University of Southern California
School of Social Work
SOWK 645- [Semester, Year]
Reflective Journal
[Student Name]
[Date]
Professor: Ken Howard, LCSW
Address:
[123 Main Street
Anytown, ST 0000]

Introduction Throughout my two and a half semesters in grad school I have heard many times over the importance of being in tune with my own feelings, emotions, bodily responses, values, belief systems, boundaries, and cultural norms. Hepworth, Rooney, Rooney, and Strom-Gottfried (2013), state that it is important for social workers to be aware of their own value systems, so that they can be cognizant of how their beliefs may affect clients with differing values. In addition, it is equally important to be aware of issues arising from countertransference. Without being fully aware of ourselves, countertransference becomes hard to recognize. By understanding our own thoughts, feelings, and values, these issues can be recognized and resolved (Hepworth et al., 2013). As such, this reflective journal is an exercise in self-awareness, recognizing countertransference, and application of clinical practice. I will begin this journal with a summary of the novel The Picture of Dorian Gray by Oscar Wilde in order to fully expound on the themes of mental illness existent in the novel. From there, I will present my assessment of the mental illness and describe the clinical approach that I would take to address these issues. A discussion on issues of countertransference that arose while reading will be included, followed by an exploration of field work experiences, and current events related to the novel.
Summary
The novel begins as painter Basil Hallward is near completion of what he believes to be his masterpiece. It is a portrait of a young and wealthy youth named Dorian Gray. It becomes evident rather quickly that Basil is obsessed with him, as he describes Dorian to his friend, quick-witted nobleman Lord Henry Wotton, as art incarnate. This becomes very intriguing to Lord Henry, who insists on meeting him. Distrustful of Lord Henry, Basil is nervous to introduce them, as he fears Lord Henry will spoil Dorian’s mind with vulgarities. These nerves prove to be validated as Lord Henry, enamored by Dorian’s youth, preaches to him of the virtues of beauty and youth. He is so convincing in his argument that Dorian curses the portrait and wishes that it would bear his wrinkles of old age, and that he would be forever youthful and beautiful. Lord Henry then takes Dorian under his wings, expounding upon him the “merits” of selfishness, lavishness, and pleasure. Dorian is absorbed by Lord Henry’s words and begins to transform, moving away from his purity and desires for philanthropy and into complete narcissism.
As Dorian becomes enraptured with himself and his desires, to his surprise, his portrait begins to grotesquely transform. The first change is the most alarming to Dorian, and occurs after his fiancé Sybil Vane kills herself because he callously ends their engagement. Before Dorian is apprised of Sybil’s death, he writes her a letter begging forgiveness, hoping that an apology and reconciliation would reverse the change to the painting, sparing him the reality of his true ugliness. While there seems to be some semblance of remorse once he hears the news, it quickly vanishes once Lord Henry’s words take hold. He convinces Dorian that her death was the truest form of art and the most perfect ending to a romantic story. With that, Dorian commits to a life of pleasure seeking, with full devotion to self and the basest of desires; he even finds pleasure in watching the portrait become disfigured and horrid. In time, Dorian becomes a social pariah. All of his friends have either killed themselves, met financial ruin, or lost everything, except for Lord Henry. Allowing hatred to take hold of him, Dorian murders Basil Hallward for painting the portrait so many years ago. While Dorian was able to destroy the physical evidence of Basil’s murder, the painting haunts him, as the gross disfigurements are evidence of all of his moral crimes, incriminating him of his wrong doings. He resolves to destroy the painting and to set himself free from its now burdensome and continuous transformation. Dorian takes the knife that he used to stab Basil and attempts to tear through the portrait. A loud cry echoes through the mansion and the servants enter the room to find Dorian, an old disfigured man, stabbed through the heart, at the foot of his restored and beautiful portrait.
