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Psychoanalysis Case Study of Gregory House M.D.


Abstract

There are many techniques used to treat and rehabilitate addiction, but the focus of this case is the use of Psychoanalysis on a fictional character who has presumably already received detoxification treatment for the use of Vicodin.  Using Psychoanalysis in addiction therapy does present a challenge.  However, several new research projects promote the use of many of the foundational treatments of Psychoanalysis.  It is recommended that any type of addiction therapy be coupled with group therapy, as well as with a relapse prevention plan.  However, this is certainly vital when using Psychoanalysis as a recovery therapy.  The combination of these therapeutic processes allow for individual healing as well as group healing and cohesion.  This paper concludes that all addiction therapists must be well rounded and integrative in their approaches in order to be successful. 

 Psychoanalysis Case Study of Gregory House M.D.

A Conceptualization and Treatment Plan

Drug addiction is a serious issue that affects a person’s emotional, relational, and physical health.  One of the reasons that addiction is so difficult to battle is that substance use reinforces itself with the perceived positive effects.  However, Khantzian (2006) says that too much emphasis is placed on the pleasure principle behind drug abuse.  There are more important aspects to the underlying cause of addiction, which are mostly emotional and chemical in nature (Pinsky, 2008).  Khantzian (2006) describes the difficulties in an addict’s coping skills, as well as trouble engaging their environment, as primary psychological reasons for drug abuse.  For this reason, Psychoanalysis can be a useful tool in treating clients with drug addiction.  The objective of this form of therapy is to discover familial or relational ties related to the drug use, and formulate a healthy support system conducive to recovery (Strean, 1984). 

 Presenting Concerns

Dr. Gregory House is a 51-year-old Caucasian male who is currently seeking addiction counseling. His drug of choice is Vicodin.  The client developed his addiction after a surgery and a misdiagnosed infarction left him with “chronic leg pain.”  He currently walks using a cane, and claims that he does not necessarily have an “addiction” because Vicodin use does not interfere with his work.  He also says that his habitual use of Vicodin is “not a drug problem, it’s a pain problem.”  Dr. House has at this time, already completed in-patient rehabilitation and detoxification.  He needs consistent follow up and addiction therapy, as well as a relapse-prevention plan.

Dr. House reports that he did not come from an affectionate home environment.  He states that while he loves his mother, his father has an “insane moral compass ” and he avoids contact with him.  House’s father was abusive towards him as a child, and several years ago, he discovered that John House is not even his biological father.  However, he is not motivated to seek a relationship with his biological father. 

In his daily life, Dr. House maintains purely superficial relationships.  This has caused trouble for his most recent relationship with Dr. Lisa Cuddy.  Dr. House realizes that his current behavior is unpredictable and irrational.  He is seriously concerned about his own mental stability.  He would like to investigate his narcissistic tendencies, because he feels that this may be the primary cause in the failure of his romantic, personal, and professional relationships.

 Case Conceptualization

  Dr. House confirms that he did not have a nurturing or supportive home environment as a child.  His father was a harsh disciplinarian and his mother was distant, which prevented him from building strong attachments with either of them.  He was deprived from making community attachments because of his family’s military lifestyle and frequent relocations.  He often found himself in foreign countries surrounded by children with whom he could not communicate.  His only solace was in learning about other cultures through archaeology.  Still, House does not (openly) report that he was lonely as a child.  This seems to indicate that he has had an early emotional disconnect.

Because he has disconnected himself from his emotions, Dr. House struggles to build relationships with others.  It is possible that Dr. House feels unworthy of valuable relationships, or more likely, that he cannot trust anyone outside of himself to meet his own needs.  His failure to bond with others only serves to validate this feeling, and is probably rooted in his early parental model.  Dr. House was deprived of an emotional attachment with either of his parental caregivers.  The emotional disconnect is further demonstrated by his lack of motivation to connect with the man he now knows is his biological father.  His difficulty building relationships with the two men in his life may be a sign, according to Psychoanalytical theory that he has not surpassed Freud’s Oedipal psychosexual stage of development (Freud, 1914/1957).  Resolution of this stage would mean that Dr. House was able to identify with either John House, or his biological father.

Dr. House may have developed a negative self-view as a child because of his lack of intimate connection with others around him.  Dr. House may also be afraid of the level of intimacy that is required from any non-superficial relationships, because his parents did not model intimacy for him.  However, he masks these fears with strong narcissism and grandiosity.  This defense mechanism allows him to deal with negative feelings.  Dr. House has been unable to make connections with women, and usually resorts to paying for sex.  Whenever he is close to developing a meaningful relationship, he self-destructs with narcissism, instead of exposing any vulnerability himself.  This allows him to push people away and reinforces his internalized view that they are leaving because they are unworthy of his “greatness.”  His relationship with Lisa Cuddy was his most intimate, primarily because after knowing him for ten years, she was able to see through his façade.

