Psychodynamic Case Study of a Client with Borderline Personality Disorder

This case study explores the therapy of a 42-year-old woman with Borderline Personality Disorder (BPD) and a history of substance abuse. The study covers the client's presentation, disability, body language, referral, problem presentation, diagnosis, medication, general health, background, history of the family, relationships history, work history, education, formulation, therapeutic objectives, therapeutic process, abstracts list, outcomes, counter transference, and reference.

TABLE OF CONTENTS
INTRODUCTION....................................................................................................................3
The Client’s Presentation
Client’s Disability
Client’s Eye Contact and Communication
The Client’s Body Language
Referral
Problem Presentation
Diagnosis/Medication/ General health
Background
History of the Family
Relationships History
Work history/ Education
FORMULATION………………………………………………………………………..….8
CONTRACT WITH THE PATIENT …..…………………………………………….….14
Rationale
THERAPEUTIC OBJECTIVES….……………….
……………………………………….16
THERAPEUTICAL PROCESS……………………………………………………………18
ABSTRACTS LIST
Abstract A
Abstract B
Abstract C
Abstract D
OUTCOMES……………………………………………………………………………….38

Counter transference
OBJECTIVES
REFERENCE ………………………………………………………………………51
I
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NTRODUCTION
I started working at a charity organization known as H.I.M.H in March 2017. I was
truly enthused or inspired by the tremendous as well as inimitable work the charity
organization was doing. The work supported men and women from different ethnic groups
which are victims of human trafficking, domestic violence as well as persons suffering from
chronic mental health and physical needs. The London’s H.I.M.H is sub-divided between
twofold centres; one unequivocally encompasses ethnic minorities’ including Arab
communities, African, and Afro-Caribbean and the other section involved everyone. The care
provided in the two situations appeared to stem from a basis of inspired hope and caring. The
Centre is full of life and colour, and I affectionately recall the feelings of wonderment the
first spell I walked into the organization. It is important to note that it explicitly deals with
ethnic minorities groups and cubicle emanates culture, a setting I have never experienced in
any place.
I encountered my first customer (Jane) while working at the H.I.M.H. Jane’s
devastating needs as well as a history of substance abuse touched me in a way which I never
projected. Jane is a 42-year-old woman and has mostly lived in London. She fluently speaks
Italian and English, therefore, identifying her as heterosexual. Jane elucidates that her mother
was very spiritual in front of other people. As a result, many people had a perception or
insight that Jane’s mother was putting on a false persona to the Italian group associated with
religion. In reality, Jane did not feel as however, her mother lived by what she discoursed or
was being truthful to church. This consternation and realization appear to have resulted in
Jane neglecting religion and developing a negative attitude toward religion.
In contrast to Jane, I am a 25-year-old female of African descent but Asian appearance. I live
by religious and spiritual values and attend church services so often, therefore, very distinct
from Jane. I have considered the comparison in the entire therapeutic relationship.
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The Client’s Presentation
I first impressed of Jane because she was an exceptionally spectacular young woman
who never looked upon her age but took inordinate pride in her physical physique or
appearance. She was tall and curvy and dressed her figure with skirts and high heels. She at
all times had face make-ups and never left her household without the application of a bright
red or purple lipstick. I conjectured how she could perceive me who was dull dressed plain
therapist sitting in her opposite. Generally, I remember Jane had a very fascinating or
appealing presence from my initial session with her.
Client’s Disability
During my first session with Jane, I thought that her outward appearance didn’t match
her communication skills. As a result, I reported this observation to my superintendent and it
clear that she had a learning disability that was perceived by the supervisor to have resulted
from strong medication. Surprisingly, Jane had not been diagnosed for the disability. It is
important to note that in several instances, the prowess of a society to spot and address an
individual’s disabilities and shortcomings may significantly change that individual’s life,
resulting in serious concerns such as relationship issues. Furthermore, this particular concern
came up during the therapy when Jane talked about online dating. She narrated how some
men relish writing to her messages online however immediately she talk to them in person or
through the phone the men put off and precipitously drift and adjourn chatting. She was
distressed that a prospective online suitor told her that there is something wrong with her.
This stuck in her mind and always feels highly judged by other people due to her disability.
She thinks that she is not wanted and would never get a potential suitor.
Client’s Eye Contact and Communication
During the first session, I realized Jane generally keeps eye contact. I failed to notice
her struggling with keeping eye contact. However, as she kept on talking I noticed that she
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experiences difficulty in maintaining eye particularly when she felt vulnerable, that is when
she said that she would never find a potential suitor. At the same time, it becomes hard for
her to understand particular concepts and interpretations and so I had to patient with her. She
occasionally uses this as a ploy or trick to shun some topics which she is not comfortable
with and quickly goes ahead to speak other things. This form of ricochet appeared to make
other persons feel as if Jane is not considering their position on a matter under discussion or
not listening resulting in a need to get another individual who communicates for her. In
several instances, I had to be firm and careful to identify and understand what she found
difficult to talk about. I was always mindful not to force her to follow my agendas or ask her
particular things she might not be ready to offer an answer.
The Client’s Body Language
Jane’s body language was at times fidgety. She would sometimes take large water gulps and
sporadically moved the chairs around if they appeared or seemed distinct from what she is
used to seeing before. Jane visits me on a Sunday morning and since we were the first people
to use the counseling room, it seemed left dull, with the lights off and the blinds low
nevertheless the large windows allowed sufficient day-light to shine via the windows. Jane
would still stand up and switch on the light on noticing it appeared darker than usual. Her
body language reveals that she experiences some problems. She needs to feel as nevertheless
she has had an impact on her instant setting even if the effect isn’t completely anticipated or
implicit.
Referral
Jane first visited a therapist when she reached at the facility. Nevertheless, Jane says
that she never got the first conferences beneficial and finally ended go to the sessions. She
made up her mind to come back to a therapy after receiving shocking news of the death of her
foster mother. It is Jane’s outreach worker who spoke to my supervisor about in regards to
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the need for Jane to get therapy. Notably, this was after she became extremely bruised, and
scarred about the kinds of treacherous sexual activity Jane was taking part in.
My supervisor at the facility was very honest. He always encouraged us to do work in
a manner which most suited us. It is easy and I felt free to work at H.I.M.H in such a setting
because before coming to the organization I counselled people at Maudsley hospital for one
year. I adored the notion of not looking at past notes or assessments written about my
customers. I simply ask the patients to let me whatever they are most contented with.
Remarkably, this tactic worked for me in that particular locale as I it provided I much time
with the customers.
On my initial slated session with Jane, she got into the room and began looking for
my manager. I recall waiting in the room pondering whether to simply wait or collect her.
After limited minutes my manager brought her in counseling room and I presented myself to
her. Jane was well dressed having her hair, make-up as well as face done. Jane sat down on
the chair looking perchance a little unsure and uncomfortable with me. She tightly held her
glass of water during the session. Nonetheless, as the meeting went on, I felt that the
supervisor was testing me whether I was worth for Jane’s case. I felt that I had to win the
supervisor and therefore I had not to disappoint her.
The Presenting Problem
H.I.M.H is a health organization that provides customers therapy depending on the
clients’ needs. Due to Jane’s evaluation, my manager and I established that an open-ended
psychodynamic psychotherapy was appropriate for Jane because of her nature issues
presenting issues explained under.
General Health/Medication/Diagnosis
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Jane has a lengthy psychiatric history. Many drugs have prescribed for her including
Lorazepam (1mg), Zopiclone (7.5mg), Omeprazole (20 mg), and Valproate Sodium and she
is presently under Lithium medication.
Jane was in 2007diagnosed with Borderline Personality Disorder (BPD) and clinical
depression up to 2016, June. She attended a clinical evaluation or assessment in the year 2010
which stated that, “since moving to the municipality, there have been no incidences of
depressive or hypomania. Nonetheless, Jane has shown some symptoms or behaviours which
indicate on-going personality difficulties. Jane experiences problems in impulse control,
maintaining positive interpersonal relationship as well as regulating her emotion.”
Jane has been referred to several health services since her first diagnosis comprising
Hospitals, social services, and charities. She has received a lot of support from H.I.M.H since
her arrival in the institution in 2008. The institution provides her with professional workforce
who supports her in the management of finances and housing. She is also provided with an
outreach worker who supports her with social needs such as encouragement and counselling.
She is satisfied with the H.I.M.H‘s services and love the staff.
Current Background
Jane told me that she was having relationships with four men during our initial
session. I challenged this because she said that she always engages with them in only sexual
activities for a maximum of two hours per weekly. Most of these men are in relationships or
married. However, Jane said that she did not want real relationships with them. She admitted
that never had never had real relationships with any man, and would like to have one,
however, men only want her for sex. Jane has lived alone since she left her foster mothers’
homestead.
Family History
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Jane comes from a large family; however, it was hard to understand what part of the
family she meant. Jane made a drawing of a family-tree on a paper during the session. This
was enormously helpful to me.
Jane’s father divorced her mother before she was born. As such, she had not seen the
father until she was 15 years old. After the divorce, Jane’s mother got into another
relationship and gave birth to two children; a girl and a boy. Jane was physically raped by the
stepfather and due to that ran away from her mother. She joined foster carer at 13 years. The
foster mother took care of her until she was18 years after which got her own residence while
studying. Jane flew to the U.S. at 16 years to meet her father for the very first time. Jane
found that the biological father had entered into a second relationship and had sired two
children.
The biological father didn’t want to know her and admitted he was embarrassed to
refer to her as his biological daughter due to her disability and outlook. She came back to
London and got another chance to meet her biological father once more due to her thirties.
She tried to maintain a relationship with him however the father was not interested, making
her give up.
Jane never mentioned her mother until a few weeks into therapy. It seemed hard for her to
talk about her relationship with the mother. She noticed that the mother never thought of her
even after the father’s open abandonment. The mother currently resides in Italy with her
stepfather and she sometimes visits. She says that she hardly visits her because she found it
difficult to deal with her mother due to her anger.
Relationship History
Jane has a history of men who she slept with. She says that her initial boyfriend at the
age of 19 was very obnoxious and would sometimes sexually assault her. She had several
foul relationships and her behavior tended to get her out of one and hand her over to another
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dangerous relationship. Three years ago, Jane’s ex-partner endangered her with a knife
injuring her.
Education/Work History
Jane is an entrepreneur. She has very successful business of buying as well as selling
trade in alcohol, cigars and cigarettes. As aforementioned her stepfather and mother live in
Italy and she visits when she goes to purchase the products to sell domestically.
Jane struggled at school due to her learning snags; however, the difficulties never
stopped from joining the college and finishing certain courses. Jane recalls finding academics
challenging. On leaving college, she struggled with her mental health and sometimes she
could not stand on her feet. On overcoming the difficulties, she noticed that her mental health
would not allow cope with a full time job time of 8am to 5pm making her to venture into own
business. Inasmuch as this was important for her life as well as confidence, she recalls feeling
isolated or segregated from the rest of the people as she had minimal interaction or
association with others.
FORMULATION
I will utilize the Lemma’s (2015) psychodynamic formulation aide memoire as a
template to structure this case study.
STEP 1: Describe the problem
Jane only mentioned her foster mother’s death during the first two sessions even
though her primary reason for therapy was to talk about the issue. During the subsequent
sessions she opened up concerning the various difficulties in her relationships with different
kinds of men. Even though, she was very open about her relationships with several different
men, she depicted a light-hearted attitude unremittingly during the relationships. She says that
she is only happy to see the men for one hour every week for sex since that is what she needs.
She says that she does not want them to either text or call her so often. Jane has
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characteristics of a masochistic customer because she gets engaged in perilous sexual
activities including bondage, beating, and whipping which results in suffering and
humiliation which more often leads her excruciating pain.
Step 2: Define the cognitive costs of the problem
Jane concedes that she experiences problems in getting into more formal and healthy
relationship, although she prefers such kind of abusive relationships. Jane suffers from fear of
isolation, segregation, and loneliness and struggles with establishing boundaries with others.
She says that rather be badly treated than remain lonely.
Step 3: Contextualize the menace or problem
Jane has an ill-fated history of shock dating back to infancy. The father departed with
the kinfolk when Jane was 3 years of age. At that time Jane had no brother or sister at until
her mother re-married one year later giving birth to two children. Her biological father later
re-coupled giving birth to two daughters. Jane craved to obtain her biological father’s love
and attention but got rejected by the father several times. Jane as well had a bad relationship
with the stepfather due to her bad treatment which later resulted in her physical abuse and
psychological neglect.
At the point when Jane was only 14 years of age, she was encouraged by a solitary
parental she referred to as Grandma as she may perhaps never again live inside her family
household with the consistent manhandle as well as contending among her. Jane was
particularly annoyed that her mom didn’t once attempt to inspire her to return or get some
information in regards adaption.
Jane had a background marked by men utilizing her for sexual activities, she had
exceptionally awful relationships when she was only 17 years of age, she recalled her
accomplice being extremely regulatory and always sexually assaulting her. From that point
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forward Rosa has ended up in numerous associations with males. When I started to see Jane,
she had this sort of association with five men, three of which were either hitched or in
submitted relationship. Jane seems to experience depression because she appears bare for
setting up a friendship with any person who is not of a sexual sort.
Step 4: Explain the patient’s most recurring and dominant object relationships
Jane feels that she been abandoned by everyone. She, therefore, wants persistent
reassurance all through any relationship, which is clear in her all close relationships with
men. Jane firstly claims that she never minds if the man is married or not because she only
wants sexual relationships.
Jane encounters others as inaccessible to her, she it at first enjoyed till others find out
about her unsafe way of life and steady stories loaded up with dramatization. For example,
with her mom Rosa needed to battle for her consideration after her dad left and her mom
began another family, putting Jane second. Because of this Jane likes to realize that she is
imperative and continually considered, she solicited me on a number from events on the off
chance that she can see me two times per week, upholding her foresight at the forefront of my
thoughts.
Step 5: Defences Identification
From my initial meeting with Jane, I have discovered that she had only 3 key
barricades which have been extensively discussed by Freud (2014). Acting out is the first
main defence. Jane has been in a relationship with a specific man that she has nicknamed “Mr
Robot”. She refers to him by this name because she says that he has no feelings. Additionally,
Jane discloses that she on several occasions she failed to secured what she wanted from the
man therefore causing unpleasant scenes at his workplace. She reveals that failure of the man
to reply to her messages is one of the main reasons for that behaviour. Therefore, this is not
