determined within a specific social context and described the social field in which Adler’s concept of the “Life-Style” could develop.

[It is] not heredity and not environment that are [the] determining factors [in determining personality]. Both are giving only the frame and the influences which are answered by the individual in regard to his styled creative power. (Adler, in Ansbacher & Ansbacher, 1956, intro.)

Recent studies in cognitive theory by social constructivists suggest that theorists are once again paying attention to the position of the early social scientists and find that they are, in essence, in agreement with them (Beck, 1976; Freeman & Urschel, 1997; Jones, 1995; Mahoney et al., 2001).

Inferiority Feelings and Compensation: The Self-Appraisal

We are born without fully developed faculties and are, therefore, dependent for a long period of time. As a consequence, we bond with our caretakers, mother in particular. This bonding to another is what makes us human and from this initial bond comes the preparation for socialization. During the course of socialization we begin to find our place in the social group. In fact, our sense of self is associated with the perception of self within the group setting. This establishes identity, the sense of who one is in relation to others (Master, 1991). As formulated by Mead, Cooley, and Adler, self-conception is considered a function of our sense of personal worth and adequacy and our evaluation of the attitudes of others toward us.

The early experiences of childhood have an important effect on future conduct; they provide the early templates for our behavior and give us the material we use to build personality and character. Children require parenting that fosters a sense of security, courage, and prosocial conduct. Failing that, the opportunities for the child to feel inferior, incapable, or inadequate are increased. If a child is pampered, neglected, or rejected there is a strong possibility that the child will not develop the selfconfidence and courage required to meet the developmental challenges.

The child that is pampered has less chance to learn persistence in the face of difficulty, and the rejected child often develops loss of self-esteem and trust. Childhood experiences such as abuse, abandonment, loss of security and conversely, overprotection and overindulgence, interfere with the development of internal aspects of personality (values, self-appraisal) that promote a smoother development to healthy and constructive mental attitudes in adulthood.

Feeling inadequate to meet life’s challenges (the “feeling of inferiority”), the child tries to compensate for assumed deficiencies—the resulting behavior can be either prosocial or antisocial, useful or useless.

The desire for power, achievement, uniqueness, and so forth can be demonstrated throughout history, across cultures, and over time. The desire for mastery and competent coping can be seen readily in most children and it is common for children to compare their skills and rate themselves against each other. But the actual differences in skill do not necessarily lead to inferiority feelings. Such feelings have to do with perceptions of social status. This feeling can also be understood as “low self-esteem.”

Attempts to preserve self-esteem or enhance it are called compensations. Compensations can be normative and socially acceptable or deviant and unacceptable. Some compensations are defensive, such as withdrawal and avoidance of challenging situations. Other compensations are offensive, such as seeking out obstacles to overcome or finding new ways to deal with challenges.

Arnold Rose (a Symbolic Interaction theorist) suggests that all neurosis can be understood as arising from a negative evaluation of the self: “[The] ‘self,’ reflecting the reactions of others toward it, is an important intervening variable in human conduct…” (Rose, 1962, p. 540).

Theodor Litman writes: “Self-conception is a function of the individual’s sense of personal worth and adequacy and an evaluation of the attitudes of others toward him” (Litman, in Rose, 1962, p. 559). The more current literature on the “self” leans towards a view of the self as a

kind of modern, atomistic self [which] aspires to an extreme sort of individual autonomy, separateness, and self-definition and confronts a natural and social world to which it has no essential ties … this notion of the self … enshrines the modern ideal of “freedom as self-autonomy” and thus reflects the intense … antiauthoritarian temper of the modern era. (Manaster, et al. 1999. p. 477)

Although we use the word “self” in many different ways in everyday speech and in this book, our concept of self is inclined toward the Individual Psychologist’s viewpoint. In contrast to the “modern” concept of self as an autonomous selfcontained unit,

[i]n the Adlerian view, individual purpose and fulfillment go hand in hand with deepening social interest, with a growing sense of belonging to wider communities and traditions, and with being of service to them. Thus, Individual Psychology is in a unique position to explain why high levels of self-esteem, which usually appear to reflect a modern, highly individualistic sense of personal dignity or worth, are so often correlated with … self-defeating strategies in living. (Manaster et al., 1999, p. 478)

Striving for Significance: Movement in the Psychic Life

We understand each human being as an organism traveling through time and space to meet a destiny. This destiny is imagined by the individual as an ideal state of being. Since the organism is always moving as if there is an end point (or final goal) it is possible to examine behavior from the point of view of the direction of the movement. This striving of the organism is always understood within a social context; that is, toward, away, or against people in the social field (Horney, 1945).

The direction of movement is influenced by this dominant goal that is selected according to the individual’s unique perception of the ideal state—bliss, paradise, nirvana. The underlying direction of movement is often largely unconscious. The dynamic aspects of personality—interests, impulses, tropisms, drives—are all part of the unifying system, which is always in movement. The unification is achieved by the existence of a goal that creates the direction of movement for the system. The movement toward a “fictional” goal is continuous, it is constant, and it is maintained throughout life (Lombardi, et al., 1996).

