Mental Health For All

NEW ASPECTS

OF

PSYCHOTHERAPY

 RESEARCH BASED ON CASE HISTORY

BY

MUHAMMAD ZAFAR IQBAL

ISLAMABAD

PAKISTAN

Introduction

Ms J, is wife of one of my best friends. He told me about his wife’s problem of sleeping disorder. After meeting with my friend, I met Mrs. J and asked about her problem. She told that she feels burden on shoulder and at the back of her head most of time. She complained to feel weakness also. She also told that she is also facing lack of concentration on her daily work, disturbance with loud voices of anyone, shivering of body without understanding any reason. She also complained about weak memory and negative dreaming which disturb her sleep. She also complaint fidgety and restless most of the time.

She went to some psychiatrists for her treatment because she had become very aggressive and started to throw things and whatever was in her physical approach. One of those psychiatrists recommended ECT for treatment and she took ECT but ECT affected her memory badly even she lost her memory for some nearest period of her life although she gets it back after my treatment.

Her treatment concluded in 50 sessions of approximately one hour and she was completely cured from her all psychological problems and now she is spending her life normal in home as well as in work station (School).

Symptoms

i)                     Sleeplessness

ii)                   Weak memory and lost of some memory of a specific time period due    to     ECT

iii)                  Burden on shoulder and at the back of her head

iv)                 Submissive behavior

v)                   Lack of concentration, confidence, will power and decision power.

vi)                 Hate with loud voices.

vii)                Shivering of body some time.

viii)              Aggressive when alone after ECT.

ix)                  Fidgety most of time

Assessment

                Since her childhood she was facing lots of psychological problem with behavior of her father who used to behave badly, strict and harsh to client. Even her mother had also been facing her father’s behavior since her marriage with his father. Mrs. J remembers that she saw her mother mostly weeping and unhappy with her life and due to her own problems she also never tried to give due attention, love and care to her daughter (Client) and she also behaved badly to Mrs. J. On his visit to home from job as he was a army person, how much time he spend his home was a tough time for both of these females i.e. client and her mother because he behaved badly, strict and always looked in a mood to taunt them, yelling at them, scolding them loudly and insulting them. 

                This behavior of her father and even her mother towards her made her deprived personality. And feelings of being deprived and ignorance effected badly in her personality and sense of deprivation was developing in her mind. She was scared of loud voices and feels fidgety and uncomfortable whenever she hear loud voice and by some time her this problem started occurring to hear any loud voice of any male even except her father. An association of loud voice with cruelty was developed in her unconscious level of mind and loud voice became stimulus for fear instinct. She thought that her father had worst behavior as compare to others. 

                Although after her marriage she had a happy life with a loving husband. Her husband is a loving person and both have been happy with each others. Her husband cares for her and tries to make her happy. When they got their first baby girl, her husband was also very happy to have a female child despite of traditional approach to have baby boy. He loves her daughter and very much caring for both of them. He usually spend time with them, plays with her daughter. Although her husband is a loving, caring and nice person but he has a bad habit that he also speaks loudly as this is the traditional habit of most of the males of their area so he also do the same. And his habit of speaking loudly again reminds her past life, before marriage in her own home, specifically pertaining to her father that how he speaks loudly. So, this was miserable position for her unconscious level of mind and her psychological problem kept increasing instead of being removed as to her husband behaves with her and their kids very nicely and in loving and caring manners.

Treatment:

After taking history of the patient from her own self, her husband, brother and mother and with consulting DSM-IV, it was diagnosed that the patient was suffering from Generalized Anxiety Disorder (GAD).

Stage-1

Stage-1 was consisted of first 30 sessions (5 sessions per week)

In first 7 sessions, I made cross questioning with her about her past history of her childhood and I focused behavior of her father specially in her childhood (1 year to 7 years) and it was clearly known that her father had much insulting and harsh behavior with her mother and even with my patient also which effected my patient’s personality and she started to face some psychological problem since her early childhood. It was also explored that whenever her father used to come back from his duty, patient was much conscious (careful) till her father remained present in home. During the period of her father’s presence in home, my patient was extra conscious and careful, definitely, this consciousness increased pressure on her nervous system and she felt burden on her shoulder although she felt much relax after her father again go to his duty. So the problem just occur only when her father remain present in home.

