Ordinary People, extraordinary psychiatrist and Mrs. Pain
First, I'd like to welcome all newcomers to PSYCHOLOGY COMES ALIVE. Review the following post, and then answer all questions in the comments section. Also, feel free to respond to the comments of others who post comments here, so we can engage in an intellectually-stimulating and emotionally-charged dialogue.
While ostensibly, the psychiatrist in ORDINARY PEOPLE shares a similar world view, or Weltanschauung, with psychoanalytically-oriented psychiatrists and psychologists, he would not be considered the paragon of such an orientation because, like Gestalt therapists, he is much more confrontational, more directive and at least as focused on the present as he is on the past.
Old school psychoanalysts depended heavily on free association, and they constantly interpreted verbal and nonverbal statements of patients in accordance with possible unconscious motives born of infantile, pathogenic conflicts and developmental fixations.
Listen to the following song, and then compare Conrad's mother, in the movie, to the character in this original song, or, if you prefer, Dr BLTrack, Mrs. Pain.
Mrs. Pain
Dr BLT
words and music by Dr BLT
Download | Duration: 00:03:28
Finally, do a little more investigation on both the psychodynamic or psychoanalytic and the cognitive-behavioral orientations (drawing heavily from your text books), then offer three first clinical impressions of Conrad, one, as an imaginary psychodynamic therapist, and one as a cognitive-behavioral therapist, and one as a psychodynamic-cognitive-behavioral integrationist. If you cannot offer the third clinical conceptualization or first impression, because you feel the two approaches are incompatible, offer a rational for that opinion.
Then, come to the next class prepared to do a similar excercise in which you will form groups and develop 2-3 treatment plans for Conrad.
Categories: movie psychoanalysis, movie analysis, song analysis
Tags: Dr BLT psychology comes alive movie analysis psychoeducation psychology song analysis
In comparing Dr. Berger’s treatment with how a cognitive-behaviorist (C
In comparing the lyrical character of Mrs. Pain with Conrad’s mother, there is an initial commonality, sung of in regards to Mrs. Pain, in the picture of drawing the shades, hanging her head to cry. Quite assuredly, Conrad’s mother did not get the impression of not having the shades drawn if she was going to shed tears. Indeed, her lack of even acknowledging difficulty, let alone allowing anyone to see her struggles, was prime bedrock for the character.
Both mothers have two sons. One named Sorrow (one dead, Buck?) and one named shame (one a “problem”, Conrad?). On the issue of Mrs. Pain going knocking on someone else’s door, it is so frequently true that our greatest pain and suffering is brought on ourselves through our own actions, or reactions – as was so eloquently and devastatingly presented by Ms. Moore to her family.
Turning to various assessments, first is the one by a psychodynamic therapist.
Conrad would probably be seen as presenting withdrawn, timid yet hostile with a stated reason for being there as a need to improve personal control so that others won’t have to worry about him. He also seems to manifest an anxiousness to examine dreams.
Suggested operational questions to explore might surround the following issues: Developmental and past events contributing to mental state; unconscious drives; the client’s stated need to improve control may indicate difficulties with and/or existence of restrained impulses; expressed immediate interest in examining dreams may indicate the presence of disturbing dreams.
Initial impression: manifests evidence showing a considerable level of internal tension/stress, and implied resentment with strong likelihood of repressed hostility.
The clinical impression from cognitive-behaviorism would include noting a youth who has internalized a base concept that he is personally deficient. This perceived lack leads to having others expressing the need to worry about him. These issues, collectively, being what he portrays as having brought him to treatment.
Conrad’s mood would be noted as somewhat depressed, with evidence of hostility. He appears resistant to investigating events.
As an integrationist, I would overwhelmingly combine the features presented in the sections above. This is due to the fact that it has arguably been proven that unconscious/emotional factors can and due influence behavior, but so do our conscious choices. I try not to discount worth merely because of a label.
