The following formulation explores the case of John (Persons et al., 1991) from a Freudian perspective, beginning by identifying his core pain, use of defences, limitations in functioning and distortions in his perceptions of self and relations to others. A psychoanalytic explanation for the development of John's problems is then followed by a discussion of proposed goals for therapy and the key therapeutic strategies to achieve this.
John's core pain is his sense of inferiority; he is highly self-critical and fears failure or disappointing others. He is most afraid that other people will reject or ignore him. John's primary defence is withdrawal (or ego restriction; Freud, 1992); he isolates himself by living alone, having no friends or intimate …show more content…
His mother confided in him about her marital problems, making him “his mother's lover” (Freud, 1949, p71, in Fall et al., 2010). The Oedipal fear of surpassing his father was heightened by his father's refusal to play checkers once his son could beat him. He may be afraid to succeed in case he upsets his father, leading him to sabotage his own success by not following through with his plans. He may have felt anger towards his father for his overly controlling and interfering parenting. These unacceptable feelings were repressed and led to over-identification with his father, demonstrated by following him into a similar profession.
John resolved his Oedipus conflict by aligning with his father and introjecting his values (Costin and Draguns, 1989). He became self-critical and incorporated his father's strict standards into an overly punitive superego, leading to the guilt and excessive responsibility which characterizes much of his object relations. His weak ego resorts to over-use of withdrawal as a defence against its excessive demands. A Freudian analyst might argue that John is phallically fixated, or has retreated to the phallic stage, because masturbation does not risk rejection by a sexual partner (Kahn, …show more content…
He needs to become aware of his conflicts and defence mechanisms, and thereby reduce his use of withdrawal as a means of protecting himself against failure, so that he can pursue his goals.
He needs to become aware of his ambivalence towards success and his conflicting desire to please his parents whilst being afraid to alienate his father. If John can become more aware of his feelings of responsibility for his parents' feelings, he might be able to focus more upon his own needs. He also needs to relate to his parents on a more equal level, without fear of rejection, to assert himself and enforce boundaries.
According to Arlow (2000, in Fall et al., 2010), personality change occurs with insight. This could be achieved through free-association and dream work, allowing John to relax his defences and become aware of his unconscious conflicts and fears. I would make interpretations and put these to John to see whether they ring true. Because John has difficulty expressing himself, he may find it difficult to disagree with them. It would be very important to encourage John to express himself and to respect his opinions. I would also look for resistance from John which would indicate that his ego was trying to protect itself from unacceptable thoughts or desires (Freud, 1949, in Fall et al.,