Psychodynamic Case Study Summary

The case of “Paula” presents a 51-year-old divorced Caucasian female with persistent symptoms of depression and anxiety. Her symptoms are related to her failed career ambitions, stress about work and difficulties in relationships. Despite years of treatment her symptoms have persisted. She has worked with therapists in both cognitive-behavioral and psychodynamic modalities. This treatment overview presents an existentially based treatment approach. In addition, other therapeutic approaches the client was familiar with were integrated in order to amplify previous gains made in therapy and with the hope of adding context and meaning to the interventions.
The client suffers from chronic depression known as Dysthymic Disorder and Generalized Anxiety

The aforementioned existential exploration was integrated with psychodynamic examination of core identity issues and cognitive behavioral therapy to address thoughts and core beliefs that contributed to the client’s symptoms. I appreciated how seamlessly the therapist was able to integrate these three modalities and although I found portions of the psychodynamic a bit heavy handed (e.g. putting constant pressure on a client’s defenses). However, I do think that the interventions were a near perfect fit for the client’s symptoms and goals. The collaborative nature of treatment was underscored with the case explicitly mentioning Paula’s co-constructed goals that included symptom reduction, interpersonal improvement, and returning to the creation of art. This was paired with the therapist’s insight into the client’s need to further explore, understand and accept her identity and reconcile difficulties from the past. I enjoyed that the case noted that existential theory puts forth the notion that the reasons for depression can vary from person to person. Part of what I enjoy about this concept is the need to explore client perceived causes rather than primarily focusing on cognitions. Along the same lines I was impressed to read that empirically based clinicians have shown that the efficacy of cognitive therapy can be improved when the client’s existential questions are explored (Addis & Jacobson,