Presenting problem and clinical description
Alec was 24 years old when he arrived at our first meeting. He explained that he had relocated to Boston for graduate school and was looking for “support for depression and anxiety.” He was very interested in my background and told me that he searched the internet about me before our first appointment. Puzzled, I wondered whether his desire to know things about me was related to anxiety and uncertainty of beginning treatment. I also wondered if this indicated problems with intrusiveness and boundaries. As I was not able to have clarity about any of these hypotheses, I shelved them, hoping to gain more clarity in the future.
Alec grew up in a privileged family. His family owned a consulting company that was passing from one generation to the next. However, Alec was uninterested in the company and was dedicated to the field of his studies, history. His father ran the company, though in his younger years pursued an academic career in archeology. It was truncated upon the death of his first wife, who died from cancer. Alec’s father became depressed, quit his academic job, and was quite literally rescued by his own father who offered him a new career in the family business. Around that time, Alec’s father met his second wife – Alec’s mother – and married her soon thereafter. Alec recalled that his childhood was sad and lonely. His father worked long hours and his mother, who was depressed for months at a time, was often unavailable. Alec’s younger brother, Mark, sustained a serious sports injury during the summer before Alec started high school. The injury left Mark paralyzed, and Alec de facto lost both of his parents who became preoccupied with extensive medical care for Mark. Alec would escape into reading fantasy novels, spending long hours reading at the expense of schoolwork or spending time with friends. His parents arranged for him to start treatment. Gradually, he was able to limit his reading and finished high school.
Hoping for a much needed sense of independence, accomplishment, and romantic fulfillment – a new beginning – Alec started college. He was busy studying, daydreaming about having a girlfriend, and attending the occasional party. He thought that his dreams had come true when he met Mary at one of the parties and both felt a strong connection to each other. He saw the relationship in idealized terms: two soulmates who fell completely in love with each other. As the two became closer, Mary shared with Alec a devastating history of abuse by one of her family members. Alec became preoccupied with Mary’s anguished childhood. He was enraged that Mary was hurt, especially by a family member. Initially, Mary felt that Alec was very understanding and sympathetic and her trust in him increased. However, as he became more and more preoccupied with “justice” and became interested in suing her family, she became increasingly worried. The tension between them grew as Mary experienced Alec as aggressive and feared that he might harm her family.
Alec felt that the abuse tainted the perfect relationship he and Mary could have had. In his mind he hoped to reinstate the perfection of their relationship, while refusing to realize that he was causing enormous distress to Mary. Mary repeatedly requested him to stop pursuing justice because she wanted to move on. Eventually, as Alec’s behavior had not changed, she broke up with him, asking him to never contact her again. Alec felt devastated that he destroyed the relationship with the woman he loved and wished to protect.
Fearing his own destructiveness, he concentrated on his studies. He graduated a few years later and started graduate studies in history, hoping to pursue an academic career. He had a few brief relationships that invariably ended after Alec would get annoyed at the “imperfections” of his partners. He was a good student, though his professors were not aware that his perfectionism was affecting his ability to do and enjoy the schoolwork. Everything needed to be done perfectly – not only did Alec need to meet the expectations of his professors, but also he had to meet his own standards. That quadrupled his work, slowed him down, and colored his experience with incessant fear of inevitable failure. After all, these were impossible expectations to meet.