Introductory Lectures on Neuropsychoanalysis: Lecture Seven " Giving a Case Presentation"

As a student or experienced clinician, have you ever been asked to give a neuropsychoanalysis/psychotherapy case presentation? Then this post is for you. I have recently developed a case presentation outline for those wishing to give a case presentation. I would like to share that outline with you in this post: The first information you want to provide in your case presentation is Descriptive Data. This data tells the age, gender identity, relationship status, sexual orientation, ethnicity, occupation, and physical description of your patient. .........Following this description of your patient you will want to share the Presenting Problem. The presenting problem is what the patient says has brought them to therapy. Most often the patient will present with some unpleasant feeling. Maybe they are depressed. Maybe they are anxious. Maybe they have lost someone dear to them and are experiencing grief. Perhaps they have been fired from their job. They might be full of rage. Whatever symptom or unpleasant feeling has brought them to therapy is what you want to share in a few sentences. The presenting symptom and unpleasant feeling will tell you what basic need/drive/emotion is not being met in their present living. There are seven such needs/drives/emotions: FEAR, PANIC/GRIEF, CARE, LUST, RAGE, SEEKING, and PLAY. Knowing what need is not being met and thus resulting in an unpleasant feeling, will begin to inform you of the unworkable, repressed prediction based in their unresolved childhood conflicts is causing their symptom........ Next you will want to speak to the History of the Presenting Problem. When did their symptom/unpleasant feeling begin? When did they get depressed or anxious, or sad or angry, etc? You will focus in on the major unmet need that is not being met and is thus leading to the unpleasant feeling. Point out the one major need of the seven ones above that has not been sufficiently met. This unmet need results from their unworkable childhood prediction. A patient's predictions may also related to their developmental stage. All seven emotional needs are trying to get met at the same time in all the developmental stages. But one need demands most to be met in each stage. Your oral/infant stage patient's prediction may often be related to their attachment ( PANIC/GRIEF) need. Your anal/toddler stage patient's prediction may be determined by their RAGE need. And your oedipal/preschool stage patient's prediction will often relate to the solving of their PLAY need. The level of realism in your patient's prediction will further inform you of the level of their defenses. The earlier childhood predictions are less realistic and require more primitive defenses. The later childhod predictions are usually more realistic and need only the more mature defenses to fend off the resultant unpleasant feelings. Based on the defenses your patient ultizes, you will be able to discern at what level of defenses they are functioning: Are they fixated in or have they revressed to the psychotic level, the narcissitic/borderline level, or the neurotic level? Knowing the level of their defensive functioning will also help you in your treatment plan, and the type of therapy they need ( I will say more about this below.) ...... Next you delve further into your patient's History. In presenting your patient's history you will want to include any past therapy experiences they have had. Have they ever seen a psychiatrist? What medications have they taken? Have they ever been hospitalized for mental illness? Is there a history of suicide attempts? You will further want to know if they have abused any substances in the past........Most importantly you will want to share in your presentation a Developmental History covering the major stages of development in your patient's life. You will share their earliest memory, their childhood memories, their adolescent experience, their young adulthood, their middle adulthood, and their senior years. In this developmental history you will particularly write about their relationships with family and close friends, and what those relationships were like, looking particularly for extrtransference patterns with parents and significant others. You will further note major losses they have experienced during their lifetime. A history of their romantic relationships will also need to be included, noting again extratransference repetitive patterns. You will also want to share what hobbies they have, how they spend their leisure time, what was their education experience, what is their religious background and present practices, and have they been married and have they had children. In their history you will particular focus on what is the faulty prediction that has led to their not getting their basic need met. .......Following this history you will share what you think is your patient's Neuropsychoanalytic Diagnosis. In other words, based on everything you have learned about your patient and their history, about their defenses and the level of their pathology, about their repeated relationship patterns in transference and extratransference patterns, and their non workable prediction and it's resultant unpleasant feelings. All this information leads to your Neuropsychoanalytic Formulation. Your neuropsychoanalytic formulation means, to the best of your ability, share your hypothesis of what has gone wrong in their lives in the past, internally and externally, and how they have unsuccessfully sought to resolve their conflicts ( through the non workable repressed prediction) to make them the person they are today. This prediction they are repeating today will clearly not have worked well for them, and that is why they have come to therapy, to rid themselves their resultant unpleasant feeling from which they suffer. You will particularly speak to how their presenting problem is the symptom of the underlying, unresolved conflict that is unconscious and originated in their childhood.......Once you have shared your diagnosis of your patient's condition, then you next share your Treatment Plan of how you plan to help them get healthier through treatment. In neuropsychoanalysis there are two major treatments: Psychoanalysis and Psychotherapy. Psychotherapy can be further divided into insight oriented or supportive therapy. Insight therapy deals primarily with unconscious predictions, whereas supportive therapy focuses mainly on preconscious predictions. Most therapies are some combination of insight and support. The choice of therapy treatment is best for your patients depends on several key factors, including their level of functioning, motivation etc. Present which type of therapy you plan to use with your patient, and what the process will be like. ..........The next step in your case presentation is to provide an Overview of the therapeutic Process to Date. In this section your summarize the beginning, middle, and ending phase of the therapy and how it went. You will emphasize major themes addressed, issues and concerns dealt with, relationships explored, repeated transference and extratransference patterns recognized and worked through, counter transference, resistances to therapy, defenses used by the patient, what has been accomplished and how your patient has improved, as well as what is yet to be done in the treatment. In summarizing each phase of therapy you will particularly focus on how you have helped your patient see their unhealthy repetitive pattern, (resulting from their unworkable prediction), and how they have hopefully progressed (by working through) with such insight into creating a new healthier prediction. You will further note how this healthier and more workable prediction is being lived out in their lives in the present. ........Having presented all of the above you are ready to share a Few Sessions of Clinical Material detailing how their treatment has gone. You will do this by providing a video or audio recording of several sessions, or detailed process notes where you write down from memory everything you can remember that was said during the sessions. You will also note how you felt in these sessions as they progressed, and what you felt was or was not accomplished in each session. You will particularly note transference and extratransference relationship patterns, resistances/defenses and countertransference. Note how in the sessions the patient is not only repeating their older unhealthy pattern (from their faulty prediction), but what progress has been made in forming a new and healthier prediction. With the presentation of actual therapy sessions you have now completed your case presentation. The conclusion of any case presentation consists of feedback, questions, and discussion....... I hope this brief outline of a neuropsychoanalysis/psychotherapy case presentation has been helpful for you and that you will look forward to presenting your next case to a group of interested listeners.