Problem Identification
Tom is a 30-year-old unmarried male currently employed as a junior faculty member at a prominent eastern university. For the last 4 months, Tom has resided with a previous female student he had mentored while she was a graduate student. While fond of this female, Tom has difficulty maintaining a long-term relationship, causing him to become increasingly irritable in relation to his current living arrangements with this woman. Tom desires this woman to find an alternate place to live, however, is unable to verbalize his request leading to frequent arguments between the two of them. This frustration has resulted in Tom feeling increased irritability, and decline in his sexual desires. Tom is only able to achieve sexual satisfaction with women he describes as being “frigid”. In addition, Tom is a successful teacher admired by his students, when required to work independently he lacks motivation to follow-through with goal-oriented tasks. This has prevented him advancing professionally by completing the final editing and review of his doctoral thesis or presenting his thesis to the doctoral committee.
Tom’s lack of follow-through in fulfilling his Ph.D. degree, and the ability to achieve intimacy in personal relationships is most likely a result of unresolved conflicts surrounding Tom’s phallic stage of psychosexual development.
Problem Origin
Prior to Tom’s birth, his mother, a hypochondriac, had been cautioned by doctors to not have children due to physical conditions. Against medical advice, Tom’s mother chose to become pregnant with Tom resulting in a difficult labor. Depleting his mother physically and emotionally, Tom’s mother suffered from prolonged exhaustion following his birth. In addition, Tom’s father, a small business owner, most likely was often absent from the home attending to the business leaving Tom’s mother to be the primary caregiver. Her prolonged emotional unavailability would have significantly impacted Tom’s early oral stage of psychosexual development resulting in maternal deprivation and lack of oral gratification. Due to Tom’s inability to form a secure attachment base to either parent, particularly his mother, would have resulted in Tom’s basic id impulses not being satiated and being insecure of his surroundings creating feelings of anger, jealousy, anxiety, and a drive to obtain his mother’s affections.
[bookmark: _Hlk38927399]However, later in the oral stage and towards the beginning of the anal stage of Tom’s psychosexual development his mother appeared extremely attentive to meeting his basic needs of ensuring he was well nourished, and maintained a neat appearance. Tom was fully potty trained by 18 months of age, potentially as a result of his mother being hyper focused on Tom’s development. Tom’s early potty training most likely was due to his mother’s disgust resulting in an unpleasurable anxiety driven libido. As a result, Tom unconsciously developed a sense of being displeasing to his mother.
During the phallic stage of Tom’s psychosexual development at the age of 5-years-old, he began to exhibit disobedient behaviors, especially towards his mother. Tom began elementary school during this time, and due to his mother’s illness was not present with Tom on his first day of school. Tom’s need for his mother’s affections are so deep his drive to satiate his need is obtained through aggressive behavior resulting in negative attention when he is disobedient.
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This stage also coincides with Tom’s mother expecting another baby. Tom’s “Oedipus Complex” and desire of not wanting to share his mother with another resulted in Tom exhibiting aggressive behavior of pointing a ray gun towards his mother’s belly symbolizing Tom’s unacceptance of an additional child to be shared by his mother and his internal wish for the baby to disappear. Months following, Tom’s mother suffered a miscarriage. Tom had witnessed blood on the bathroom floor, and his mother being taken to the hospital. Tom consciously sensed something terrible had happened to the baby, and secretly is relieved when his mother returned from the hospital with no infant. Tom unconsciously believes he had been responsible for this death due to his “wishful desire” of being an only child.
Tom associated his mother’s pregnancy with “her being ill”, and not being present resulting in a desire of eliminating any obstacle standing between he and the object of his desires, being his mother’s affection. This most likely resulted in Tom’s internalizing unconscious thoughts of guilt and self-blame for his “unacceptable desires”. In order to protect his conscious mind these thoughts were repressed resulting in conflict between Tom’s id and super ego. While Tom academically excelled and received acceptance through his peers, his mother’s affections are were only provided to Tom when he suffered reoccurring respiratory infections. Tom’s desires were satiated by his mother’s hyper focus of on Tom is during these times of illnesses. During this Tom also becomes preoccupied by fantasies of “Jack and the Bean Stalk”.
