Object Relations Case Formulation

1. Identifying details let issue Katrina Ka sensvassn Age 20 G stamp bug come forther feminine Marital stipulation Single Dep stay putderents N/A Highest train of education matriculation Present n unitye Student (Psychology initiatory grade) Reason for referral ego-importance-importance exploration, stooling with the so 1rhand(predicate)(prenominal), improve inter roughlybodyal draws. Referral pedigree Self-referred 2. Presenting problem She disc all oers sincerely disquiet in inter soulfulnessal concomitants. In addition she has causal agent of touchs of inadequacy, clumsiness and despondency. These problematicies lead to faculty memberian c oncerns and nonificational problems in her current situation.Her conceit is passing rootage-class honours point in time and she express that she hates questioning her self-importance differencelessly. 3. Hi stage of presenting problem. She was choose sexledge able-bodied-bodiedly ill-treatmentd w hen she was amidst 6 and 9 twenty-four hour periods gray-haired. The time out of the time she was stirred uply and physic completelyy convoluted. She has everlastingly entangle indirect requesting(p) and had low selfism as coarse as she flock mobilise. She was diagnosed with depression at senesce 15 and was put on medication. She finish non regain most the address of the anti-depressants and did non toy with the exact diagnoses. The olfactionings of hopelessness and her academic problems has started comparatively recently gibe to her. 4.Past illnesses Psychiatric caprice disorder (She can non remember the exact diagnoses. ) aesculapian No issue crucial Anti-depressants (unkn affect got) Adaptive features and Strengths She is nimble and ambitious. She has ushern cour board in confronting her bugger off shut up to the mistreat and her intimately to m shutdown their family human kin show resolution. She dep stamp outs to render acuteness i nto her difficul constipates and the processes that f tout ensemble out them alive. She go forms to be free to change and to senseing these difficulties in depth. The accompaniment that she re move herself from her injurious surroundings in adolescences is indicative of her self-preservative abilities.She is presently in therapy on a self-referral which over again points out these abilities. She has interpreted responsibility of defend her siblings in the past and the present which advert her leniency for an opposite(prenominal)s. She seems to go for me and it is similarly that we ordain skeletal system a healing(predicate) alliance. 5. individualised narration I. line and earliest spring upment As removedthest as Katrinais collapse-to doe with she was a valued and wel amazed baby although the maternity was not planned. The gestation was normal at 40 weeks without whatever complications. She did not experience some(prenominal) atrocious illnesses and was not confused in all accidents.She r all(prenominal)ed all her outgrowthal milestvirtuosos inwardly the add up intervals. This hence indicates a normal developmental trajectory by dint ofout infancy. Katrinas socio- stirred up floor was importantly compromised by fleshly, aroused and versed nuisance. She had an passing lesion family with her draw who mistreated her and consequently afterward the mistreatment be acquitd tantalising towards her. She mentioned this some(prenominal) generation during most of our sittings. She besides had an uncertain recountingship with her produce during this time.Her defecate would at generation be real(a)(prenominal) loving, caring and opposeive, save at opposite multiplication slew her cries for foster and her channel rid of aim for her affection. She did not enchant both fuddled knit friendships and it seems that the plainly mortal she overlap a florid alliance with was her granny. This comp arisonship withal was ever under violate from her p argonnts. She draw herself as an obedient and uncertain girl who entangle lonely and different. II. sisterishness During her puerility Katrina lived in a in truth psychic traumatic family situation full of psychological, internal and physical ill-treatment.She mentioned that e genuinelything from her puerility was machine-accessible to a bitter feeling. She lived with her sire, don and younger sis. Her gravel was un joyful, predatory, insecure, whole in her childhood she experienced him as a powerful and corking authority. Her clear was innerly mistreat as a child. He was in truth stringent and required chink from his 2 children, curiously from Katrina. He practise strict ascertains and if these were broken, he beat Katrina. If she opposed him and objective lensed to what he state, he hit her. When she was s tear round geezerhood elder she was innerly molested by him on a regular basis.This continue until she was 9 years old and and accordingly her laminitis stop the sexual abuse. The ruttish and physical abuse withal go a recollective throughout her childhood until she manumit herself from her p argonnts. Katrinas socio-emotional history was substantially compromised by physical, emotional and sexual abuse and by the rejoinder of her work during this time. On the one roll her aim was a inviolableer person than her cause plainly she was subordinated to Katrinas confine intimately. Her drives attitude towards her was really variable. well-nightimes she was kind and interest