As I learn more about Otto my appreciation for his depth and pain grows. As Vic mentioned it is often very hard to get a feeling for a client presented this way. I however initially had a negative reaction towards Otto. His style of presenting felt "bullyish" and I thought that this would prove to be telling about how he had been treated in his childhood. It is often the sign that a patient would have to repeat very traumatic experience with you. I must confess that the degree to which this is true surprised and saddened me. We are meeting a man who is in acute pain. It is only surprising how well he has done and how intact many of his capacities for relating are. He has a lot to be proud of but I fear he would have trouble recognizing that.
Goals- Otto wants to be free to be in tune with himself and his environment. Otto wants to have a better relationship than that of his parents, sister, or first wife. Otto wants to feel proud of his work and all he has accomplished
Traumas- Otto appears to have experienced his family as out of control, very harsh with overreactions to minor transgressions, punitive and unprotective. Both parents are described as severely flawed. He has had to parent himself- never seen and heard by them. The cruel picture of his mother telling him she wanted him to die and in fact tried to kill him will be a cornerstone for his development of his sense of self. Not what you would want. He seems to have married a woman just like mom who continued the pattern of abusing and attacking. This isn't surprising given his role models.
Beliefs- (This category is best developed with the patient as one would need to see the idiosyncratic way in which one's patient internalized his experiences but we can try to guess some possible ones and correct as we get more information.) Otto must believe that he wasn't suppose to live- that he is a burden to his parents that didn't deserve attention and love and that in fact - that he wasn't lovable. As children often blame themselves for what ever treatment they receive, he is like to have come to feel Bad inside as if there was something horrible about him that should have been destroyed before he was even born. This kind of belief is very serious and foretells many dangers around suicidality. I would always take his feeling very strongly. It will be very important to disconfirm this belief as it interferes with developing close relationships leaving one very sensitive to rejection issues. Otto is likely to believe that women are weak and easily hurt and is likely to fear his capacity to damage them by trying to get his own needs met. He may believe that they are often out of control He may out of a compliance and identification fear his own abilities to be in control of his emotions. He is likely to believe that woman won't like or love him. Otto may believe that men are insecure and weak and want to put him down and find reasons to attack and punish him. He may be afraid to show his skill and success for fear that this will result in harming or humiliating a man (his dad). Since he has had great work success it would be important to trace how he has felt free to do so.