Case Studies

Case study for Feminist Theory

Stan’s fear of women and his gender-role socializa-tion experiences make him an excellent candidate to benefit from feminist therapy. A therapeutic rela-tionship that is egalitarian will be a new kind of experi-ence for Stan.Stan has indicated that he is willing and even eager to change. Despite his low self-esteem and negative self-evaluations, he is able to identify some positive attributes. These include his determination, his ability to articulate his feelings, and his gift for working with children. Stan knows what he wants out of therapy and has clear goals: to stop drinking, to feel better about himself, to relate to women on an equal basis, and to learn to love and trust himself and others. Operating from a feminist orientation, I will build on these strengths.

In the first session I focus on establishing an egalitarian working relationship to help Stan begin to regain his personal power. It is important that the therapeutic relationship does not replicate other rela-tionships Stan has had with significant figures in his life. I consciously work to demystify the therapeutic process and equalize the relationship, conveying to Stan that he is in charge of the direction of his therapy. I spend time explaining my view of the therapy process and how it works.A gender-role analysis is conducted to help Stan become aware of the influence of gender-role expecta-tions in the development of his problems. First, I ask him to identify gender-role messages he received while growing up from his parents, teachers, the media, faith community, and peers. In his autobiography Stan has written about some of the messages his parents gave him, and this provides a natural starting point for his analysis. He remembers his father calling him “dumb” and his mother saying, “Why can’t you grow up and be a man?” Stan wrote about his mother “continu-ally harping at” his father and telling Stan how she wished she hadn’t had him. He describes his father as weak, passive, and mousy in relating to his mother and remembers that his father compared him unfavorably with his siblings. Stan internalized these messages, often crying himself to sleep and feeling very hopeless.I ask Stan to identify the damaging self-statements he makes now that are based on these early experi-ences. As we review his writings, Stan sees how societal messages he received about what a man “should” be were reinforced by parental messages and have shaped his view of himself today. For example, he wrote that he feels sexually inadequate. It appears that he has introjected the societal notion that men should always initiate sex, be ready for sex, and be able to achieve and sustain an erection. Stan also sees that he has already identified and written about how he wants to change those messages, as exemplified in his statements that he wants to “feel equal with others” and not “feel apol-ogetic” for his existence and develop a loving relation-ship with a woman. Stan begins to feel capable and empowered as I acknowledge the important work he has already done, even before he entered therapy.I follow this gender-role analysis with a gender-role intervention to place Stan’s concerns in the con-text of societal role expectations.Therapist:Indeed, it is a burden to try to live up to so-ciety’s notion of what it means to be a man, always having to be strong and tough. Sometimes real strength comes through our vulnerability. Those aspects of yourself that you would like to value—your ability to experience your feelings, being good with children—are qualities society tends to label as “‘feminine.”Stan:[replies wistfully] Yeah, it would be a better world if women could be strong without being seen as domineering and if men could be sensitive and nurturing without being seen as weak.Therapist:Are you sure that’s not possible? Have you ever met a woman or a man who was like that?Stan ponders for a minute and then with some ani-mation describes the college professor who taught his Psychology of Adjustment class. Stan saw her as very accomplished and strong, but also as someone who empowered him by encouraging him to find his own voice through writing his autobiography. He also remembers a male counselor at the youth rehabilita-tion facility where he spent part of his adolescence as a man who was strong as well as sensitive and nurtur-ing. I ask Stan if there are other people in his life now who might support his efforts to be more accepting and affirming of his androgyny.As the first session draws to a close, I invite Stan to talk about what he learned from our time together. Stan says two things stand out for him. First, he is beginning to believe he doesn’t need to keep blaming himself. He knows that many of the messages he has received from his parents and from society about what it means to be a man have been undesirable and one-dimensional. He acknowledges that he has been lim-ited and constrained by his gender-role socialization. Second, he feels hopeful because there are alternatives to those parental and societal definitions—people he admires have been able to successfully combine “mas-culine” and “feminine” traits. If they can do it, so can he. I ask Stan whether he chooses to return for another session. When he answers in the affirmative, I give him W. S. Pollack’s (1998) book Real Boys to read. I explain that this book descriptively captures the gender-role socialization that many boys experience.Stan comes to the following session eager to talk about his homework assignment. He tells me that he gained some real insights into his own attitudes and beliefs by reading Real Boys. What Stan learned from reading this book leads to a further exploration of his relationship with his mother. He finds it helpful to understand his parents’ behavior in the context of soci-etal expectations and stereotypes rather than continu-ing to blame them. I help Stan to see how our culture tends to hold extreme positions about mothers—that they are either perfect or wicked—and that neither of these extremes is true. We talk briefly about what he has learned about mothers as saints or sinners. As Stan learns to reframe his relationship with his mother, he develops a more realistic picture of her. He comes to realize, too, that his father has been oppressed by his own socialization experiences and by an idealistic view of masculinity that he may have felt unable to achieve.Stan continues to work at learning to value the nurturing and sensitive aspects of himself. He is learn-ing to value the “feminine” as well as the “masculine” aspects of his personality. He continues to monitor and make changes in his self-talk about what it means to be a man. He is gaining awareness of these messages that come from current sources such as the media and friends, and each day he adds to his journal, noting how these messages are transmitted and the ways that he is challenging them.Throughout our therapeutic relationship, we discuss with immediacy how we are communicating and relating to each other during the sessions. I am self-disclosing and treat Stan as an equal, continually acknowledging that he is the “expert” on his life.

