Case Formulation Angelina Jolie Essay Example

that unlike most girls, she had an infatuation with blood and vampires so she dropped the acting classes and aspired to be a funeral director instead. Her first serious boyfriend was at fourteen and her mother allowed him to live in their home for two years. AJ referred to that first relationship to be like a marriage, she said: I started having sex, but sex didn't feel enough and emotions didn't feel enough. And in a moment of wanting to find something honest, I grabbed a knife and cut him, he cut me back and we had this exchange of something.

Then covered in blood and my heart racing, thinking there was danger, I felt more honest than whatever the sex was supposed to be. So I went through a period that when I felt trapped I would cut myself. I have a lot of scars. (Rajang, 2010, p. 1) After the breakup, she decided to go back to acting and continues to act today. In her twenties, AJ was into tattoos, risky behaviors, and she struggled with disordered eating and drugs like heroine and cocaine. She would also talk to everyone about adopting babies, including her drug dealers. AJ was married twice that ended in divorce and is presently engaged.

She met her previous husbands on the movie set; they played the role of her husband, and were involved or married to other woman at the time. AJ has a fixation with death and blood. She purchased coffins, burial plots as a wedding gift, wore her husband’s blood in a vial, wrote his name in blood on the back of her wedding

T-shirt, and wrote a sign in blood professing her eternal love for him. She also had a number of unsuccessful love affairs. After this series of relationships, AJ was hospitalized for suicidal and homicidal ideations when she was twenty-five.

Presently, AJ has been in a 7-year relationship with Brad, another co-star that was married to another woman when they met. AJ becomes extremely volatile at the mention of Brad’s ex wife. She and Brad have six children. AJ adopted three children from third world countries and the couple has three biological children. They employee six live-in nannies and it is important to her that the nannies stay hidden from the media. AJ has a lot going on from wedding planning, six children, to filming a new movie, as well as traveling to visit with Syrian refugees.

She says that she can become anxious if she is not traveling and can’t sit still for very long when in a room. She has no friendships to speak of. Presenting Problem AJ says she is ‘feeling down’ more than usual lately and attributes this to her wanting to adopt another child. But Brad has said that he doesn’t want to. Yesterday, she says that Brad found her after she had been crying in the shower for several hours. She didn’t know why she was crying. Additionally, she hasn’t been sleeping well and her disordered eating behaviors are resurfacing. She has an increased preoccupation with food and exercise.

She believes that she is too fat and being thin equates to how successful she is. She reports that Brad says that she is underweight; this is a

constant struggle between them. AJ believes he is not being truthful, and she fears that he will abandon her if she were a higher weight. AJ presents with some risky and impulsive behaviors. She has started cutting again. She was given a ticket for driving 85mph; her attitude about this ticket suggests entitlement. She felt due to her prominence/fame she should not be held accountable. Also, AJ began an affair with an old lover, Jenny. She fears abandonment from her husband if he were to find out.

Before taking any action, I would seek information concerning previous therapy attempts and hospitalizations. What did the counselor employ and what were the results? What was the diagnosis? What has AJ responded to, if anything? What was obviously not successful? I would start the process of gathering more information to ascertain the severity and diversity of any substance abuse, her sleep patterns, more specific eating habits, and mood. I would further explore whether AJ experiences suicidal thoughts or ideation, her level of anxiety, energy level, libido, and any weight gain or loss.

She has mentioned that she is close with her brother, and kissed him on the lips, in public, when she received an Emmy award. So I would explore that relationship, as well as the one with her estranged father, and to have her describe more in depth her relationship with her peers, if any. I think that creating a genogram to explore familial relations on both sides of AJ’s family might be useful. Theories Psychodynamic – Psychosexual Stages Sigmund Freud’s psychosexual stages relate to AJ at several times in her life.

AJ did

not have an opportunity for being held and nursed by her mother, with the enjoyment of sucking and receiving things into her mouth. During her mother’s depression, AJ was given very few toys that didn’t allow the opportunity for much oral gratification. This interfered with the development of the oral stage creating the envy that seems to be part of AJ’s life. She was envious of her co-stars relationships. The lack of appropriate development in this stage may have also contributed to her personality with the strong tendencies to take drugs and eating disordered behaviors.

Further information concerning the method(s) used in her toilet training would be useful. Was she reinforced negative or positively during toilet training? This first experience with discipline may have shaped her feelings and interactions with outside authority. This may in part explain the rebel attitude she has had most of her life. Moving into the genital or phallic stage, the information presented does not indicate AJ with having a strong bond with her mother or her father who was mostly absent.

