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Case Conceptualization Paper

Case Conceptualization Paper

Chloe Espinosa

Southwestern College and New Earth Institute

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Case Conceptualization Paper
The client came to therapy because she is experiencing what she describes as "obsessive

thinking" about an addictive relationship that occurred over four years ago. The client was eight

when she first developed feelings for a boy in her grade, Darren. He later became her first love.

The two dated on and off between the ages of thirteen to seventeen, remaining friends on their

breaks from the relationship. Though she has not spoken to him since high school, she is now

twenty-two and cannot seem to shake the thought of him. For the first two years after their break

up she did not talk or think about him much, but two years ago she saw him in a store and has

not been able to silence the obsessive thinking since.

The client has mixed feelings about the relationship. She acknowledges that it was an

unhealthy relationship, but also longs for the thrill and adrenaline that came with it, as well as the

person she was when she was with him. I asked her about who she was then and she described

herself as more daring, adventurous, and exciting. He used to push her out of her comfort zone

and taught her to live with zest. Indeed, he was the first person to show her the thrill underlying

rebellion.

The client has no interest in rekindling the relationship but thinks about the relationship at

least once a day, which gives her a great sense of guilt, as she is currently in a happy relationship

with another man, Jim, and feels that such thinking is a form of betrayal. I will note, however,

that most of her thoughts about Darren focused mainly on her own feelings and who she was at

the time. Additionally, the client has dreams about Darren. She mentioned having nightmares

where she picks Darren over her relationship with Jim. Though she does not believe she would

do that in real life, it scares her to think that there might be an unconscious part of her that would

fall back into the same pattern in an instant.

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Case Conceptualization Paper
The client also mentioned feeling that she is spiritually bound to Darren by a cord. She

wants to sever this cord but is afraid she will miss the excitement that still remains. The client,

thus, hopes to find a way to nurture the part of the bond that holds vitality, while also ridding

herself of its draining aspects. Her goals in therapy are, therefore, to think about her relationship

with Darren less, and ultimately, cut the unhealthy cord that connects her to him.

Analytical Therapeutic Approach

I decided to take an analytical therapeutic approach because there are focuses on bringing

unconsciousness into consciousness to establish a greater individuation, dream analysis,

archetypes, and symbols, all of which are associated with the problems my client is facing

(Neukrug, 2018). Analytic therapy holds that neurosis emerges from longing to integrate

unconscious parts of self into consciousness. The goal here is to have an integrated psyche,

which is made up of the unconscious, collective unconscious, and personal unconscious

(Neukrug, 2018). Counselors, thus, examine the various "opposite" personality and attitude traits

a client holds, determines which of those opposites lie in the unconscious, and encourage the

client to inspect, understand, and accept them to mold a holistic self-awareness (Neukrug 2018).

Dreams and symbols are important to understanding and interpreting the unconscious because it

speaks only in images. The client reflected some powerful images to me that I hope to process

with her.

Darren was a part of my client's life for a majority of her early childhood and teenage

years. According to Counseling Theory and Practice by Edward Neukrug "Jung believed that

childhood influences affect our psychological make up and determine how we consciously view

the world. Symptoms, thus, represent a desire to regain parts of self that have been lost to the

unconscious" (Neukrug, 2018, p. 76). It seems that those early experiences with Darren have
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Case Conceptualization Paper
been repressed to the personal unconscious but the client is now hoping to integrate those

memories and parts of herself that she once repressed. From talking to her, I gathered that she

has already been uncovering some of the personal unconscious memories but she has yet to

individuate those parts of herself. I also suspect that the client is not missing Darren, but rather

missing the vitality she felt when she was with him. It also sounds as though she was

experiencing life through the lens of the rebel archetype while she was in the relationship.

Additionally, the client mentioned that she did not think about Darren after their break up for two

years, and repressed any memory that was associated with him. I imagine that in repressing

memories of Darren, she also repressed any parts of herself she associated with him into her

unconscious, such as the rebellious persona she wore around him that held her vitality. Thinking

about Darren again then resurfaced the rebellious drive she once suppressed. It seems that while

she was with him, the client was extroverted, rebellious, and adventurous, but those qualities

have since become part of the shadow after persistent repression.

To treat the client, I used dream analysis and amplification. Firstly, I used dream analysis

because I believed that it may be an opportunity to address the dreams and symbols the client

encounters, while also providing understanding towards the dissonance she experiences between

her unconscious and conscious choices. For instance, I asked my client to recall one of the

nightmares where she picked Darren over Jim. She was then instructed to describe the dream. In

her dream, she was an adolescent again and had gone to a business dinner with her parents.

