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Case Analysis

The final phase of treatment is to develop a therapeutic relationship. Because Maria has been victimized by her culture and the majority culture, developing trust and groundwork for the "I-Thou" relationship is important. A concurrent component is to help her reframe the paradigm for a cure. In the past she has sought to find herself through others, but now Maria will become instrumental in helping herself gain power in her life situation.

Her dreams seem to be a sign of positive prognosis for Maria. The ideal and final interpretation of the dreams will be made by and with Maria. At a deep level, her real self is confronting her isolation from others (e.g., "shadowy figures" in a foreboding culture, "large warehouse-type structure"). The shadowy figures may be aspects of herself that she is facing (e.g., aspects of her despised and idealized selves manifest in her victimization and isolation) for the first time. She cannot figure out how to escape and is afraid. This shows that Maria is focused and motivated to confront these aspects of herself and her world. Escape no longer is providing solace. She is ready to change.

The counselor needs to help Maria confront the anxiety of death. By meeting her fears of loss and engulfment and encountering the aspects of herself that are frightening, she will sense all that she has encountered and survived. Maria will also develop a stronger sense of herself and her responsibility for making her own choices. By continuing to flee or withdraw from anxiety-provoking situations, Maria avoids being and living. She is trapped in her fears by her depression and isolation.

Counseling involves helping Maria on her journey as she encounters the fears embodied in the shadowy figures and the many differing ways she may feel compelled to turn. It is important for the counselor not to offer advice (providing yet another box with another arrow). Instead, Maria needs to gain her own voice and sense of herself. This will occur through the process of validating her pain, hearing her story, and helping her to find meaning in herself and her existence. Unfortunately, the rational, mathematical lens through which Maria has viewed the world has not provided adequate perspective or appreciation of her subjective pain.

The counselor is providing a context of relating to others that will help Maria to learn that her sanctuary (e.g., escaping through depression, living through others, and looking to others for her answers) only perpetuates her anxiety. By facing her insecurities, Maria will gain a sense of inner strength, awareness, and individuality. By taking responsibility, she can realize the freedom she has to be herself. Once she has recognized her power and responsibility to choose, she can be herself in relation to others.

Group counseling might be helpful when Maria has developed a sense of her true self. The group would allow Maria to connect with others with similar struggles, to validate her pain and her abilities to survive, and to develop healthier ways of relating. An interpersonal, process-focused group for survivors of abuse would be most helpful for Maria.

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