Initial Presentation and Symptoms

Christina is 17 years of age when she came to the clinic accompanied by a staff member from a child welfare agency.  Several police raids had found her drunk or in possession of small amounts of drugs.  Christina repeatedly told the welfare workers that her troubles were the fault of her 25-year-old ‘friend’, who often walked out on her and hooked up with other women.  If he loved her the way she wanted, she would not have to drink alcohol or take drugs; she would be in ‘seventh heaven’ without them.

At the initial consultation Christina is a well-dressed young woman wearing an excessive amount of make up and scantily dressed.  Christina attempts to establish contact with the counsellor via small talk “so, how’s it going, and what can I do for you, cool shoes?”  Reversing the roles an attempt to make an effort to present herself as autonomous and independent; Christina does not want to reveal any weaknesses or ask for advice or help.  Christina’s skillful small talk moves the counsellor into the role of the one seeking help.

Patient History

Christina recounts her family history as if it were a novel – exciting, dynamic and creative.  She is the only child of rich parents.  She has no idea where in the world they are currently travelling; she hasn’t had regular contact with them for over two or three years.  Christina lives with a group of people and states ‘they’re cool but we’re not close’.  Christina believes she was artificially conceived and that her father is not her biological father.  But that is unimportant; you can’t depend on men anyway, so why should she give any thought to who her biological father is.  Christina’s mother spends all her time thinking about her career and as a child Christina had been just another beautiful ‘ornament’ to show off next to all the other museum pieces that her parents had collected.  Christina had lacked for nothing, had had an overabundance of toys and presents and she had no idea how many nannies had taken care of her or how often they came and went.  Christina saw her mother only occasionally for brief periods when they would have special ‘times’ together going to the movies or zoo.  Christina always looked forward to these moments however was always deeply disappointed because even though her mother would spend an entire afternoon with her she was ‘never really there’.  When asked what she meant by that comment, she answered defensively, ‘you know, being there heart and soul’.

Christina began to experience difficulties in adolescence, when she was constantly falling in love with different boys and could think of nothing else.  According to her, school and learning were simply ‘passé’.  Christina was always disappointed in her relationships with boys and men because they were so undependable, and so Christina ‘sailed’ from one to the next.  This image stays with the counsellor who asks, ‘have you ever looked for a harbour?’  Christina becomes pensive, ‘yes I guess you could look at it that way’.  Like a ship on the high seas constantly discovering new exotic islands, losing oneself completely in fantasies. How wonderful it would be on these islands…except there is no harbour, no harbour where the boat could be anchored safe from the waves, or where one could make a homey place ashore’.

Christina’s dialogue is philosophical at times and often quotes quotations and examples from The Little Prince.  Christina also mentions that her mother has remarried for the third time, and that she is not sure where she is at the moment.  Christina has had no contact with her father in two years maybe three.  She attended a number of private schools because of her academic problems, but failed miserably at each because she always ‘fell fatally in love’.  At some point out of frustration she began to drink at parties; when she drank her pain of being left by another boy was tolerable.  Christina had her first sexual encounter at 13, and sexually too slid from one relationship to another.  The counsellor stays with this image and asks, ‘whether when sliding she had ever wanted support?’  Christina became pensive again, silence, ‘yes, support, being held, having someone who was always there for me.  But those are silly fantasies that can never come true’.

The counsellor senses Christina is becoming sad and thoughtful and withdrawing into herself.  Christina explained that it was in the dark phases of her depression that she first began using drugs; never regularly only when she could no longer endure her pain and yearning.  Christina had an uncanny ability to talk about herself openly and insightfully.

consider how you think Christina would best be helped in talking therapy. In developing a treatment plan, you are required to consider the specifics of Christina’s presentation. Given that ours is a psychodynamic unit you are encouraged to use psychoanalytic concepts to develop an optimum treatment.

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