Personality Development & Treatment Paper: Emilio’S History Of Presenting Problems

The client, Emilio, is a 34-year old Ecuadorian American. His older brother Juan is 37, while his two younger siblings Isabel and Miguel are 30 and 28 years old respectively. His parents have lived in America for the past 42 years. Emilio was fired recently from work and he believes he was laid off because of rumors about his drinking at work. His performance at work had been deteriorating over the past several months and he had been reprimanded twice over the last month for accounting errors that had cost the company some money. He had also missed work a few times due to drinking too much the night before. While he admits that he does drink excessively at times, he states that he has had no DUIs and does not have a criminal record. His girlfriend broke up with him recently due to his excessive drinking at parties, and his excessive need to “fit in” at these events.

Emilio mentions that his older brother Juan, who he looks up to as a role model, had similar problems with drinking, but was able to quit drinking and he believe that he will be able to do that as well. He feels that he doesn’t measure up to his siblings as he sees them as quite successful, either in their careers or in their personal relationships. He feels that his parents don’t have much praise for him or care about him, compared to their other children. He is now apprehensive about asking to move in with his parents, as it might disappoint them, like his recent breakup. In his own words, he identifies himself as ‘never good enough’ in his parents’ eyes and not being able to measure up to anyone’s expectations of him. He believes that he must do great things to be acceptable, but he is feeling pressured by this. Several components of the client’s self-concept emerge from this case description. On his intake form, he had answered yes to drinking problems, but insists on clarifying with the therapist what he meant by that. This could mean that while Emilio understands that he does have a drinking problem, he fails to understand the magnitude of the problem. He further clarifies that he has had no run-ins with the law, so his drinking can’t be a big issue. He fails to understand the impact his drinking has had on his personal life and his work. He seems to be in a state of denial.

Another perspective is that he wants the therapist’s approval and hence clarifies that he has had no legal trouble. It can further be inferred, that although he drank excessively on occasions, it was only after his breakup that his drinking started impacting his work significantly. I’d recommend that Emilio must first come to terms with reality and understand the magnitude of his drinking problem and how it has harmed his personal and professional life. In this case, a therapeutic intervention will empower him and help him gain insights into his current situation. Following this, a therapeutic intervention to challenge his distorted beliefs and promote desirable behavior can be implemented.

The Person-Centered perspective

According to Rogers (1959), human beings have an underlying ‘self-actualizing’ tendency where they have an innate tendency to manifest their potential. He believed that for an individual to achieve self-actualization, he must be in a state of congruence in the three areas of self-worth, ideal-self and self-image. Central to the Rogerian theory is the notion of self-concept, which are the organized, consistent perception patterns and the beliefs one holds of their own self. Rogers maintains that individuals want to behave, feel and experience in ways that are consistent with their self-image and which reflect what they would like to be their i. e. ideal-self. Higher the overlap between self-image and ideal-self, higher the self-worth of the individual. The person will be in a state of incongruence when their totality of experience is unacceptable to them and is distorted in their self-image. In Rogers’ view, a child has two basic needs - self-worth and positive regard from other people. He suggested that feeling of self-worth is constructed in early childhood, from the interaction of a child with its parents. As the child grows, interactions with significant others and their evaluations will affect the child’s feelings of self-worth. He also emphasized the need to be regarded positively, and to feel respected, valued and be treated with affection. According to Rogers, individuals who received unconditional positive regard from their parents and friends in childhood are more likely to self-actualize.

On the contrary, individuals who experienced conditional positive regard as a child are more likely to seek approval frequently from others. The person-centered approach also rests on the belief that the necessary conditions to bring about therapeutic change lies on the quality of the therapeutic relationship. To increase the client’s growth force, the attributes of empathy, unconditional positive regard and genuineness need to be communicated in therapy.