concurrent to her claims that during the week various men do not distract her.
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Subsequently, splitting is the next defence. Klein utilized this name to make a
reference to the partition of an object or item into ‘bad’ and ‘good’ (Axelrod, Naso and
Rosenberg, 2018). Likewise, Jane frequently shifts from romanticising and overly adoring a
friend, partner or family member to hate them the in the subsequent week. For instance, in the
case of ‘Mr Robot’, she will get into a sexual activity with him at his work or her house one
day. However, she will be extremely violent towards him the next day. As a counsellor, this
situation has made me review our relationship and consider if I will be the bad and good
object or item interchangeably during the course of our work.
Notably, it is clear that Jane has been developing the characteristics of a dismissive
attachment style (Ainsworth, 2015). Dismissive attachment style can be comprehended
through her emotional dismissal of vital relationships, for example, the relationship between
Jane and her mother. It is evident at the beginning of the therapy session that Jane idealised
her biological mother. However, her mother constantly accused her for causing her father’s
departure and failed to enthusiastically try to stop the frequent abuse caused by her stepfather.
Therefore, this does not appear to be the standard mother-child attachment. I was able to
confirm this by inquiring from Jane if she remembers any earnest memories with her
biological mother, which she took time to recall (Lemma, 2015). Jane story disclosed her
dismissive attachment style as she was hesitant about communicating her pain.
Jane’s situation made her to dissociate. Dissociating is another important defence that
was advanced by Freud (2014) which Jane uses for protection. Jane can be in the therapy or
counselling room, entirely participating in the conversation and precipitously lose
concentration and track of thought therefore getting into a pre-occupied state.
Yalom relies on Maslow (2013), to summarize important personality traits and
defences, related to existential isolation. They include less independence, neediness for
affection and praise, and sacrificing happiness and joy for the illusion of one’s belonging.
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They also include enduring unpleasant relations because the perception of being lonely is
unbearable. The author refers to this a ‘deficiency-motivated individual’. In the course of this
case study, I will continuously make references in regards to how Jane utilizes this paramount
defences.
Step 6: Identify the aims of treatment
Jane clearly struggles with intimacy and establishing healthy sexual relations. Despite
Jane seeking support from the therapy sessions, it soon became evident to both Jane and I that
she only wanted to concentrate on her many intimate relationships. However, this is not what
she longed for. Most of the therapy session will particularly focus on aiding her to develop
the ability to manage and control her loneliness devoid of meeting men weekly. In the same
token, I perceived that it would be appropriate to use the psychodynamic approach in Jane’s
case. Although Jane lacked reflection and consciousness, I thought that it would be
advantageous to enable her be conscious of things she was unaware of.
During the course of the therapy session with Jane, I strived to motivate her to remain
safe. However, when she engages in sexual activities she would be at risk of encountering
dangerous activities, for example, being beaten which would leave her seriously wounded. I
intended to make sure that she keen concerning her safety. I did this by using safe words and
being able to comprehend why she keeps on engaging in such dangerous activities. It is
imperative to note that in this contemporary society participating in any activity is one’s
choice (Altbach, Arnold and King, 2014). Throughout our session, I am determined to
comprehend Jane’s behaviour and allow her make to the decision of choice herself.
THEORETICAL ORIENTATION
My supervisor frank concerning how I worked when I first arrived at H.I.M.H. After
conducting few therapy sessions with our clients, we deliberated on which approach we
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thought was the most relevant for that specific customer. Based on my training and education,
I considered psychodynamic approach, person-centred, CBT (cognitive behavioural therapy).
I decided to utilize the psychodynamic technique with regards to Jane’s case. The information
I had concerning Jane revealed that she had just lost her step-mother. She also formerly had
numerous defence issues which were already discussed in the facility’s staff portal. The
manager informed me that the discussions were associated with Jane getting involved in
masochistic behavior with different men. Lowen (1958, p. 195) states that a masochist is one
of the most challenging and complicated health problems that a psychiatrist encounter.
Kernberg, 2013, (p. 245) claims that a psychotherapist deals with after discovering different
aggression levels. Subsequently, it is quite useless to try to diagnose masochistic
presentation. However, it is probable to utilize an analytic model. Notably, I have adequate
experience to diagnostically treat patients. Therefore, I resolved that Jane’s masochistic
presentation and Borderline Personality Disorder will be appropriate to use psychodynamic
method.
Rationale
According to the approaches which are relevant to my health practice, I had an
intention of utilizing the psychodynamic approach. However, I couldn’t disregard my
background as well as subsequent Cognitive Behavioural Therapy education. It is essential to
consider an array of methods to develop an efficient and probable treatment procedure.
Moreover, the psychodynamic model entails primarily motivation, defences as well as how
they relate to people’s childhood experiences (Shefler, 2014). It is important to note that
person-centred approaches mainly concentrate on conscious focuses as well as consequent
inspiring the customers’ urge for self-satisfaction especially via the utilization of the key
conditions of Rogers (2013). Lastly, Cognitive Behavioural Therapy focuses in transforming
behavior via concentrating on the present situation, that is, on the here and now. Both the
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person-centred and Cognitive Behavioural Therapy approach focus on the current situations.
Nevertheless, psychodynamic method greatly intends to uncover a person’s unconscious
thoughts which range from childhood experience to how it impacts people’s thoughts as well
as behaviour currently. Notably, I was feeling that Jane’s concerns were based on her
unpleasant history. Furthermore, the most appropriate way to attain our objectives would be
via discovering certain forgotten memories specifically from her babyhood or infancy and
trying to link memories to the present difficulties.
I accept that the techniques conflict in a variety of ways. According to Altbach,
Arnold, and King (2014), in epistemology these approaches can swiftly be integrated. For
example, it becomes easy to facilitate the maintenance of strict and clear boundaries as well
as make significant transference interpretation. Moreover, this can be done using the person-
centred approach’s core conditions, for example, remaining congruent, empathy and letting
therapy to be predominantly customer-led. Having used psychodynamic approach I was
unable to completely steer clear my CBT and person-centred training. Therefore, I
involuntarily relied upon Yalom who considers a more existential psychotherapy. In every
scenario, there is effort to remain impartial and balanced therefore providing the case study
with the most suitable material to be used.
CONTRACT WITH THE PATIENT
After the initial therapy meeting with Jane and consulting with the manager, I
concluded that Jane ought to see me at least once every week. Approximately, 40 minutes
will be enough for psychodynamic works. Moreover, the charity organization does not charge
customers as they are a charity organization. The organization offers support freely and
neither did I charge Jane. Jane knew that I was delivering my services voluntarily.
Furthermore, I was just carrying out my medical hours for free.
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Jane was already a frequent client to H.I.M.H. She also knew the organization’s other
staff and had been receiving help from her outreach employee. H.I.M.H endeavours to
separate counselling support and other activities. However, this is usually difficult as the
organizations’ staff works from the same office. I had earlier described our confidentiality
and privacy agreement to Jane before the commencement of the therapy. Jane had numerous
questions concerning the dynamic between support workers and counsellors. I further
clarified that the work we conduct is entirely confidential. However, this is not applicable
when she is or any other person was at a severe risk. No other information concerning the
therapy session would be communicated to any other member of staff except for the
supervisor who is usually an external member to the organization. Despite having kept strong
boundaries in regards to this, it was however sometimes challenging whenever I would be
questioned concerning Jane’s improvement or regarding any safeguarding issues. As Jane
developed relationships with the different men, she failed to understand clearly therefore got
involved in some dangerous sexual activities. There were numerous safeguarding concerns
raised by other members of staff which I could get from the organization’s shared portal. To
begin with, I was requested to give additional safeguarding concerns online so that other
members of staff could access and read. Nevertheless, after an extensive discussion with the
supervisor, we agreed on completely keeping outreach and counselling work entirely
separate. I was only supposed to consult with my supervisor in regards to any concerns that
arise. Consequently, this aided in maintaining confidentiality and privacy and I feel
customers became more at ease to convey issues knowing that they would not be shared with
other team members.
Generally, Jane and I met each other for forty seven therapy sessions. The sessions
occurred from 7th May, 2017 to 20th July, 2017. An assessment session was vital after every
eight weeks even though we summarized and subsequently conducted reflection all through
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the course of our work. The evaluation and analysis sessions were significant in confirming
with Jane concerning the counselling and what aspects were helpful or unimportant. I
maintained a record of the discussions regardless of such sessions being unstructured. We
normally revisited what Jane had learnt or discovered concerning herself. Additionally, this
included any new information together with what she wanted us to concentrate most on. In
every scenario I discovered key information which enabled me to develop a better, more
appropriate model that Jane would utilize to enhance her communication.
These evaluation and analysis sessions were precisely helpful while working with my
client Jane. She developed a tendency to disclose every aspect which occurred with any
partner or something else memorable which happened during the course of the week. I could
utilize what we had discussed in the previous sessions to help maintain our work focused.
Furthermore, this helped me to link her present experiences to her past encounters or more
importantly, make a reference to a particular goal to ensure that she clearly understands what
occurred to her.
THERAPEUTIC OBJECTIVES
I now believe that Jane only wanted someone to talk to. She never disclosed that it
would be paramount that she works on something concerning herself or more important try to
comprehend both her present and past. She only needed me to listen to the story that she
provided. Similarly, she only required someone who would stop, listen and evaluate or
analyse devoid of getting something else in return. I discovered this when I noted that Jane’s
major difficulty was loneliness. She has several men around her that only require sexual
encounters with her and many females that only seem to get bored to constantly listening to
her uninteresting dilemmas which happen when she sleeps with married men. On account of
this, I resorted to keeping her company and slowly aiding her to gain awareness. However, I
evidently comprehended that everything would progress slowly. I needed to be patient
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because of Jane’s naïve perception of the world and probable learning difficulty. Therefore,
this meant that it would be not possible to consider that I could make any significant
transformations in her life.
As stated by Ainsworth (2015), Jane reveals that she has a timid attachment style. The
goal of the meetings was to attempt to utilize our counselling relation to give her a
safeguarding foundation which she never experienced in her childhood life. Therapeutic
relations are useful in helping to heal adult’s unpleasant early experiences with their
respective caregivers (Holmes, 2014). According to Holmes (2014), “The objectives of
therapeutic process is to offer a setting which fosters treatment. Additionally, Yalom’s
approach is thoroughly related to attachment researchers like those of Holmes (2014) and
Fenichel (2014). He discusses the essence of having a safe attachment during babyhood as
well as the potential adverse results of experiencing unsafe attachments. Yalom elucidates
that, “A dissatisfying state of fusion-existence or too early or too tentative emergence leaves
the individual unprepared to face the isolation inherently in autonomous existence” (2014, p.
362). Therefore, it was part of my work to aid Jane deal with the situation. Yalom further
claims that this generates anxiety but eventually leads to personal growth. He explains, “It is
the facing of aloneness that ultimately allows one to engage with another deeply and
meaningfully” (2014, p. 362).
The other main aim to concentrate on in this therapy session with Jane is endings.
Jane clearly understood that our work would come to an end although it was open-ended. In
the same token, this would be a significant aspect of our work having in consideration her
dismissive attachment style and subsequent experiences of abandonment. I deemed it
essential to consider our ending early. Therefore, I had to conduct adequate preparation for it
and attempt to reduce any related feelings of avoidance or abandonment.
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Generally, I strived to aid make the unconscious things conscious through adopting
insight. As Jung proposed. “Until you make the unconscious conscious, it will direct your life
and you will call it fate.” Consequently, this reveals the necessity of trying to make the
unconscious conscious. Lakhani, A. (2013) explains that 85% of the verdicts that we make
are controlled by the unconscious structures and more so content, for instance, desires,
emotions, memories and instincts. Therefore, I also endeavoured to inspire a reflection and
awareness concerning Jane’s behaviour patterns to help her comprehend her present situation.
THERAPEUTICAL PROCESS
Foremost, Jane stated that she enjoyed sex from these men. We developed a routine
where Jane would explain to me what occurred during the week. Additionally, this happened
for the beginning 3 months of the therapy which consisted of 13 sessions. It was completely
difficult to remain assertive during this sessions. Whenever I inquired anything from Jane,
she was not willing to answer. She only continue talking and pretending not to hear me. I
frequently got upset by the drama and constantly felt like we were not making any progress.
Likewise, this occurred up to the 12th session. Jane continued explaining what these different
men required from her whether it was beating, being blindfolded, biting, leaving scars or
bondage.
On account of this, I inquired from Jane what she really needed from the men. At first
she answered as usual “I want them to have sex and leave me alone for the rest of the week.”
She then proceeded with her story. Subsequently, I asked “But what is it that you really
want?” However, she ignored this question and continued talking. I proceeded, “I know this
is difficult to answer but what is it that you want?” Jane started crying and constant said “I
don’t know” up to the end of the session.
The session was significant as it reminded me precisely of something that I read from
Yalom (2012). I read concerning a group exercise that Irvin Yalom conducted by asking the
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group members to inquire from each other what they wanted. In the same token, this question
aroused numerous responses including “I want the childhood I never had”. Similarly, the
question evoked pain especially for Jane. At first, I didn’t think that this question would bring
forth any feelings. Nonetheless, after reflecting on it I realized that the session was essential
for the entire therapy period.
After this specific session, I confided to my supervisor that I did not think that Jane
would return. I was however relieved when Jane came back the following week. I
immediately realized that something was unusual. Jane did not have any make up at all. She
told me that she had been critically thinking about the most recent session. Similarly, she told
me that the experience she was having is not what she wished for. Therefore, she dumped all
the five men. Nevertheless, she re-united with one of the men later on. She started crying why
frequently saying “Why me.” Afterwards, Jane completely changed. She became very truthful
and keenly listened to the interpretations that I gave her. She was also willing recall her past
and subsequently link it to her present life experiences.
Notably, this session might be comprehended through the use of Stephen M. Johnsons
(1994) book called ‘Character Styles’. Stephen explains about specific character styles. The
chapter called ‘The Defeated Child: Social Masochism’ is helpful is in understanding Jane’s
presentation. Throughout this particular chapter, Stephen Johnson makes reference to his
earlier work of 1991. He utilized Fairburn’s (1974) model that is of intrapsychic structure to
suggest four examples of internal object relationships. These models can be used to
comprehend symptomatic behaviour. Johnson, (1994) claims that this specific model is
particularly utilized as a way of “mapping the internal dynamics of the masochistic person all
along the continuum from character style to personality disorder” (p. 202). Of the four
prototypes, I am convinced that Jane mostly fits Prototype III. Stephen labelled Prototype III
as “Resistance-Rebellion”. He further defines it as “behaviour that can be explained most
20

