Presenting problem and clinical description
Alec was 24 years old when he arrived at our first meeting. He explained
that he had relocated to Boston for graduate school and was looking for
“support for depression and anxiety.” He was very interested in my
background and told me that he searched the internet about me before our
first appointment. Puzzled, I wondered whether his desire to know things
about me was related to anxiety and uncertainty of beginning treatment.
I also wondered if this indicated problems with intrusiveness and
boundaries. As I was not able to have clarity about any of these
hypotheses, I shelved them, hoping to gain more clarity in the future.
Alec grew up in a privileged family. His family owned a consulting
company that was passing from one generation to the next. However, Alec
was uninterested in the company and was dedicated to the field of his
studies, history. His father ran the company, though in his younger
years pursued an academic career in archeology. It was truncated upon
the death of his first wife, who died from cancer. Alec’s father became
depressed, quit his academic job, and was quite literally rescued by his
own father who offered him a new career in the family business. Around
that time, Alec’s father met his second wife – Alec’s mother – and
married her soon thereafter. Alec recalled that his childhood was sad
and lonely. His father worked long hours and his mother, who was
depressed for months at a time, was often unavailable. Alec’s younger
brother, Mark, sustained a serious sports injury during the summer
before Alec started high school. The injury left Mark paralyzed, and
Alec de facto lost both of his parents who became preoccupied with
extensive medical care for Mark. Alec would escape into reading fantasy
novels, spending long hours reading at the expense of schoolwork or
spending time with friends. His parents arranged for him to start
treatment. Gradually, he was able to limit his reading and finished high
school.
Hoping for a much needed sense of independence, accomplishment, and
romantic fulfillment – a new beginning – Alec started college. He was
busy studying, daydreaming about having a girlfriend, and attending the
occasional party. He thought that his dreams had come true when he met
Mary at one of the parties and both felt a strong connection to each
other. He saw the relationship in idealized terms: two soulmates who
fell completely in love with each other. As the two became closer, Mary
shared with Alec a devastating history of abuse by one of her family
members. Alec became preoccupied with Mary’s anguished childhood. He was
enraged that Mary was hurt, especially by a family member. Initially,
Mary felt that Alec was very understanding and sympathetic and her trust
in him increased. However, as he became more and more preoccupied with
“justice” and became interested in suing her family, she became
increasingly worried. The tension between them grew as Mary experienced
Alec as aggressive and feared that he might harm her family.
Alec felt that the abuse tainted the perfect relationship he and Mary
could have had. In his mind he hoped to reinstate the perfection of
their relationship, while refusing to realize that he was causing
enormous distress to Mary. Mary repeatedly requested him to stop
pursuing justice because she wanted to move on. Eventually, as Alec’s
behavior had not changed, she broke up with him, asking him to never
contact her again. Alec felt devastated that he destroyed the
relationship with the woman he loved and wished to protect.
Fearing his own destructiveness, he concentrated on his studies. He
graduated a few years later and started graduate studies in history,
hoping to pursue an academic career. He had a few brief relationships
that invariably ended after Alec would get annoyed at the
“imperfections” of his partners. He was a good student, though his
professors were not aware that his perfectionism was affecting his
ability to do and enjoy the schoolwork. Everything needed to be done
perfectly – not only did Alec need to meet the expectations of his
professors, but also he had to meet his own standards. That quadrupled
his work, slowed him down, and colored his experience with incessant
fear of inevitable failure. After all, these were impossible
expectations to meet.