Case Study
Seeking Non-Institutional Psychiatric Care
Twenty-four-year-old Max gets his mother’s assistance in seeking non-institutional psychiatric care. He has been quiet and withdrawn of late and no longer wants to go to work. In the discussion with the psychologist it is revealed that Max’s family was of a non-conformist faith and at the age of 22, he moved in with his cousin and adopted a different lifestyle. Although he acts responsibly in going to work at the mechanical workshop where he is employed, Max is also out partying a lot, drinking and experimenting with drugs, and having numerous short-term relationships with women.
Max’s new lifestyle also involves him going to the gym, and he takes anabolic steroids for a while to improve his results. On several occasions, he has been questioned as to how his lifestyle and faith go together, which angers him so much that he might take a swing at his critic. Eventually, Max confesses that the contrast between his religious values and his lifestyle is too great, and that is why he has been so withdrawn.
The Psychologist In Supervision
The psychologist finds it difficult to help Max with his religious dilemma because he is not a man of faith himself. Still, he feels he understands that Max’s religious beliefs are important to him. The psychologist’s uncertainty leads to his raising the subject of his failings in a supervision group. There he learns that Max’s religious dilemma is a contact rebus and that other things are much more difficult for the patient to solve, namely his drug abuse and destructive behavior towards others.
The Psychologist returns to the Patient
When the psychologist returns to his patient, he questions the religious dilemma. Max then starts to talk about his fear of meeting people and his anxiety over being unable to control his anger, and the possibility of him being violent again. Moreover, he is very worried about telling his friends about these problems because he thinks they will laugh at him and he has been avoiding them for this reason.
The Withdrawing Contact Rebus
After talking to the psychologist about his troubles, Max has the courage to tell his friends. He feels they respond positively and demonstrate great understanding. After a further two meetings with the psychologist, Max stops contacting him. The psychologist then calls him to ask how things are and Max is relieved that the psychologist isn’t angry with him but wants to continue helping him. He turns up for his next appointment.
Discussion
A Verbal Contact Rebus
The patient first employs a contact rebus which invites the psychologist to concentrate on the religious dilemma created by his current lifestyle. It is a verbal test that would involve lengthy discussions about theology. It is known territory for the patient where he tests if the psychologist stops at this verbal level or understands that there are emotional problems behind the religious dilemma.
Supervision
With the help of his supervision group, the psychologist is able to solve this contact rebus so that Max has more courage to get in touch with his anxiety and pain. His next contact rebus arrives in the guise of his absence from appointments and failure to cancel: Max is withdrawing from the psychologist. It is the same test that Max employed on his mother and friends.
The Withdrawing Contact Rebus: The Client
In this case, destructiveness is openly enacted, not concealed. Max starts to get to grips with his problems and has a positive experience in so doing. He then interrupts this positive development and bars progression, seemingly wanting to destroy his relationship with the psychologist. Max’s contact rebus contains both aggressor and victim elements. He is an aggressor towards the psychologist in the way he gives negative feedback for the help he receives, but he harms himself by ruining his opportunity to receive further help.
The Withdrawing Contact Rebus: The Psychologist
In turn, the psychologist is invited to feel offended and maltreated, which may lead to his reluctance to initiate renewed contact or work with Max altogether. The role of victim is also offered to him in that he will feel he has done something wrong and is a failure. This role also involves his not contacting the patient, but in this case, it is because he has nothing to give him. Dissonance is seen in the amount of energy Max expends on staying away. Had he been more apathetic from the start, he might not have gone ahead with the liaison or not made an effort.
The Solution of the Contact Rebus
Since Max is committed to it, his absence is not a question of apathy. The psychologist seems to have passed the test by not adopting the role of aggressor or victim and maintaining a positive commitment to Max. When he calls Max, he receives positive affirmation from the client that his absence has to do with his commitment. The psychologist solves the contact rebus by contacting Max and showing that he is still concerned about him, upon which Max employs a compliance contact rebus by resuming discussions with him.
A General Theory
The contact rebus theory is not only useful therapeutically; it is a universally applicable concept of human behavior that lends itself to other contexts of human interaction, for example, lovers (Motivational Work, Part 1: Values and Theory, page 349 – 388).