THE CASE OF MARIA: A PSYCHOANALYTIC APPROACH
From a psychoanalytic perspective, Maria appears to be experiencing anxiety and depression as a result of unconscious conflicts originating from early childhood experiences. And while Maria is aware of her depressive symptoms and is able to articulate her history and the current circumstances that are contributing to her mental state, she is mostly unaware of the primary origin of her unconscious conflicts and how her early life has shaped her adult experiences and contributed to her current presentation.
Maria arrives for her appointment 15 minutes early and appears motivated to reduce her troublesome symptoms. Her anxiety is evident, and from the standpoint of psychoanalytic theory, it could be assumed that her symptoms are a result of a conflict between her id, or her basic drives, and her superego, the moral and ethically responsible component of her personality.
In addition, she is experiencing an elevated level of guilt, indicating the strong presence of the ego, or the mediator between the id and superego. The counselor, practicing from a psychoanalytic perspective, may assume that Maria is experiencing unconscious psychological conflicts between the desire to have her personal need to gain autonomy and be independent and her need to remain loyal to her cultural traditions and family expectations. The ego is being challenged because Maria is using strong defense mechanisms, including repression, or the blocking of unconscious conflicts from awareness, and compensation, or her attempt to cope with the discomforting feelings by immersing herself in her work.
Maria mentions that she has considered suicide. On a superficial level, this is associated with her depressive symptoms. However, the psychoanalytic practitioner would apply Freud's concept of death instincts and examine Maria's recent experiences in an abusive relationship. These experiences may have led Maria to unconsciously contradict her life instincts and gravitate toward a natural impulsive desire to die. The psychoanalytic practitioner understands that the energy created by the life instincts is known as the libido and are exemplified in love, cooperation, and other prosocial actions. Maria details her negative relationship experiences and thereby illustrates the dramatic imbalance between the love she needs and the lack of love she has received.
Conjunctively, Maria mentions that she is unable to maintain meaningful relationships with various men, and although she has been dating, she views her future as negative. This would indicate an arrest at an earlier stage of life, during which her tasks were left unaccomplished. She appears to be developmentally arrested at the fourth psychosexual stage, the latency stage, during which the developments of the ego and superego contribute to a period of calm in personality development as the id and libido are suppressed. This stage occurs between ages 6 and 12, and Maria states that during this time of her life, she spent most of her time taking care of both the house and her younger siblings. Therefore, it may be assumed that she did not involve herself in developmental tasks appropriate to this stage, including intellectual pursuits, social interactions with both genders, and personal interests. Unable to resolve this stage before now, she seems to be struggling with these areas in her life as a result.
Maria also seems to be struggling with these issues in her dreams, which present as recurring nightmares with saturated psychoanalytic themes. The first poignant theme is that of Maria running from shadowy figures. In psychoanalytic theory, this would represent the parts of herself that she is struggling to repress, or her id impulses and desires intruding on her carefully articulated reality. This aspect of her dreams also indicates the rapidity of her unconscious struggle, which indicates a strong desire to merge her unconscious with her conscious. As she runs from the figures, she is faced with boxes and crates with arrows pointing in all directions. This would indicate options and opportunities with multiple choices, but the contents of the containers still remaining hidden.
The primary goal of the psychoanalytic counselor would be to help Maria bring her unconscious processes into consciousness and alert her to how her mind is hiding past experiences to help her cope with current experiences. The counselor may begin with dream analysis and explore the symbols in the dreams and engage Maria in connecting those symbols to themes in her life. For example, the counselor may illustrate how the shadowy figures represent the repressed, unconscious drives from which Maria is feeling increased pressure to acknowledge and confront, and then address the boxes and arrows as symbolic of a needed change in her life.
The counselor may also use free association to encourage Maria to recognize her own unconscious processes as they become evident to her through this exercise. As the counselor helps Maria to analyze her dreams and fantasies, identifiable themes and patterns will become evident and will provide Maria and her counselor with a great deal of material to examine.
The counselor may also explore with Maria the implications and consequences of her psychosexual development and elucidate how any unaccomplished tasks at these levels have greatly contributed to her relationship issues and the manifestation of her anxious and depressive symptoms. For example, because Maria was immersed in family responsibilities during her adolescence, she was unable to engage in her own self-development. Consequently, she is now struggling to maintain a healthy balance between all aspects of her life.
Maria and her counselor will likely meet weekly or biweekly for months or even years, until both Maria and the counselor are satisfied that her unconscious processes are now fully in her awareness. She may recognize how the manifestation of maladaptive behaviors and symptoms indicates a psychic struggle that she must fully contemplate in terms of mental and personality processes.