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Abstract There are many techniques used to treat and rehabilitate addiction, but the focus of this case is the use of Psychoanalysis on a fictional character who has presumably already received detoxification treatment for the use of Vicodin. Using Psychoanalysis in addiction therapy does present a challenge. However, several new research projects promote the use of many of the foundational treatments of Psychoanalysis. It is recommended that any type of addiction therapy be coupled with group therapy, as well as with a relapse prevention plan. However, this is certainly vital when using Psychoanalysis as a recovery therapy. The combination of these therapeutic processes allow for individual healing as well as group healing and cohesion. This paper concludes that all addiction therapists must be well rounded and integrative in their approaches in order to be successful. Psychoanalysis Case Study of Gregory House M.D. A Conceptualization and Treatment Plan Drug addiction is a serious issue that affects a person’s emotional, relational, and physical health. One of the reasons that addiction is so difficult to battle is that substance use reinforces itself with the perceived positive effects. However, Khantzian (2006) says that too much emphasis is placed on the pleasure principle behind drug abuse. There are more important aspects to the underlying cause of addiction, which are mostly emotional and chemical in nature (Pinsky, 2008). Khantzian (2006) describes the difficulties in an addict’s coping skills, as well as trouble engaging their environment, as primary psychological reasons for drug abuse. For this reason, Psychoanalysis can be a useful tool in treating clients with drug addiction. The objective of this form of therapy is to discover familial or relational ties related to the drug use, and formulate a healthy support system conducive to recovery (Strean, 1984). Presenting Concerns Dr. Gregory House is a 51-year-old Caucasian male who is currently seeking addiction counseling. His drug of choice is Vicodin. The client developed his addiction after a surgery and a misdiagnosed infarction left him with “chronic leg pain.” He currently walks using a cane, and claims that he does not necessarily have an “addiction” because Vicodin use does not interfere with his work. He also says that his habitual use of Vicodin is “not a drug problem, it’s a pain problem.” Dr. House has at this time, already completed in-patient
Resolution of this stage would mean that Dr. Dr. His only solace was in learning about other cultures through archaeology. It is possible that Dr. because he feels that this may be the primary cause in the failure of his romantic. The emotional disconnect is further demonstrated by his lack of motivation to connect with the man he now knows is his biological father. 1914/1957). Dr. House was deprived of an emotional attachment with either of his parental caregivers. and several years ago. House may also be afraid of the level of intimacy that is required from any non-superficial relationships. . he discovered that John House is not even his biological father. because his parents did not model intimacy for him. or his biological father. House confirms that he did not have a nurturing or supportive home environment as a child.rehabilitation and detoxification. or more likely. Dr. He is seriously concerned about his own mental stability. personal. He needs consistent follow up and addiction therapy. she was able to see through his façade. In his daily life. Lisa Cuddy. Dr. Dr. Case Conceptualization Dr. However. House struggles to build relationships with others. primarily because after knowing him for ten years. his father has an “insane moral compass ” and he avoids contact with him. His father was a harsh disciplinarian and his mother was distant. His failure to bond with others only serves to validate this feeling. House does not (openly) report that he was lonely as a child. This seems to indicate that he has had an early emotional disconnect. He was deprived from making community attachments because of his family’s military lifestyle and frequent relocations. he is not motivated to seek a relationship with his biological father. which prevented him from building strong attachments with either of them. Still. House’s father was abusive towards him as a child. House maintains purely superficial relationships. according to Psychoanalytical theory that he has not surpassed Freud’s Oedipal psychosexual stage of development (Freud. His difficulty building relationships with the two men in his life may be a sign. House feels unworthy of valuable relationships. instead of exposing any vulnerability himself. This defense mechanism allows him to deal with negative feelings. This allows him to push people away and reinforces his internalized view that they are leaving because they are unworthy of his “greatness. He states that while he loves his mother. Dr. This has caused trouble for his most recent relationship with Dr. House reports that he did not come from an affectionate home environment. Dr. as well as a relapse-prevention plan. However. and is probably rooted in his early parental model. and professional relationships. House realizes that his current behavior is unpredictable and irrational. that he cannot trust anyone outside of himself to meet his own needs. He often found himself in foreign countries surrounded by children with whom he could not communicate. House has been unable to make connections with women. House was able to identify with either John House.” His relationship with Lisa Cuddy was his most intimate. he masks these fears with strong narcissism and grandiosity. Whenever he is close to developing a meaningful relationship. Dr. he self-destructs with narcissism. He would like to investigate his narcissistic tendencies. and usually resorts to paying for sex. Because he has disconnected himself from his emotions. House may have developed a negative self-view as a child because of his lack of intimate connection with others around him.