In next 7 session I analyzed her behavior during presence of her father in home and emotional effects during her father’s presence in routine as well as due to scolding, snubbing (in loud voice) or harsh behavior of her father with her or her mother. I also analyzed that how her unconscious level of mind perceives her father’s behavior and how it affected her unconscious level of mind. After cross questioning and analyzing it was found that her father’s harsh, insulting behavior and scolding them in loud voice was become a stimulus for her fear instinct. Although this has become a stimulus for her fear instinct but as well as it created the sense of deprivation, humiliation and indignity for which her unconscious level of mind reacted due to her feelings of anger and being humiliated but her these feelings was suppressed by her conscious level of mind due to same stimulus so she could never be able to express her anger and used to sob and weep in low voice when she was alone.

In next 7 sessions I asked her to write about two topics specifically, one is her father and loud voice of males. So initially I asked her to write about her father and while she was writing, she felt very difficulty to write about her father because her all symptoms were appeared like burden on her shoulder which showing resistance of her unconscious level of mind. Next day when I made cross questioning after analyzing her writing and her behavior, during this session of cross questioning, her all symptoms were again strongly appeared although consciously she tried to avoid any negative remarks about her father (this because of traditions, customs and religiously most people can’t be able to say anything negatively about their parents). In next session, I continued cross questioning with her about her father and at last she admitted that she did not like her father at all since her childhood. She also admitted that she disliked her father since her childhood and she has been keeping negative feelings and hate about her father since childhood even sometimes she had in her mind some abuses in very bad wording but she never expressed these sought of feeling to anyone else tried to get rid of these negative feelings consciously.

After this I asked her to write about loud voice of males specifically. During writing the about loud voice of males, same symptoms were appeared as appeared during writing about her father. After analyzing her writing, I made cross questioning to her in next session and it was known that the loud voice of males has been associated with her father being a stimulus by her unconscious level of mind because her father used to scold and humiliate her in loud voice so whenever she hear any male speaking anything in loud voice her symptoms were appeared. Her husband is very loving and caring husband for her and father for their kids but unfortunately her husband also use to speak in loud voice in routine not to show any anger but even he speaks in loud during normal and routine conversation. So loud voice of males has become a reference for her stimulus and her unconscious level of mind always used to associate every loud voice of any male with her stimulus. The loud voice of any other male, except her father, at any place even on road has become a reference for her stimulus. This reference also brings all symptoms which are associated with stimulus.

NEW ASPECTS

OF

PSYCHOTHERAPY

RESEARCH BASED ON CASE HISTORY

BY

MUHAMMAD ZAFAR IQBAL

ISLAMABAD

PAKISTAN

Introduction

Ms J, is wife of one of my best friends. He told me about his wife’s problem of sleeping disorder. After meeting with my friend, I met Mrs. J and asked about her problem. She told that she feels burden on shoulder and at the back of her head most of time. She complained to feel weakness also. She also told that she is also facing lack of concentration on her daily work, disturbance with loud voices of anyone, shivering of body without understanding any reason. She also complained about weak memory and negative dreaming which disturb her sleep. She also complaint fidgety and restless most of the time.

She went to some psychiatrists for her treatment because she had become very aggressive and started to throw things and whatever was in her physical approach. One of those psychiatrists recommended ECT for treatment and she took ECT but ECT affected her memory badly even she lost her memory for some nearest period of her life although she gets it back after my treatment.

Her treatment concluded in 50 sessions of approximately one hour and she was completely cured from her all psychological problems and now she is spending her life normal in home as well as in work station (School).