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I am not sure that in this particular instance there are really any shockingly different motivations or approaches that would be taken by either a psychodynamic or a cognitive-behavioral therapist. In my opinion, the crux of the problem is that Conrad feels guilty that he lived and his brother did not. This is in part due to the fact that he believed that his brother had more worth to his family (and possibly to the world) than he does. Because I do not think that this belief is buried very deeply, I do not think that it would take years of analysis to uncover. This belief that he should not have survived the accident has twisted the way in which he sees all subsequent occurrences. I look at it like seeing everything through a dirty lens.
I suppose if I were a purely psychodynamic therapist, I would want Conrad to eventually uncover the origins of his feelings about the “love differential” between his relationship with his mother and the relationship that his brother had with his mother. From a cognitive-behavioral standpoint, simply understanding that this thought exists and that it is modifying other thought processes would be adequate to change his behavior. A combination of these two scenarios would be the perfect solution. Understanding the deep origin an how it is tainting current thoughts, which subsequently changing his behaviors would be optimal.
As for the comparison of Conrad's mother and Mrs. Pain:
Mrs. Pain and Conrad’s mother are not at all alike. Mrs. Pain is openly sharing her woes, whereas Conrad’s mother not only does not share her pain, she does not even acknowledge it’s existence.
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A cognitive behaviorist might differ with Dr. Berger in that they would clearly identify a problem and then set a goal for the client to achieve in relation to that problem. In the movie, Dr. Berger did not seem to ask Conrad to identify his problem, nor did he seem to try to set a goal for Conrad to try to achieve. In relation to Conrad's transference issues, I think Dr. Berger should have identified and spoken to them better than he did. Conrad may have been able to benefit from Dr. Berger identifying those issues for Conrad so that he could better understand what he was going through. It could have proven beneficial for Dr. Berger to point out that Conrad was feeling guilty because he survived the accident while his brother did not or that the reason why his mother is distant may not be because of him.
Conrad's mother and Mrs. Pain have a lot of similarities in that they both have problems dealing with their pain and letting it go. Instead they bottle it up and keep it around with them. Conrad's mother does this by keeping her son's room as a reminder of him and not talking about his death. She also bottles up her pain by distancing herself from Conrad because he reminds her of what happened to her son. Mrs. Pain keeps her pain with her by not leaving her house and surrounding herself with memories that cause her pain. Mrs. Pain does not deal with her husband's death and instead wallows in it when she should be moving on with her life.
One of my impressions of Conrad is that he is a troubled youth who is having problems dealing with the guilt he feels as a result of his brother's death. Conrad feels that it is all his fault because he let go and is unable to resolve that issue until Dr. Berger points out that it is not all Conrad's fault. Another impression of Conrad is that he does not have a stable family life in which he can express his feelings properly. I came to that conclusion because the father expressed interest in his son's treatment while the mother refused to meet with the therapist.
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1. How would a cognitive-behavioral therapist treat Conrad: The therapist would identify core beliefs by probing automatic thoughts and exploring cognitive distortions such as: labeling (exploring Conrad's inaccurate view of himself); personalization (blaming himself for his brother's death and mom's leaving). He would identify emotions (quality and degree)and thoughts that influence mood when Conrad discusses rejection by mother, receiving bad news, dreaming about accident. The therapist would use Socratic questioning to modify beliefs ("Could there be another way of viewing the cause of your mother's departure?)Also, having Conrad respond to the distressing image of brother drowning could help modify the meaning Conrad has attached to the event.