Darren, Jim, and both their parents were all at the dinner. She recognized that she and Darren had

broken up years ago and approached him to gain closure. Instead she recalls falling for his charm

and running away from the dinner party with him.

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Case Conceptualization Paper
I asked the client if Darren represents anything to her. She believes he represents

rebelliousness and exhilaration. I wondered if Jim symbolized anything; she thought that he

symbolized stability and order. I then asked what in the dream made picking Darren so appealing

in the moment. The client admitted that it was not that she picked Darren over Jim, but rather

that she was choosing freedom and rebellion over constant structure and responsibility. The

client then realized that there was meaning behind her parents being at the party as well. In her

youth, she often felt she was under strict regulations mandated by her parents. Darren served as

an escape from those restrictions then, and now in her dream. I then pointed out that it seems she

misses how it felt to not be weighed down by structure and responsibility and though she felt that

Darren was the only door to that, adventurousness can come from within as well. She agreed and

began to see how the rebellious archetype she once embraced has since retreated to the shadows

because she thought it belonged solely to her relationship with Darren.

Amplification is a technique used to magnify symbolic meaning (Neukrug, 2018). We

tried this technique as well because my client mentioned feeling she has a symbolic cord

connecting her to Darren, which I felt was powerful imagery. Thus, I inquired about what the

cord looks like. She described the cord as a pipe, inflexible, rigid, armored, and hollow. The

word armored peaked my interest because it implies that the plating can be removed; the client

agreed, and said that she believes a lot of the plating that armors her cord seems to stem from

within her. I asked if she feels she is protecting the cord, and she said she is, because he is the

last connection to her rebellious, adventurous side. I was then curious because she referred to

him as her only connection to that side of herself, yet it seems that, that part of herself still exists

in her unconscious, revealing itself when she dreams or thinks about Darren. Essentially, the

shadowed parts of herself are attempting to be integrated but only know how to do so through
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that relationship. She then realized that the armor around the cord was protecting those parts of

herself that are tangled in his memories, not in her relationship with him.

An analytic therapeutic approach seemed to be applicable to my client's problem because

she already used language similar to the themes in the approach, such as references to the

unconscious, to dreams, and to symbols. Additionally, I could see the therapy eventually being

effective in accomplishing her final goal, cutting the cord to Darren, which in turn would likely

help accomplish her other two goals. The client either has or has attempted to repress most

emotions and thoughts associated with Darren. Repression requires introspection into the

unconscious, thus, a technique that establishes individuation by tapping into the unconscious,

and encourages analysis of symbolic meaning would likely be effective in helping my client to

understand her own unconscious processes and integrate them into her conscious ones. I also

believe that introspection and analysis might help her pinpoint which parts of the armor belong

to her and be able to see adventurousness and healthy rebellion as a parts of herself that were

temporarily hiding in the shadows.

Behavioral Therapy

The next theory I plan to use is behavioral theory. This theory holds that people are born

as impressionable "blank slates" who learn through contact with their environment (Neukrug,

2018). Learning is continuous throughout a lifetime and is susceptible to change (Neukrug,

2018). According to this theory, learning is accomplished in three ways: social learning, classical

conditioning, and operant conditioning. I plan to use this theory with my client because it seems

that her problem arose from a combination of the three different learning types, and thus, may be

helped through those same learning techniques.

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Case Conceptualization Paper
My client initially entered therapy, concerned about her obsessive thoughts regarding her

ex-boyfriend, Darren. She mentioned that she sometimes misses the thrill and adrenaline

associated with thoughts of him. Obsessive thinking about him may be the only way she knows

to access feelings of excitement. It, therefore, seems that those thoughts serve as reinforcement

to continue thinking about him. Additionally, it also sounds as though the client has classically

conditioned herself to pair excitement and adrenaline with Darren. This likely occurred as a

result of only taking on a rebellious persona around Darren, thus associating him with that thrill.

Likewise, she dated Darren throughout her teenage years, which are usually marked by increased

emotional intensity (Seigel, 2013). I imagine that between emotional intensity, addictive love,

and their naturally tumultuous relationship, other adventures did not seem as exciting by

comparison, therefore reinforcing the idea that Darren was essential to letting loose and

experiencing excitement. Her symbolic "cord" she mentions above seems to be those

associations she has between him and adventure. This was also affected by the fact that Darren

was the one who modeled the rebellious, adventurous, and exciting behavior and my client

learned from his example.