accurately by the aggression of libidinal self and object against the antilibidinal object.” (p.
207). Correspondingly, he clarifies that a child is fighting back. In Jane’s scenario, she is
actively demonstrating rebellion against the restraint which was as a result of her mother’s
silence as she was mistreated by both her biological and step-father.
Importantly, in the masochist’s scenario, Johnson (1994) explains that any opportunity to
rebel or resist had been prohibited. In this case, Jane was inappropriately controlled by her
father, submitted to different men because of fear and silenced by her biological mother.
Therefore, this meant that Jane’s self-expression was only through display and exaggeration
of self-defeat. Johnson (1994) notes that it is this impossible state which causes the oft-note
extreme rebellion to transformation of the masochistic character. Notably, this is one of the
core elements of the therapeutic relation with Jane which I actively struggled with since my
original intention was to attempt to “cure” her from allowing men to abuse and mistreat her
through sex. However, after numerous unsuccessful attempts and consequent relapses I
changed my strategy. Therefore, I helped her comprehend what made her feel that way
instead of how to stop. It is arguable that this defeat has been caused by Jane’s character style
as Stephen Johnson quotes “the client will defeat the therapist the way he was defeated”
(p.229).
The major thematic concerns throughout the course of our work were Jane’s relation
to men and masochism. I spent a considerable amount of time talking to Jane concerning
abandoning her mother that deserted her, abusive step-father and biological father. An
unfortunate situation occurred during the course of out therapeutic work. A building which is
close to H.I.M.H caught fire. Jane lost several friends and also other service users which we
knew at H.I.M.H. Therefore, this tragedy necessitated that we move relocate our therapy
sessions to another centre that was far away. Finally, last theme that was dominant in our
21