Dr. House seems to be conflicted between his cognitive self (which says he is lonely and wants a relationship with Dr. Cuddy) and his emotional self (which tells him that women cannot be trusted and he only needs himself).  His lack of attachment is rooted in his detachment from his parents, and has weakened his capacity of forming autonomy.  Dr. House seems to think that he is entirely self-sufficient.  If he allows someone, especially a woman, to become so close that he is emotionally attached to them, he fears that he may lose something of this artificial self–sufficiency.  This idea, and its proximity to the opposite sex, should be explored in relationship to Dr. House’s mother, according to Freud’s Phallic/Oedipal stage of psychosexual development (Jones & Butman, 1991).

Dr. House’s primary issue is his addiction recovery.  Dr. Drew Pinsky (2008) says that addiction is less psychological than it is biological.  However, the psychological factors must not be ignored, and are key to recovery .  A recent study of addiction found that there is a great capacity for using Psychoanalysis in treating addictive behavior (Khantzian, 2006).  Battling addiction can be a lonely struggle.  Since Dr. House has been unsuccessful in building intimate relationships, he has been unable to build effective addiction treatment supports.  Effective addiction recovery treats the nature of addiction, while nurturing the client’s ability to maintain will power (Pinsky, 2008).  Having proper emotional and physical stimulation helps to keep the body alert and able to fight temptations.  Support is a necessary part of temptation treatment, and can make or break rehabilitation (Pinksy, 2008).  By developing intimate bonds with a support system, Dr. House will be allowing himself the safety of relationship building while revealing his vulnerability.  This may be a gateway for him to develop more meaningful relationships.

In psychoanalytic theory, defense mechanisms are the supports to a weakened ego (Murdock, 2009) that defend against perceived attacks.  Traditional Psychoanalysis usually confronts defense mechanisms (Corey, 2008).  However, Pinsky (2008) thinks it is best to provide clients in recovery with healthy ways of coping before taking away the maladaptive ones.  One way to do this is to re-frame coping skills and defense mechanisms and define healthy alternatives.  For instance, Dr. House has gone without the use of drugs for his chronic leg pain for a year.  He does not NEED medication for pain management.  His drug use at this time is strictly mask nagging inferiority feelings and vulnerability since his break up with Dr. Lisa Cuddy.  According to Dr. Pinsky’s (2008) theory, it would be advisable to teach Dr. House new ways of dealing with both his perceived leg pain and his feelings of abandonment (rooted in his early parental interactions) in order to effectively treat him.

Treatment Plan

Goals for Counseling

From a Psychoanalytic perspective, the goal of treatment for Dr. House is to help him gain insight into where his fear of vulnerability comes from, and how these experiences have negatively impacted his relationship building skills.  It is important to bring to consciousness any unresolved issues that are causing current struggles in relationships. Dr. House is allowing himself to be isolated, which is hindering his recovery, on many levels.  Forming strong relationships in a group rehabilitation therapy setting, along with a positive therapeutic bond with the counselor, will provide Dr. House a foundation for healthy relational skills. 

It is also and important goal to help Dr. House search for underlying depression or anxiety caused by his lack of emotional connection.  Addicts often are ill equipped to deal with strong emotions, leaving them pre-disposed to drug abuse, and at even greater risk for relapse (Pinsky, 2008).  Defense mechanisms generated by Dr. House’s emotional detachment have, for the most part, been successful in his attempt at keeping his inner-self protected.  However, when Dr. House began treatment for his chronic leg pain, he found a new way of coping.  Freudian psychoanalytic theory associates addiction with the oral stage, the first need-gratifying stage of development (Murdock, 2009).  Khantzian and Treece (1985) add that, “Opiates were said to produce a state reminiscent of a blissful closeness and union with the mother, which resulted in avoidance of separation anxieties aroused by the adolescent dependency crisis (p. 13).”  Khantzian (2006) also believes that drug and alcohol abuse act as a defensive strategy that bridges the gap between a person’s functional and defective ego, allowing them to cope.

 Interventions

Confrontation

Dr. House provides an air that he is superior, even though he uses the advice of others in solving his diagnostic cases.  This grandiose personality can be especially grating on therapists.  It is important to confront Dr. House on these matters, without taking too much from his fragile ego.  For instance, pointing out that he was assisted in solving a certain case, but commending him on a job well done.  One point that would be important in using confrontation with Dr. House is to not be affected by his narcissism and allowing it to cause counter transference, and feelings of negativity towards him.  I would search my reasons behind any confrontations before hand and have an understanding of how it will benefit Dr. House.