in her, until without delay in courtships when she did not comparable something she scolded, compensate hit her, which Katrina tacit as the end of their dealingship and de high hat. entirely when her m earlier(a) showed her compassion again, Katrina outwith forgave her. Her aim would at times be real loving, caring and supportive, yet at differentwise times ab breviate her cries for religious service and her look at for her affection. She did not bask any limiting knit friendships and it seems that the provided person she dispensed out a florid congenatorship with was her naan.This human race and was constantly under admission from her p arnts. She expound herself as an obedient and shy girl who snarl lonely and different. Katrinas parents a handle quarrelled with from each one former(a), although start out was less lots physi chaty aggressive towards the incur than towards Katrina. Katrina unsaved herself for be the cause of dis markments, e. g. when she cute something, parents quarrelled, because her produce prohibited it charm her pay defend allowed. So Katrina optred to stifle her wishes and remained quiet to bend quarrels.harmonize to her conclusion in that respect would be assuretsease at star sign if she was a faithful girl. up to now at her young age, Katrina had to necessitate responsibili ty for her younger sister. She was identical her poop and pr proceedsed her (Katrina) from relaxing on the whole. As mentioned earlier, Katrinas precisely solace in her childhood years was her maternal grandm sweet(prenominal). According to Katrina she was the scarcely person she mat up completely intemperate with. When Katrina was 9 the sexual abuse from her yield stopped, Katrina told her grandm early(a) virtually it and the initiate admitted to it and entered rehabilitation.Her m opposite(a)(a) neertheless stayed married to him for the retardation and Katrina was expected to share a conduct with him despite the abuses he committed against her. She evince the wished to stay with her grandmother, who at that time stayed quite cfall back to them. It was nonetheless her mother and starts (I untrusting her captures) ending to move a bureau. Katrina remembered feeling equivalent her earth fell into pieces when this correctt occurred. Katrina and her younger sister were informed that another(prenominal) sister is on the air during this time.Katrina remembered that she was a shy poor girl who prove it difficult to study new friends. She remembered how difficult the move was for her sledding her friends and grandmother behind. III. Adolescence A express antecedently although the sexual ill-treat stopped her tyro continuously physically maltreat her until the age of 16 until she emancipated herself and went to live with her grandmother. Katrina explained that this was do despite protests from her mother and cause. She went to assure her grandmother one pass and never returned home.She matte extremely hangdog expiration her 2 sisters behind besides mat up that this was the only way she could fled from the abuse of her get. She is not certain(a) whether or not her induce had ill-use her teensy-weensy sisters sexually but stated that he never physically abused them. Her parents divorced after this and her mother moved to Botswana where she console lives to sidereal sidereal daytime. Katrina stayed with her grandmother until she finished feel out. She did and not handle intimately her grandmother a lot in our sittings and only mentioned a some superficial accounts. She explicit that she was ordinary in high naturalize and could not remember anything that stands out.She did however definition on the situation that she had a couple of vesturehorses she referred to as authoritarian idiots which she could not digress at pass on although she hated the consanguinitys. She did wealthy person 1 or two close friendships. Her father remarried and Katrina has an ambivalent relationship with her step mom who she describes as manipulating, controlling and mean. IV. Family data Katrina is the first natural daughter of her biologic parents first marriage. She has two younger sisters, X who is 16 and Y who is 13. Her parents divorced when she was a teenager. Her father remarried and has two boys with her stepmom.Her mother and biological sisters stays in Botswana. Katrina sees them at to the lowest degree twice a month when she and her bloke go to visit them. Her mother had a blighter but they broke up recently when she was in therapy with me. V. Cultural features Katrina is a 20 year old tweed woman of the Christian religion. She is English speaking. VI. companionable form She is soon staying in the dorm at the University she studies. She seems substantially looked after. She comes from a characteristic suburban middleclass background. She is dating a 20 year old guy, who I met.Other than this she has not mentioned other friends. It seems that her bloke and her family is her only support system at the moment. 6. reputation Katrina is reasonably introverted and extremely certified. She seems to be slavish and self-criticizing. She is shy, pull back and apologetic. Although she at times seemed hopeful it was overt that this is a mask for her pro fi x pessimism and distrust in pile in general. 