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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.
Toms 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 Toms phallic stage of psychosexual development.
Problem Origin
Prior to Toms birth, his mother, a hypochondriac, had been cautioned by doctors to not have children due to physical conditions. Against medical advice, Toms mother chose to become pregnant with Tom resulting in a difficult labor. Depleting his mother physically and emotionally, Toms mother suffered from prolonged exhaustion following his birth. In addition, Toms father, a small business owner, most likely was often absent from the home attending to the business leaving Toms mother to be the primary caregiver. Her prolonged emotional unavailability would have significantly impacted Toms early oral stage of psychosexual development resulting in maternal deprivation and lack of oral gratification. Due to Toms inability to form a secure attachment base to either parent, particularly his mother, would have resulted in Toms basic id impulses not being satiated and being insecure of his surroundings creating feelings of anger, jealousy, anxiety, and a drive to obtain his mothers affections.
[bookmark: _Hlk38927399]However, later in the oral stage and towards the beginning of the anal stage of Toms 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 Toms development. Toms early potty training most likely was due to his mothers 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 Toms 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 mothers illness was not present with Tom on his first day of school. Toms need for his mothers affections are so deep his drive to satiate his need is obtained through aggressive behavior resulting in negative attention when he is disobedient.
This stage also coincides with Toms mother expecting another baby. Toms 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 mothers belly symbolizing Toms unacceptance of an additional child to be shared by his mother and his internal wish for the baby to disappear. Months following, Toms 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 mothers 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 mothers affection. This most likely resulted in Toms 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 Toms id and super ego. While Tom academically excelled and received acceptance through his peers, his mothers affections are were only provided to Tom when he suffered reoccurring respiratory infections. Toms desires were satiated by his mothers 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 Toms unresolved Oedipus Complex his oral and anal impulses are repressed. His sexual energy is applied to his academics. However, Toms 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 Toms acts of stealing relating to his fantasies during the phallic stage of psychosexual development. This unresolved conflict of Toms Oedipus Complex results in an unconscious fixation and preoccupation focused on the character Jack stealing the giants money. Toms 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 mothers pocket book. Tom sought gratification of his unmet desires through his aggression by stealing, living out his fantasy reality. This resulted in Toms aggression being displaced through stealing representing his forbidden desires towards his mother, and receiving pleasure of being the only object of her affection. Toms 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 mothers 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 Toms genital stage of psychosexual development of adolescence, Toms 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 Toms friend and not him resulting in Tom viewing girls to be self-centered. These repressed memories are associated with Toms perception of his mothers self-centeredness for not placing her attention on Tom in early childhood. Toms 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 womans 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 Toms 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 Toms intellectual achievements, but lack of follow-through to complete professional advancement as an adult potentially signifies Toms 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. Toms 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 Toms low self-esteem developed in the anal stage of psychosexual development. Toms lack of motivation associated with completing his Ph.D. potentially also arises from his unconscious conflict and inner turmoil of losing his mothers affections and attention. Toms drive is the need for a secure attachment with his mother. The lack of secure attachment has manifested in adulthood as Toms inability to securely attach to females intimately. In addition, Toms avoidance of intimate relationships and achieving sexual gratification with frigid female sexual partners reflects Toms self-blame, and unconscious guilt associated with secretly being responsible for his siblings death symbolizing Toms 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 Toms 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 Toms current reality and maladaptive behaviors.
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