session was endings. I motivated Jane to review her relation with endings from the
commencement of our work. I have included an extract from our last ending below.
Abstract
List of Abstract:
1 Session
21
20:08 - 23:31 - Break - 23:44 – 23:01 =
5.89
Lines (J1 - J26)
2 Session
35
16:17 – 17:18 = 3 mins 39 secs Lines (S26 - J30)
3 Session
37
42:002 - 43:02 = 59 secs Lines (S30 - J35)
4 Session
46
29:11 - 35:14 = 7:09 min Lines (S35 - J56)
Abstract A: Session 22
Jane become less rebellious and more truthful to any discussions concerning her past.
Additionally, this happened by our 22nd session. Jane attempted to become less vulnerable or
emotional before this session. Prior to this session, Jane was only discussing past
relationships with men. For instance, a few years ago Jane’s boyfriend become extremely
aggressive and subsequently threatened to execute her if she failed to be submissive. The
following tape starts with us discussing about this experience and the reason Jane is unable to
say no to the different.
22

Transcript Process comments
J1 My sexual experience with the men
was awful. One of the men even
put a knife on my throat but I did
not engage him in the fight.
This shows that the controlling
abuse relationship that Jane was
undergoing could lead to her death
S1 Mmmmmh
J2 I think failing to engage him saved
my life. I think beginning to fight
him could result in more problem.
she was precluded to resist because
she feared for her life, therefore,
remained defeated
J2 Mmmmm Hmmm
J3 Typically, failing to fight him
assisted me a lot more so in regards
to my personality.
S3 Because you were afraid or? ... I was not sure whether she was
afraid. However, her body language
showed she was scared.
J4 Yes, I was. The man wanted to
pierce my throat.
S4 Did you become the submissive I was trying to associate this
particular experience to her present
23

role.
R5 Yes, I was very exceptionally
submissive. I think saying ‘no’
helped me to overcome the
situation.
This shows her defeated character
S5 Mmmh
J6 I was really taken aback to see the
guy holding a knife.
S7 So what is that thing which makes
you occasionally want to become
the leading one?
At this instant I needed to
reconnoitre both sides of Jane’s
character because she frequently
says she is dominant both.
J7 Do you mean dominant in the
bedroom?
The Yalom’s (2014) existential
segregation defence outline that
‘compulsive sexuality’ refers to
promiscuous sexual activity act
which is a powerful relief for a
lonely person who does not truly
engage with the sexual partners.
This basically defines most of Jane’s
relationships and it has become
custom to this kind of relationship.
So I had to challenge her on this
24

kind of relationships or coupling.
S7 Or?
J8 Yes. I am actually dominant in the
bedroom. However, I do not want
to take much time in the bedroom
after my experience with Mr
Obedient.
This evidently exhibits Johnson’s III
prototype because in this case Jane
is fighting back as Johnson
elucidates in his theory. The
masochist’s is the only way of
expressing self-defeat particularly
via libinal self-expression.
S7 Would like to get them back? This is a quite significant point to
aid mirror out Jane’s situation as she
is saying she would like avenge.
Advising her on the impacts of
revenge was important. I believed it
would help to widen her awareness
on revenge.
J9 Yes
Abstract B: Session 34
Notably, this extract shows Jane’s major difficulty, that is, isolation. My client agrees to meet
the men weekly since she is entirely lonely and therefore cannot overcome the situation.
Overcoming the condition will not be ease for her. For people to ‘cure’, Yalom argues that
“There is no solution to isolation, it is part of existence; we must face it and find a way to
25