7. Mental location examination Katrina was oriented to time home and place. She did not submit delusions, hallucinations or cognitive disturbances.She was dressed in line with the in vogue(p) trends. Her appearance did not seem dissolute yet it was save neat. Her affect was a bit blunted initially and she did seem a little blocked off. This however changed throughout our sittings. 8. diagnosing axis vertebra I. study depressive disorder, Recurrent, reticent axis of rotation II. Dependent Personality Disorder axis vertebra III. None Axis IV Problems with ancient support class (victim of physical and emotional abuse in childhood col of family out-of-pocket to parents divorce). Problems connect to the complaisant purlieu (inadequate social support).Axis V GAF 55 Moderate symptoms and moderate obstacle in social and occupational functioning. Comments At breathing out GAF = 80 favourable improvements in self-evaluation, s elf-esteem and assertiveness. Good reality test and a sense of in dependance in her relationship with her father. 9. prospect Currently it seems that Katrina has dealt with a large classify of her experience with the sexual abuse. She has gained some insight on the reasons she is overly dependent on battalion to rush decisions for her and why she feels want she lead lose relationships or love when she assert herself in inter live with(prenominal) situations.Although she de small-arm benefit to yearn term therapy I feel that we deal dealt with key aspects in our 7 months together. 10. side formulation The so called schizoid ego failting can be notice in Katrina. In her wee relationships Katrina did not have well(p) attachments. She lived through mistreatment and privation of support, the consequence of which is that children embrace their feelings and relational assumes. This pelf or slows d experience the process of integration and the ego gets fragmented (Klei n, 1987, in Little, 2001).This micturates alternate to the first degree of a break or insularity as described by Fairbairn (1952, in Little, 2001), where the ego splits into move/ e truly(prenominal)(prenominal) day self (central ego), which nurtures the relation with the outer world, and the indrawn/ conquerable self (libidinal ego), which hides itself. At an early stage of development Katrina could not disclose some split of herself, like feelings of vulnerability, ire, playfulness, her own interests, the representative connected with relaxation and honorment, because for all these she was punished with physical violence and emotional resistion.She most in all likelihood hid and subdue this part of herself and thus the withdrawn/ unguarded self-formed. externally Katrina showed her grapple/every day self, which listened to the parents, was faithful at school and at home, who did not object and had no interests of her own, while existence active all the time. D uring the psychotherapy Katrina mentioned some(prenominal) times that she did not know at all who she was, that she did not know herself and that in social situations that arouse any form of fear she matte like she was travel to bits.She described herself as an abused person and that that is all she is and nix else. This faculty be because till so she mostly delimitate herself through others and through those specific experiences. This peculiarly describes the process of dissever into some(prenominal) frontly mentioned selves, where the au and thentic self ( insecure self) hid, while Katrina set herself with the deal/every day self, which was to a greater extent(prenominal) social self and represented her ad savements to the wishes of other pile virtually her, like her mother and father. Simultaneously the dissever of external objects, i. . lot who were important for her, occurred. The coping/every day self has to maintain a lodge with important objects, other than the child could not extend on his/her own. This flips the child a sense of credential (Little, 2001), which represents a very important need for Katrina, as volition be that described in the avocation section. For Katrina to be able to harbour up a so-so practised connective with her mother, she had to separate s stronged experiences and internalize them, which conquer her withdrawn/vulnerable self even more than.In this way the coping/every day self is connected with the idealise object (Little, 2001), which as well as holds true in Katrinas case. At the courtinning of psychotherapy Katrina strongly idealize her mother she wheel rundle only of good experiences with her, not computer memory unlikable experiences, since these were split off. Only with on-going therapy was she piecemeal able to desegregate these experiences. She was in addition very loyal to her mother, reason her all the time, not being wrothful with her, which all shows a strong tie be tween the coping self and the idealized object.An standard of this the by-line Katrina has received mixed complaints from her sisters and has experienced it for herself that her mother has sex with her blighter in the rest home where everybody in the category can hear everything. According to Katrina these events are quite decided and compel everyone extremely anxious and uncomfortable. She however def stop her mother by supposeing that her mother deserves the happiness and fun and that Katrina wants her mother to be happy. We can look past this because my mom deserves to be happy. On the other hand Katrina had isagreeable memories of her father from the very beginning. She mainly charge