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Questions for Discussion

1.     For Triangle of Conflict, what is the Defense (D), the Anxiety (A), and the Feeling (F)?

a.     Feeling: Carla is feeling loneliness, sadness, and inadequacy. She feels sad and lonely that she doesn’t have a boyfriend. She feels like nobody understands her as all her friends are in relationships which makes her feel like something is wrong with her which just contributes to the loneliness and sadness.

b.     Anxiety: Carla has anxiety about fear of abandonment in her romantic relationships, so she seeks out reassurance from her partner. This has caused partners to withdraw which only strengthens this fear.

c.     Defense: Carla’s defense mechanism is avoidance. She avoids talking with her partners about her emotional needs or other issues such as avoiding confronting Zach about his phone calls to his ex-girlfriend.

Cyclical Maladaptive Pattern Model

1.     What are the acts of the self?

Carla gets into relationships with men who are not able to meet her emotional needs and is dependent on external validation in her relationships and from her parents.

2.     What are the expectations of others’ reactions?

Carla expects that her partners will abandon her and that they don’t understand her.

3. What are the acts of others toward the self?

There is a pattern in her relationship of Carla seeking reassurance and men in response being distant. Her dad is over involved in her romantic life as he hired an investigator to look into her ex-boyfriend.

4. What are the acts of self toward the self?

She has a lot of self-criticism and shame and feels that she is nothing without a boyfriend.

5. What would your reaction (as a therapist) be to the client?

I would react to Carla with empathy and provide a safe space for her to share ger feelings and needs and validate this.

6. What would the goals of therapy be?

I would want to talk with Carla about her issues surrounding self-worth and self-esteem as these seem to be at the core of her issues and feelings. I would want to work on ways to build up her self worth and self confidence.

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Feeling (F): Need for Reassurance/Fear of Abandonment. Carla experiences a strong need for reassurance in her romantic relationships, stemming from a deep-seated fear of abandonment. This fear is likely rooted in her early childhood experiences, particularly the challenging dynamics with her father and the parentification she experienced due to her sister's illness.

Defense (D): Avoidance of Direct Confrontation/Seeking Indirect Reassurance. To protect herself from the anxiety of potential rejection, Carla avoids directly confronting her partners about her needs. Instead, she seeks reassurance indirectly, often becoming increasingly "needy" and anxious, which ultimately pushes her partners away. This avoidance is also evident in her tendency to withdraw from her supportive friends when in a romantic relationship, further isolating herself from potential sources of comfort and validation.

Anxiety (A): Rejection/Disapproval. Carla experiences significant anxiety related to the possibility of rejection or disapproval from her romantic partners. This anxiety is heightened by her belief that she is "nothing without a man" and her perception that she is somehow flawed, leading to men losing interest. Her anxiety is also fueled by her father's overbearing and intrusive behavior, which reinforces her fear of being controlled and judged.

Cyclical Maladaptive Pattern Model

1. Acts of the Self: Carla exhibits behaviors fueled by a deep-seated fear of abandonment and a belief that she is "nothing without a man". This manifests in:

Need for Constant Reassurance: She seeks frequent validation and affirmation from her romantic partners, often becoming "needy" and anxious.

Indirect Communication of Needs: She avoids directly confronting her partners about her needs and insecurities, hoping they will change or "come around" without direct communication.

Prioritizing Romantic Relationships to the Detriment of Other Relationships: She tends to let her close female friendships "fall away" when in a romantic relationship.

Difficulty Expressing Negative Emotions: She struggles to articulate anger or frustration, often resorting to sadness, self-blame, or withdrawal.

2. Expectations of Others’ Reactions: Carla anticipates the following reactions from others:

Rejection and Abandonment: She expects men to lose interest and leave her, reinforcing her belief that she is flawed and undesirable.

Lack of Understanding: She believes her friends and family cannot relate to her struggles because their lives appear more fulfilling.

Disapproval and Anger: She expects negative reactions from her father if she challenges his intrusive behavior, despite feeling violated by his actions.

3. Acts of Others Toward the Self: Carla's perception of how others treat her often confirms her negative expectations:

Romantic Partners Withdraw: Men initially drawn to her charm and intelligence eventually distance themselves, frustrated by her neediness and indirect communication. Bob, John, and Zach all exhibit this pattern.

Father is Overbearing and Intrusive: Her father, while offering financial support, exerts control and judgment, particularly regarding her dating life. He paid for an expensive dating service and even hired a private investigator to look into Zach, reinforcing Carla's feelings of being controlled and not trusted.