Case study for Choice and Reality Therapy

As a reality therapist, I am guided by the key con-cepts of choice theory to identify Stan’s behav-ioral dynamics, to provide a direction for him to work toward, and to teach him about better alternatives for achieving what he wants. Stan has not been effective in getting what he needs—a satisfying relationship.Stan has fallen into a victim role, blaming others, and looking backward instead of forward. Initially, he wants to tell me about the negative aspects of his life, which he does by dwelling on his major symptoms: depression, anxiety, inability to sleep, and other psy-chosomatic symptoms. I listen carefully to his con-cerns, but I hope he will come to realize that he has many options for acting differently. I operate on the premise that therapy will offer the opportunity to ex-plore with Stan what he can build on—successes, pro-ductive times, goals, and hopes for the future.After creating a relationship with Stan, I am able to show him that he does not have to be a victim of his past unless he chooses to be, and I assure him that he has rehashed his past miseries enough. As counsel-ing progresses, Stan learns that even though most of his problems did indeed begin in childhood, there is little he can do now to undo his childhood. However, he can adopt a different perspective on his past experi-ences and the meaning they hold for him today. He eventually realizes that he has a great deal of control over what he can do for himself now.I have Stan describe how his life would be differ-ent if he were symptom free. I am interested in knowing what he would be doing if he were meeting his needs for belonging, achievement, power, freedom, and fun. I explain to him that he has an ideal picture of what he wants his life to be, yet he does not possess effective be-haviors for meeting his needs. I talk to him about all of his basic psychological needs and how this type of therapy will teach him to satisfy them in effective ways. I also explain that his total behavior is made up of acting, thinking, feeling, and physiology. Even though he says he hates feeling anxious most of the time, Stan learns that much of what he is doing and thinking is directly leading to his unwanted feelings and physiological reac-tions. When he complains of feeling depressed much of the time, anxious at night, and overcome by panic at-tacks, I let him know that I am more interested in what he is doing and thinking because these are the behavioral components that can be directly changed.I help Stan understand that his depressing is the feel-ing part of his choice. Although he may think he has lit-tle control over how he feels, over his bodily sensations, and over his thoughts, I want him to understand that he can begin to take different action, which is likely to change his depressing experience. I frequently ask this question, “Is what you are choosing to do getting you what you want?” I lead Stan to begin to recognize that he does have some, indirect control over his feelings. This is best done after he has made some choices about do-ing something different from what he has been doing. At this point he is in a better place to see that the choice to take action has contributed to feeling better, which helps him realize that he has some power to change.Stan tells me about the pictures in his head, a few of which are becoming a counselor, acting confident in meeting people, thinking of himself as a worthwhile person, and enjoying life. Through therapy he makes the evaluation that much of what he is doing is not get-ting him closer to these pictures or getting him what he wants. After he decides that he is willing to work on himself to be different, the majority of time in the ses-sions is devoted to making plans and discussing their implementation. We both focus on the specific steps he can take right now to begin the changes he would like.As Stan continues to carry out plans in the real world, he gradually begins to experience success. When he does backslide, we talk about this and together help him fine tune his plan. I am not willing to give up on Stan even when he does not make major progress, and Stan lets me know that my support is a source of real inspiration for him to keep working on himself.I teach Stan about choice theory and encourage him to do some reading that can stimulate his think-ing about changes in his life. Stan brings some of what he is learning from his reading into his sessions, and eventually he is able to achieve some of his goals. The combination of working with a reality therapist, his reading, and his willingness to put what he is learn-ing into practice by engaging in new behaviors in the world assist him in replacing ineffective choices with life-affirming choices. Stan comes to accept that he is the only person who can control his destiny.