Psychoanalysis Theory Case Study

This paper contains a case study on psychoanalysis about a patient suffering from depression and anxiety. Both his primary and secondary psychological problems are characterised linked to his childhood experience and stress about his career. The paper also contains assumptions about psychoanalysis theory and its specific influence on the case study. The necessary counselling techniques have been included in this paper to give a sense of direction to professional therapists encountering such problems. Finally, the paper addresses the cultural issues to be avoided during the therapy sessions and the measurement outcomes of the sessions.

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Psychoanalysis Theory Case Study
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PSYCHOANALYSIS THEORY CASE STUDY 2
Psychoanalysis Theory Case Study
Abstract
The process of psychologic treatment is complicated. Any person showing signs of
psychological disorders should seek help from a professional. Many theories are in place to offer
psychological treatment; they include, Psychoanalytic, Adlerian, Client-Centered, Reality,
Existential and Gestalt. This paper contains a case study on psychoanalysis about a patient
suffering from depression and anxiety. Both his primary and secondary psychological problems
are characterised linked to his childhood experience and stress about his career. The paper also
contains assumptions about psychoanalysis theory and its specific influence on the case study.
The necessary counselling techniques have been included in this paper to give a sense of
direction to professional therapists encountering such problems. Finally, the paper addresses the
cultural issues to be avoided during the therapy sessions and the measurement outcomes of the
sessions. Most measurement tools are included in a self-report that is used to monitor the
progress of the patient.
Introduction
The theory of psychoanalysis developed by Sigmund Freud is based on the fact that
human beings have hidden, repressed feelings (Freud, 2001). The primary goal for a therapist
conducting psychoanalysis on their patient is to make the patient acquainted with such
subconscious feelings (Bollas, 2017). Through several therapy sessions, a patient’s childhood
conflicts become revealed to both the therapists and their clients, allowing the client to have a
normal, anxious free, and healthy life. Freud’s psychoanalysis theory also mentions that dreams
provide a significant gateway to getting into a client’s subconscious and feelings. Therefore, a
therapist can ask their patient about some of their dreams relating to the problem. This essay is

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an analysis of a case study of a therapist narrating to his supervisor about an encounter with one
of his recent patients called Paul.
Paul is a 34-year old person dealing with anxiety issues. His wife recommended him to
see a therapist (Dr Lori) regarding his anxiety episodes. Lori tells his supervisor (Irvin Yalom)
that Paul has been dealing with not only anxiety and bouts but also cases of depression and cases
of low motivational. This conclusion is after several months of therapy sessions (7 months to be
exact), conducted on a weekly basis, although the frequency dropped to once in every two weeks
for some time due to financial implications. Paul had been struggling with his professional career
for a very long time. This had made him feel like a loser in life. As part of the therapy session,
Dr Lori asks Paul to narrate to him the events in his being stuck at “the train station” station
dream.
Paul’s Problem
A patient’s profile usually contains the section referred to as “reason referral” where they
are supposed to fill what problem they are suffering from. Some of the basic psychology
disorders are classified into the following three categories: eating disorders like anorexia
nervosa, personality disorders like antisocial problems, mood disorders like depressions, anxiety
etcetera, psychotic disorders like schizophrenia, and sexual disorders like sexual dysfunctional.
Medical specialists argue that the specific causes of these disorders are not known, but there are
a number of contributing factors (Claridge and Davis, 2013).
Paul has shown cases of mood disorders characterized by depressions, anxiety, and low
motivation. According to Dr. Lori, Paul’s wife was concerned about her husband’s bouts and
anxiety problems that she recommended him to see a therapist. These problems may be