Due to Tom’s unresolved “Oedipus Complex” his oral and anal impulses are repressed. His sexual energy is applied to his academics. However, Tom’s avoidance of contact sports, and frustration with females are a result of these repressed memories. Unresolved internal conflicts arise creating energy in need to be released. Unconsciously this energy is released through Tom’s acts of stealing relating to his fantasies during the phallic stage of psychosexual development. This unresolved conflict of Tom’s “Oedipus Complex” results in an unconscious fixation and preoccupation focused on the character Jack stealing the giant’s money. Tom’s unconscious idealization of this character resulted in Tom living out fantasies by engaging in stealing pocket change from his father, and stealing bills placed by his father in his mother’s pocket book. Tom sought gratification of his unmet desires through his aggression by stealing, living out his fantasy reality. This resulted in Tom’s aggression being displaced through stealing representing his forbidden desires towards his mother, and receiving pleasure of being the only object of her affection. Tom’s growing hostility towards his father is symbolized, and acted out by Tom stealing from his father symbolizing “defeating” the giant (his father). By defeating his father, Tom has no other opponents to contend with for his mother’s affections. While, at the same time, Tom unconsciously fears his father due to his forbidden desires and fears he will be castrated or punished by his father.
During Tom’s genital stage of psychosexual development of adolescence, Tom’s academic performance begins to decline. While Tom experiences normal adolescent sexual desires towards the opposite his repressed memories and repressed aggressive emotions towards his mother are further deepened when Tom experiences his first rejection at 14 years-old when he takes a girl to a party and she focuses her attention on Tom’s friend and not him resulting in Tom viewing girls to be self-centered. These repressed memories are associated with Tom’s perception of his mother’s self-centeredness for not placing her attention on Tom in early childhood. Tom’s aggression is displaced inwardly blaming himself for this rejection. As a result, Tom progressively unconsciously mirrors his aggression towards women that he is displeasing and unable to obtain a woman’s affections. Tom maladaptive behaviors stemming from his inability to securely attach and trust prohibits Tom from forming intimate relationships resulting in Tom developing defense behaviors of self- sabotaging relationship by acts of verbal aggression.
Problem Continuance
In early infancy Tom’s basic id impulses were not satiated creating frustration and an inability to form a secure attachment to a primary caregiver, specifically his mother. A failure to achieve oral gratification resulted in a sense of mistrust, and a need to satiate secure attachment. Based on Tom’s intellectual achievements, but lack of follow-through to complete professional advancement as an adult potentially signifies Tom’s mother was too attentive to Tom in later infancy creating a fixation of dependency on his mother, as well as oral incorporation as seen by his desire to acquire knowledge. Tom’s low self-esteem later manifested itself in his inability to complete his Ph.D. that while he had the intellectual ability, his lack of motivation and inability to complete his work independently was most likely also a result of oral incorporation associated in the oral stage of development and his fear of being displeasing to his mother associated Tom’s low self-esteem developed in the anal stage of psychosexual development. Tom’s lack of motivation associated with completing his Ph.D. potentially also arises from his unconscious conflict and inner turmoil of “losing” his mother’s affections and attention. Tom’s drive is the need for a secure attachment with his mother. The lack of secure attachment has manifested in adulthood as Tom’s inability to securely attach to females intimately. In addition, Tom’s avoidance of intimate relationships and achieving sexual gratification with “frigid” female sexual partners reflects Tom’s self-blame, and unconscious guilt associated with secretly being responsible for his sibling’s death symbolizing Tom’s unconscious feelings of deserved punishment for his acts.
Problem Treatment
In regards to a plan of treatment for Tom, there is a need to create a safe nurturing environment that would enable Tom to establish trust within the therapeutic relationship. One of therapy would explore and bring awareness of Tom’s internalized self-blame, guilt, and low self-esteem arising from unresolved childhood conflicts involving his perceived forbidden desires. An aim of this would clarify maladaptive expectations and assumptions in order to reconstruct appropriate responses while providing a new reality associated with his childhood. The goal would be to alleviate distress and anxiety associated with Tom’s current reality and maladaptive behaviors.
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