Symptoms

i)                     Sleeplessness

ii)                   Weak memory and lost of some memory of a specific time period due to ECT

iii)                  Burden on shoulder and at the back of her head

iv)                 Submissive behavior

v)                   Lack of concentration, confidence, will power and decision power.

vi)                 Hate with loud voices.

vii)                Shivering of body some time.

viii)              Aggressive when alone after ECT.

ix)                  Fidgety most of time

Assessment

                Since her childhood she was facing lots of psychological problem with behavior of her father who used to behave badly, strict and harsh to client. Even her mother had also been facing her father’s behavior since her marriage with his father. Mrs. J remembers that she saw her mother mostly weeping and unhappy with her life and due to her own problems she also never tried to give due attention, love and care to her daughter (Client) and she also behaved badly to Mrs. J. On his visit to home from job as he was a army person, how much time he spend his home was a tough time for both of these females i.e. client and her mother because he behaved badly, strict and always looked in a mood to taunt them, yelling at them, scolding them loudly and insulting them. 

                This behavior of her father and even her mother towards her made her deprived personality. And feelings of being deprived and ignorance effected badly in her personality and sense of deprivation was developing in her mind. She was scared of loud voices and feels fidgety and uncomfortable whenever she hear loud voice and by some time her this problem started occurring to hear any loud voice of any male even except her father. An association of loud voice with cruelty was developed in her unconscious level of mind and loud voice became stimulus for fear instinct. She thought that her father had worst behavior as compare to others. 

                Although after her marriage she had a happy life with a loving husband. Her husband is a loving person and both have been happy with each others. Her husband cares for her and tries to make her happy. When they got their first baby girl, her husband was also very happy to have a female child despite of traditional approach to have baby boy. He loves her daughter and very much caring for both of them. He usually spend time with them, plays with her daughter. Although her husband is a loving, caring and nice person but he has a bad habit that he also speaks loudly as this is the traditional habit of most of the males of their area so he also do the same. And his habit of speaking loudly again reminds her past life, before marriage in her own home, specifically pertaining to her father that how he speaks loudly. So, this was miserable position for her unconscious level of mind and her psychological problem kept increasing instead of being removed as to her husband behaves with her and their kids very nicely and in loving and caring manners.

Treatment:

After taking history of the patient from her own self, her husband, brother and mother and with consulting DSM-IV, it was diagnosed that the patient was suffering from Generalized Anxiety Disorder (GAD).

Stage-1

Stage-1 was consisted of first 30 sessions (5 sessions per week)

In first 7 sessions, I made cross questioning with her about her past history of her childhood and I focused behavior of her father specially in her childhood (1 year to 7 years) and it was clearly known that her father had much insulting and harsh behavior with her mother and even with my patient also which effected my patient’s personality and she started to face some psychological problem since her early childhood. It was also explored that whenever her father used to come back from his duty, patient was much conscious (careful) till her father remained present in home. During the period of her father’s presence in home, my patient was extra conscious and careful, definitely, this consciousness increased pressure on her nervous system and she felt burden on her shoulder although she felt much relax after her father again go to his duty. So the problem just occur only when her father remain present in home.

In next 7 session I analyzed her behavior during presence of her father in home and emotional effects during her father’s presence in routine as well as due to scolding, snubbing (in loud voice) or harsh behavior of her father with her or her mother. I also analyzed that how her unconscious level of mind perceives her father’s behavior and how it affected her unconscious level of mind. After cross questioning and analyzing it was found that her father’s harsh, insulting behavior and scolding them in loud voice was become a stimulus for her fear instinct. Although this has become a stimulus for her fear instinct but as well as it created the sense of deprivation, humiliation and indignity for which her unconscious level of mind reacted due to her feelings of anger and being humiliated but her these feelings was suppressed by her conscious level of mind due to same stimulus so she could never be able to express her anger and used to sob and weep in low voice when she was alone.