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contributed by stress and childhood experiences (Claridge and Davis, 2013). The therapist
discusses with his supervisor the fact that Paul’s depression may have been caused by stress from
professional failure. The client had a lot of pressure proving to himself and the rest of the world
that he was not a failure. This was after professional setbacks in the creative animation industry.
His peers had succeeded in building their careers and making lots of money from animation
industry. However, Paul was struggling in the same career path; he even tried to start his own
animation company and failed. In addition, Paul had a setback back in his childhood where he
failed to live up to his passion of drawing. He therefore feels the need to prove himself, career-
wise, that he is not a failure. The two therapists argue that such stress may be the primary cause
for Paul’s depression, anxiety, and bouts (Bittner, Goodwin, Wittchen, Beesdo, Höfler, & Lieb,
2004).
Secondary Problems
Secondary psychological problems result from a primary problem. Some of the secondary
problems experienced by Paul are persistent and excessive worry and fear that result from
anxiety issues (Beck, Emery & Greenberg, 2005). Fear results from an emotional response to a
real or perceived threat. Anxiety, on the other hand, is caused by the anticipation that a threat,
whether real or perceived, may occur. Generalized anxiety issues can be caused by the excessive
worry of a person’s daily activities. Some stress and worry may be normal. However, Paul’s
stress comes from a panic disorder that may be as a result of worry and stress that his miserable
career problems may be permanent.
In addition, the client’s depression comes from grief after a failure. The therapist tells his
supervisor that Paul finally opened up after several therapy sessions and confessed that his grief
came after constant failure in the creative animation industry. He, however, wishes to deal with

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his feelings first. He asked Dr Lori to recommend the necessary steps to deal with his fears,
worry, and grief that are a result of his career failures.
Psychoanalysis Assumptions of Paul’s Problem
According to Freud S. (2001), Freud S. (2003), and Freud S. (2012), psychoanalysis
theory is based on the thought that patients can be treated by bringing their minds from
unconscious feelings, motivations and thoughts to consciousness. Therefore, this theory has
some assumptions about the possible causes or origin of Paul’s anxiety, depression, and bouts.
The first assumption is that the problems are repressed in the patient’s unconscious mind. It also
follows that treating a patient does not only involve reducing the symptoms because more
neurotic symptoms would replace the substituted. This explains why Dr. Lori focusses on
making his patient relax and then have him talk about his childhood memories and his dreams.
Another assumption is that the causes of the psychological problems are unresolved
issues in a patient’s developmental stage. As a child, Paul was very interested in drawing. His
family provided him with all the necessary support to pursue his drawing passion, but he failed
in making real progress. Paul relates his childhood failures to his current professional situation
where he cannot make a breakthrough in the creative animation industry despite his peer’s
success. The therapist agrees that this unresolved childhood experience is the primary cause of
Paul’s stress and depression. The dream about being stuck in a train station means that the
client’s subconscious mind is giving in to the fact that Paul cannot do anything to help his
current situation. Treatment would involve bringing this conflict to consciousness where Paul
can deal with the issue.
Counselling Techniques

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The following three counselling techniques would be appropriate in addressing Paul’s
psychological problems: free association, dream analysis, and transference (Seybert, Desmet,
Erhardt, Horz & Mertens, 2011). Free association includes making the patient free to talk about
his personal life. Most clients are usually in denial that they need therapy, especially the first-
timers. Paul was hesitant at first to share his intimate issues after being made to see a therapist by
his wife. However, after several sessions, he increased the frequency of visiting Dr Lori. He
stopped feeling shameful and focused on getting better. Therapists should create a free
environment that would make their clients free to discuss their problems. Dream analysis is also
an important technique for evaluating the subconscious mind. A therapist should evaluate their
patient’s dreams to help them resolve their fears and worries. Finally, transference is the process
of redirecting a patient’s feeling towards the therapist. This process is most helpful for patient’s
dealing with anger issues. It sometimes involves provoking the patient to lash out at the therapist
so that he could say what he feels inside. These three techniques used collectively are effective in
counselling to help the mental patient in their recovery (Seybert, Desmet, Erhardt, Horz &
Mertens, 2011).
Cultural Issue
Having a prior cultural knowledge about the client is very important for a therapist
(Callister, Beckstrand & Corbett, 2010). It helps one to avoid stereotyping and bias issue that
may negatively influence therapy. For example, making comments about Paul being the only
child and the stereotypes that come with them being spoilt will not reflect well on the therapist’s
side. According to Stompe, Ritter and Schrank (2009), patients become more depressed when a
stereotypical or biased comment comes from their psychologists. Dr Lori should, therefore,

