more clinical example

(I have been describing a clinical case I am seeing right now.
The purpose of my doing this is to start up some kind of
discussion of a clinical topic on CSGnet. I hope Ed Ford, and
Dick Robertson will join in. And it would be nice to hear from
some CSGnet listeners out there who may have clinical interests
but are not card carrying clinicians.)

A summary of reactions(mostly private messages) I have received
so far: (a) Bill Powers' first reaction to the initial case
description was: don't psychologize, ask the person. By this, he
means find out what experiences(perceptions) are being controlled
by the person. The method of levels is the primary tool to do
this within HPCT., (b) Clifford Gann's initial reaaction was that
the man's sexual life with his wife was not satisfying., (c) Gene
Bogess' comment was that the man was out of control and having
the affair with the babysitter was a way to resestablish control;
Gene expressed the opinion that HPCT therapy, or maybe any sort
of therapy, was not up to handling something as complex as a
marriage relationship. I invite the above named people to correct
my summary if it is not quite right. Now on with the case.)

I had my first joint meeting with the man and his wife. This is
the first time I met her. Her experience of the relationship is
quite different from his. According to her: He ignores her and
gives others more time than her. He doesn't value her, treats her
like sh__, and has done so from the beginning of their marriage.
When asked what she liked about him initially, she mentioned many
postive qualities(exciting, intelligent, personable, etc..) but
these are not shown to her now. She wants her husband to be with
her the way he is with others. What happened didn't surprise her,
it is consistent with the way he is. What does surprise and
disturb her is the fact that he allowed this woman into their
family life. She confided things to this woman. She plans on
revenge against this woman.

My impressions of the wife: She was obviously having very strong
feelings during the session and her body was shaking. I was
struck by her unwillingness to share with him, the kind of
activities she does as hobbies. To her, this was an area just for
her. Sharing it would result in losing part of herself. She
already gives too much to him she thinks. Also, I asked her if
she was seeing a counselor for herself. She said that she gets
more out of talking with her friends, people she is familiar
with. I asked her to describe herself on an
introversion/extroversion dimension. She described herself as way
over on the introverted side. (He, described himself way over on
the extroverted side.) She does not feel as though she has
control over anything and uses screaming and yelling to get his
attention. (He reacts by becoming quiet and withdrawn). She had a
very controlling mother. (He had a very controlling father). In
summary, the experiences which are important for her to control
seem to be: privacy, being someone he values and respects,
revenge at the babysitter.

My impressions of the way they were together: They have radically
different perceptions when it comes to each other and their
relationship. They were not able to talk on a topic and resolve
it. They jumped all over the place in conversation. They sat on
the same sofa but did not show any affection towards each other.
He touched her leg which was moving a mile a minute and she
pushed his hand away and interpreted it negatively.

Some additional facts which came out: Their son was diagnosed
with a serious neurological condition during the past Winter.
This really threw her. Her concept of the perfect son had to be
changed. She needed her husband then and he needed her then but
they couldn't be there for each other.

Treatment interventions so far: I described Ed Ford's Quality
Time Program and told them to start it this week. She is willing
to give the marriage to the end of summer to see if it can be
different. He is willing to give it whatevr time it takes to make
it work. I will be seeing him on an individual basis as well as
seeing them as a couple.


To: Clifford Gann, Gene Bogess, Bill Powers, interested CSGnet
From: David Goldstein
Subject: more on clinical example
Date: 05/08/92