In next 7 sessions I asked her to write about two topics specifically, one is her father and loud voice of males. So initially I asked her to write about her father and while she was writing, she felt very difficulty to write about her father because her all symptoms were appeared like burden on her shoulder which showing resistance of her unconscious level of mind. Next day when I made cross questioning after analyzing her writing and her behavior, during this session of cross questioning, her all symptoms were again strongly appeared although consciously she tried to avoid any negative remarks about her father (this because of traditions, customs and religiously most people can’t be able to say anything negatively about their parents). In next session, I continued cross questioning with her about her father and at last she admitted that she did not like her father at all since her childhood. She also admitted that she disliked her father since her childhood and she has been keeping negative feelings and hate about her father since childhood even sometimes she had in her mind some abuses in very bad wording but she never expressed these sought of feeling to anyone else tried to get rid of these negative feelings consciously.

After this I asked her to write about loud voice of males specifically. During writing the about loud voice of males, same symptoms were appeared as appeared during writing about her father. After analyzing her writing, I made cross questioning to her in next session and it was known that the loud voice of males has been associated with her father being a stimulus by her unconscious level of mind because her father used to scold and humiliate her in loud voice so whenever she hear any male speaking anything in loud voice her symptoms were appeared. Her husband is very loving and caring husband for her and father for their kids but unfortunately her husband also use to speak in loud voice in routine not to show any anger but even he speaks in loud during normal and routine conversation. So loud voice of males has become a reference for her stimulus and her unconscious level of mind always used to associate every loud voice of any male with her stimulus. The loud voice of any other male, except her father, at any place even on road has become a reference for her stimulus. This reference also brings all symptoms which are associated with stimulus.

Whatever has been happening with my patient since her childhood lead her defense mechanism of unconscious level of mind to make a shelter against fear instinct? And this shelter is over consciousness about cleanness. She always remain over conscious about cleanness for example if she has cleaned her kitchen and after some time when she visits kitchen next time she was usually of the view that may be there is some incest in kitchen so she again started to clean everything in kitchen unnecessarily and if she has cleaned her home but she sees any little piece of litter/dust or garbage on anywhere in floor she must clean whole house anyway although her mother was not much conscious about cleanliness so she never try to instruct her about cleanliness and never ask her to clean her house or anything else since her childhood.

When I asked her to write about cleanliness and make cross questioning, she feel all problems and appears all symptoms as appeared during writing about references.

During last 9 session of first stage, I made cross questioning in broad view repeatedly about stimulus, references and shelter to strike her fear instinct again and again. Her behavior was getting rude and harsh and aggression level was much increased even in a session her unconscious level of mint resisted as much that her some senses like sense to hear and talk was suspended for almost 1 minute. She was not been able to listen and talk anything during this minute and this was a clear sign that when I tried to repeat it during cross questioning that her all problem/ symptoms caused by her stimulus, references and shelter and when I insisted to make her realize the fact, her unconscious level of mind resisted much forcefully and halted her senses for a while.

Stage 2

Session 31-50

In those sessions, I asked her to write about her stimulus, references and shelter again but this time I asked her to write only positive possibilities about her stimulus and references as there are many other reasons why a person can speak in loud voices so I tried to make her understand and write that what can be other possibilities of her stimulus and references and on the other side I asked her to write some negative aspects about her shelter that why she was so conscious about cleanliness and what happened if she does not repeat this practice again and again and why she felt so uncomfortable with a little bit dust on floor and what if she just clean that part of floor not the whole floor or when she sees an incest on any item in kitchen so what happens if she only clean that item not the whole kitchen.

Basically these negative associations with stimulus and reference, associated with the stimulus, are the main cause which suppressed her real personality and when with the help of writing and cross questioning, she explored the all other positive possibilities and her conscious level of mind have griped the positive aspects of stimulus and reference, the negative associations of stimulus and reference were removed from unconscious level of mind and when her unconscious level of mind became realistic about stimulus and references then automatically her unconscious level of mind don’t need any shelter anymore which it has made against those stimulus and reference and this scenario made her personality at normal.

