Alma is a 30 year old Caucasian female. She is the daughter of a minister and takes care of her mentally ill mother and took over the duties of a minister’s wife due to her mother’s absence. She loves to sing. She is very shy, well-spoken and behaves like a gentle woman of the highest class. She dresses from neck to toe with all of her body covered except her face and hands. Since she was a girl she has had a liking for a man named John. She has few close friends and relies heavily on her father for opinions and advice. The reason for this is that she is constantly engaged in working for the parish. Alma is quite innocent and childlike in her behavior. She is not worldly. She has a lovely home and is socially well-liked. The only health issue she displays is slight anxiety when she is introduced to intimacy or situations she is not used to.
The presenting problem is Alma’s sexual repression. She is so sheltered due to her upbringing that anything considered taboo by the church she has never experienced. She considers herself a proper lady. She speaks with care as to not upset or speak badly of others and will not talk about improper subjects. When John returns from university Alma’s life and feelings are turned upside down. John is a classic immoral bad boy, and he tests her sexually trying to bring out the repressed intimate side of Alma.
This brings out the sexual dysfunction in Alma. According to Yangki Christine Akiteng, “the sexually dysfunctional experience anxiety and even panic at the thought of any sexual interaction because the "sexual" makes them feel like they are on "dangerous" ground” (1). Alma cannot get close to a man because as soon as she does she becomes greatly disturbed and tries to flee. She cannot even look at the naked body, even in a doctor’s office. She is terrified of sex and the anatomy. Alma is almost bitter and side steps sexuality and sensuality as base animal instinct. She escapes through the spiritual. She has built a safe haven around herself with her religious fervor and ministerial duties to fulfill the needs for intimacy and connection in a relationship. She is obsessed with the soul, as her name means soul. Alma has spoken of her awkwardness in social situations regarding men. She explains that once a nice man wanted to ask for her hand in marriage, and she could not even bear to discuss it and left the date to go home. Alma describes a tragedy that occurred due to one streak of unusual jealousy in which the bad boy John was drunk and ready to marry a loose woman. Alma called John’s father and an accident happened and he was killed. John blamed Alma for his father’s death, accusing her of being a spinster that could not love. According to Yangki Christine Akiteng “You are sexually inhibited and may see anything sexual as something dangerous that can interfere with the proper conduct of the "good" man or woman -- so you've been told” (1). This is how Alma was raised so her background and childhood programming as a preacher’s daughter has been ingrained in her behavior.
Alma describes how after John’s father’s death she took to being reclusive and experienced a deep sadness that borders on depression. She stopped teaching singing and going out. She stayed indoors in her night clothes and did not even attend to grooming. Her coping methods of escapism seem to be her only known coping method. She stayed indoors for several months in mourning over the tragedy and losing John’s attentions.
Alma shows traits of both sexual repression and sexual dysfunction. According to Yangki Christine Akiteng “You feel the need to hide those "dirty sexual" parts of your body” (1). Alma’s dress, which covers every aspect of her body, is indicative of one that is ashamed of the anatomy and the sexuality of both women and men. Alma hides her body in order to remain safe. Her clothes serve as a physical barrier between her body and those of other people.
Unfortunately, Alma explains that she lost her chance to be with John and she was ready to take their relationship to the next level and become intimate. However, while she expressed her love openly for the first time she was surprised to learn John was already engaged to a younger friend of hers. She had made a transition past her dysfunctional sexuality but in doing so she pushed forcefully ahead and ended up becoming too sexually forward. This flip flopping shows that Alma is sexually immature.
Alma is stuck in what Kendra Cherry calls “Freud’s Latent Period” this is the period of development in which “sexual feelings are inactive” (1). Full developmental range of the personality cannot happen if a person does not completely go through every stage of development psychologically and the person will remain in that early stage until something changes in their adult life to push them forward. Alma has anxiety and sexual dysfunction that needs to be treated. Alma has experienced a new set of circumstances in her life as she goes out on her first real date, but she acts out of character and flirts shamelessly with a stranger. This sort of behavior can lead to harmful results for Alma both physically and emotionally.
Alma needs to attend one-on-one counselling in order to find professional and logical advice. Alma shows symptoms of being in an identity crisis as she becomes the new person. If she is not careful she could ruin her reputation and future. Counselling will help to unravel the many years of programming about her body, sex and social mores that have Alma confused. It will also assist her in making proper choices when it comes to partners, relationships and how to maintain dignity while dating.
For her anxiety she should be prescribed medication that will alleviate the symptoms as needed. Her past use of medication to numb her feelings does raise caution. She is possibly a candidate for psychological or emotional addiction to anti-anxiety medication. Giving Alma any medications that have a natural addictive property is not advised. She admits to sharing her medications with the stranger she took to the casino. This also needs to be taken into consideration. Alma does not understand regular feelings of heightened emotions when intimate and mistakes them for a medical problem. Due to Alma’s ignorance of sexuality she seeks medication to soothe her new feelings. It is best to counsel Alma on the truth of what she is feeling rather than to offer medication when it is not needed. If true anxiety persists, medication options are available.
Alma’s short term results do not look favorable. She has displayed emotional sensitivity to criticism and has a very logical mind. If utilized correctly a counselor can use the process of logic to help Alma understand her situation. However, the deep obsession with spirituality may be a difficult issue to get past. If Alma will take the advice and guidance offered to her rather than dispute it as nonsense she has potential to make strides toward becoming more balanced in her mental and emotional state. The first step is to get Alma to talk openly about her past and her ill mother. Once she feels safe in discussing private issues further progress can be made into the deeper subjects of sexuality. This must be taken slowly and carefully. Alma is potentially a client that could abandon therapy after a few sessions due to fear. Even though Alma has supposedly opened herself up to being more seductive, she is putting herself at risk. This needs to be addressed within the first few sessions.
Alma’s long term results can be extremely favorable for achieving balance within her life both emotionally and mentally. Once she is able to process her own fears of sexuality and create healthy boundaries, Alma should be able to live a relatively functional life and form long-lasting relationships with both men and women. She would be able to wisely decide for herself what clothing is appropriate and how to behave accordingly to her own needs. Alma needs to understand that just because she is not sexually active or married even at her age, it does not make her unlovable or unneeded. Whether she decides to become sexually active or not she needs to come to the realization that society does not dictate the proper age of sexual exploration. Alma, through continued therapy should have a positive prognosis for recovery from sexual dysfunction, immaturity and repression.
Works Cited
Cherry, Kendra. Freud’s Stages of Psychosexual Development. About.com. n.p. n.d. Web. 27 June 2015.
Cherry, Kendra. How to Write a Psychological Case Study. About.com. n.p. n.d. Web. 27 June 2015.
Yangki, Christine Akiteng. Sexually Repressed, Sexually Immature Or Sexually Dysfunctional -- Which One Is It? n.p. n.d. Web. 27 June 2015.
