Originally Posted by Mofromco:
“OK, I'm a medical person, but I don't have a real understanding of psychotherapy and the processes that go with it. What do you mental health professionals propose will be the next step in DMs quest? I have been led to understand that psychotherapy is an in depth treatment and exploration of motivation as opposed to regular treatment....well, you're depressed, take these pills. Where does Martin have to go and who does he have to see to help him next. I have a feeling that he has to explore his past and isolate the incident that is the source of his blood phobia to get beyond it. There are so many factors that go into it...frogs, glass, blood, Mummy, clocks, watches, the closet under the stairs, time....what is next? What do you think "the man on a mission" has to do?”
I have to preface this by saying that if three therapists got together to try to figure out a treatment plan (as in a case conference, e.g.) you would probably wind up with 4 or 5 different ideas of where to start and how to proceed.
i do have to say also that I don't buy into the notion that some particular "trauma" caused his phobia. E.G. he didn't see his mother cut herself badly while slicing onions, and her hysterical reaction. It may have provided a template, but I highly doubt any particular incident was causal. So therapy to "uncover" this cause would not be helpful.
Martin Ellingham has three different things going on, at least. First and foremost, his marriage is in immediate, deep trouble. Second, he has recently had an episode of what looks like anxiety mixed with depression. Third, he has long-term issues, amounting to a kind of personality disorder. Each of these has different treatment implications.
Let's say that the anxiety-depression problem has temporarily at least, gone into remission. Given the confident way he strode out of the hospital, and his behavior in general after his "breakthrough" session with Doctor Ruth, I think that's a fair assumption. If it hadn't, and that was at this point, his only problem, his therapist might refer him for meds of some kind - which wouldn't help particularly with the blood phobia itself, but might help him better sleep and eat, and generally be more functional. That, combined with some kind of short-term talking therapy, probably of the cognitive re-structuring variety, (helping him to reframe his thinking in more realistic and less catastrophic ways) would probably be where most therapists would go, at least initially, until the greater scope of his problems became clearer.
The longer-term personality issues are far more difficult to treat, and I think that there would be less agreement about how to go about treating him. First of all, there is the "differential diagnosis" issue. Is he really on the autistic spectrum? at the better functioning end, as in Asperger's? If you thought that, the treatment implications are different, it seems to me. I don't happen to think that, despite the many people who passionately believe that he is. I just think he has developed long-term, deeply rooted character traits to protect himself, and they are now so much a part of him that he would think of them as just the way he is, rather than experiencing these traits as symptoms of anxiety or depression, as in insomnia, loss of appetite, diminished libido, etc.
So those traits, that are dysfunctional and cause him real pain, are very difficult to treat. Some would argue for long-term psychodynamic psychotherapy -- basically talking, with a focus on identifying defense mechanisms, how they play out in his life, how family of origin issues influence him in his life today, and so on. Others, and I think I would be in this camp, would argue that one could also do cognitive-behavioral work on these personality issues (and I will spare you the reasons why I think that).
To me, however, the real place to start would be couples counseling. His issues, where he really is dysfunctional, are in relationships. Working out, in real time, what is going on with him when he interacts with Louisa, is likely to both help his issues AND his marriage -- the burdens and breakdowns of which are the precipitating issues in his recent "breakdown." And, since neither he nor Louisa apparently have the slightest idea how to communicate with each other, they do need a lot of coaching. So that is where I would recommend starting.
I must say that I got so that I hated doing couples counseling. That is because by the time I saw most couples, they were so angry and bitter and determined to blame the other person for the major share of marital dysfunction, that sessions were often quite unpleasant, and even made things worse. Also, I have to say, I wasn't very good at it, and that is always off-putting! But Martin and Louisa are not at that point; they actually want their marriage to work, rather than the useless exercise of assigning blame and punishing the other. So they are good candidates for this kind of work.
But I doubt that BP will go that way. In fact, I am a little concerned that, given the way they should him "resolving' in E8, that they won't go in that direction at all.