Course of treatment
In therapy Alec described his desolate life and his preoccupation with Mary and how he wronged her, with an acute awareness that given how the relationship ended he could not try to work things out with her, try to have a relationship with her again, or even offer an apology. I wondered whether he was trying to find something perfect in his life to undo the devastating events of his childhood. Was his aggressive pursuit of justice in fact a displaced feeling of being wronged when his brother Mark got injured and “stole” his parents from him? These were some of the possible explanations of the dynamics, but Alec was not able to access any of these possibilities in his narrative. He was preoccupied with extreme perfectionism and catastrophic expectations which came to a head when he started working on his master’s thesis. He wanted to impress his professors and submit an outstanding piece of research. At the same time, he feared that even the smallest mistake would lead to failure. He hoped that by writing such an impressive thesis, he would solidify his reputation in the department and thus would secure the most glowing recommendations for possible future jobs. Consequently, his master’s thesis was exceeding in length, scope, and the research methods required for a master’s thesis, and existed only in his mind. His lofty aspirations paralyzed him and made him feel panicky and his writing was limited to disjointed paragraphs written in a state of anxious frenzy. To cope with the anxiety, he reassured himself that he would organize his thoughts “at some later point in time,” only to generate a few more disjointed paragraphs and escalate his humiliating expectations of failure.
I worried about him. His high expectations were interfering with the completion of the thesis and he was not willing to compromise. He requested multiple extensions, each time fearing rejection and, also, ruining his reputation in the eyes of his professors. Consciously, he was pursuing perfection. However, I wondered whether, at the same time, Alec was also fearing graduation, fearing growing up, fearing taking on the responsibilities of adulthood and of a professional and personal life. He grew up with very sad examples of what it meant to be an adult. His mother was disengaged due to depression. His father sacrificed his happiness in service of taking care of others. His brother was full of aspirations and hopes but was paralyzed. With these role models in front of him, how could Alec feel hopeful about his own adulthood?