I intend to use stimulus control and aversion therapy to assist my client in overcoming

her obsessive thinking about Darren. Stimulus control is accomplished through changing the

stimulus so that desired behaviors may arise (Neukrug, 2018). In the present, Darren is the

stimulus that has been conditioned to give her a rise in adrenaline. I asked my client, if there are

other times that she experienced the adrenaline she feels when she thinks about Darren. In her

teens dancing was one of her primary outlets that significantly boosted feelings of excitement,

but she also feels that it has been harder to achieve the same rush she felt then, now.
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I asked if there was a more recent time that she experienced a rush. She said sometimes

she has one when she does something completely out of character, like snowboarding, but feels

as though sometimes she needs a push to be adventurous, otherwise she will not do it. I asked if

Darren used to function as this "push", to which she said absolutely. She admitted that she once

told Jim that she wanted to snowboard and do more spontaneous things but needed him to help

push her because she sometimes can be neurotic and will talk herself out of healthy risks. I then

pointed out that in telling her boyfriend she needs a "push", she was "pushing" herself. She

seemed delighted by this idea. In talking to her I, therefore, realized that Darren served as both a

stimulus to push her, as well as a stimulus that excites her. From talking, she realized that she

knew how to push herself and that she could use spontaneous activities, like snowboarding to

build new, healthy associations to adrenaline. The thrill from the activity would then serve as a

positive reinforcement.

Obsessive thinking about Darren seems to be another major concern to her. I thought that

we could address this by pinpointing ways in which she could create an aversion to thinking

about Darren by pairing thoughts about him with negative stimuli. I asked what she thought

about this and she showed interest in trying it. Thus, I asked if there was a way she would feel

comfortable creating an aversion during her thought patterns. She responded that she often thinks

about the positive ways in which he made her feel and neglects the negative, such as the feelings

she had after he cheated on her, leading to their break up. I asked if she could give me an

example of one of her obsessive thoughts and then model how she would shut it down with an

aversive thought. She thus, thought about a time that they ditched school and snuck into

someone's back yard to jump on a trampoline. I told her to really focus and try to be present

within that moment. I then asked her to recall a memory of him that hurts her. She remembered a
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time that he told her that he was never in love with her. I asked her to recall the feelings

associated with that. She remembered feeling betrayed, hurt, broken, and hopeless. I then asked

if she would feel comfortable using this exercise whenever she experiences an intrusive thought

about him. And she said she would.

This modality would most likely be fast and proactive in changing my client's behavior,

but in my opinion, it lacks the spiritual and symbolic emphasis that analytical therapy possessed.

The tactics used in behavioral therapy could be effective in creating healthier associations to

adrenaline and showing my client that adrenaline can be achieved through internal processes

rather than external one's, as shown when I pointed out that my client was essentially pushing

herself when she asked her boyfriend to help push her to be spontaneous. She has made

inflexible cords (associations) between Darren and excitement. Challenging those associations

and introducing new ones could help her to overcome obsessive thinking by creating new

associations between excitement and an activity like snowboarding, therefore "cutting the cord"

that connects her to Darren and introducing a healthier one. Likewise, I strongly believe that she

could overcome obsessive thinking by making the habit aversive. However, there are some

predicaments with how well this therapy can address my client's problem. Though behavioral

therapists may shape therapy to the client by accessing the client's terminology and spiritual

beliefs, I felt that it falls short in addressing the importance of symbolic meaning to

conceptualize and overcome this specific client's problems.

Solution Focused Brief Therapy

Finally, I will utilize solution focused brief therapy (SFBT) to treat my client's presenting

problem. "SFBT is a pragmatic, anti-deterministic, and future-oriented approach that offers

optimism and hope in the ability of the client to change quickly" (Neukrug, 2018). This theory
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holds that language plays an essential role in shaping one's reality and then maintaining it

(Neukrug, 2018). Therefore, it is believed that through well worded questions, and solution

focused language, the client may begin to use their strengths to overcome obstacles, while

remaining focused on therapeutic goals (Neukrug, 2018). My client seems to get transfixed on

her past experiences in her relationship with Darren, so I believed that this therapeutic style

could help her feel grounded in the present as she makes changes to impact her future.

In the client's present reality, it seems that she feels that her "obsessive thinking" is

pathological and problematic. In therapy I intend to offer her comfort in the idea that she is not

alone in her "obsessive thinking" and that many people experience similar sensations when

thinking about past relationships. I, therefore, hope to ensure her that she is not pathological for

having such thoughts. Additionally, the client is extremely focused on her past problems with

Darren, but seems to be making small steps to achieve her goals, such as simply deciding that

this may be hurting her. I hope to instill the idea that her reality is valid, while also helping her

navigate and focus on future, long-term goals through the use of her own strengths, abilities,

language, and cognitions.

