Psychology: A Case Study Of Jerry's Psychodynamic Approach

a. Throughout the case description, Jerry listed multiple things he experiences fear or startle responses from. First, he stated that he does not share his war experiences with his family because he is afraid that they will leave him and think he is a monster, which may be associated to not sharing his thoughts and feelings with anyone else in his life. Second, Jerry sought psychotherapy because of anger dysregulation and insomnia, both of which may be secondary to his doctor’s recommendation that any undue stress could cause his condition to worsen. Therefore, I hypothesized that he is afraid of his health decreasing, which can be associated to a fear of losing his autonomy, feeling like he is worthless, and subsequently dying. Third,
Jerry expressed that he avoids nightmares, which led me to believe he has a fear of his nightmares, which can be associated to his insomnia, and/or a fear of daydreaming (why he keeps himself busy throughout the day). Fourth, Jerry’s reaction to the firework show demonstrated he has a fear of fireworks, which can be associated to loud sounds, a car backfiring, and gunshots. Fifth, Jerry stated that he experiences anxiety from the red tail lights on cars at night, this fear may be associated to laser pointers, bright signs (e.g., beer signs at bars), seeing a movie, being in dark rooms, and/or stop lights.
b. Since Jerry expressed multiple fears, he engages in certain behaviors that help him avoid confronting those fears. For example, Jerry avoided talking to his wife and family about his wartime experiences. In addition, to avoid experiencing his emotions he drinks excessively. Moreover, in an attempt to avoid experiencing his nightmares, Jerry avoids sleep. Another maladaptive behavioral response is Jerry experiencing anger dysregulation, which results in him lashing out at his wife.
c. In addition to his fears and behavioral responses, Jerry experiences multiple cognitions that perpetuate those fears and behavioral responses. First, Jerry believes that “I can’t get close to anyone” because, if he did, they would find out that he is a “monster”. In addition, Jerry believes he is a “horrible” and “evil” person, as a result of his wartime experiences, and, as a result, he believes he needs to be punished. Finally, he avoided telling his family about his war time experiences because he believes “they can’t handle it” and that they will leave him if they find out who he truly is.
d.
When looking at and configuring Jerry’s fear structure, I used a bottom-up approach to better understand his PTSD symptoms. Specifically, I began by writing down his fears (i.e., nightmares, fireworks, decreased health, red tail lights on cars, and sharing his war experiences with others), which is the most basic level of the fear structure. After that, I noted his behavioral responses to those fears (i.e., lashing out at his wife, and avoiding sleep, emotions, and talking about his wartime experiences). Last, I recorded his cognitions associated to his fears and/or behavioral responses (i.e., I’m going to hell, I can’t get close to anyone, they can’t handle it, they’ll think I’m a monster, I’m a horrible/evil person, I can’t let my guard down, and I deserve to be punished). As noted by the double-sided arrows in the picture, each component of the fear structure (i.e., fears, behavioral responses, and cognitions/meaning) are interconnected. The fears of certain things/situations lead to certain behaviors (e.g., avoiding his fears), which leads to developing cognitions about the fears. Similarly, Jerry’s cognitions about his traumatic experiences cause him to behave in a certain way, which reinforces his cognitions and behaviors and leads to him developing specific fears related to his traumatic experience, and then generalized to other associated things, situations,
etc.