The Unconscious

For Sigmund Freud, the unconscious was a storehouse of instinctual drives and impulses kept in check by a censoring, repressing ego. Our position is different. We do not believe that the unconscious is always inimical, a wild beast that needs to be tamed. Most of us are not always aware of what we are doing, nor do we always understand or want to acknowledge why we do what we do. We tend to protect our self-esteem by denying, rationalizing, blaming others, and using other self-protective forms of thinking. We want to shield ourselves from shame, guilt, and fear; from having to face things we do not want to face.

People are only dimly aware of the constructs that underlie their innermost motives, their biased perceptions, their idiosyncratic, highly subjective views of the world and people. These views, formed in early childhood, are private, somewhat autistic, often nonconsensual, and are never fully explicated and examined until psychotherapy. They form a “private logic” for understanding the world and acting in it.

In addition to these unapprehended constructs, our biases tend to create selectivity in our perceptions so that we filter out information that would require us to change our biased beliefs. In this way we reinforce our private pictures of reality. We are usually not aware of how we are being influenced by our private logic, by pictures of the world that are no longer true, by decisions made long ago for reasons that are no longer recalled.

Finally, it is not economical to be fully conscious of all of our activities, for it would be a hindrance if we had to give every bit of incoming information equal weight. We are eased through life because we perceive selectively and prioritize.

The Emotions

Emotions are energizers of behavior—dynamic forces that produce movement. Thought alone does not lead to action, but thoughts and emotions tend to concur and effect each other. Emotional arousal can be produced by a sequence of thoughts as well as vice versa. For example, if depressed, we have depressive thoughts. On the other hand, emotions can be evoked by cognitive appraisals; e.g., “That girl is thinner than I am and prettier too. I’ll never be that pretty and thin. I am a failure.”

In time, we learn to call forth our emotions in order to carry out an intention, to accomplish a purpose. Thus, we summon anger in order to intimidate another, to display bravery, or to win an argument by “overpowering” another.

Although we are born with certain built-in emotional responses, we learn to use emotions as strategies in the pursuit of our private goals. The idea that passions can be overwhelming is not accepted as an excuse for inappropriate behavior. In ordinary life situations people are responsible for their own emotions.

Others, such as the French existentialist Jean-Paul Sartre, have also seen the emotions as “strategies for coping with a difficult world. [Emotions] are, accordingly, our responsibility, not mere excuses.” Sartre argues that emotions have “‘intentionality,’ ‘finality’ or purpose. A person is not caused to be angry, fall in love, grow resentful. He or she has reasons for doing so.… Emotions are our own doing.… [They are] strategies, knowingly and willfully under-taken” (Solomon, 1996, p. 11).

The Life-Style

We have previously said the individual’s striving towards the goal of significance and social belonging could be observed as a pattern that manifests itself early in life and plays like a musical theme throughout each lifetime. This theme, which Adler called the “Life-Style,” functions as a blueprint for action, but remains primarily unconscious; that is, outside awareness. This life-style is both a perceptual and a coping style and thus is demonstrated in all aspects of a person’s behavior.

The life-style pattern is formed and developed early in life when experience is limited and cognitive abilities are still underdeveloped. Observations and interpretations about social living and the behavior of others are made before language develops, before symbolization matures. Interpersonal transactions and the behavior of others in the environs influence these interpretations. But without the full ability to discriminate and to evaluate impressions, people come to mistaken conclusions and assumptions about what it takes to meet the challenges of living in a world of others. Wilson quotes Francis Bacon: “[T]he mind, hastily and without choice, imbibes and treasures up the first notice of things, from whence all the rest proceed, errors must forever prevail, and remain uncorrected” (Bacon, in Wilson, 1998, p. 23).

As children we affect, by our behavior and interactions, the forces around us. As adults we construe, we think, and we draw conclusions about what is happening around us and make decisions based on the mistaken apperceptions we formed as children, unaware that we are using fictional constructs based upon long past experiences from which we have drawn biased conclusions.

The Creative Self

Intervening between the stimuli acting upon us and the response we make to stimuli are our biased apperceptions. It is these biases that determine how we respond. Influenced by our genetic inheritance and the social environment, we make unconscious decisions about appropriate behavior and act accordingly. Through the use of selective perception we extract from the environment whatever information we need to aid us in the expression of our life-styles, and we block out information that could create cognitive disson...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Introduction
• 1. Psychodynamic Theory
• 2. Psychodynamic Psychotherapy
• 3. The Metamorphosis
• 4. Who Is Sylvia?
• 5. A Letter to Daddy
• 6. “Are You Lookin’ At Me?”
• 7. The Replacement
• 8. Icarus
• 9. To the Manner Born
• 10. Guilty Pleasures
• 11. Epilogue
• Index