Emilio’s identity and value systems are strongly influenced by his family, especially his parents. He has allowed others to determine his self-worth and believes that he needs to live up to the highest standards, to win the approval of others. When he doesn’t feel that he’s able to achieve his goals or live up to his conditions, his self-worth diminishes. His ideal-self centers around being the version of himself that his parents are proud of. His future is vague, he has always looked up to his older brother and because he too struggled with the drinking habit and quit it, that he would also eventually be that way. His capacity to move forward is limited by his lack of self-worth and believes he needs to try hard to fit in everything. Consequently, he is inclined to look to others especially by comparing himself with his brother Juan for directing and guiding his life. He does take responsibility for his actions, especially his drinking behavior. He attributes his failures to the lack of unconditional positive regard from his parents during childhood that has resulted in him trying too hard to fit in. Person centered therapy would evoke autonomy and motivation in Emilio as this strength-based approach would allow him to tap into his inner strength, empowering him and increasing his self-awareness and self-esteem. His dissatisfaction with his life has made him succumb to alcohol to cope with his distress. Therefore, this approach can work if the therapist establishes a relationship with him that communicates empathy and unconditional positive regard, this will enable him to engage in self-exploration and ultimately become his true self. He will begin to understand that for him to be accepted, he needs to first fully accept himself and take responsibility for his life.

The goal of this approach is to create a threat-free therapeutic climate, where he is fully accepted by the therapist. He needs to be reassured that he has resources within himself to become the person he really is, apart from what others have expected him to be. Therapeutic change will manifest in his ability to be more open to experience, his internal source of evaluation and enhancing his awareness of himself, eliminate feelings of distress, increase the ability to trust himself and his willingness to live more spontaneously. The immediacy of the therapeutic relationship will encourage Emilio to explore the conflicts between who he wants to be and who he is right now, thereby increasing his self-awareness. He will be more in touch with his surroundings and his own feelings, reducing the need to deny the experience. The therapist will empower him to set effective goals for therapy since only he knows his problems best, thereby empowering his actualizing tendency. Since he must already be struggling with feelings of low self-worth, the therapist should let him know that they accept him fully for who he is and will not reject him. If the therapist presents himself to the client as he really is, the genuineness of the therapist will further increase Emilio’s trust on the therapist and he would feel safe to share his feelings and bring about more insight into his drinking habits.

The Gestalt Perspective

Perl’s famous quote that individuals are not in the world to live up to others’ expectations, nor should the world feel obligated to live up to the individual, is very apt for Emilio. Gestalt therapy believes that individuals cannot exist separate from their environment or from their interpersonal relations. The boundary between the individual and the environment must be permeable in nature to allow for interaction, yet stable enough to promote autonomous action. When this boundary becomes unclear or impermeable, dysfunction results. The individual is viewed as self-regulating who can motivate themselves to problem solve. If their environments permit, individuals will have increased growth and develop effectively. Cornini and Wedding (2000) explain that a psychologically healthy individual has the capacity to self-regulate though life’s changes and has ultimately developed a sense of wholeness between the body and mind. The Gestalt view of human nature is that, through becoming fully aware of what is happening within and outside oneself in the here and now, the individual learns to deal with their problems. This perspective also demonstrates that, problems usually arise when a person tries to be someone they are not. Inauthenticity and living with a mask do not promote change in the individual, moreover, it promotes a stagnation in personality. Change happens when the individual integrates a disowned part of their self into their mix of identity. The unification process of re-owning the parts of the self that have been disowned leads to them becoming strong enough to move toward their personal growth. So, the client needs to be aware of what they are and in their current position, as opposed to becoming a person they are not. Reliving the past or being anxious about the future hinders the individual’s potential to be authentic and not come to terms with who they are. In the case of Emilio, for much of his life, he has concentrated on what his parents have expected him to be. While operating on that mode, he has neglected being in the present moment and lost insight of what is triggering him toward drinking. Being a 34-year-old man and single wouldn’t be the regular scenario in his culture especially when he has two younger siblings who are settled in life, nor would living with his parents because he lost his job. He is afraid that he can’t measure up to anyone’s expectations and that he is unsuccessful in comparison to his siblings. He also assumes he lacks the inner resources, so looks to alcohol as a form of support which becomes his dependency. Self-actualization occurs only when an individual gradually becomes fully aware of the entirety of themselves and not just parts. Emilio isn’t aware of the greater parts of himself where he has had accomplishments and only identifies with the lesser parts of himself where he feels he is inadequate. He was so strongly influenced by being successful and proving himself to be great in others’ eyes that an event like being fired triggered a crisis.