take it into ourselves.”
Transcript comments
S28 So I think about whether there's a
piece of you that doesn't generally
or need is devoted of a cozy
relationship
Yalom outlines a ‘constant searching
down affection' as a key guard for
the insufficiency roused singular
Smith (2012) cites – "via hunting
down adoration, the hypochondriac
individual escapes from the faintly
perceived feeling of disconnection
and void at the focal point of being.
The arrangement is bound to come
up short since one misidentifies the
issue. One thinks of it as that one is
included, while in fact it is that one
can't love."
J30 Yes I fear close relationships and I
do not know the reason why
S31 Because there's a part of you that
says that you want more from him
but you've accepted that he gives
you this one hour a week for nearly
two years
I believe that this somewhat
resembles Rosa, although she
Thinks that she is capable and
willing to love, her traumatic
childhood and abuse from her
fathers have tarnished a healthy way
26

of her loving another man.
R3
1
(pause) yeah yeah that's (laughs)
one hour a week ahh one hour week
for 2 years ermm but yeah.
S31 I maybe going back to us talking
about you you may be not wanting
a real relationship with a man and
you know you only have an hour a
week with Mr Robot man you have
an hour week here with me maybe
that's all you're capable of
accepting ..as part of a relationship
only because it's too scary to think
about having a relationship like that
with your stepfather
I clearly had my own agenda here as
I went back to discuss this further– I
also shouldn’t have nearly said
‘capable’ even though I quickly
changed this to ‘capable of
accepting’ it sounds harsh to say one
is incapable of having a relationship
and this may have been too difficult
for Rosa to hear.
R3
2
yeah it's just I don't know I mean I
do want to have a relationship it's
not like I don't It's not it's not like I
don't
I believed her when she said this I
think Rosa began to really want
more for herself and in her
relationships. It is also important to
note that Rosa is comfortable with
disagreeing with me or sharing her
interpretation of what's happening to
27

her and this is great for our work as
we are comfortable with ruptures
and challenges.
S32 but it's how much of a relationship
you're willing to have maybe an
hour week is more comfortable
maybe more than that is too much
R3
3
Yeah
Abstract C: Session 36
It is vital to include this extract although it is extremely short. The extract reveals
considerable growth and the steps Jane has already initiated to improve her condition and
start the process of transformation. During the previous session prior to this one, Jane
conveyed her excitement because an agency had accepted her. The agency aids in match
making couples specifically for a well renowned show called the Undateables. Jane
involvement will be private and therefore not included in the Television show. At first I was
very astonished that she chose our agency for care and support (Major, Whelton and Duff,
2016). I assumed that the show would only air singletons which had particular disabilities. I
did not classify Jane in this category although she has learning difficulties and even mental or
psychological health diagnosis.
After consulting with my supervisor, my doubts were greatly reduced. Moreover, this
step was really helpful to my client and I told her that as indicated in the extract below. My
supervisor specifically had some experience with an ally who had earlier on used our agency.
28

The friend commented positively in regards to the organization. Likewise, this aided me
realize how significant this was for the therapy sessions that I had with Jane.
At the end of this precise extract Jane confesses that she was never connected to any
man emotionally. Furthermore, I believe in the meaning and essence of masochism. It is the
inability of connect or empathise with other people. Therefore, it was critical that my client
became conscious of this aspect. It would be imperative in aiding her comprehend the reason
that makes her fail to connect emotionally with other people which is the key cause of the
struggle she experiences.
Transcript Process comments
S33 Okay
R3
4
Because like you know because of
my age and stuff so it's not like like
I'm gonna send the form in next
weekend and I'm going to get a
phone call within about
I could hear changes in Rosa’s
narrative here. When we began
therapy she would have really
struggled with this and it was
probably what put her off doing this
sort of thing sooner. Now she has
prepared herself for how difficult
this process may be for her
especially if she is rejected.
Rosa is also a woman that knows
how to get men very easily and this
is usually through engaging in sex
29

with them straight away. This shows
that she is willing to wait and not
use her usual tactic of seducing men
and this may mean that they reject
her.
S34 so it can take some time
R3
5
yeah yeah because she did say to
me like and the men might not like
me they might turn around and say
no she did warn me about it
I could have explored this a bit more
as Rosa has a past full of rejection -
we did at a later stage, but I believe
she mentioned this hear because of
her anxieties around putting herself
out there and potentially being
rejected again.
S35 Mmmm
R3
6
so basically, no so I just need to
kind of take that first step and
This was great to hear, and I was
genuinely very happy for her
S36 Yeah
R3
7
need to take that first step and
S37 it's it's a big step to you because it
means that you're putting yourself
out there for someone to connect to
I wanted to express my thoughts as I
didn't get a chance to as our session
had ended. When she told me the
30

view I'm more than a sexual in
more than a sexual way
week before She may have noticed
my confusion and I wanted to
acknowledge how big this was for
Rosa. She was finally saying no to
one hour a week and yes to a
committing long-term relationship.
R3
8
yeah yeah because because when it
comes to the emotional erm when it
comes to men on an emotional
level I don't think I've ever
connected to a man on an
emotional level
I wonder if Rosa has connected to
anyone else on an emotional level
before.
Could this unconscious coupling be
one of her first experience of real
emotional human connectedness?
Abstract D: Session 47 – Final Session
Although I had adequately prepared for my ending with Jane, I confided to my
supervisor that I had difficulty in informing her that I would soon leave. Nevertheless, during
the last 4 weeks of our counselling sessions I opted to inform my customer, Jane, about our
ending. The previous 2 weeks were before I told her were difficult for me as I could not find
the appropriate way of telling her. Nonetheless, I could easily inform other customers that I
was leaving. Jane failed to show up for week five’s therapy session therefore had to
communicate to her in regards to our endings four weeks before. Having analysed this
situation in my supervision, I constantly expressed my thoughts concerning our ending. I,
therefore, was sure Jane would not attend our sessions. Despite being adequately prepared for
31

this situation I was however amazed when Jane rang the buzzer. Working with Jane made me
reviewed our relationship concerning endings. Although I had previously not had difficulty
with endings, in this scenario I became extremely conscious about Jane difficulty with our
imminent ending therefore postponed telling her which is not my nature.
During the last session, Jane came to the counselling session with a piece of paper. As
she placed it on the table adjacent to us, I inquired why she had come with it. Staring at the
paper, Jane said “this is my preferences form for the undateables, could we complete it
together”. I appreciated her effort that she valued every aspect concerning our sessions. It a
very good way of concluding our work. Making frequent inquiries about what was the
necessity of a relationship to her and what she needed from the various relationship had
formed the basis of our therapy sessions. I strive to educate and inform Jane that a weekly
session of masochism is not an effective relationship (Stokes, Pogge and Zaccario, 2013).
Additionally, this was also aimed at transforming her perception in regards to what a
relationship ought to be. We used approximately 30 minutes to answer the queries provided
in the Undateables form. We also conserved more concerning Jane’s opinion on our ending
and the entire therapeutic journey. The following extract begins us discussing Jane’s past
experiences and how and why she steers clear endings.
Transcript Procedure comments
S38 So you continue...
J48 I just steer clear it
S39 So you clearly observed this
particular ending or completion
Jane steered clear conversing in
regards to completions all through
the year. It is imperative to link
32

endings or completions to
something. As an experienced
therapist I can evidently conclude
expertly. In addition, the counselling
period with my customer, Jane,
would certainly end. Nevertheless,
Jane would agree and consequently
proceed communicating concerning
another element. It, therefore,
became difficult to convince her that
it is vital we discuss endings or
completions. Reviewing this
experience, I ought to have been
more cautious when doing that so
that our encounter becomes
prosperous.
J3 Yes and I am even convinced that it
is true.
S41 Wow. That is great.
J50 Yes. Yes. Yes because like
S41 How do you manage to
successfully mitigate the fear of
I thought I was conversing with
myself. I subsequently discovered
33