Conclusion

1. Mrs. J was a patient of GDA
2. Basic reason was behavior of her father (Specially speaking in loud voice which became stimulus for her fear instinct).
3. Loud voice of any male became reference for her stimulus.
4. Unconscious level of mind (defense mechanism) made a shelter against stimulus and reference that is “over conscious about cleanliness”
5. Treatment could not be possible without deep analysis of her unconscious level of mind that what was the stimulus and references for fear instinct.
6. It was necessary to explore all positive possibilities about her stimulus and references (loud voice) to make her personality unsuppressed and make it at normal.
7. When all other positive possibilities were realized by her unconscious level of mind and negative association with stimulus and reference removed so there was no need of any shelter so the role of shelter was also wiped out.
8. Minimum 5 sessions per week required for treatment because if there was gap between each session and next session may not be conducted on consecutive day, the fear which was explored in one session may again suppressed and resistance level of the client may also again suppressed. So continuity in sessions without having gap is very important in treatment for proper cure.

Whatever has been happening with my patient since her childhood lead her defense mechanism of unconscious level of mind to make a shelter against fear instinct? And this shelter is over consciousness about cleanness. She always remain over conscious about cleanness for example if she has cleaned her kitchen and after some time when she visits kitchen next time she was usually of the view that may be there is some incest in kitchen so she again started to clean everything in kitchen unnecessarily and if she has cleaned her home but she sees any little piece of litter/dust or garbage on anywhere in floor she must clean whole house anyway although her mother was not much conscious about cleanliness so she never try to instruct her about cleanliness and never ask her to clean her house or anything else since her childhood.

When I asked her to write about cleanliness and make cross questioning, she feel all problems and appears all symptoms as appeared during writing about references.

During last 9 session of first stage, I made cross questioning in broad view repeatedly about stimulus, references and shelter to strike her fear instinct again and again. Her behavior was getting rude and harsh and aggression level was much increased even in a session her unconscious level of mint resisted as much that her some senses like sense to hear and talk was suspended for almost 1 minute. She was not been able to listen and talk anything during this minute and this was a clear sign that when I tried to repeat it during cross questioning that her all problem/ symptoms caused by her stimulus, references and shelter and when I insisted to make her realize the fact, her unconscious level of mind resisted much forcefully and halted her senses for a while.

Stage 2

Session 31-50

In those sessions, I asked her to write about her stimulus, references and shelter again but this time I asked her to write only positive possibilities about her stimulus and references as there are many other reasons why a person can speak in loud voices so I tried to make her understand and write that what can be other possibilities of her stimulus and references and on the other side I asked her to write some negative aspects about her shelter that why she was so conscious about cleanliness and what happened if she does not repeat this practice again and again and why she felt so uncomfortable with a little bit dust on floor and what if she just clean that part of floor not the whole floor or when she sees an incest on any item in kitchen so what happens if she only clean that item not the whole kitchen.

Basically these negative associations with stimulus and reference, associated with the stimulus, are the main cause which suppressed her real personality and when with the help of writing and cross questioning, she explored the all other positive possibilities and her conscious level of mind have griped the positive aspects of stimulus and reference, the negative associations of stimulus and reference were removed from unconscious level of mind and when her unconscious level of mind became realistic about stimulus and references then automatically her unconscious level of mind don’t need any shelter anymore which it has made against those stimulus and reference and this scenario made her personality at normal.

Conclusion

1. Mrs. J was a patient of GDA
2. Basic reason was behavior of her father (Specially speaking in loud voice which became stimulus for her fear instinct).
3. Loud voice of any male became reference for her stimulus.
4. Unconscious level of mind (defense mechanism) made a shelter against stimulus and reference that is “over conscious about cleanliness”
5. Treatment could not be possible without deep analysis of her unconscious level of mind that what was the stimulus and references for fear instinct.
6. It was necessary to explore all positive possibilities about her stimulus and references (loud voice) to make her personality unsuppressed and make it at normal.
7. When all other positive possibilities were realized by her unconscious level of mind and negative association with stimulus and reference removed so there was no need of any shelter so the role of shelter was also wiped out.
8. Minimum 5 sessions per week required for treatment because if there was gap between each session and next session may not be conducted on consecutive day, the fear which was explored in one session may again suppressed and resistance level of the client may also again suppressed. So continuity in sessions without having gap is very important in treatment for proper cure.