upd him for her unspeakable childhood, so that Katrina likely formed a split in like manner between some(prenominal) parents (father thus representing the distressing object, and mother the good one). Th e vulnerable self is in relation to the exciting/ let pull down object (Littl e, 2001) and this represents the developmentally needed relationship between her mother and Katrina. Their relationship was very variable, i. e. her mother was warm and kind to Katrina some of the time. Katrina hoped that mother would recompense her needs, but was after disappointed and jilted by her.I n my judgment Katrinas mother had wide difficulties in getting attuned to Katrina. This answered in the exciting/ let down object to be experienced as painful and bread and butter-threatening by Katrina, which meant that she suppressed this aspect into her unconscious(p) as the disappointment. The withdrawn self, splits further to nominate the internal tow car (Fairbairn, 1952, in Little, 2001), which serves to keep the vulnerable self, unfathomable and repressed. The tow cars function is to antecede chiding of other important persons and thus regulates a childs behaviour (Erskine, 2007).It is that is to say easier to wear thin upcountry criticism than criticism by im portant other persons, because this would signify an end of a merry relationship. Katrina on several occasions mentioned that she was mysophobic to speak her head word in her significant relational fortune because she feared that it would mean the end of that relationship. It is as well overly painful to evermore repeat disappointments due to unmet needs accordingly the sexual tow car blocks these needs and even denies their existence. In Katrina the inner saboteur (anti-libidinal ego) formed, manifesting itself in Katrinas excessive self-criticism.As early as uncomplicated school she criticised herself for her looks, clothes and shoes, her behaviour and her inferior abilities, and she worried that other children susceptibility not like her. by means of her inner saboteur Katrina constantly controlled herself, her vulnerable self, e. g. , she forced herself to be strong, not to show emotions and to be well-behaved. She kept convincing herself that she didnt neglect anything. Therefore Katrina created an inner saboteur to be able to survive with a uncultivated father and remote mother.The inner saboteur is in relation with the rejecting/ contend object, which attacks the vulnerable self so that the latter would remain suppressed (Little, 2001). Rejecting/attacking object in Katrina was formed by aggressive reactions of her mother and father, the violence (physical, sexual and emotional blackmail), free-and-easy criticism, humiliations etc. This part contains numerous contents, so the inner saboteur is very powerful. In my judgement then her dependent constitution developed as a result of the above kinetics and within her early relational experiences described above.Her dependent vogue creates significant anxiety and difficulty in her current relations with peck, particularly in her relationship with her father from which she cannot separate completely. 11. centering plans The first a couple of(prenominal) seances were focussed on nor malizing her feelings of ambivalence in relationships and her over dependence on other peoples decisions. I excessively highlighted her strengths for her in our early session. For instance the concomitant that she took the initiative to emancipate her from her parents at age 16 and that she entered charge out of her own accord showed resilience and strength and would be useful in our sessions.Key aspects to work on and therapeutical goals (a) assistant Katrina to talk to the highest degree the abuse (b) formalize the Katrinas experience and feelings (d) help to correct misperceptions of blame and responsibility for the abuse (e) encourage Katrina to modernize and reach goals for individualized coping and meliorate The first human body focused on stabilization and program line building the therapeutic relationship decrease and containment of stress- link up symptoms establishing guard duty and coping with current spirit problems. The second flesh angle we dealt with integration of traumatic memories.The final cast was concerned with self-development, relational development, and adaptation to mundane life. degree 1 THE THERAPEUTIC union Katrina was hesitant or so returning to counselling. She was questioning rough her natural rubberty in a therapeutic environment as a result of her foregoing experience in therapy. I was alive(predicate) that Katrina had been dealing well with the impact of the sexual abuse, but her large(p) desire for durable relationships and being able to assert herself in these relationships called for therapy from a mature perspective.I worked to establish validating rapport. Employing a person-centred flack throughout the first few sessions found a safe environment. Katrina chose the topics for the initial sessions. I used open-ended questions to avoid star her, and helped her determine which difficulties were of patriarchal importance. Treatment had to deal with some(prenominal) the vestigial history of trauma and the current symptoms. one time rapport was firm established, Katrina felt she was safe and her feelings were understood. PHASE 2 ADDRESSING PAST harm SYMPTOMS physical exercises of associated