completion and even continue
coming to the counselling sessions
like today?
that this precise completion was one
of the most challenging or difficult
part of counselling period. In the
same vein, this is because we had
spent a lot of time with my client,
Jane and I constantly felt
comfortable being with her..
J52 Errrrrrrmmmm certainly sad
S42 Mmmmmmmh
J44 Extremely sad. (Jane sniffs). Yes
completely sad. Yes since like
mmmmmmmhhhh. Unhappy since
I am not comfortable when
experiencing situations which are
related to completions or endings.
S54 Certainly yes.
J45 Yes. I completely dislike anything
feeling that is associated with
endings. I entirely hate conclusions.
I realized that both my customer and
I hate completions. On the contrary,
as an expert I ought to be more
relaxed in regards to issues that are
associated with conclusions or
endings. In addition, it is certain that
34

there is some trait in me which
overly makes me constantly dislike
or entirely hate endings.
S45 It is alright
J46 My personality makes me fail to
like endings. In general, most
people do not like the notion of
being related or associated with
bad, unfortunate or unpleasant
situations and occurrences. For
example, yesterday was my step-
mother first death anniversary.
S46 Yes since we have been together
for over one year.
I completely forgot that Jane
primarily sought our organization’s
services because she was
experiencing sorrow and grief.
J48 It was basically one year. However,
I was not entirely surprised when
my granny passed on. I clearly
comprehended that she would
eventually die. Additionally, this
because she was visibly weak. You
also understand that she was
35

extremely old. The situation
provided me with an opportunity to
become knowledgeable about such
situations. I feared the ending or
completion since I was the only
person that she was close to. The
ending or completion would not be
unpleasant had I been seeing her
less frequently.
S46 Yes. The experience was really
hard.
J48 Typically, my behaviour was aimed
at maintain a considerable distance.
I constantly ensured that there
existed a significant distance
between us. Furthermore, when my
granny passed away I was entirely
shocked. It has been challenging
for me to adjust to the situation.
Nevertheless, one of my relatives
experienced a completely different
situation. My cousin would
frequently go to the health facility
to check on her. She actually
Jane evidently put much emphasis in
regards to distance. At this point, I
thought it would be essential to
review the various relationships she
had been in. Therefore, I discovered
that all of them had an element of
distance. Jane visits different male
friends at least for an hour every
week. Therefore, this reveals that
there exists a considerable distance.
36

visited our granny daily. She would
have wished to be with her much
longer.
S48 Yes. We dealt with matters
differently.
J49 Yes. However, I had decided to do
what I perceived to be right.
S49 Are you comfortable attending
today’s session? Are you much
contented with completions or
endings? Can you experience
endings as well as get over them?
As an experienced therapist, my
purpose was meant to certainly
reveal to Jane the improvement we
had achieved. However, the question
became very challenging to ask her.
Honestly, it would be unrealistic to
conclude that Jane had gained the
ability to handle every completion or
ending.
J49 Yes. Certainly, this is right. Yes. I
can manage the situation. On the
other hand, it will be challenging to
mitigate the problem as I have not
been experiencing goodbyes or
endings prior to this scenario. In
general, nobody likes goodbyes.
Jane just told me anything that she
perceived was right to inform me as
her counsellor.
37

S50 Hmmmmmmmh
J50 Importantly, I realized that my
mentor or counsellor was leaving.
S50 What motivated you to attend
today’s session?
J51 I actually do not know.
S51 What has changed concerning this
particular completion or ending?
I was not certain of the information I
wanted to convey to Jane. However,
I was concerned that she was
steering clear of completions or
endings. I was completely contented
that we would come to a successful
ending after the therapy sessions.
J52 (Starts crying). I typically do not
understand. I do actually not
recognize the reason that made me
come (cries).
S52 Hmmmmmhhhhhh endings or
goodbyes are completely hard.
I appreciate the fact that Jane
noticed our completion or ending.
The ending indicates that she
realizes and appreciates the
improvement or progress that we
38

have made.
J53 Mmmmmmhhh. I entirely hate
goodbyes. I even felt like crying.
S54 It is alright.
J54 I fail to understand the situation. It
is just clear that I hate completions.
Additionally, this is because no
person likes an ending or goodbye.
I attempted to analyse and evaluate
ending. I did this during the period
that we have been with Jane.
However, she failed to reply to my
inquiries. I would have further
analysed this situation if I had
adequate time.
S56 Yes
J56 I fail to comprehend endings or
goodbyes. I dislike it whenever
persons are leaving.
Notably, this reveals Jane’s
agonizing fear of isolation and
loneliness.
S55 Mmmmmmmmh
J56 Typically, it is important to note
that the main reason I was
considering whether I should attend
the session was because my friend
was leaving. However, there was
39

no reason of failing to attend the
counselling session as it is
paramount
S56 Did you critically consider
attending today counselling
session?
I was completely convinced that
Jane may show up to the last
therapeutic session. More
importantly, this situation was
challenging for Jane. I made an
inquiry because I was amazed that
she actually came.
J57 No. I do not like the process Maybe Jane failed to convey the
truth?
S57 We ought to appreciate the time we
have been together as well as the
activities that we have performed or
conducted. Likewise, it is important
that you considered coming.
I was completely astonished that
Jane showed up. Similarly, I made
an effort to assure her that
encountering endings or goodbyes is
vital.
J59 Yes. Yes. Additionally, this
because you have extremely aided
me.
S59 Mmmmmmmmh
40

J60 Yes. In addition, this is because it is
the first goodbye or ending.
Wow! That is great.
OUTCOME
Foremost, I certainly had difficulty with my therapeutic association with Jane,
specifically in the initial eight weeks of the sessions. Basically, I experienced challenges like
dealing with Jane who was withholding and cold and brought sadomasochistic dynamic
between us. Her extensive, dramatic storytelling period was characterized by victimization,
seemed as an angry attack especially on me and a humiliation of our work.
Johnson (2013, p.218) clearly explains what Jane experienced during the initial stage
of the therapeutic session. Johnson states that, this kind of an individual consciously sees
herself or himself as perfectly well-intentioned, not-guilty or innocent, however unlucky,
victimised, unfortunate, misused or unappreciated. The person sees the innocence of, for
example,” Who, me?” as well the unfair treatment of “Why me?” So in Jane’s case, she is
pervaded by the masochist’s conscious self-presentation and consciousness. Johnson states
that the masochist will ask for aid or come to therapy but will not actually believe that the
assistance will be upcoming or if something positive is forthcoming. The masochist will only
present himself or herself because there is nothing or she can do.
During the counselling, Jane took me like a brick-wall that has does not have any
purpose, opinion, or feelings. Jane would occasionally tell me long stories and at the same
time flout or disregard any fundamental point or input that I provided. She also would refute
having any reactions in regards to the therapy. On several occasions, Jane would ignore me
by pretending that she is keenly listening then proceed with her story. The cycle continued
making me feel worthless. Additionally, this is because I felt that the sessions were becoming
tedious and frustrating. Yalom (2014) describes a client in one of his books called
41

‘Existential psychotherapy’. He argues “Yet how can he or she address me if I am not
around” (Yalom 2014, p. 414) I recall my manager telling me to continuously remain hesitant
to Jane’s drama and that it should not affect my work. Jane’s audio diary which progressively
continued every week became useless. Instead of empathising with Jane, I frequently
identified with the oppressors in her stories. Her female allies who do not like neither the
stories nor the men leave Jane after obtain what they require. They do not keep her company
therefore fail to connect with her emotionally. Therefore, I am convinced that Jane narrated
her tales to maintain an emotive distance precisely amid us.
According to Blizard (2001, p.55) in any vicious transference a customer seems self-
sufficient or autonomous and may even dismiss the specialist or therapist’s points. The
patient takes up the role of the ‘specialist’ making the therapist to start feeling inept. It is
important to note that this is because of the fear of being rejected. Therefore, the client strive
to intimidate the expert or therapist. In Jane’s case, she achieved this by constantly failing to
value my input and ignoring me. Blizard further suggest that this client’s behaviour can make
the therapist angry. Therefore, the therapist loses objectivity, becomes incapable of making
valuable interpretations and is unable to establish therapeutic boundaries. I experienced that
this was the most difficult part in the course of my work. I felt that I had been doing nothing
for the past three months making me frustrated. As evident in this case study, I was able to
overcome this conventional routine. It is explicit that our rapport become stronger because I
did not relent in Jane’s case.
Jane had a frustrated and revengeful tone due to her sadness. However, sometimes she
was self-loathing and apologetic when conveying her distress. A notable thematic concern
that was dominant in Jane’s life was her incapability to integrate and abandon the distinct
parts of herself. Nevertheless, after concluding 3 months of the therapy sessions, Jane became
less secretive and withholding. She was able to disclose to me her hidden character traits.
42