Themes of Mental Illness The most obvious theme in the novel is narcissism. While it seems that each of the central characters meet a few of the diagnostic criteria for narcissistic personality disorder, as outlined by the American Psychiatric Association (APA) (2013), it is Dorian that meets all of the criteria. He has a “grandiose sense of self, is preoccupied with ideas of power, brilliance, beauty, and/or ideal love, believes he is special, requires excessive admiration, has a sense of entitlement, interpersonally exploitive, lacks empathy, envious of others or believes others are envious of him, and shows arrogant, haughty behaviors or attitudes” (APA, 2013, p.669-670). The APA (2013) explains further that people with narcissistic personality disorder believe that they are uniquely special and should only associate with others who possess equal greatness. Their feelings of self-worth are enhanced by associating with individuals that they have deemed as important. It appears that Dorian assigns Lord Henry to this status of grandiosity. Dorian has great regard for him and because of this he sees him as the authority on life. Dorian often uses Lord Henry as his moral compass, which always serves to feed his own narcissism. Additionally, Sybil Vane was an idealized love. Dorian perceived Sybil to be perfect, as her abilities on the stage completely enraptured him. His love for her was based on her prestige and capabilities as an actress. However, Sybil found a truth in her love for Dorian that she had never experienced before. She became so overwhelmed by this emotion that it became impossible for her to fake passion on stage, rendering her unable to act. This led to Dorian’s quick renunciation of his love for Sybil. To Dorian, Sybil’s acting was what made her great and without this ability he found her worthless and shallow. His actions are quintessential narcissistic behavior. As mentioned above, narcissists only associate with those they perceive as “the best”. It is difficult to ascertain the diagnosable disorder that led to the suicide of Sybil Vane, as she does not meet the full criteria for any one disorder categorized as a suicide risk. However, suicide is a clear indication of serious mental illness and is the fate of not only Sybil, but of several of Dorian’s acquaintances. A thorough examination of the personal history of any of these victims may give rise to a diagnosis of major depressive disorder, bipolar disorder, or posttraumatic stress disorder, as the APA (2013) lists these disorders, among others, as carrying a risk of suicide.
Assessment and Clinical Approach When looking at the case of Dorian, several initial ideas as to the development of his narcissistic personality disorder come to mind. From a Kohutian framework standpoint, it can be argued that Dorian did not have a positive selfobject as a child, thus disabling him from successfully completing the formation of self. As explained by Kohut and Wolf (1978), selfobjects are objects, most likely a caregiver, which are felt as an extension of ourselves. It is the selfobject’s job to mirror back to the child their uniqueness and capabilities. The second job of the selfobject is to embody ideal strength and calmness in which the child can emulate and merge. When these two things occur, talents and skills are able to be fostered, and a cohesive self is developed. This was originally explained by Kohut as the bipolar self. Flanagan (2011), states that towards the end of Kohut’s career, he added a third pole called the twinship pole. This pole emphasizes the importance of recognizing sameness in others. When Lord Henry investigates Dorian’s past, he finds that his father was killed in a duel orchestrated by Dorian’s grandfather. His mother died within a year of her husband’s death, leaving baby Dorian behind to be raised by his emotionless and fearsome grandfather. Dorian seems to have inherited a great deal of money as well as the manor in which he lives. With this bit of background information, one can surmise that Dorian was not able to form a cohesive self, as the tasks of each pole (mirroring, merging, sharing likeness) were never completed. In addition, having inherited his fortune, there is no indication that Dorian developed any skills or abilities, as he does not seem to have a career or the need for one, thus accentuating his lack of a tripolar self. Dorian, devoid of any sense of self-worth, finds “purpose” in his appearance and latches on to Lord Henry as a selfobject, albeit an unhealthy one. When examining Dorian’s case from a Freudian standpoint, it can be determined that Dorian’s drive primarily operates through his id, with full disregard to his superego. As explained by St. Clair (2004), the id operates unconsciously to satisfy instinctual drives. It was explained to me once that the id is the “wild child”. On the opposite end of the spectrum is the superego that helps to distinguish from right and wrong, bringing a sense of punishment or reward (Robbins, Chatterjee, & Canda, 2012). Likewise, I recall the superego being described as an “angel”. While we see glimpses of Dorian’s ego trying to negotiate between his id and superego, it is Dorian’s instinctual drive towards pleasure that wins the battle time and time again. If Dorian were a client of mine, I would approach him from a psychoanalytic standpoint, utilizing Kohut’s self psychology. I think it is crucial to explore possible early childhood trauma that Dorian might have endured at the hands of his grandfather, as well as issues surrounding the loss of his parents. It is quite possible that Dorian