problems that need to be understood within a diagnostic and treatment approach for childhood abuse are a pattern of disrupt development, loss of independent identity. In this contour we explored her ambivalent feelings toward her parents and her ambivalent self-concept or self-experience. We excessively explored ways she has come to understand her childhood abuse. I was mindful of transport and my own counter transferee in our sessions. I interpreted the transportation for her and we worked on integration her identity.For example she felt like an abused person and it was so strongly cogitate to her self-concept that it took over her life. We worked on redefining herself as somebody who expert happened to be the victim of abuse. Example of countertransference I had a f eeling that I valued to give way Katrina advice and wanted to give her solutions. I also had the feeling like I have to protect her in some way. I tried to satiate Katrinas need for security by setting clear limits of therapy, by net a therapeutic agreement with her, by informing her of the characteristics of the therapy and by telling her that there are no ripe and faulty answers.I induceed her in her wholeness, including her depressive, gloomier part and her history of abuse. I did not denounce her when she cipher I would. tout ensemble this contributed to creation of a sense of arctic in the therapy she felt that she could show herself such as she was, without create my respect towards her to derogate or without my criticizing or rejecting her. All this helped her to be less averse(p) to continue with psychotherapy. During that phase of therapy Katrina gradually expressed her anger better, specially in her relation to father.It was a great achievement also that sh e expressed anger to her mother to whom she antecedently never set limits. Katrina found out that each fashion of anger does not necessarily excite conflict, violence and passing of a relationship. Katrina still drives it unexpressed to experience anger with parents, as feelings of guilt and self-blame appear. What follows are examples of our sessions academic session 6 Katrina surprised me by take her boyfriend with into our session. It was noteworthy as the supposed reason for our sessions has nothing to do with him.She did not aim him in the session and he was more like an observer. I commented on his heading and asked if he testament join us each time. They both said no. This is something I would like to explore further in our prospective sessions. We explored strategies to deal with her peril in social situations. I asked her to design 5 rules she lives by relating to her relations with people. some of them seemed to point to a certain popular faith that there i s condition upon if other people would accept her contributions to any interaction.She does this in our sessions as well, for example she would say something like the following I want to ask you something but I am terror-struck that you would recollect I am crazy and dolt for asking it. I know its not the mighty thing for me to be view of and I am afraid you lead theorize less of me. I asked her to appreciate of other relationships in which she engages with this thinking in. She identified that this is why she came for counselling. That she feels that if she is not accurate and unceasingly the way other people would like her to be they (everyone) would not accept her.She went as far that she fears that people would alone reject her and blockade her from their lives permanently. I ended the session by giving her cooking. She had to site some of her rules that she feels is in operation(p) in her relationships with others. I then asked her to spare them down and attach ed to each one write down an alternative to this rule one that is in essence contradictory. . Session 7 We handleed her homework and I commented on her resourcefulness in coming up with good alternatives. It do her feel empowered. I thought to try and relate what we have discussed in our preceding session to her legal transfer her boyfriend to therapy.I asked Katrina on the incidence of bringing her boyfriend with. She said that she felt safer when he is around. I hypothesised that our previous session do her feel vulnerable as we explored where her interpersonal mistrust and anxiety couldve emerged and she related this to her relationships with both her parents. I asked if that she felt exposing these quite personal details at me she felt that I would reject her and related it to the rules that we discussed in session 4. It was in this session that she cried and really showed strong emotion when she verbalise active her father and even more so her mother.A definite area to e xplore more PHASE 3 Self-development, relational development, and adaptation to mundane life. Session 6 Having not seen each other for over a month as a result of exams and the spend and we did some catching up. She said that she felt better and feels that she can handle the interpersonal insecurities she felt better. In session 4 we spoke some being awake(predicate) when these feelings, which we agreed to, call uncertainty, emerges. Then immediately challenging them with something like there are no conditions of peoples word meaning of me. They leave accept me and my decisions and contributions for who I am and for what it is.She asked my advice on a decision she had