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A Conceptualization and Treatment Plan

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A Conceptualization and Treatment Plan

Abstract

This study explores the psychoanalytic therapeutic intervention for a sociopathic young man. Nebert is a victim of childhood abuse in the hands of his drunken and impoverished parents. His mental disorientation attests to the fact that his condition is a product of the negative upbringing. The client had sought a form of defensive mechanism that was illustrated in criminal conduct, violence, and rudeness towards his peers and seniors. The process of treatment was based on the need to confront the negative associations that the client had attached to certain objects in his mental universe. The therapy sought to establish a break that would reclaim the client from the weight of the influence of past abuses. The desired outcome of the therapy was behavioral changes and the pursuit of moral goals by the client. At the end of the therapy, the client was able to recognize his weakness of character within the wider picture of the influence of an abusive upbringing. Accordingly, he expressed readiness for positive adjustment of the self.

 

Presenting concerns

Nebert is a 26 year old jobless and homeless young man. Nebert is exceptionally bright with high school academic records showing that he is an above average individual. He held top positions several times and has received several presents for academic excellence. Nebert is the only son of his parents who are separated. He has spent much of his time with his mother who educated him from the proceeds of selling cheap liquor. Nebert has witnessed his parents’ fights occasionally and is also aware that his mother engages in prostitution to supplement for her meager income.

He was admitted to University to pursue a degree course in medicine. He dropped out of the university twice but was taken back by his mother. Nebert was eventually expelled from the university and has turned to petty crime for the purposes of financing his drinking and drug attachments. Nebert is extremely rude to his peers and superiors and keeps to himself most of the time. Occasionally he falls into problems with law enforcement agents and has been arrested and charged for minor offences several times. Currently, his relationship with his mother is icy although they meet occasionally.

However, he has severed his links with his father completely and does not wish to relate to him in any manner. His father, who is an alcoholic, has started another family in the adjacent slum of which Nebert is aware. Further information suggests that Nebert incurred prolonged physical abuse from his father and occasionally also from his mother. The young man can and has often displayed characteristics of violence. His main targets are elderly men and his more stable and successful peers.

Case conceptualization

It appears that Nebert’s problems are rooted in his upbringing. As child Nebert naturally perceived of his family and the parents as the ideal. He did not envision a possibility of an existence beyond the frame of reference supplied by his relationship with his parents and his home. But when the home he trusted turned abusive, violent and disorderly, Nebert might have adopted a completely different perspective about the world. He began perceiving the world as a cruel place that cannot nurture the tender feelings and aspirations of children. This reality might have sunk deeper with the physical brutalities meted out on him and his mother especially from his father.

The source of protection was quickly and dangerously reversing into a system of internal abuse. Nebert did not have the opportunity to experience parental love. He was lacking both in material and emotional resources. His impoverished parents could not adequately cover for his needs. The situation was worsened by the fact that both his father and mother were alcoholics. Consequently, Nebert grew up in a loveless environment that was informed by frequent quarrels and fights between his parents. These hostilities and quarrels appear to have embedded themselves in his subconscious mind. The development of the self was inhibited by the influences of poverty and violence.

Nebert might have imagined that his situation was peculiarly out of order especially when he looked at other families in the neighborhood that seemed to cope well with situations. Poverty, conflict, and disrespect appear to be fundamental building blocks to his misery. The situation was even worsened by the fact the family eventually ended up breaking. In his mind, the eventual break up of the family symbolized a final collapse of the only citadel of protection that he had known despite its apparent disorder. The self remained formless in a way that could not be reconciled to the situation in his life.

Nebert’s inability to bond with his peers is a representation of the fact that he considers himself inferior to others who come from relatively stable families. His rudeness to his seniors would be interpreted as a payback gesture to a generation that has denied him his rights as a child. The maladjustment of his personality is a response against the stifling forces that have seized his destiny (Bower, 2005). He appears to consider his existence as a default phenomenon. As a defensive mechanism, Nebert sought to compensate the shame of his family in education. He seems to have made up his mind to work hard in school with the objective of reversing the situation at home. This resolve was meant to be a demonstration to the society of the good side of his background.

The consequence of this subconscious decision is seen in his impressive academic record, which he sustains from high school to university. However, things appear to have collapsed at the moment when his parents eventually broke up. There was no longer any pride to defend or any family name to sustain. The unfolding of the negative events appears to have dampened his enthusiasm for academic excellence. The subconscious mind might have recorded the heavy blow with the final response that he was not willing to adjust in any positive sense (Fonagy, 2001). There also appears to be an oedipal complex to the situation.

Although Nebert does not wish to mend relations with his parents, he is particularly hostile to his father. In some sense, he perceives his father as the author of the family’s downfall. It might also be possible that Nebert unconsciously blames his father for standing in the way of motherly love, which he yearned for but never really received. It is for this reason that he demonstrates a certain element understanding towards his mother. At the level of the self, Nebert perceives of himself as having been born in a world of evil men who are both uncaring and violent towards those they have to protect. Accordingly, he adjusts his attitudes in a negative fashion towards his father and fellow men. His self seeks out for the most convenient method to relieve childhood trauma. The only available method for him to releave his trauma appears to be violence and crime.

One of the methods he uses is rudeness particularly against the elderly men in the society. He considers them as part of the network of the evil male ensemble that was behind the collapse of his home. The self believes that it can only redeem itself by shielding away from all forms of association with these forces of destruction. This subconscious decision eventually boils down to his personality, which is aloof and unpredictable. Another dimension that illustrates the efforts of the self to redeem itself is to be found in Nebert’s criminal nature. Nebert has been brought up in an impoverished environment. Part of his family’s problems and its eventually disintegration can be considered to be products of poverty. Any family unit requires a certain level of material and financial resources in order for it to function at the very basic level.