suffers from distrust, further disabling him from developing meaningful relationships. While Dorian is quite enamored with his outward appearance, I feel that there is deep suffering in terms of lack of self-worth. As such, working with him to develop a true cohesive sense of self would be the main priority. According to Kohut and Wolf (1978), of the disorders acquired from the lack of developing a complete tripolar self, narcissistic personality disorder is the only disorder that can be resolved. This can be achieved through the close and empathetic assistance of a mental health clinician, as they can serve as a selfobject for the client (Kohut & Wolf, 1978). Switching focus to Sybil Vane, it is possible that her mental instability comes from deep-rooted attachment issues. The reader is only given a few clues as to her relationship with her mother, but it does not seem to be a nurturing relationship. Rather, her mother seems overly focused on Sybil’s career as an actress. Sybil’s mother does not appear interested in her new- found love until she hears that Dorian comes from wealth. Even after Sybil’s brother implores her to stay away from Dorian because of his poor reputation, her mother shows little concern for her daughter’s well-being. Additionally, when Sybil first falls in love with Dorian, she is overcome by excitement and attempts to share her joy with her mother, but she is relatively unmoved by her daughter’s happiness. Using Ainsworth’s theory of attachment as explained by Hutchison (2013), it seems possible that Sybil developed an anxious attachment as a child. An anxiously-attached child is characterized by their extreme distress in the absence of the caregiver. Sybil’s attachment issues seem to manifest themselves when Dorian’s rejection throws her into panic, causing her to beg him not to leave, as she grovels at his feet, and ultimately kills herself in his absence. In working with Sybil, I would take a cognitive behavioral therapeutic (CBT) approach. CBT assists an individual in identifying faulty beliefs and negative patterns of thought, and supports them in positively changing these patterns, thereby altering their behavior (Hepworth et al., 2013). It appears that Sybil is suffering a great deal from mental health issues and, as stated before, may also be dealing with the effects of an insecure attachment style. It would be crucial to explore her feelings of self-worth and to assist her in identifying negative thought patterns. The goal would be for Sybil to develop a true and positive sense of self so that she does not weigh her worth on the affections of others. To begin restructuring Sybil’s thought patterns, I would have her write a list of attributes that she likes about herself. This task seems simple, but for someone suffering from extremely low self-esteem, this exercise can be very difficult. Once completed, I would ask Sybil to place this list where she can read it daily and add to it. The University of Southern California’s Virtual Academic Center (n.d.) asynchronous material demonstrates the usefulness of thought records in transforming negative thought patterns. As such, I would have Sybil keep a thought record so that she can track her thoughts, the attached emotions, and alternative positive thoughts that she may substitute for any negative thoughts.
Countertransference
The Picture of Dorian Gray is one of my favorite books and touches on several themes that are relevant to my own life, as are several of the unusual characters in the story. This seems odd to say, as the themes in the book are generally tragic and the characters mostly terrible people. While I do not see myself or my life as terrible or tragic, the ability to recognize myself in these themes and characters helps me to see that I can relate to almost anyone or anything on some level. This, I believe, assists me in demonstrating genuine empathy for my clients and people in general. That being said, choosing only one character that I relate the most to is difficult, but for the purposes of this journal I will discuss the countertransference I felt with Dorian Gray.
While it is quite clear that Dorian suffers from narcissism, I believe that he also suffers from issues of control. This I can relate to deeply. In my early twenties, I suffered from an eating disorder for five years. I am not sure if the disorder began because of insecurities about my appearance or out of a need to have a sense of control in my life, but somewhere along the line the two needs blended into one raging debilitating disorder. It took years for anyone to catch on and I was often praised for my ever-slimming body, giving me the encouragement to continue my destructive behavior. Dorian, too, was praised for his appearance and was continuously encouraged by his confidante and mentor to value his youth above all else. Outwardly I was shrinking, as were my jeans. I was starving my body, but feeding an inward ugliness that was growing daily. Much like Dorian and his portrait, transformed by his desires for vanity and pleasure, I, too, hid away the shameful secret that I was perpetuating. I soon took comfort in the ritual of binging and purging, as it became a coping mechanism for all of life’s stresses, big or small. When the shame brought on by my disorder became too much, I would cope in this way, which really was not coping at all. Dorian seems to have similar behavioral patterns. At times, there appears to be some semblance of guilt for his actions, but he is able to rationalize his poor behavior and return to it, then delight in the transformations of his portrait.