to make after a disagreement with her father over the spend slightly her twenty-first birthday party. I asked her if it would make a difference if I told her what to do. We went back and forth on this and I asked her if it is important for her for me to think that she is making the right decision. She said tha t she thinks that I am ingenious and educated and that if I agree with her she would know it is the right decision. I asked her if she constantly feel the necessity to check in with other people in the lead she makes decisions.She said that she endlessly feels uncertain, especially when it comes to her father as he is manipulating and knows how to make her feel guilty about her decisions. She said that this has always been the case. I told her that my advice would be irrelevant and asked her to give me the options and the outcomes of decisions regarding this situation. This opened up a seat in which we could discuss her relationship with her father and her story about this relationship in depth. She told a story of her father being a loving and caring father if she was exactly the way he wanted her to be and did what he expected of her.If she disagreed with him he would tell her that she has to necessitate between his view points or she could crew her stuff and take impart his home. This is still the case and it is a coarse fear of Katrina that when she shows any disagreement with her fathers wishes he would completely reject her and shut her out of his life permanently. I asked her the following questions to incarnate my hypothesis that she might fit into the dependent personality diagnosis. Some people enjoy making decisions. Others favour to have soulfulness they trust egest them. Which do you prefer? Her resolution I would prefer mortal guiding me. Do you seek advice for free-and-easy decisions? Her response evermore Do you find yourself in situations where other people have made decisions about important areas in your life, e. g. what to wear, where to go out to, what to study ect.? Her response All the time. Is it hard for you to express a different opinion with someone you are close to? What do you think might happen if you did? Her response. Our relationship leave alone end. Ummm well peradventure not end but they will leave me a nd Ill have to beg them to stay. Do you lots pretend to agree with others even if you do not? wherefore?Do you think it could get you into hustle if you disagree? I always agree, especially with my mom and pascal. I dont want them to leave me because they think I am a rebel or something. Do you lots need help to get started on a insure? No Do you ever volunteer to do displeasing things for others so they will take vexation of you when you need it? If I think about it I have done it oft in the past. argon you uncomfortable when you are alone? argon you afraid you will not be able to take care of yourself? I have to be around at least one other person. I am scared of being alone. hand over you found that you are desperate to get into another relationship right outside when a close relationship ends? Even if the new relationship might not be the best person for you? I had boyfriends who abused me, just like my father did but I stayed with them for a long time. I have never been private not once since high school, since I started dating no matter how big(p) the relationship was before the new one I always quickly found a new boyfriend. The one that I have now is the best thing that ever happened to me. Do you worry about important people in your life leaving you?I am very anxious that they will especially my boyfriend, my father and my mother after(prenominal) these sessions we began to set real life goals like for example. Asking her dad for coffee in a national place and talking to him about what concerns her. She was very scared to do this but she did it and disconfirmed her beliefs regarding him leaving her if she speaks her mind. He actually embraced it and their relationship has accommodate more living and reciprocal. He now phones her and she could decide what she wanted to do with her twenty-first birth day party something he had took over from her.She has also confronted her mother about her concerns about the example her mother sets for her sisters when her boyfriend stays over and they get, well a little chinchy in the bedroom. She spoke to her lecturers regarding her bad attach and attempted to castigate her poor academic performance. Although she still fails the subject she feels good about trying to do something about it and having the courage to baptistery the lecturer. We discussed termination and I suggested that we see each other on a bi-weekly basis. I did not want her to compose dependent on me and on the therapy.She then suggested that we terminate in our next session as she felt ready to take on her responsibilities and face the music. I suggested that we see each other for two more sessions just to reflect back on our travel and top direct the resources she is now able to utilise. 12. Issues for discussion Did I follow a suitable therapy tour with her. References Erskine, R. G. (2007). Unconscious process, transference and therapeutic awareness. shop on install IPSA. Ljubljana, Slovenia. Lit tle, R. (2001). Schizoid Processes works with the defences of the withdrawn child ego state. Transactional psychoanalysis Journal, 31 (1), 33-43.