2. Comparison between Mrs. Pain and Conrad's mother:
- They both want to cover the truth (Mom to cloak problems in a "perfect image", Mrs. Pain to draw the shades and turn out the lights)
- They both drag down others and fill their hearts with misery (Conrad first, then the dad)
- They blame others for problems (Mrs. Pain knocks on other's doors, Mom blames Conrad, then husband)
- They left (Mrs. Pain after lightning struck, Mom after Dad confronted her)
3. 3 Clinical impressions of Conrad:
A. Psychodynamic: Conrad is afraid of violating parental standards (super ego) and is experiencing moral anxiety. He has repressed painful thoughts, has unconscious memories of mother's rejection, and has denied true feelings by failing to express them. He uses sublimation by swimming when he does not enjoy that sport. He has developed a false self since he has not learned to develop separate from his mother. He could be stuck in an anal stage since his mother has responded with disgust toward messes he makes (suicide attempt).
B. Cognitive behavioral: Conrad has dysfunctional core beliefs about being lovable, his believing that he should be dead instead of his brother,and that he is the cause of his mother's behavior. Intermediate belief: Need to swim to feel loved. Situation: Quit swim team. Automatic thought: I'm a loser. Reactions: Reluctance to tell parents, avoid friends, shame, anger.
Goal: remove biases or distortions in thinking so Conrad will function more effectively. Could be suffering from post traumatic stress disorder. Needs to learn techniques to manage intense anxiety symptoms and modify meaning Conrad has attached to traumatic event. (stop blaming self for surviving)
C. Psychodynamic cognitive behavioral integrationist: Conrad's behavior is influenced by his beliefs. The unconscious, repressed beliefs regarding mom's rejection leads to conscious, automatic thoughts of inadequacy in swimming and relationships. When the unconscious material and internal conflicts are exposed, dysfunctional thinking exchanged for functional, childhood experiences reconstructed and reinterpreted,feelings and behavior will change.
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I believe that a CBT approach would differ slight in regard to dealing with the unconscious manifestation displayed by Conrad, whereas the psycho-dynamic approach seemed to be more foster a more interpersonal client-patient relationship I feel like a CBT approach may be slightly more detached and 'objective', which may or may not have positive ramifications in regards to the client, Conrad.
In this specific context, I feel that 2 main issues that had been unconsciously repressed by Conrad. One was the issue of his brothers death and the guilt that was being felt by Conrad along with false thoughts of him being responsible for his brother drowning. Under a CBT model, I believe the approach would additionally differ in regards to addressing his current automatic thoughts rather than attempting to address more than his passed unconscious tension, although I am not certain about how these differences would appear in the therapeutic setting.
In regards to the song comparison with Conrad's mother I would state that the similarity is noticeable in that Conrad's mother appeared to view herself as a 'victim' and even cause pain to herself in one way or another. Although I do not believe she was the type of person to consciously cause pain to her life, she may have been doing so unconsciously. Also, she was unable to see how her lack of affection and love had a negative impact on her son Conrad, and she may have even unconsciously held him responsible for her others sons death and being that the song talks about a soon named shame there seems to be a parallel there in connection with Conrad.
In regards to the analysis of Conrad between the different schools of thought I would believe that as a psycho-dynamic analyst, I would view Conrad as having unconscious conflicting emotions between his parents Ideals and standards and his own drives and desires. As pointed out in the movie when Conrad quit the swim team, but avoid telling his parents for fear of going against their ideals.
As a CBT therapist, I would view Conrad as having unhealthy automatic thoughts driving him to feel guilty and shameful in regards to passed events, namely, his brothers death.
As an integral therapist I would view Conrad as having a distorted perception of reality due to false beliefs spawning from unhealthy guilt and shame from passed events, namely, his brothers death. This had resulted in unconscious automatic thoughts which resulted in a psychotic outburst episode culminating at the end of the flick. In addition, Conrad had additional conflict between super-ego ideals of society and parents and his personal feelings and thoughts.
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Conrad's mother and Mrs. Pain are similar in that they both need others to hold their pain. Mrs. Pain comes right out and says it, "I'll drag you down and fill your heart with misery". Conrad's mother adds to his misery by ignoring him, saying he quit the swimteam to punish her, making herself the center. Mrs. Pain left when the singer said he wanted her and her disesase gone. Conrad's mother left when Conrad and Dad wouldn't pretend they're all right and hold the pain for her anymore.
