Psychodynamic Therapy Case Study: XYZ's Anorexia and Trauma

This case study explores the application of psychodynamic psychotherapy to a 34-year-old female client, XYZ, presenting with a complex history of anorexia nervosa, PTSD, and social anxiety disorder. The client's background includes childhood bullying, a home break-in, an abusive relationship, and strained family dynamics. The analysis focuses on identifying key issues, including the client's repeated flashbacks and panic attacks, and the underlying theory of psychodynamic psychotherapy, which emphasizes working through painful unconscious feelings. The study proposes a three-step time-limited dynamic therapy approach, focusing on establishing security, addressing core issues like negative self-image and self-harm, and encouraging the client to openly face her issues. The formulation emphasizes the importance of identifying defense mechanisms like disavowal and displacement, and tailoring the therapy to address past traumas to facilitate systematic categorization and resolution of the client's issues.

Running head: PSYCHODYNAMIC PSYCHOTHERAPY
PSYCHODYNAMIC PSYCHOTHERAPY
Name of the Student
Name of the University
Author note

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Psychodynamic psychotherapy underlines the inner workings of a patient’s psyche
and advocates that the client’s self-awareness and the understanding of the impact of past on
the behaviours of the present (Basham et al., 2016). Psychodynamic psychotherapy can be
used as to tap into the unconscious mind and attempts to unfold the series of upsetting
feelings, urges and desires as well as thoughts that are too troublesome for the conscious
mind, built upon the background that these recurring troubling instances that are housed in
the unconscious still influence our behaviour.
In the case of the current client, the following points highlight her key issues as
recorded during the counselling sessions:
1. Client was bullied between 5 – 8 years of age by the daughter of her caretaker who
was of the same age.
2. At age 16 she experienced a break in into her house and hid behind he door, causing
her to have repeated fearful recollections of the incidents for quite some time.
3. Her previous relationship was strained because of an abusive and controlling partner,
intimacy was painful, relationship had many instances of abuse, post relationship
phase was marked by frequent stalking by her ex-partner.
4. Familial relationships does not appear to be good with father who suffers from type 1
diabetes and is controlling about everyone’s diet. Brother does not want to talk about
any kind of issues and so relationship is strained.
5. Client shares good relationship with grandmother who takes care of her nutrition.
6. Client suffers from acute anorexia nervosa and PTSD, social anxiety disorder and
experiences repeated flashbacks and panic attacks whenever a triggering element like
memory or reference to above points 2 and 3 are encountered.
The underlying theory of psychodynamic psychotherapy entails that in order to bring
in a change in the symptoms or the behaviour (Basham et al., 2016; Gabbard, 2014), the

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painful unconscious feelings need to be worked through. Two key element that a lot of
therapies have recorded are the aspects of ‘disavowal’ and ‘displacement’ (Krupnik, 2002);
the former being a common defence mechanism where the patient lives in denial of the
influence of the painful memories and the latter is where the emotional outbursts become too
overwhelming for the patient and so it gets redirected towards others (Krupnik, 2002). Thus
the first step in psychotherapy formulation would be to identify if the patient has any of these
two mechanisms employed. Afterwards a three step time limited dynamic therapy (Krupnik,
2002) approach can be used to help the patient. First step would be to establish a sense of
security and understanding with the patient followed by a middle step where the patient’s
issues would be systematically addressed and evaluated. The second step is the most crucial
as it addresses not only the issues but also the outcomes of these issues like negative self-
image, self-harming, antisocial behavioural elements etc (Shelder, 2010). The final step
encourages the patient to face the issues she is having and be open about them to allow for an
outlet for her unconscious negative thoughts to transpire.
This kind of a formulation works better with the current client because the trauma is
not immediate, rather it lies in the past wherefrom it will become easier for the client to
systematically categorise the issue and address them separately.

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References
Basham, K., Byers, D. S., Heller, N. R., Hertz, M., Kumaria, S., Mattei, L. ... & Shilkret, C. J.
(2016). Inside out and outside in: Psychodynamic clinical theory and
psychopathology in contemporary multicultural contexts. Rowman & Littlefield.
Gabbard, G. O. (2014). Psychodynamic psychiatry in clinical practice. American Psychiatric
Pub.
Krupnick, J. L. (2002). Brief psychodynamic treatment of PTSD. Journal of Clinical
Psychology, 58(8), 919-932.
Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American
psychologist, 65(2), 98.