Serge or I don t want to know what might change my life. Dana Castro, PhD Ecole de Psychologues Praticiens Paris

Transcription

1 Serge or I don t want to know what might change my life Dana Castro, PhD Ecole de Psychologues Praticiens Paris

2 DSM IV AXIS II avoidant personality disorder Serge s Questions 1 - Why do I always come to nothing? 2 - Why do I have such difficulties in meeting people and stay with them? 3 - Why do I run every time I m teased? 4 - Why do I get shocked each time people talk about me? Which are clearly topics that bother avoidant personalities.

3 The purpose of the psychological assessment, conducted within the frame of Therapeutic Assessment : enlighten this young man s unique personality traits offer a customized therapy Tests used: WAIS III TIQ = 131 RORSCHACH TAT

4 The avoidant personality disorder is explicit in the Rorschach Structural Summary R = 19; L = 2.17; CDI = 4; SumT=0; AFR= 0.36 And enables the assessor to answer Serge s questions by explaining those personalities cognitions, affective states and defence mechanisms. Why do I have such difficulties in meeting people and stay with them? Why do I run every time I m teased? Why do I get shocked each time people talk about me?

5 SELF IMAGE permits to develop the answer to Serge s question 3-4 3r+(2)/R = 0.68 Fr+rF = 3 Rorschach I) 8. an insect who could fly but his wings are not grown 9. it s an abstract painting, no meaning (Intell) VI) 12. a crashed animal..it had been crushed by a vehicle deep conflict between the perceived self image and its narcissistic è compensation. Feelings of helplessness. caused by guilt streaming from the gap between aspirations and obligations Rorschach : W/M = 10/1; T TAT : 8 = the little boy (1)imagines himself later on medical studies Later on he will stand before the surgical table. TAT 16 = Sadness and obligation. One must work for his parents and their aspirations. He s not happy in life. No strength to make decisions, no choice, one has no choice.

6 Inner strain - Rorschach : EA < es and SumC >WSumC Risk of worsening and of increasing psychological distress Inner resources - Rorschach :EA < N and WAIS III QIT = 131 Gap between cognitive and affective capabilities

7 Family links TAT à1. Here we see a boy bending over his violin. Looking at his face, he must hate it, but his parents force him. He asks himself what can he do to stop all that. He s unhappy. He doesn t like to hurt his parents. There is no solution. He laments his fate. (?) He will not go to see his parents. à 2. Here we see a peasant family. The son is in the fields, the mom, The girl of the house, their girl bares on her shoulders all family s worries. All the family rely upon her. à 3. This is for sure, a boy who had been punished cause he did stupid things. He is crying. à 7 BM. A father and son. The son is a business man, he did good studies and now administers the family s business à 8. The little boy (1) imagines himself later on medical studies Later on he will stand before the surgical table. à 16 Sadness and obligation. One must work for his parents and their aspirations. He s not happy in life. No strength to make decisions, no choice, one has no choice. submission to family s values generates inner conflict and gap between self fulfilment and filial duties. These data enable the assessor to answer Serge s question 1 and 2 (come to nothing for himself ) and stay with people

8 SORTS OF DATA Level I - close to patient beliefs and perception: inner strain; feeling of helplessness ; avoidance reactions to social stress Level II quite distant from patient s point of view but not threatening Including positive information : inner resources (IQ); Fr+rF= 3 ; aspirations (TAT) Level III threatening patient s ego and/or integrity : Family links

9 Treatment priorities Feedback strategies 1, soothe affective turmoil (inner strain) recognise, accept and name the emotions of the inner strain 2. restore self image and self confidence discussing resources and potentialities 3. promote action and decrease isolation explaining psychotherapy : interest, processes and possible outcome 4. promote decision making and cultural identity building L3 unsuccessful trial and risk of disintegration 5. decrease family influence and increase free will L3 unsuccessful trial and risk of disintegration I m not here to talk about my parents!!!!

10 Behaviour cognitive like psychotherapy was offered twice for 6 months each time for one session a week. During Therapy, Serge often referred to the feedback session checking progress and to the goals that has still to be achieved. Therapy came to an end, a year and a half after the assessment when Serge started to work as a sales agent on market places and to go out on Friday nights with people from his own community. Anxiety was at a lower level and self esteem increased. According to is own words Serge felt more empowered to cope with people. But was he with any people? Not with people outside its community. Points 4 and 5 were impossible to discuss efficiently. Serge stayed very descriptive on matters concerning his parents, complaining about them but opposing any discussion.

11 A HAPPY END? Two year later, Serge called my office to know if my health was good and if I was well. My secretary gave him an appointment and he came to see me in due time. He was very well dressed, with branded cloths (pushed by his narcissistic traits) He told me another story with which he felt much better: He was married in his community to a young girl chosen by his parents. He still worked as a sale agent in a clothing business and was doing quite well. He explained he just dropped in to say hello, and to thank me for the help provided in choosing his life, which is good now and pleasant. No more conflict and no more doubts. Everything is at its place.

12 Conclusion and discussion for clinical practice How might, classified information (Level 1-2-3), collected from test interpretation, be used by therapists in psychotherapy dynamics? Priority intervention amplifier, which answer the question of how to start therapy in order to make the client feel rapidly better and enhance, by that, engagement in the change process. And also of what makes him feel better. Level 1 in priority intervention is recognition and acceptance. The effect is relief and reassurance. Level 2 in priority intervention is problem conceptualisation with the client, explaining psychological facts and connecting him to his feelings. The effect is valorisation, curiosity and thinking association. Level 3 in priority intervention is creating enough confidence and courage in daring to address aching problems.

13 What is the status of level 3 information collected from test interpretation? Therapeutic goals organizer: from their very beginning they point the way towards the course of therapy. Enabling, when subjects are ready, deep psychological healing or when they are not, efficient ways in coping with the problem. Serge s case is a very speaking example.

14 When Level 3 information collected from test interpretation is neither displayed nor discussed, does it mean that the change process has failed? For the assessor and the therapist it is important to accept the fact that the patient knows best and cannot be leaded to where he did not want to go! That is why even if not all the aching problems have been addressed, therapy may be beneficial.for a while!