Case prognosis
Alec improved during the treatment. Symptomatically he no longer met
criteria for any mood or anxiety disorders, and he was able to manage
occasional bouts of anxiety effectively. His early difficulty in
regulating self-esteem had improved, though occasionally he was
vulnerable to the familiar tendency to think in black and white terms,
judge intentions based on the outcome, and expect that he needs to be
perfect to be accepted. He worked and managed work stress, was
financially self-sufficient, and had a fulfilling relationship with
Kate. He was developing a sense of identity and building his own family.
What allowed these changes to happen? These changes occurred against the
backdrop of the maturation and development of Alec in terms of identity,
career, and intimacy, which were both challenges and opportunities for
his growth (Levenson, 1978). Initially, these areas of his life had
posed challenges and evoked fear of disappointments and failures. Due to
his difficulty regulating his self-esteem and the desire to preserve an
ideal sense of himself, he had retreated into the comfort of his
parents’ home. Through processing the difficult experiences of growing
up, gaining greater clarity regarding the self-defeating ways in which
he was protecting himself from disappointments and failures, and
developing a deeper attachment in therapy, he rejoined the developmental
trajectory. The reality of his life became the source of change. His
life had posed an ultimatum: he felt pressed to choose between working
for the family company versus overcoming his fears, developing his own
career, separating from his family, and declaring his own identity.
Moving forward with his own wishes challenged his role identification
with his family members that resulted in paralysis (like his brother),
avoidance (like his mother), and an expectation that life is a joyless
process of sacrificing one’s needs (like his father). As he rejoined the
developmental trajectory, he navigated the complexities of work, his
romantic relationship, and his own independent life. Initially, these
evoked fears that were understandable given his difficulties regulating
self-esteem and reintegration into life after a long break. Alec showed
the ability to learn from his experiences, regulate his emotions in
service of pragmatic outcomes, and resolve ambivalent and mixed feelings
in the face of new experiences. He continued to use therapy in a
productive way and developed a new recognition that it is possible to
rely on others. The new experiences of love, commitment, and evolving
intimacy in his relationship with Kate allowed him to see himself and
her as lovable despite imperfections. He also discovered his
professional capabilities as well as his ability to manage conflicts and
stress at work. He was learning from life experiences. Similar to
earlier stages in treatment, the therapy process and life experiences
worked synergistically to promote growth and new learning, and challenge
maladaptive ways of functioning.