Academic journal article Indo - Pacific Journal of Phenomenology

A Phenomenological Case Study of the Therapeutic Impact of Imagery: Rescripting of Memories of a Rape and Episodes of Childhood Abuse and Neglect

Academic journal article Indo - Pacific Journal of Phenomenology

A Phenomenological Case Study of the Therapeutic Impact of Imagery: Rescripting of Memories of a Rape and Episodes of Childhood Abuse and Neglect

Article excerpt

This paper presents a systematic case study of the psychological assessment and treatment of Anna, a 43-year-old white health professional who, as a child, had experienced neglect and emotional abuse and, at age 18, had been the victim of a drug facilitated sexual assault (DFSA). In terms of the DSM-IV-TR (American Psychiatric Association, 2000) she met criteria for Posttraumatic Stress Disorder (PTSD), Major Depressive Disorder (MDD), Social Phobia (SP) and Avoidant Personality Disorder (APD) (see Diagnostic Considerations section).

Fosha (2009, p. 173) has emphasised the importance of "elucidating the phenomenology of emotion-based transformational experience" which is an open ended organic process that is set in motion by experiential interventions. These were used with Anna within an integrative model that incorporated cognitive therapy and Schema Therapy (ST). Psychotherapy provides a naturalistic setting in which therapists collaborate with clients in investigating the nature and underlying processes contributing to problematic experiences. Systematic case studies provide a means of studying psychotherapy. Moreover, at the heart of a systematic case study is a narrative that portrays significant features of the phenomenology of the client's problematic experiences, of the experience of working with them in therapy and of the impact of aspects of the therapy on the client's evolving sense of self. Such studies document a process in which the client's initial experience, which is often opaque and not understood, is investigated and allowed to unfold in a manner that discloses its deeper nature (Finlay, 2011).

In systematic case studies, following an initial assessment, a case formulation is derived that is based on existing theory, where appropriate. This formulation guides the therapist's approach to working with the client. As the story of the case develops, it allows for an examination of the existing theory and the extent to which it does justice to the phenomenology of the client's emerging experience. This means that such studies are of significant practical utility in that they can directly inform future clinical practice (Padmanabhanunni & Edwards, 2012).

Anna: A brief history

In order to provide a context for what follows, a synopsis of Anna's history and presenting problems is presented here. Anna (43) was raised in a punitive and neglectful home environment where her narcissistic mother persistently criticised and shamed her at home and in public while her father dismissed or belittled her need for comfort and reassurance. To preclude criticism and ridicule, Anna relinquished activities she enjoyed, including drawing and painting, and often secluded herself in her bedroom. As a child, she sought companionship with her older brother, Paul, but he was emotionally and physically abusive towards her. He regularly inflicted bruises on Anna which her mother ignored, attributing them to her daughter being a clumsy child. In school, Anna had difficulty approaching or initiating social interactions, fearing she would 'stuff up', say something 'stupid' and 'be laughed at'. She also dreaded being asked questions in class by her teachers. Anna experienced early physical maturation and was either mocked by her peers or exposed to inappropriate sexual remarks. To avoid the possibility of being called upon in class and the unwanted attention from peers, she started absconding from school and studied at home. During adolescence, she developed no close friendships and experienced this time as an intensely lonely period in her life.

After completing high school, and in order to escape her home environment, Anna visited a holiday resort where she was invited to a party. Despite feeling socially anxious, she decided to attend and savour the experience of being away from home. She drank one soft drink, spent time on the dance floor and tried to interact with some of the people present. She was approached by an older man who asked about her age and whether she was alone. …

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