However. House’s mother. 2008). and are key to recovery . 1991). One way to do this is to re-frame coping skills and defense mechanisms and define healthy alternatives. House has gone without the use of drugs for his chronic leg pain for a year. the goal of treatment for Dr. according to Freud’s Phallic/Oedipal stage of psychosexual development (Jones & Butman. House seems to be conflicted between his cognitive self (which says he is lonely and wants a relationship with Dr. while nurturing the client’s ability to maintain will power (Pinsky. 2006). Dr. it would be advisable to teach Dr. In psychoanalytic theory. will provide Dr. he has been unable to build effective addiction treatment supports. to become so close that he is emotionally attached to them. House has been unsuccessful in building intimate relationships. House will be allowing himself the safety of relationship building while revealing his vulnerability. However. and how these experiences have negatively impacted his relationship building skills. House search for underlying depression or anxiety caused by his lack of emotional connection. This may be a gateway for him to develop more meaningful relationships. House is allowing himself to be isolated. Treatment Plan Goals for Counseling From a Psychoanalytic perspective. along with a positive therapeutic bond with the counselor. 2008). For instance. A recent study of addiction found that there is a great capacity for using Psychoanalysis in treating addictive behavior (Khantzian. Dr.Dr. He does not NEED medication for pain management. and has weakened his capacity of forming autonomy. According to Dr. Forming strong relationships in a group rehabilitation therapy setting. Pinsky’s (2008) theory. Addicts often are ill equipped to deal with strong . His drug use at this time is strictly mask nagging inferiority feelings and vulnerability since his break up with Dr. 2009) that defend against perceived attacks. House’s primary issue is his addiction recovery. 2008). Support is a necessary part of temptation treatment. on many levels. Since Dr. Having proper emotional and physical stimulation helps to keep the body alert and able to fight temptations. and its proximity to the opposite sex. Pinsky (2008) thinks it is best to provide clients in recovery with healthy ways of coping before taking away the maladaptive ones. Dr. he fears that he may lose something of this artificial self–sufficiency. Drew Pinsky (2008) says that addiction is less psychological than it is biological. House is to help him gain insight into where his fear of vulnerability comes from. House seems to think that he is entirely self-sufficient. which is hindering his recovery. especially a woman. and can make or break rehabilitation (Pinksy. should be explored in relationship to Dr. House new ways of dealing with both his perceived leg pain and his feelings of abandonment (rooted in his early parental interactions) in order to effectively treat him. Battling addiction can be a lonely struggle. defense mechanisms are the supports to a weakened ego (Murdock. This idea. It is important to bring to consciousness any unresolved issues that are causing current struggles in relationships. His lack of attachment is rooted in his detachment from his parents. If he allows someone. Dr. It is also and important goal to help Dr. Dr. By developing intimate bonds with a support system. Lisa Cuddy. House a foundation for healthy relational skills. Cuddy) and his emotional self (which tells him that women cannot be trusted and he only needs himself). Dr. Traditional Psychoanalysis usually confronts defense mechanisms (Corey. the psychological factors must not be ignored. Effective addiction recovery treats the nature of addiction.
