Looking again on this therapy, I find it telling that during his therapy, my client (called Richard pertaining to confidentiality reasons) came back and back again to his like for Green Floyd's record "The Wall". With its designs of mental illness, schizoid isolation and oppression, it appears as obvious a message while Richard would have given myself.
Richard, a light British male in his later forties, was referred to the bereavement NHS counselling support I you are not selected for by simply his GP, following the loss of life of his mother who have he cared for for many years. His bereavement was complicated by long term major depression (medicated as 2000), anxiety and panic attacks and what Richard described as social anxiety resulting in poor support.
Actually, we had a great explicit 18 weeks disovery contract (Sills, 2006 ) aiming at understanding his prevents around the grieving process, start creating a fresh narrative to reshape his identity (Berne, 1972) with a behavioural end goal of enabling him to raised tolerate and express his feelings (cry). This was extended for a additional 10 weeks to provide him with additional support until he started a CBT program with a several service, something of an implicit holding deal.
My plan for treatment evolved consistent with my analysis: I first based personally on Minikin's treatment plan, focusing on building our working bijou, strengthening his Adult, decontaminating of his grief philosophy ("when you're gone, you're gone") and dipping in deconfusion (allowing him showing his weeknesses and cry).
Yet , as Richard's schizoid persona structure emerged in the room (Masterson & Klein, 1989), We partially reframed this around Masterson's approach: building the significant alliance took centre level through staying nonintrusive and creating a...
... pression" (Green, 1983), producing his standard sense of hopelessness and my dissociative countertransference.
Coming from his reported social anxiety and his fear of the judging eyes of others, panic attacks and out of body activities when subjected to people, I actually hypothesised a strong schizoid personality structure wherever Richard mainly occupied the Master/Slave break up (Masterson & Klein, 1989), bailing down to the coercive Other to be able to maintain some kind of connection and satisfy a lot of recognition being hungry (Berne, 1970).
The death precipitated him in the other side of the schizoid split: at this point free however in exile, even more isolated through the ultimate starvation. In seite an seite, his currently diffuse impression of personal was additional depleted as his identity as his mum's carer disappeared. This shift heightened a strong abandonment depression.
Figure you below summarises my representation.