Friends Offer Unsatisfying Support: While well-meaning, her friends cannot fully understand her struggles, making her feel isolated and misunderstood.

4. Acts of the Self Toward the Self: Carla internalizes the negative messages she receives, leading to:

Self-Criticism and Low Self-Esteem: She blames herself for relationship failures, viewing herself as undesirable and "nothing without a man".

Suppression of Anger: She turns her anger inwards, blaming herself rather than acknowledging her legitimate feelings of frustration and resentment towards others.

Guilt and Self-Doubt: She feels guilty for having negative feelings towards her father, despite recognizing his overbearing and intrusive behavior.

5. Therapist's Reaction: The sources provide a glimpse into how a therapist might react to Carla:

Feeling Drained and Frustrated: Similar to her romantic partners, a therapist could become irritated by Carla's indirect communication and difficulty expressing anger, as illustrated in the case of Mr. Johnson.4

Wanting to Help and Empower: The therapist's goal would be to help Carla break free from this cycle, encouraging her to assert her needs directly, process her anger in healthy ways, and build a stronger sense of self-worth.

6. Understanding Carla's CMP provides a roadmap for therapy. The goals would be to:

New Experience: To provide Carla with a new relational experience where her needs are validated, direct communication is encouraged, and her feelings, particularly anger, are explored without judgment. This could involve techniques like role-playing assertive communication, exploring the origins of her fear of abandonment, and challenging her negative self-beliefs.

New Understanding: To help Carla understand her CMP, recognize how it affects her relationships, and develop healthier coping mechanisms. This could involve identifying triggers for her anxiety, reframing her self-perceptions, and developing more effective communication strategies

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Triangle of Conflict:

1. Defense (D): Carla's defense is primarily avoidance as she frequently avoids confrontation in her relationships. Specifically, Carla is avoiding confronting her current partner regarding the possibility of him maintaining contact with an "ex" girlfriend.

2. Anxiety (A): Carla's anxiety manifests through the need for reassurance and validation through a partner. She has identified feeling as if she is unworthy when without a romantic partner. When in a committed relationship, she frequently seeks validation and feels disconnected without it. This often leads to her desperately holding onto the relationship.

3. Feeling (F): The underlying feeling that Carla is experiencing is loneliness. She has identified feeling worthless when without a romantic partner. She also struggles to hang out with her family as she feels to be the only one without a partner. Secondary emotions include shame, sadness, and frustration. She is ashamed that she has not been able to maintain a partner and feels isolated from the rest of her family. This leads to sadness and frustration regarding her seemingly inability to maintain a relationship.

Cyclical Maladaptive Pattern Model:

1. Acts of the self: Carla seeks frequent validation through her romantic partners, though repeatedly chooses to date unavailable men who are unable to meet her needs. This leads to her anxiety manifesting in desperation to maintain the relationship, despite feeling as if her needs are not being met.

2. Expectations of others' reactions: Carla is fearful that if she voices her needs for reassurance, her partner will become irritated and leave her. She expects to be abandoned again, leading to further insecurity.

3. Acts of others toward the self: The acts of her partners and family further confirm her expectations as her previous partner distanced himself when she would ask for reassurance. He would refuse to give her the validation she needed, adding to her shame and loneliness. Further, Carla's family have overly involved themselves in her relationships as her father spent a significant amount of money on dating apps for her and hired a PI to follow her partner. This brings on more shame as her family reinforces the idea that Carla is worthless without a partner.

4. Acts of self toward the self: She is deeply self-critical and feels worthless without a partner, reinforcing her negative self-image. She blames herself for her partners' distance and inability to maintain a relationship. She also isolates herself from her support system as she often drops her friends when in a relationship. This again reinforces her loneliness.

5. Therapists' reaction: I would feel empathetic for Carla and frustrated with her family for being too involved in her dating life, reinforcing her feelings of loneliness and shame. I would validate her frustrations and anxieties regarding her relationships but also be frustrated with the men not reassuring her.

6. Goals of therapy: Goals of therapy would include increasing self confidence without a partner. A stronger sense of self-worth would be critical to build so that Carla feels worthy without a partner as well as with one. Therapy goals would include discussing and recognizing her patterns of rejection and choice of unavailable partners. Finally, it would be important to encourage Carla to maintain contact with her friends and rebuild those relationships, while ensuring she does not sabotage them again.

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Triangle of Conflict

1. Defense (D): Carla uses a defense of avoiding confrontation, particularly in her romantic relationships.

2. Anxiety (A): Carla experiences anxiety related to her need for reassurance in her romantic relationships, especially fear of being left or rejected.