Furthermore, she was now able to reveal her deep isolation, desperation, heartache and
resentment. Primarily, Jane realized that she required my aid or help for a significant and
considerable progress in regards to her situation.
Notably, after the 13th session, Jane now heard me as I inquired assertively what she
actually needed from the relationships. Particularly, the session influenced several
transformations in Jane which even surprised me. On reflection, I assumed the role of the
aggressors. The frequent inquiry concerning what Jane needed made her change to a self-
defeating submissive style (Breiter et al., 2015). Moreover, she dumped all the men that she
had been having sexual relationships with. On the contrary, I doubted if this precise session
caused any emotions to Jane. It is because she has been previously told what she needed in
her life nonetheless I was treating Jane like a mature person. The numerous questions that I
asked were aimed at making her cooperate and open up to make the therapy sessions
successful.
After completing this therapy session, I wanted to assert myself but Jane was only
attending them to acquire something useful from them instead of utilizing them as a record or
diary. Jane discussed her family’s situation and most importantly her relations with her
parents. She also described her precise childhood commemorations. In addition, this is
evident in the extracts provided above where Jane answers questions, gives me an
opportunity to talk and listens to my significant interpretations. Jane, therefore, had to
connect with me emotionally. She explores her association or relation with other people in
my conversation with her. She interacted with me in a manner she was not used to by
attending the sessions and allowing me into her life. Similarly, this reveals the progress she
has made.
Another change which occurred in Jane after evading the fire, observing building burn
and witnessing her neighbours avoiding death, made her get stressed. After the fire, during
43

the 14th session, Jane was communicating her existential opinions of existence and purpose in
her life. My client stated that she needed transformation, move forward and obtain much from
life. She realized that death actually exists. Yalom’s (2016) brings forth a lot concerning
death nervousness. In (2014, p. 173), he explains that each nervousness nightmare
encompasses death and terrifying imaginations encompassing such subjects as mysterious
belligerents breaking into someone’s household, constantly when discovered, results in fright
of death” He goes ahead to state that the wakening experience does not concern being an
usual or curious happening or concept; in reality is the livelihood of medical or clinical
practice. Accordingly, the author states how he spends ample time education therapists some
of the ways of identifying and harnessing the wakening takes for therapeutic practice. The
author is making reference to nightmares and it is important to note that Jane has had a
personal experience and understanding of these kinds of dreams. I, therefore, used the
aforementioned approach to motivate Jane toward transformation and becoming a person
who loves herself irrespective of challenges or difficulties. Jane boldly started to make
progress from the night of the fire when she escaped death. She had not earlier stated that she
feared death or she would die despite now having a greater value of life.
I thought of Jane’s reaction the most during the final week that I would announce that
I will be departing from H.I.M.H service. I found it difficult to convey this information to
her. Furthermore, this is because of strong countertransference and her being my longest
client. We had all along worked towards achieving a successful ending during the course of
the year. In the 43rd session, I informed Jane that I was planning of telling her something as I
summarized the earlier discussion. However, she straightway said “Oohh nooo you are not
expecting like me, are you?” then stared at me upsettingly. I just smiled as I reviewed what
she had just said. I had been single for a long time though I was 26 years old. I informed Jane
that I would be leaving to concentrate on finishing my studies.
44

More importantly, this triggered me to think of Jane’s relation with her biological
mother. Her mother had previously neglected her after getting a new household. Likewise,
this might have been a possible prognostication of Jane’s initial association with her mother
as she alleged that I was also planning to leave her because of her child. Jane continued
coming for the next few sessions but she suddenly became sad and tearful. She confided to
me that some days she would lose focus and start doing silly activities. For instance, she
would press the water dispenser button, however, not accurately therefore started forgetting
vital things (Fenichel, 2014). As evident in the last excerpt, Jane needed me to observe how I
had transformed her life. She needed me to partly hold and even try comforting her during
her stressful moments. Moreover, Jane clearly explained she needed comfort because she was
had not steered clear ending of her problems. I am sure that Jane might have regretted
consuming her time to make herself comfortable and talking frankly to me. She was upset
because I was leaving when she was working hard to get the most from the therapy sessions.
Generally, I am pleased and satisfied with the progress that we made during the
course of the year. Jane transformed from sleeping with numerous men to becoming more
aware and subsequently reflective as she overcame her initial ending. On the other hand,
there are several issues which I feel that I should have improved and done better. As a
therapist, I have for instance learnt that I could have handled the challenging dynamic that we
had at the beginning of the therapy session (Linehan, 2018). I realized that Jane became
cautious when describing the unfortunate fire incident. I was later informed that her outreach
employee had told her that I witnessed a client who died in the fire incident. Additionally,
this can be clearly comprehended through the use of Yalom’s existential defence, which
requires a therapist to put the needs of his or her client first before considering other things’.
According to Smith (2012), in a case like Jane’s, the therapist has to put the needs of the
patient first perchance to the disadvantage of himself or herself to avoid the dismay of
45

antagonizing existential isolation.” It is my belief that Jane was utilizing my loss as an avenue
to steer her present existential catastrophe particularly the stress of losing several friends and
neighbors and also her nearly dying.
After a thorough talk with Jane she agreed that we could discuss the events that
occurred during the night of fire, she was still not willing to disclose more details.
Nevertheless, there existed an element of her ‘trying to put my wants first’ because she
presumed that I was experiencing a hard or tough time in regards to the loss of her friends
and neighbors. Despite this being inevitable, I strived to make sure that Jane felt reassured
and that she could comfortably describe the fire occurrence.
Countertransference
I constantly evaluated who I was to Jane in the transference during the time we had
been together. It is evident that there existed a solid countertransference with Jane when I
encountered her outside the therapy room during one night. On account of the intensity of the
fire, I was required to control a night bus service to enable residents to come in and
communicate. Moreover, this come up after the public had requested the board to establish a
way of catering for people who witness inferno and struggle to have a sleep at night. I
therefore supplied the bus with bottled water, coffees, and tea prior to leaving for work.
One night when I was stocking the bus and arranging sofa cushions and curtains prior
to the night shift staff commenced work, I heard someone calling my name. I was on the deck
so I had to go downstairs and I found out that it was Jane. She was coming from the silent
march accompanied by her two neighbours. She introduced me to them as her therapist. The
neighbours started laughing after looking at each other. Jane did not realize that as she was
busy asking questions in regards to the night bus service. As this occurred I recall feeling
somewhat uncomfortable. I failed to maintain boundaries in this case although I did not
communicate with the neighbours and I felt the desire to protect Jane. I discovered that she
46

was uniquely naïve and this might be the reason why the different men easily manipulate
Jane. After this encounter I analysed this occurrence in supervision and discovered that the
feeling to protect Jane is the same as that one that I feel in the same case with my younger
sister.
During my work at this critical moment at H.I.M.H, it was impossible to maintain
objectivity and distance as it is the norm in my psychodynamic work. I was continually aware
of this and therefore made sure that I maintained boundaries. According to Yalom, Freud’s
position is that the specialist or therapist had difficulty in maintaining objectivity. Moreover,
this makes the expert to lose control and be swayed by what a patient wishes instead of what
the patient needs. “In Freud’s opinion, if a therapist opens up to a patient and engages in
usual human intercourse, he or she will forgo objectivity and, therefore, enhancing value or
effectiveness” (Freud 2014, p. 412). Jane seduced me with excitement and enthusiasm of her
lifestyle and ignored my questions making it impossible for me to assert myself and
consequently take control. Through my personal reflection and supervision, I discovered just
as Freud had proposed that this is what Jane wanted. It was to simply continue with her
stories devoid of being vulnerable. She required me to take charge just like caregivers
without mistreating her or suddenly abandoning her.
In the same token, this necessity to protect Jane was just an urge from my personal
feelings in accordance to my family life’s context. As Yalom (2014) explains, this usually
develops from childhood encounters. During my upbringing, my biological mother and sister
experienced an extremely troubled relation. Additionally, this entails my mother’s experience
of postnatal depression which happened after my sister’s birth. My mother excessively
struggled to deal with the situation. Interestingly, I am informed that I actively endeavoured
to aid her. Recently during one of the family gatherings, my younger sister remembered a
story that she had been told by our mother. My mother narrated the whole story and other
47