make no difference in recovery. the first needgratifying stage of development (Murdock. for the most part. Dr. or other activities (Khantzian. House. Freudian psychoanalytic theory associates addiction with the oral stage. Analysis of transference One of the most important factors in the therapeutic process is the client/therapist relationship. In fact. He needs to see that relationships can be nurturing. House’s internalized ego. been successful in his attempt at keeping his inner-self protected. work. 110)” and that the therapy model. 2009). Khantzian and Treece (1985) add that. Since he began treatment and detoxification. but commending him on a job well done. will be at risk for substance dependence. an individual is broken. House’s drug use provides him with a synthetic validation for his narcissism. and at even greater risk for relapse (Pinsky. House on these matters. without taking too much from his fragile ego. House provides an air that he is superior. 13). . However. Narcissism prohibits individuals from achieving satisfaction in relationships. Khantzian (2006) says that people who struggle with their need to be acknowledged. to love and be loved. The effects of this will hopefully be a building of mutual trust and respect. he no longer has that artificial crutch. or experience of the counselor. House’s emotional detachment have. House needs to learn comfort in confiding. he found a new way of coping. House is to not be affected by his narcissism and allowing it to cause counter transference. “Opiates were said to produce a state reminiscent of a blissful closeness and union with the mother. Defense mechanisms generated by Dr. when Dr. pointing out that he was assisted in solving a certain case. Establishing the relationship Considering the fragile state of Dr. I would search my reasons behind any confrontations before hand and have an understanding of how it will benefit Dr. This grandiose personality can be especially grating on therapists. Without it. Dr. For instance. even if. even when his attitudes are unacceptable. It is important to confront Dr. and feelings of negativity towards him. even though he uses the advice of others in solving his diagnostic cases. allowing them to cope. and especially if. Interventions Confrontation Dr. One point that would be important in using confrontation with Dr. 2008). and the effects of being accepted. It is important on my part to be favorable and feed into his strengths to provide him with sincere encouragement during the initial sessions. which resulted in avoidance of separation anxieties aroused by the adolescent dependency crisis (p. it is important that I reach out to him with acceptance and empathy. For this reason. Strean (1994) says that all patients “will respond to interventions in terms of the transference (p. Dr. transference cannot be assessed. setting. 2006). House began treatment for his chronic leg pain.emotions. House also needs to be able to forge relationships with others in his peer group and therapy group.” Khantzian (2006) also believes that drug and alcohol abuse act as a defensive strategy that bridges the gap between a person’s functional and defective ego. leaving them pre-disposed to drug abuse.
CA: Thomson Brooks/Cole. House’s insecurities were formed and provide him with an opportunity to correctively deal with these experiences. S. However. In J. An ego/self theory of substance abuse. R. House to form other options for reactions. Theory and practice of counseling and psychotherapy. (1991). House’s self-esteem need not be threatened by his vulnerabilities. House needs to be validated for his strengths. Conclusions With time and support. On narcissism: An introduction. We can then begin to match these emotions with other instances of similar feelings and their root cause. . that patients need a strong emotional counteract-ant. House to recognize his own fear of inadequacy and how his grandiosity is interfering in his daily relationships. London: Hogarth Press. This will hopefully ensure the client can counter the strong compulsion for them. E.Because of the vital role transference plays in the healing process. Modern psychotherapies: A comprehensive Christianappraisal. insight alone is not enough. and openly confront and express them. The standard edition of the complete psychological works of Sigmund Freud. 30. Jones. This makes him feel adequate. Belmont. Dr. L. IL: InterVarsity Press. I recommend that Dr. House heal his relationship patterns if he wants to treat his addiction. & Butman. (2008). and Trans.” It is important that Dr. E. References Corey. 2006). National institute of drug abuse: Theories on drug abuse: selected contemporary perspectives. insight provides a look into the emotional and logical though process. (2006).). Dr. Pinsky (2008) says that while addiction is “treatable” it is not “curable.. House will find meaningful relationships to be satisfying. Selfrealization of past conflicts and perceptions of feelings that have been repressed will allow Dr. and ask him to seek himself for insight on his situation. it is hoped that Dr. G. House likes to solve problems. Khantzian. Dr. The goal of this form of therapy is to allow Dr. (1914/1957). It is vital that Dr. I would like to challenge him to see himself as a puzzle. Freud. Insight In the Psychoanalytical therapeutic model. Substances themselves are such strong behavior reinforcements. House makes a connection between insight and an emotional experience. S. and can even be an asset. and feeds his need for validation. The goal of insight is to find how Dr. Dr. and develop other behavior patterns (Khantzian. This paper concludes that addiction therapists must be well rounded and integrative in their approaches in order to be successful. Downers Grove. Strachey (Ed. House connect with his feelings about me during our sessions. but learn that weakness is acceptable.
NY: HarperCollins Publishers.com/2011/04/25/psychoanalysis-case-study-of-gregory-house-m-d/ . DSM-III diagnosis of narcotic addicts: Recent findings. Theories of counseling and psychotherapy: A case approach. Psychosomatic Medicine. N..wordpress. Lipowski. C.L. New York. Cracked: Putting broken lives back together again: A doctor’s story. NY: BrunnedMazel Publishers. (1994). Upper Saddle River. Pinsky. (2) 153-171. D. Z. Murdock. New York. (1984). H. (1985). E. (2009).Khantzian. and Treece. NJ: Prentice Hall. 46. (2008). 42. Archives of General Psychiatry. Essentials of psychotherapy. What does the word psychosomatic really mean? A historical and semantic inquiry. http://coltsfankana. 11-26. Strean.
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