Establishing the relationship

Considering the fragile state of Dr. House’s internalized ego, it is important that I reach out to him with acceptance and empathy.  Narcissism prohibits individuals from achieving satisfaction in relationships, work, or other activities (Khantzian, 2006).  He needs to see that relationships can be nurturing, even if, and especially if, an individual is broken.  For this reason, Dr. House also needs to be able to forge relationships with others in his peer group and therapy group.

Khantzian (2006) says that people who struggle with their need to be acknowledged, to love and be loved, will be at risk for substance dependence.  Dr. House’s drug use provides him with a synthetic validation for his narcissism.  Since he began treatment and detoxification, he no longer has that artificial crutch.  It is important on my part to be favorable and feed into his strengths to provide him with sincere encouragement during the initial sessions.  The effects of this will hopefully be a building of mutual trust and respect.  Dr. House needs to learn comfort in confiding, and the effects of being accepted, even when his attitudes are unacceptable.

Analysis of transference   

One of the most important factors in the therapeutic process is the client/therapist relationship.  Without it, transference cannot be assessed.  In fact, Strean (1994) says that all patients “will respond to interventions in terms of the transference (p. 110)” and that the therapy model, setting, or experience of the counselor, make no difference in recovery.  Because of the vital role transference plays in the healing process, I recommend that Dr. House connect with his feelings about me during our sessions, and openly confront and express them.  We can then begin to match these emotions with other instances of similar feelings and their root cause.

Insight

In the Psychoanalytical therapeutic model, insight provides a look into the emotional and logical though process.  The goal of insight is to find how Dr. House’s insecurities were formed and provide him with an opportunity to correctively deal with these experiences. Self-realization of past conflicts and perceptions of feelings that have been repressed will allow Dr. House to form other options for reactions, and develop other behavior patterns (Khantzian, 2006).

However, insight alone is not enough.  It is vital that Dr. House makes a connection between insight and an emotional experience.   Substances themselves are such strong behavior reinforcements, that patients need a strong emotional counteract-ant.  This will hopefully ensure the client can counter the strong compulsion for them.  Dr. House likes to solve problems.  This makes him feel adequate, and feeds his need for validation.  I would like to challenge him to see himself as a puzzle, and ask him to seek himself for insight on his situation.

Conclusions

With time and support, it is hoped that Dr. House will find meaningful relationships to be satisfying.  The goal of this form of therapy is to allow Dr. House to recognize his own fear of inadequacy and how his grandiosity is interfering in his daily relationships.  Dr. House needs to be validated for his strengths, but learn that weakness is acceptable, and can even be an asset.  Dr. House’s self-esteem need not be threatened by his vulnerabilities.  This paper concludes that addiction therapists must be well rounded and integrative in their approaches in order to be successful.  Dr. Pinsky (2008) says that while addiction is “treatable” it is not “curable.”  It is important that Dr. House heal his relationship patterns if he wants to treat his addiction.

 References

Corey, G. (2008).  Theory and practice of counseling and psychotherapy.  Belmont, CA: Thomson Brooks/Cole.

Freud, S. (1914/1957).  On narcissism: An introduction.  In J. Strachey (Ed. and Trans.).  The standard edition of the complete psychological works of Sigmund Freud.  London: Hogarth Press.

Jones, S. L., & Butman, R. E. (1991).  Modern psychotherapies: A comprehensive Christianappraisal.  Downers Grove, IL: InterVarsity Press.

Khantzian, E. (2006). An ego/self theory of substance abuse. National institute of drug abuse: Theories on drug abuse: selected contemporary perspectives.  30.

Khantzian, E., and Treece, C. (1985).  DSM-III diagnosis of narcotic addicts: Recent findings. Archives of General Psychiatry. 42, 11-26.

Lipowski, Z. (1984).  What does the word psychosomatic really mean? A historical and semantic inquiry.  Psychosomatic Medicine.  46, (2) 153-171.

Murdock, N.L. (2009).  Theories of counseling and psychotherapy: A case approach.  Upper Saddle River, NJ: Prentice Hall.

Pinsky, D. (2008).  Cracked: Putting broken lives back together again: A doctor’s story.  New York, NY: HarperCollins Publishers.

Strean, H. (1994).  Essentials of psychotherapy. New York, NY: BrunnedMazel Publishers.

One response

  1. I do believe all of the concepts you have offered on your post. They’re very convincing and can certainly work. Still, the posts are too quick for newbies. May just you please extend them a little from next time? Thank you for the post.

    August 19, 2012 at 1:01 pm

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