Nebert’s family appears to have sunk below the mark of the irreducible minimum. Psychoanalytically, poverty has a demeaning aspect to the development of the self. Victims of poverty begin to imagine themselves as being sub-human. They occasionally imagine themselves to have descended to the level of animals. It was partly because of this reason that the family experienced to frequent bouts of violence. Studies have found out that there are possibilities for the occurrences of reactionary domestic violence, which result out of poverty (Fonagy, 2001). As a defense mechanism against the seemingly unstoppable descent into further violence, Nebert might have thought of crime as the necessary safeguard and the last alternative. Through stealing and pilferage, Nebert considered himself to be exerting some form of responsibility to the society.

At the subconscious level, he holds a deep-seated grudge against the society which he considers complicit in his family’s misfortune. It might be precisely because of this reason that he adopts a personality of rudeness and aloofness against the society.  By stealing, he appears to consider the fact that he is simply reclaiming the equilibrium that should have existed had his family remained stable. He considers himself opposed to the world in which he lives. His self considers of everything around him as some form of great conspiracy that are part of an elaborate plan to design his damnation. It is partly because of this reason that he chooses to drop out of university. His suspicious self appears to link up the institution with every other reality that torments his conscience.

This suspicion was fostered during his childhood at the point when he realized that his parents could not sustain any form of love for him. The psychoanalytical configuration that works in him establishes some form of dichotomous relationship between the world and him. His self establishes a system of difference that sets the world apart as an entity that exists outside his sphere of feelings and interests. The world according to him is a remote existence founded on the ideals of selfishness, violence, hopelessness, and betrayal. He can only relate to this world in terms of attack, conquest, or vengeance. Although education would have been a more convenient way to establish some form of reconciliation with this distant world, Nebert opts for a method that would further perpetuate his desire to wrest from the world the privileges and rights that were denied to him as a child.

Goals and Interventions

The process of helping Nebert involved a structural awakening to his true condition. I sought to help Nebert see the bigger picture of his weaknesses. The main objective of the therapy was to awaken Nebert to the fact that there was a singular force that was controlling his personality especially in the negative sense. The process of therapy was targeted at the core of his self. Helping Nebert involved a gradual process of supplying his psychoanalytic structures with a fresh set of objectives by which he might learn to redefine his world view. In the long run the therapy was aimed at reclaiming Nebert from the defensive processes by which he had established his streak of petty crime and negative personality traits.

I explained to him in plain terms that there were alternative ways through which he could perceive the world without bitterness and grudge. I sought to explain to him that although he failed to find love from his parents, the environment in which he lived was full of people who were angling for an opportunity to engage with him in meaningful ways. I asked him to consider extending feelings of love and concern particularly for his mother who had remained concerned about his welfare. My task involved reminding him of the specific incidences in his life in which his mother had sought to compensate for the love she failed to give him during his upbringing. This was an illustration that his parents might be hurting out of guilt for not having given him the love that he deserved. However, I also reminded him that his parents still had important roles to play in his future.

These conciliatory advices were meant to assist Nebert in undergoing some meaningful transformation in the self, which would help him reunite with his environment. Therapeutic measures for a psychoanalytically estranged individual must involve express gestures to reclaim his trust and confidence in the objects and systems that he had learnt to distance himself from. Some of the objects that were fundamental in the rebuilding of his world view are his parents, people in authority, the elderly, his peers and the learning institutions. Studies have shown that victims with psychological disorders tend to construct negative monstrous associations in the objects that they attribute to their misfortunes (Fonay & Target, 2003).

However, these responses take place at the subconscious level and the individual may not be aware that he or she is acting out of form. Such individuals lock themselves up in private worlds which they construct in their mental universe. Their intention is to escape from the larger world which they deem oppressive and cruel to their survival.  I welcomed him to the idea of how he might change if only he went back to college to complete his studies. I helped him realize that his character was simply a natural reaction to a past that he could not change. I sought to explain to him that his criminal aspects were injuring some other people in the same way and even in greater proportions than what he was underground.

An important dimension in this therapy was to awaken Nebert to the fact that the society was not part of his mistakes. I told him that some other people may have experienced worse situations but did not choose either crime or rudeness as their options. By giving him this information, I was trying to make him realize how important it was for him to consider life on a more positive note. At his young age, I told him that he still had many opportunities to mend things and impact positively even to his separated and previously abusive parents.

Conclusion

At the end of the lengthy therapy, Nebert had acknowledged the fact that he could engage with the world in a positive way than he had done in the past. He had accepted that to mend fences with his parents and reestablish interest in his academic pursuits. Precisely, Nebert accepted to pursue a course in programming. The therapy session had achieved the objective of a different a psychoanalytical locus based on positive relations with the world around him. Nebert also realized that the world was full with opportunities that could compensate for what he had lost in the abusive upbringing.

Several psychoanalytic studies agree on the need to reconfigure the mental processes of maladjusted individuals by awakening them to revised models of perceptions of the world around them. Theories and concepts that underpin these studies suggest that the mental limitations and personality deformities are structural. The argument is that these deformities are anchored and sustained by historical factors that create a defective mental universe in the psyche of the victim (Gaddini & Limentani, 1992).

Consequently, the individual adopts certain responses that are aimed towards dislodging these structures from his or her mental system. The danger often is that these victims tend to generalize their defensive mechanisms in the general direction of the perceived enemy. In extreme cases, such reactions tend to condense into sociopathic habits that endanger the society and the victims themselves. In the case of Nebert, the response was aimed at reversing the perceptions of the structures in a way that would assist in the development of positive associations between him and the objective world around him.

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