As a cognitive-behavioral therapist, my clinical impression of Conrad is he's clearly depressed, but not actively suicidal. Thus, CBT would be appropriate.
Conrad's dysfunctional or distorted thinking that his brother's death by drowning is his fault, is causing, or at least contributing to his depression. Conrad's additional distorted thought is, that he can't get well as long as his mother holds him responsible for Buck's death. I observed this when Conrad said "She'll never forgive me." As Conrad's CBT,I would aim for cognitive change like Dr. Berger did when he said, "Don't blame her because she can't love you more than she's capable of". Working off Dr. Berger's statement, I'd give a CBT homework assignment for Conrad to reflect on his childhood experiences with his mother, making note of when she was more affectionate, more approving and affirming in the years before Buck's death. My hunch is that Conrad would realize his mother was always rather aloof, not affectionate, etc. and that Buck's death had very little to do with his mother's affect and behavior towards him. With additional sessions I would continue to confront the dysfunctional thoughts like, he needs his mother's forgiveness,that he's responsible for her pain, etc., that keep Conrad in sadness. Like Berger, my goal would be for Conrad to forgive himself.
As psychodyanamic therapist, my clinical impression is that Conrad's depression is holding his family together. My theory appears to be correct because when Conrad begins to emerge from his depression, when Conrad and his dad connect more deeply, his mother cannot tolerate the change and she leaves, thus, the family as he know it, falls apart. I would encourage Conrad's interest in dreams as material for our work together to make the uncinscious concious.I would feel we've achieved positive transfersnce when Conrad hugs Dr. Berger and cries. Berger has become the loving parent providing the corrective experience that Conrad needs.
As integrationist, i would note Conrad's depression, draw out his negative, dysfunctional thoughts in order to confront their uselessness and contribution to his depressive mood. I would explore his family relationships both current and past and work with his dream material for metaphors representing his struggles to assist him in relieving his anxiety. At the start, I'd ask more open ended questions, be more emotive and less confrontational than Dr. Berger to develop a strong therapeutic alliance with Conrad.
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1. A CBT therapist would identify a problem, or a set of problems and set out to acheive goals to help these problems with the client themselves. In the movie, Dr. Berger did not do this with Conrad but rather, allowed a free-flowing stream of consciousness to develop in each session as Conrad became more in-tune with his feelings. iT was a slow process, but one which u;timately benefitted the charactor of Conrad becasue he was not instatly aware of his deep-rooted issues and it would not have served him well to try to identify these problems right away. Therefore, a CBT therpaists' mission to set goals would not have been able to be fully acheived either. The approach used in the film was the best way to conduct therapy with Conrad.
Conrad's mother was like Mrs. Pain in the way that both women are stuggling with pain, nut MORE SO HOW to deal with that pain. If one doesn't handle the pain and try to place it in a better and more healing light, then it will grow and develop into a monster that affects lives in disasterous and sneaky ways. Sneaky becasue suppression is the fastest way to make something grow- it will fester queitly in the depths of your soul until one day, a small and seemingly insignificant and unrelated event will occur and the person will completely go to pieces, revealing the layers of suppressed and festered pain, anger and sorrow that has had a chance to accumulate in the depths below.
Conrad is suffering from PTSD after the death of his brother and I think he should be treated primarily for that purpose. All feelings of depression, guilt, shame and removal of one's self from family and friends are all clear signs of the presence of this disorder. The subsequent feelings of anger, frustration at not understanding himself or feeling misunderstood and alone in relation to everyone around him is also clearly in result of him suffering a great deal of grief and sorrow for the loss of his brother that he hasn't fully and properly allowed to heal and release. He has kept it bottled up and needs to release his pain, before he becomes tight and twisted like his mother, the greatest antagonist of the film, because she was the figure who was most suppressed and wouldn't deal with her emotions, not allowing anyone else's to be set free either.
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