3. Feeling (F): The underlying feeling is a combination of loneliness, fear of abandonment, and a sense of inadequacy.

Cyclical Maladaptive Pattern Model

1. Acts of the self: Carla seeks reassurance and validation from men, demonstrating clinginess and desperation for their approval, even when they show signs of disinterest.

2. Expectations of others’ reactions: Carla expects that if she seeks reassurance or expresses her needs, men will become irritated or leave her.

3. Acts of others toward the self: Men in Carla’s life often respond to her neediness by distancing themselves, becoming non-committal, or avoiding emotional engagement.

4. Acts of self toward the self: Carla internalizes blame for her relationship difficulties, believing there is something inherently wrong with her, adding to her low self-esteem and feelings of inadequacy.

5. Therapist’s reaction: I would validate Carla’s struggles and help her explore the roots of her dependency on external validation, offering a non-judgmental space for her to process her emotions. I would also encourage her to reflect on her self-worth beyond relationships.

6. Goals of therapy: The goals would include helping Carla build a stronger sense of self-worth independent of romantic relationships, addressing her fear of rejection, and developing healthier patterns of attachment in relationships.

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For Triangle of Conflict, what is the Defense (D), the Anxiety (A), and the Feeling (F)?

Defense - Carla avoids conflict in her minds eye by not expressing her emotional needs directly. This is seen by engaging in behaviors that reduce her anger towards her father and distracting herself through dating multiple people and never truly resolving the emotional turmoil she experiences.

Anxiety - Carla experiences intense bouts of anxiety when she experiences her needs being unmet. This is seen in Carla's romantic relationships, as she seeks constant reassurance from her partners in hopes to curb this anxiety response. Furthermore, this anxiety becomes exacerbated when the fear of abandonment and rejection clouds Carla's psyche leading to Carla being desperate to hold onto relationships.

The primary underlying feelings that Carla experiences are sadness, shame, and anger.

Cyclical Maladaptive Pattern:

Model

1. What are the acts of the self?

Carla seeks a level of emotional reassuring but grapples with this want and appearing needy. She also repeatedly pursues unavailable men and avoids confronting her partners in fear that Carla expressing her needs and discomforts will lead to them abandoning her. This need and fear of abandonment is closely linked to Carla's own view of her self-worth, and the desperation Carla exhibits for a lasting relationship.

2. What are the expectations of others’ reactions?

Carla has the expectation that if she were to express her emotional needs, her partner would become irritated and annoyed with her and eventually abandon her. Carla also believes that if her father perceives her to be struggling, he will ultimately take control and support Carla. Although this may be seen as a pro, Carla describes the thought of this as very overwhelming. Lastly she expects men and future partners (like Zach) will ultimately lose interest in her reinforcing a belief that although she craves a lasting relationship and love, she is in fact unworthy of this.

3. What are the acts of others toward the self?

John made a conscious effort to distance himself from Carla when she was craving reassurance, ultimately confirming Carla's fears, which are that if she is too needy, she will lose her relationship. Zach falls into a different category, but the ramifications are as drastic as John's acts towards Carla. Zach strings Carla along through inconsistent affection, which leads Carla to have intense anxiety and doubt her own self worth. Lastly, Carla's father, although protective in some ways, becomes overly involved, leading Carla to a place of resentment as she feels and perceives herself to be dependent on her father.

4. What are the acts of self toward the self?

Carla's blame she places upon herself for the multiple failed relationships reinforces a theme in Carla's mind that she is broken, unlovable, and unworthy of love. Carla actively withdraws from friends because of the shame she feels from the events described above, as well as envy towards others, which entails deepening the anxiety and depressive state Carla experiences.

5. What would your reaction (as a therapist) be to the client? 6. What would the goals of therapy be?

I would certainly be concerned, as Carla has many cognitive distortions and deeply routed thoughts about herself that have led her to use maladaptive coping strategies in hopes of quelling these needs. There is a level of narcissistic vulnerability that appears to be potentially also clouding Carla's mind and decision making process. I would hope to create a safe environment where Carla feels safe and validated in hopes to eventually exploring Carla's maladaptive patterns, eventually leading to the development of emotional insight. Goals would be centered around Carla recognizing these maladaptive patterns and how she views them serving her and her emotional needs. Furthermore, I would want Carla to develop skills around building self-worth through Carla being able to become more assertive and express her needs. Through this process the hope would be that Carla will develop self-compassion and self-love for herself.

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Carla's analysis

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Thinking Routine 2