The therapeutic objectives here is for the therapist to promote an increased awareness for the client by empowering him. With awareness, Emilio will be able to identify the aspects of himself which were denied and move toward an integration of the many facets within himself. He will begin to gradually assume responsibility of his experience. The therapy will facilitate the necessary interventions to help increase his awareness and insight of his thoughts, feelings and actions in the present. During therapy, he will be able to express the feelings of not receiving the appreciation he believes was due for him through expressing his moment-by moment experience so that his energy is released to enable creative pursuits instead of being utilized on defenses which are growth -inhibiting. For example, interventions which target the intensification of his here-and-now experiencing would be implemented. Although he must feel anger, through the session, the therapist can gauge whether Emilio has kept these feelings locked within himself, which is getting in the way of him feeling empowered. It is essential that the therapist shouldn’t impose his own agenda and making his own interpretations, cues should be derived from what Emilio says during the session. The cues will provide a base for constructing experiments that will enable the heightened feelings during the session. Some of the experiments that can be carried out for him will be, dramatizing a painful memory with his parents or setting up a dialogue and role play with a significant other from his life. Through this experiential learning, he will recognize the blocks to development, and he can start experimenting with his different choices. He will be invited to try new behavior and see what insights these experiments provide for him. Through the sessions, the polarities within him will also surface, like his parents’ expectations of him, but whether he wants the same for himself and is comfortable in trying so hard all the time.

The Cognitive Behavioral Perspective

CBT is based on the idea that how an individual think, feels and acts all interact together. Specifically, thoughts determine feelings and behavior. This perspective believes that individuals’ abnormality stems from their faulty cognitions about the world. The faulty thinking is attributed to cognitive deficiencies which are the result of lack of resources, or cognitive distortions which are because of the incorrect processing of information, these cognitions cause misinterpretations in the way the individual sees things. Ellis proposed that it is through irrational thinking, while Beck advocated the cognitive triad. The cognitive distortions are identified through evaluation and the client learns to recognize, analyze and monitor disruptive thoughts the behavior part of therapy consists of tasks and homework exercises given by the therapist which will enable therapeutic change. So, in the case of Emilio, his interpretations of situations and self-defeating illogical patterns of thinking, cause him great anxiety for him. In the situation at work, although he wasn’t the only one to be fired, he believed that he was singled out because of the rumors at work. This indicates the cognitive distortion of personalization, where he feels that everything others do and say is a direct personal reaction toward him. This is also demonstrated in his comparisons with his siblings when he says that his younger brother Mike was better taken care of by his parents because of his socially charming personality.

Another distortion being, his all-or-nothing thinking, that if he isn’t successful and does great things, he wouldn’t be accepted by others. He also indulges in catastrophizing and overgeneralizing certain events in his life like his parent’s dearth of praise after making the honor roll which could have been just one isolated event. He has come to a general conclusion that his parents ‘always’ went out of their way to accommodate his other siblings and appreciated them more in comparison. Emilio also uses a lot of extreme language like always and never in excessive amounts, which is another example of catastrophizing distortions in him. He also seems to have some unacknowledged irrational beliefs that everyone has expectations of him which he always needs to measure up. If he can effectively acknowledge his various irrational beliefs, therapeutic change will manifest during the sessions.

The objective of therapy would be to assist Emilio in learning to replace his irrational self-defeating beliefs with more productive beliefs. To accomplish this goal, Ellis (1957)’s ABC model of personality can be utilized. The model is based on the premise that the activating event does not cause the emotional consequences but rather it is his beliefs about the activating event which is the source of his problems. Emilio can be taught to diligently apply self-challenging techniques which will free himself of the defeatist thinking that led to his problems of low self-esteem. Further, behavioral homework assignments will force him to confront some of his faulty beliefs which has led to some of his personifying and catastrophizing behavior. Effective treatment exercises like Self-affirming thoughts, where he can write a list of things he loves about himself and recites it on a regular basis in front of the mirror would also benefit the client.

Another goal of therapy would be to free him of the alcohol use behavior, where the therapist can develop a reward system to address his occasionally drinking excessively. He can be taught to manage frustration of his inadequacy and not being successful in his life more positively like by doing things he likes like going to the gym, engage in volunteering work or practicing meditation. He can also improve his decision-making skills like making short to do lists for the day or using positive self-talk and journaling. The positive self-talk will also increasingly improve his self-image. He can also work on his ‘trying too hard’ behaviors by purposely putting himself in a situation, where he will completely refrain from being complaisant.