Eventually, I became careless in leaving clues about my disorder around: rings on the backs of toilets; abruptly excusing myself from family dinners, only to return with puffy red eyes. It was as if I did not care who knew anymore. I just needed to get whatever was inside of me out, food, emotions, all of it. This became a very isolating and lonely place. While I left the evidence out there for anyone who cared to notice, I refused the emotional support that comes with a concerned and observant support system. I was an emotional pariah of my own volition, while Dorian became a social pariah of his own doing. We both hid from the necessity of change, clinging to our unhealthy security blankets, terrified of how we would cope without our illnesses. However, unlike Dorian, I am delighted to say that I was able to pull myself from the grips of this disorder, establish a positive sense of self, and recognize the amazing support system that I have.
Relatable Field Work Experiences and Newsworthy Events
It is not narcissistic personality disorder that I have come across in my field work, but maladaptive coping. While Dorian suffers from narcissistic personality disorder, he also has a grave inability to positively cope with the world around him. This is evident by his inability to develop supportive and loving relationships, emotional vulnerability, and a true sense of self-worth. Like Dorian, many of the clients that I have worked with have an inability to cope successfully with the adversity that they have been faced with. While the book does not draw on obvious parallels to my fieldwork, the inkling of childhood trauma and insecure attachment present in the book are hard to ignore. These issues come up time and time again for a majority of my clients and have long-lasting implications into adulthood. In the book we can see the effects that unresolved trauma and insecure attachment had on Dorian and Sybil. Among my clients, the prevalence of drugs and alcohol abuse is further proof.
A more overt comparison of the theme of narcissism can easily be seen in the image obsessed American society. The emphasis on youth and beauty is prevalent in every media outlet and even on every toy shelf. Not only do we, as a society, value youth, we want it immediately. The quickest route to beauty seems to be the road most traveled. We have no qualms about injecting our faces with paralysis-inducing chemicals. We spend thousands of dollars on treatments that burn, suck, pump, remove, shrink, and enlarge whatever area of our bodies we deem imperfect. Like Dorian, we need to be perfect, we need to look young, and we need to feel important. When Dorian saw his portrait for the first time, it was as if he had never seen himself before, as if he was looking at an idealized version of himself. This became his standard for all time. We put this same undue pressure on ourselves, seeking the perfection of the youthful, airbrushed faces that we will never be able to obtain.
These issues have broader implications for social work as well. Researchers Derenne and Eugene (2006), state that the mass media has a powerful effect on disordered eating and body dissatisfaction across genders. With the prevalence of social media, these standards of beauty, and the social pressures to obtain them, seem to be more widespread than ever before. To this end, social workers need to be aware of the ever-changing media climate and perpetuated trends that can have serious implications for the mental health of their clients.
Conclusion
The Picture of Dorian Gray is a tremendous story in which I have had the pleasure of reading twice. While the message seems simple, a more thorough exploration of it allowed me to find reflections of myself in it that I missed the first time I read it. Additionally, it touches on several relevant themes to clients that I have worked with and anticipate working with in the future. This journal served as a fantastic exercise in self-exploration as well as clinical practice.

References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Derenne, J.L., & Eugene, B.V. (2006). Body image, media, and eating disorders
Academic Psychiatry, 30(3), 257 – 261. doi 10.1176/appi.ap.30.3.257
Flanagan, L. M. (2011). The theory of self psychology. In J. Berzoff, L.M. Flanagan, & P. Hertz. (Eds.), Inside out and outside in (3rd ed.). Lanham, MD: Rowman & Littlefield.
Hepworth, D. H., Rooney, R. H., Rooney, G. D., & Strom-Gottfried, K. (2013). Direct social work practice: Theory and skills (9th ed.). Belmont, CA: Brooks/Cole, Cengage Learning.
Hutchison, E. D. (2013). Essentials of human behavior: integrating person, environment, and the life course. Los Angeles, CA: SAGE.
Kohut, H., & Wolf, E. (1978). Disorders of the self and their treatment: An outline. International Journal of Psychoanalysis, 59, 413-425.
Robbins, S. P., Chatterjee, P., & Canda, E. R. (2012). Contemporary human behavior theory (3rd ed.). Boston: Allyn & Bacon
St. Clair, M. (2004). Object relations and self psychology: An introduction (4th ed.). Ontario, Canada: Thomson: Brooks/Cole.
University of Southern California, Virtual Academic Center. (n.d.).
Wilde, O. (1890/1939). The Picture of Dorian Gray. Greenwich, CT: Appleby & Company.