In the therapeutic setting I would use presuppositional questions and reframing as

interventions for my client. Presuppositional questions are asked in ways that assume that

circumstances will change, thus helping clients to remain hopeful and focused on ideal future

goals (Neukrug, 2018). An example of this might look like the following:

Counselor: "I'm hearing that one of your goals in therapy is to cut your emotional cords to

Darren.”

Client: "Correct, I just feel that I have an especially draining tie to him that I cannot seem to

shake."
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Counselor: " Can you tell me about a time when you had another draining cord to someone or

something and how you cut that cord?”

Client: "Well, I used to have one connecting me to resentment towards my father for past

discretions, but was eventually able to cut it.”

Counselor: "Wow, I imagine that must have taken a lot of work and forgiveness. Were there any

tools that helped you cut that cord that would be helpful as you prepare to cut the one to

Darren?"

Client: "I really try to forgive so thank you for acknowledging that. I guess the greatest tools that

helped me cut that cord were forgiving both my dad and myself, self-patience, and understanding

and accepting my emotions through writing. To even begin to cut my cord to Darren I need to

forgive him for hurting me, as well as forgive myself for feeling hurt. That's the other thing; I get

extremely impatient with myself because it has been four years since we were together, yet I still

grieve, but I also realize he was a huge part of my life for nine years, so a little self-patience may

help me remember that just because I have not cut the cord yet, does not mean it is impossible.

Journaling may be especially helpful, and may help me sort through the feelings armoring my

cord. A huge reason I struggle to cut this cord is because my cord to him is both positive and

negative but I think journaling would help me identify the negative parts I want to cut.”

In this example I used exception-seeking questions and compliments to help the client access

tools that may assist her in "cutting her cord" to Darren. In recalling a time that my client

overcame a similar obstacle, she is able to decipher strengths that can be utilized to overcome

one that may seem hopeless in the moment.

Next, reframing also seems to be another useful technique to help my client. As

mentioned, my client feels that she is unhealthy and pathological for experiencing, what she
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describes as "obsessive thoughts". I hope to reframe this belief so that she is not pathologizing

her problem nor identifying with it. In the dialog above, the client states that " I still grieve, but I

also realize he was a huge part of my life for nine years, so a little self patience may help me

remember that just because I have not cut the cord yet, does not mean it is impossible", which is

the first step in reframing her problem. Instead of saying that she is pathological, she reframes

her wording to say that she is grieving over a nine-year relationship, which is valid and normal

given her circumstances. Grieving is also a word that is natural, relatable, and suggests a state of

mind that may be changed.

I would also like to address the term "obsessive thinking". I asked how the client felt

when she used this terminology and she admitted that it felt uncontrollable and seems to give her

permission to think about him without stopping because it is "out of her control". Additionally, I

noticed that she mainly focused on herself in her accounts of "obsessively thinking" about

Darren. Her thoughts mainly seem to be about who she was when she was with him. When I

brought this up to her she agreed. I then asked her how she might conceptualize this in a way that

would demonstrate constructive language. She believed that a better word might be

"reminiscing", which felt manageable and controllable. Making small changes in the language a

client uses to describe their problems, could have a powerful impact on a client's perceived

ability to change their undesired circumstances.

SFBT seemed to be the most effective therapy at instilling hope, and resilience in my

client. This approach felt holistic in that it was empathetic towards her presenting problem, easily

applied to spiritual contexts, and served as a catalyst for fast change in my client. The emphasis

on language the SFBT poses seemed to be what the client connected to most. One of her goals,

for instance, was to cease "obsessive thinking" about Darren. Reframing the way in which she
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approached her problem by "normalizing" it, helped her see problems as mutable rather than

hopeless. She also addressed her reluctance to stop thinking about him and realized that she does

not want to completely stop thinking about him but to do so in a non-intrusive way, which could

occur by "cutting her cord" to him.

Likewise, using strengths to achieve goals empowered the client by reminding her that

she has the tools she needs present within. The client's initial goal to "cut her cord" to Darren,

therefore, seemed more manageable because she remembered doing such an act before and

which tools she utilized to do so. Whereas analytical therapy felt as though it would take a long

time to make any changes in my client, and behavioral therapy did not quite address my client's

spiritual well-being, SFBT felt fast, concise, and comprehensive to my client's specific needs.

Simply by reframing and accessing her inner strength, I have already seen a change in her

approach to the presenting problem and a greater sense of confidence in her ability to reach her

therapeutic goals.
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Case Conceptualization Paper

Works Cited

Neukrug, E. (2018). Counseling Theory and Practice. Nelson Education.

Siegel, D. J. (2013). Brainstorm: The Power and Purpose of the Teenage Brain. Penguin.