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avoid relating his client’s childhood issues with the fact that Paul was the only child in the
family.
The therapist could sensitively address this cultural issue by applying the following two
techniques: avoiding assumptions on culture, and avoiding the use of the catch-all phrase for
example, “all single children…”, Which can be termed as stereotyping. The following two issues
can be effectively implemented by the therapist taking care of their choices of words and
avoiding making jokes on such matters.
Expected Outcomes of Therapy
Therapists expect to see certain outcomes in their patients as the sessions progress. This
helps to evaluate their treatment (Thompson et al., 2000). Paul’s level of depression and anxiety
attacks should be progressing to a minimum as he keeps attending the therapy sessions. The
measurement criteria would be based on the answers provided on the self-report (Löwe,
Kroenke, Herzog & Gräfe (2004). The measurement outcome encompasses symptoms severity,
quality of life, and functioning. For example, I would expect fewer cases of the “stuck in a train
station” dream as the sessions progress. Also, I would expect positive views on professional
work like how Paul is working hard to get his career on track except for feeling remorse about
his professional failures. Lastly, I would expect a happy and positive relationship with the family
members like going on family vacations. The process of dream analysis would be effective in
counselling the client about being stuck in professional failure. This would be appropriate for a
positive outcome during the subsequent sessions.
Conclusion

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In conclusion, the psychoanalysis theory is an effective way of dealing with mental
problems. Every person undergoing some psychological disorder should see a therapist. The
professionals are equipped with the necessary knowledge to provide counselling while avoiding
cases of cultural bias or stereotyping.

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References
Beck, A. T., Emery, G., & Greenberg, R. L. (2005). Anxiety disorders and phobias: A cognitive
perspective. Basic Books.
Bittner, A., Goodwin, R. D., Wittchen, H. U., Beesdo, K., Höfler, M., & Lieb, R. (2004). What
characteristics of primary anxiety disorders predict subsequent major depressive
disorder? The Journal of clinical psychiatry.
Bollas, C. (2017). The shadow of the object: Psychoanalysis of the unthought known. Routledge.
Callister, L. C., Beckstrand, R. L., & Corbett, C. (2010). Postpartum depression and culture:
Pesado Corazon. MCN: The American Journal of Maternal/Child Nursing, 35(5), 254-
261.
Claridge, G., & Davis, C. (2013). Personality and psychological disorders. Routledge.
Freud, S. (2001). Psychoanalytic Comments on an Autobiographical Account of a Case of
Paranoia. The standard edition of the complete psychological works of Sigmund Freud,
12, 3-84.
Freud, S. (2003). Beyond the pleasure principle. Penguin UK.
Freud, S. (2012). The future of an illusion. Broadview Press.
Löwe, B., Kroenke, K., Herzog, W., & Gräfe, K. (2004). Measuring depression outcome with a
brief self-report instrument: sensitivity to change of the Patient Health Questionnaire
(PHQ-9). Journal of affective disorders, 81(1), 61-66.

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Seybert, C., Desmet, M., Erhardt, I., Horz, S., & Mertens, W. (2011). Therapists' techniques in
psychoanalysis and short-term and long-term psychodynamic therapy: are they different?
Journal of the American Psychoanalytic Association, 59(3), 592-602.
Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing
generalized anxiety disorder: the GAD-7. Archives of internal medicine, 166(10), 1092-
1097.
Stompe, T., Ritter, K., & Schrank, B. (2009). Depression and culture. Neuropsychiatrie: Klinik,
Diagnostik, Therapie und Rehabilitation: Organ der Gesellschaft Osterreichischer
Nervenarzte und Psychiater, 23(4), 253-262.
Thompson, C., Kinmonth, A. L., Stevens, L., Pevele, R. C., Stevens, A., Ostler, K. J., ... &
Cooper, D. (2000). Effects of a clinical-practice guideline and practice-based education
on detection and outcome of depression in primary care: Hampshire Depression Project
randomised controlled trial. The Lancet, 355(9199), 185-191.
Zhang, D. (2007). Depression and Culture---A Chinese Perspective. Canadian Journal of
Counselling and Psychotherapy/Revue canadienne de counseling et de psychothérapie,
29(3).