things related to our family issues to make my cousins believe it. Particularly, she narrated a
story concerning the night that my younger sister was born. She said that when they got home
she left the baby in the living room and went to sleep. Furthermore, she also recalled waking
up the next morning and sat by her side waking her up shouting “the baby is crying wake up!
The baby is crying wake up!” As my mom took care of my younger sister, she realized that
her skin was becoming dark purple because of consistent crying throughout the night.
Notably, this is an explicit instance of my protective measures and concern in regards
to my sister, starting from my early age. In spite of Jane being almost twice my age, I always
felt as I was older than her. Similar to my younger sister, she would keenly pay attention to
my personal interpretations. As such, she viewed me as being more knowledgeable. During
one therapy session, I requested Jane to tell me how she viewed me but she did not comment,
however, pointed at a table which was in the room and said “The tiny dot you in the table
represents me while the entire table represents you”. I shared this imperative information with
the supervisor because Jane seemed to be naive. It is vital to think developmentally
concerning a child’s comprehension and perspective about the world. I realized that adults aid
facilitate and develop a child’s awareness by joining the dots. Furthermore, this is revealed by
the desire to support and help Jane in regards to safeguarding concerns. In one of the
counselling sessions she was unable to sit properly because of pain. The pain was as a result
of being intimate with one of the men the previous night. Jane made me actively perform my
role of a protective mother. I continuously reminded her of the various things that can help
keep her in a safe environment or state. In addition, this is a clear instance of my
countertransference in the therapy room with Jane. Therefore, this was something which
required supervision and to be aware of.
She once stated that I make her recall one of her Asian allies that she studied with in
high school. Upon making further inquiries, my client disclosed that this occurred because
48

the Indian friend was clever. Jane viewed me this way since my appearance made her feel
that I was wiser and older. Subsequently, having discovered this information, I understood
that I had to conduct my duties in an effective and hardworking manner. Likewise, I had to
work extra hard to make sure that Jane reduces her reliance on me to provide her with
answers. I strived to impact skills which would help her develop her own awareness.
Therefore, this is in accordance with what Freud proposed as the key aim for a
psychodynamic counselling or therapy.
On a similar note, my younger sister is undeniably needy and this was always my
expectation and experience with my client Jane. She would attempt to utilize her extra time to
test boundaries. She once observed me greet another service user in the waiting area. She
later inquired if I was also providing the person with counselling. On account of this scenario
she requested to that we organize more than one meeting in a week. Having a clear
understanding of my countertransference with Jane, I became very careful concerning
whether I should concentrate with “protecting her” during the course of our counselling
sessions. Particularly, this would be vital and fundamental and this meant that we would not
easily handle some of the ruptures. Moreover, this is a very paramount aspect in regards to
my psychodynamic practice. I was extremely cognizant not to make Jane completely agree
with all the things that I told her. I, therefore, challenge her to maintain a broader perspective
towards various elements. In spite of Jane partly agreeing with what I told her, she was able
to disagree with some of the elements which I interpreted in an inaccurate manner.
Goals
After conducting a critical evaluation of our session’s objectives I discovered several
things. Jane usually conducted little reflection and awareness concerning her relationship and
herself. She originally utilized the fifty-minute sessions to convey her dramatic encounters
and also fill her diary concerning events which occurred during the week. After two vital
49

therapy sessions, a significant transformation happened concerning our therapeutic relation.
Jane began noticing the essence of the counselling. She would now better tell her story. She
started sharing more information in regards to her childhood experiences. She also expressed
her feelings concerning the specific relationships that she had. Significantly, she became
more frank during the course of our work.
As evident in the above extracts, Jane started to reflect herself devoid of requiring
reminders from me, I reviewed one of the sessions in which Jane sat down and stated I had
been considering dismissal this indicating how much development Jane had registered as far
as her mindfulness and consciousness are concerned. She was additionally frank to connect
together various parts of herself and subsequently comprehend and understand where they
might have originated from as well as how she has turned into the manner in which she is at
present. When we started therapeutic process sessions, I would make inquiries to trigger her
to do as such. However, she would dismiss each invitation to further uncover more details of
herself. Although, this turned out to be considerably less demanding for her, as evident all
through the extracts, for instance she knew that her outrage in badminton was profoundly
established and not just as a result of what her friends had said. Jane likewise recognized that
she did not sincerely and emotionally associate with any man. She said that she always stayed
away from all wind-ups.
As recommended by Holmes (2014) and Yalom (2014) it was critical that the
therapeutic relationships becomes solid to make sure that Jane develops a self-autonomous
account or narrative. Similarly, this was unquestionably not the situation for the initial
months of counselling and it took numerous obstacles to keep up genuine relationships as
evidently proposed by Yalom. As disclosed in the excerpts, my therapeutic relation with Jane
was one in which Jane would become secure and comfortable in. We became comfortably
ready to challenge each other while maintaining transparency and honesty.
50

Jane became capable of conquering her first appropriate ending as proposed by
Messler Davies (2010, p. 85). According to Messler Davies (2010, p. 85), the process of
mourning and termination of mourning encompasses the analyst as a ‘stand-in’ of sorts,
which is a representation of part for all the separations suffered by the patient, unresolved
abandonments, ungrieved as well as the unmourned.” . She discovered that our conclusion
was troublesome in light of the fact that I spoke about the previous abandonments as well as
divisions she experienced. She placed me on a platform because I was the only individual
who remained with her or could help her in regards to her problems. It is vital to note that I
keenly listened and never got exhausted of her stories in comparison to her companions. I
also did not utilize her like men she had relationships with. I did not become furious with her
the way her biological father did. However, I neglected her like her biological mother.
Freud anticipates that an examination will avert a repeat of troubles later on. He states
that an analyst will assess whether repressed materials have been made sentient or not; so
much that was indecipherable has been elucidated, and so much internal resistance conquered
that there is no need to fear a repetition of the pathological processes concerned.” In spite of
the fact that, Jane has just barely started demonstrating her defencelessness and opening
previous injuries. It is my feeling that much of what was earlier subdued has been completed
cognizant as Freud proposes. Nevertheless, Jane has barely been provided with the tools to
overcome the difficulties. In spite of the fact that, Jane comprehended her masochistic
conduct in a better way and did not have shielding concerns hailed throughout the previous
four months of treatment. Similarly, this was as well a big reprieve despite the fact that my
point was not to keep her participating in such activity, I needed her to be in a safe condition.
In general, Jane began to reflect and connect parts of her life without a moment's hesitation
and she became capable of conquering her first ending.
CONCLUSION
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In conclusion, generally, I pick this contextual analysis as it showed me an
extraordinary arrangement and indicated to me issues I might not have perceived so clearly
previously. I am knowledgeable concerning my challenges with completions and to become
conscious of such concerns as it might hinder me completely from making adequate
preparations with customers in regards to our endings. In the same vein, as an experienced
counsellor I have at no time been preoccupied in therapeutic work as I have felt in the initial
few months with my customer Jane. In the same token, this was a great learning opportunity.
The supervision and reading taught me an imperative lesson when I am in the same situation.
Jane similarly preferred to test limits or boundaries. For example, she may keep conversing
after we conclude the counselling period. As a counsellor, I desired to stay firm or assertive
to efficiently maintain such significant limits that aim at supporting me in my development as
a specialist. Additionally, this particular scenario constantly challenged me all through the
counselling room because of the disaster that happened in the specific locality. More
importantly, the precise situation implied that having seen Jane close to the counselling
organization as well as failing to control or manage what my colleagues would inform Jane
concerning me would be devastating. It is also possible that she found out more details in
regards to my personality and character as opposed to what I actually thought she would get.
Likewise, this would be through conversing with other customers and staff. At first I truly
found it difficult to handle this situation. Nevertheless, I taught myself different techniques of
managing it skilfully and subsequently maintain significant boundaries. Ultimately, I did not
have any experience working with essential masochistic demonstrations previously.
Continuously dealing with Jane's difficulties or complications made me attain incredible self-
assurance and certainty. My critical skills as an expert were at first overpowered with Jane’s
paramount scenario or case.
52

After starting this vital course, I felt frightened as most persons usually experience.
Additionally, worrying about a substantial concern of insecurity in regards to my age, as far
as being the most youthful and the most inexperienced among my friends. However, as I
conclude my professional internship, together with the assistance of supervision, toiling
tirelessly in practice and finishing the imperative medical sessions, I am assured I have gain
enough experience as well as capacity to effectively treat customers and consequently keep
on growing during the course of the next few years. From the current experiences I am sure
that I may not have made a similar development as well as learn more concerning my
personality. Beginning this critical journey implies opening or exposing injuries I perceived
may have been ideally left closed. Nonetheless, the vital experience has given me a new
sensitivity and understanding regarding feeling vulnerable and spending time with patients
yet entirely believing in the perspective of therapeutic relationship.
53

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