During this stage, girls who successfully proceed to latency overcome the Electra complex and no longer envy their father’s penis. In this stage, AJ learns her individual role by identifying with her mother in an effort to possess her father vicariously. Fixation at this phase develops a phallic character, which like AJ is narcissistic and reckless. Freud suggested that fixations in the phallic stage could be the cause of homosexuality, which might explain AJ’s identifying as bisexual. Psychodynamic – Object Relations

AJ’s history should also be reviewed through the lens of object relation’s theory. The theory

suggests that people relate to others in their adult lives that were shaped by family experiences from infancy. There was a lack of strong relational attachments in AJ’s early life where she was unable to trust whom her caretaker would be from day to day. Because of these developmental factors, AJ has been unable to form meaningful long-term relationships. Her short-lived friendships and marriages are similar to the short-lived relations she had with her caretakers.

AJ displays symptoms indicating adaptation of the defense mechanism of displacement. Displacement is a redirection of the feelings she has for her father to another more acceptable and safer target. I believe she learned to use displacement as a baby, yearning to express love but not having a consistent caretaker to accept or reciprocate. Her father would have become the longed for recipient of her love. Therefore, it is no coincidence that all three of AJ’s husbands were co-stars that played the role of her husband and two look just likes her father. Psychodynamic – Drive Theory

In his book Beyond the Pleasure Principle, Freud proposed, “the goal of all life is death” (Cherry, 2012). Freud’s death drives normalize sadism and masochism where a person repeats painful situations, is self-destructive, has wishes for death and inflicts self-suffering. AJ heavily flirted with the darks side and is infatuated with death and aggression. She has a knife collection that fills an entire room. She cut her boyfriend during sex and he cut her. She jumped from airplanes and was seriously into drugs. In her acting work, AJ also picks roles that seduce death, violence, destruction and insanity.

Freud postulates

that people are compelled to repeat painful or traumatic episodes even though such repetitions appear to contradict the instinct to pursue pleasure. In the death wish drive, the mechanism for change is through the compulsion to repeat, a person attempts to bind the trauma so they can return to a state of quiescence. Freud’s therapeutic goal is for the client to make the unconscious conscious by free association (Prochaska & Norcross 2010). With the consciousness rising, AJ will become more aware of her behaviors.

However, there are limitations to Freud’s work where he was unconcerned with interpersonal relationships. I believe when the therapist cannot interact with the patient, they cannot help the patient insightfully discover their maladaptations or formulate an action plan for change. Further, the therapist cannot be the mechanism for change, which you will see in Kohut’s work. Psychodynamic – Self psychology Heinz Kohut’s self-psychology is another psychodynamic perspective that we can apply to AJ. Contrary to Freud, Heinz Kohut developed a psychodynamic perspective based on the self rather than drives.

He suggests that our sense of self is developed in infancy by way of the empathetic nurturance offered by parents. This development of self is particularly vital in the way a mother continually approves of and enjoys her child. The healthy child internalizes this self-reflection and learns to love his/herself through their mother’s positive reactions. When the child’s needs are met, the child develops a strong sense of self. Children whose needs are not met, who are raised by caretakers that are not able to be empathetic and/or are narcissistic, may result in a profound sense of worthlessness.

These

children search for affirmation and acceptance throughout their lives. They rely on others to regulate their self-esteem and provide them with a sense of value (McLean & Gillig, 2007). It may also lead to protective withdrawal from others, hostile aggressiveness, and even rage. Predominant feelings in this situation may be inner emptiness, depression, self-hate, and shame (Baker & Baker, 1987). The understanding we have of AJ’s infantile experience leads us to wonder if her mother’s inability to bond with her and perhaps her lack of empathy in general has resulted in AJ not developing a strong sense of self and ego.

AJ collects children from impoverished countries that need her; this provides her with her sense of value. In treatment, Kohut recommends helping the patient develop these missing functions. The mechanism for change, Empathy in this case, may require transference on three levels, mirroring, idealizing transference and twinship. AJ will need the therapist to mirror the empathy that she never received in order to build a missing structural part of her self (McLean & Gillig, 2007). Idealizing transference will involve becoming a replacement parental figure that is soothing but ever present authority.

It seems that AJ’s mother failed to provide appropriate parental authority when she allowed AJ’s boyfriend to move in her bedroom at the young age of fourteen. Finally, twinship requires actually feeling the pain with AJ from the lack of parental empathy and support she received. With a strong therapeutic alliance, Kohut’s empathic trio is especially suited to help AJ rebuild her ego and move on to live a more fulfilling life (Baker & Baker, 1987). Cognitive Behavioral Individuals develop in

part based on the thoughts they experience and learn and associate with their behaviors.

