Combinations of change processes

PSYC 6220/5220/8221: Psychology of Personality
CREDIT LINE: SYSTEMS OF PYSCHOTHERAPY: A Transtheoretical Analysis, 9th Edition, by James O. Prochaska and John C. Norcross. Copyright 2018 by Oxford University Press. Reprinted by permission of Oxford University
Press via the Copyright Clearance Center.
The Case of Mrs. C is excerpted from Systems of Psycotherapy: A Transtheoretical Analysis, 9th Edition,
by James O. Prochaska and John C. Norcross, and does not reflect a clinical assessment of the client and
the family members experiences.
THE CASE OF MRS. C Psychotherapy systems are not merely static combinations of change processes, theoretical contents, and research studies. The systems are, first and foremost, concerned with serious disorders afflicting fellow humans. In comparing systems, it is essential to picture how the psychotherapies conceptualize and treat the presenting problems of an actual client. The client selected for comparative purposes is Mrs. C. Mrs. C is a 47-year-old mother of six children: Arlene, 17; Barry, 15; Charles, 13; Debra, 11; Ellen, 9; and Frederick, 7. Without reading further, and astute observer might discern Mrs. Cs personality configuration. The orderliness of children named alphabetically and of childbirths every 2 years are consistent with obsessive-compulsive disorder (OCD). For the past 10 years, Mrs. C has been plagued by compulsive washing. Her baseline charts, in which she recorded her behavior each day before treatment began, indicated that she washed her hands 25 to 30 times a day, 5 to 10 minutes at a time. Her daily morning shower lasted about 2 hours with rituals involving each part of her body, beginning with her rectum. If she lost track of where she was in her ritual, then she would have to start all over. A couple of times this had resulted in her husband, George, going off to work while his wife was in the shower only to return 8 hours later to find her still involved in the lengthy ritual. To avoid extended showers, George had begun helping his wife keep track of her ritual, so that at times she would yell out, Which arm, George? and he would yell back, Left arm, Martha. His participation in the shower ritual required George to rise at 5:00 A.M. in order to have his wife out of the shower before he left for work at 7:00 A.M. After 2 years of this schedule, George was ready to explode. George was, understandably, becoming increasingly impatient with many of his wifes related symptoms. She would not let anyone wear a pair of underwear more than once and often wouldnt even let the underwear be washed. There were piles of dirty underwear in each bedroom corner. When we asked her husband to gather up the underwear for the laundry, we asked him to count them, but he quit counting after the thousandth pair. He was depressed to realize that he had more than $2,000 invested in once-worn underwear. Other objects were scattered around the house because a fork or a can of food dropped on the floor could not be retrieved in Mrs. Cs presence. She felt it was contaminated. Mrs. C had been doing no houseworkno cooking, cleaning, or washingfor years. One of her children described the house as a state dump, and my (JOP) visit to the home confirmed this impression. Mrs. C did work part -time. What would be a likely job for her? Something to do with washing, of course. In fact, she was a dental technician, which involves washing and sterilizing all the dentists equipment.
PSYC 6220/5220/8221: Psychology of Personality
CREDIT LINE: SYSTEMS OF PYSCHOTHERAPY: A Transtheoretical Analysis, 9th Edition, by James O. Prochaska and John C. Norcross. Copyright 2018 by Oxford University Press. Reprinted by permission of Oxford University
Press via the Copyright Clearance Center.
As if these were not sufficient concerns, Mrs. C had become unappealing in appearance. She had not purchased new clothes in 7 years, and her existing clothes were becoming ragged. Never in her life had she been to a beautician and now she seldom combed her own hair. Her incessant washing of her body and hair led to a presentation somewhere between a prune and a boiled lobster with the frizzies. Mrs. Cs washing ritual also entailed walking around the house nude from the waist up as she went from her bedroom bath to the downstairs bath to complete her washing. This was especially upsetting to Mr. C because of the embarrassment it was producing in their teenage sons. The children were also upset by Mrs. Cs frequent nagging to wash their hands and change their underwear, and she would not allow them to entertain friends in the house. Consistent with OCD features, Mrs. C was a hoarder: she had two closets filled with hundreds of towels and sheets, dozens of unused earrings, and her entire wardrobe from the past 20 years. She did not consider this hoarding a problem because it was a family characteristic, which she believes she inherited from her mother and from her mothers mother. Mrs. C also suffered from a sexual arousal disorder; in common parlance, she was frigid. She said she had never been sexually excited in her life, but at least for the first 13 years of her marriage she engaged in sexual relations to satisfy her husband. However, in the past 2 years they had intercourse just twice, because sex and become increasingly unpleasant for her. To complete the list, Mrs. C was clinically depressed. She had made a suicide gesture by swallowing a bottle of aspirin since she had an inkling that her psychotherapist was giving up on her and her husband was probably going to commit her to a psychiatric hospital. Mrs. Cs compulsive rituals revolved around and obsession with pinworms. Her oldest daughter had come home with pinworms 10 years earlier during a severe flu epidemic. Mrs. C had to care for a sick family while pregnant, sick with the flu herself, and caring for a demanding 1-yea

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