Assignment 1
Three different case scenarios:
Scenario 1 – “Betty” Betty is a 39 year old single woman of Filipino origin living in Vancouver. She works as an Operational Assistant for an aircraft charter company. She has her Mother living close and an estranged Father. She is the older of the only other sibling being her Brother and has strong family ties to aunts and cousins. She is in good health and exercises obsessively. She does not use drugs but drinks to the high end of social norms. Betty describes her childhood environment as abusive. Father would drink and physically abuse her Mother. Betty has vivid recollections of getting up in the morning and seeing blood on the walls. Betty is resistant and evasive when asked if she was abused by her Father. Betty relates of an instance when she was a young woman that caused her inability to walk alone on the street for several months. She evades providing any details of that instance. In past relationships Betty has had episodes of regression and transference in the event of confrontations. Betty has had therapy previously where she was diagnosed with Histrionic Personality Disorder. She quit after two sessions because she felt there was no progress being made. She also didn’t like the counsellor who was a woman.

Betty is unable to maintain an intimate relationship for anything longer than two or three months. She believes those relationships to be more intimate than they are. She also is sexually promiscuous and is constantly seeking attention and dresses provocatively. Betty becomes frustrated when she feels she is not the center of attention. She is known to have inappropriate outbursts of sexual context and not remember. Interactions with men are sexually charged and flirtatious. Betty says that she has difficulty getting along with other women. She exhibits exaggerated emotional states and shifts quickly between them. Betty’s primary complaints are that she feels depressed, and at times unexpectedly becomes overwhelmed with sadness. She feels there is always something missing in her relationships and generally feels “used” by men. At 39 years old she thinks her looks are diminishing and will no longer be able to attract men. Betty also believes she will never be able to have a long lasting relationship where she would be able to have a child. Her last boyfriend accused her of being “emotionally manipulative” and “immature”. Betty is outraged by these accusations but at the same time desperately motivated to understand why someone would say those things. Betty is reaching out for help with her issues but doesn’t know where to start.
For Betty a primarily psychoanalytic context would be appropriate with integrated CBT techniques. A general approach initially until specific issues can be identified and then treated. I feel that working with Betty will take a lot of time requiring many sessions. Firstly, developing the Client Counsellor relationship will take time based on Betty’s distrust of men and difficulty relating to other women. Betty is quite intelligent therefore a realistic matter of fact approach with lots of support is important. Emphasis on boundaries in relationships should be made clear based on her sexuality and manipulative behaviour. I would be reluctant to challenge Betty’s resistances too soon and develop rapport while clarifying her issues.
Working with Betty within a psychoanalytic frame first, will be more beneficial than any behavioural interventions as she unlikely has any connection to her unconscious. Once Betty better understands her unconscious motivations and becomes more self-aware, the behavioural issues can be tackled. My experience with Betty in challenging her behaviours leaves her confused as she has no connection to the motivations. By examining Betty’s shifting state of mind she will gain increased self-awareness and hopefully reduce her emotional volatility. I would exploit her tendency to