Children’s traits in particular develop via social learning. This can include modeling the adults in their lives and/or how they are reinforced throughout childhood. AJ’s lack of healthy relationships is likely linked to her father’s inability to model caring behaviors toward her and toward AJ’s mother. In addition, AJ’s mother didn’t seem to provide a model for empathetic relationships. That would have made it difficult for AJ to learn these skills. AJ’s father left his family after having an extra marital affair, which left her to question the wisdom in working toward the creation of long-termed committed relationships.

We may see some result of this in AJ’s inability to form long-term friendships. Another factor that may be responsible for AJ’s lack of emotional connections was the negative reinforcement learned in her early childhood. Multiple caretakers coming and going into her life may have reinforced the idea that it is not wise to develop close relationships because they will not last. Moving toward a holistic approach by putting control back in the hands of the patient, Aaron Beck is well known for the use of cognitive behavior therapy (CBT).

He uncovered that maladaptive interpretations and conclusions often accompany depression. He suggests that psychological disturbance frequently stems from automatic thoughts. AJ’s automatic thoughts surrounding her self image and Brad not wanting to adopt another child is making her feel denied and rejected. She also feels lonely and thinks that a new child will bring joy to her life. Brad is seen as the person preventing her from joy, but she

represses her anger towards him because she also fears his abandonment. She convinces herself that she needs validation, so she turns to her ex-lover.

Built on Beck’s approach, Albert Ellis developed cognitive restructuring, which is a step-by-step process for noticing and disputing irrational beliefs. Ellis believed that our ‘core beliefs’ lie under the rules that guide how people react to events. The outcomes from the rigid demands people place on themselves, and others, are evaluative thinking such as awfulizing, discomfort intolerance, people-rating and over-generalization (Frogatt, 2005). With her adoptions desires being refused, AJ overgeneralizes that her life is miserable.

Her dichotomous thinking for being thin to be successful is a pressure she imposes on herself contributing to her disordered eating and obsessive exercising. Her mind reading about what her husband is really thinking about her body also contributes to her eating disorder. Beck believes that automatic thoughts reflect habitual errors in thinking which lead to AJ’s maladaptive behaviors. I believe AJ Jolie has Borderline Personality Disorder (BPD), a psychological illness characterized by unstable relationships, poor self-image, reckless, impulsive and often self-destructive actions and dichotomous thinking.

Like AJ, people with BPD are particularly dependent on how other people are treating them at the current time. She is highly functioning as an actress and producer, but is unable to control her emotions and cannot function when upset, which might explain her crying for hours in the shower. Marshia Linehan’s Dialectical Behavioral Therapy (DBT) is an effective treatment for BPD. It promotes change (behavior therapy) and acceptance (Zen). Treatment usually consists of two sessions each week.

One is with a counselor and the other

is group therapy to learn the following skills: Emotion regulation, distress tolerance and reality acceptance skills, interpersonal effectiveness, and also mindfulness skills. The counselor is responsible for helping to replace maladaptive behaviors and teach skillful adaptive behaviors (Linehan, 1993). The goal will be for AJ to work collaboratively with the therapist to use cognitive processes to balance change with acceptance. The first task will be to address her life threatening behaviors and suicide ideation.

She will be taught crisis survival skills in order to tolerate pain and accept life as it is in the moment rather than using impulsive behaviors. She will be taught emotion regulation skills to improve controlling her emotions and receive help navigating interpersonal effectiveness. The second task will be to address anything that threatens continuation of therapy. In AJ’s case, her frequently moving around the globe will become a barrier for this type of treatment and possibly some commitment and motivation work, like “What are you willing to do? ” will need to be done with her.

Task three, will focus on the quality of life behaviors that are inconsistent with a meaningful life such as her reckless driving, having affairs, etc. Conclusion In order to help AJ affect a change to mental wellness, it will require a multitude of therapies as discussed in the case. Freud’s developmental stages are helpful in providing some insight towards her formulation of personality and maladaptive behaviors but it does not provide a ‘good enough’ mechanism for change. I believe that Kohut’s mirroring, idealizing transference and twinship will help bolster AJ’s ego in her healing process.

What she will get from the

client-centered therapy is the capacity to be more empathic not only with others, but with herself, just as the therapist is attuned to her. Meanwhile cognitive behavior therapy will help her to become aware of her irrational self-image and to change her destructive thoughts. Mindfulness in her Dialectical Behavioral Therapy will help her to accept that life has stressors and will teach her the skills to deal with them. The DBT skills should be the primary focus in her recovery.