I like to guess very freely and broadly when first reading through a case. The information provided in this format is limited; as more information becomes available, I will correct my first impressions and narrow my guessing.
Otto's urgency and choice of a "nearby" therapist may reflect his impulsivity and possibly a tendency to overwhelm others with his desires. His stiff, formal demeanor might express an imperious attitude that was disturbed by the presence of another, psychological, authority, making him feel ill at ease. Perhaps he became unsure of his ability to dominate.
He does not make any reference to his feelings about Sally. They have lived together for 3 years. Does he love her? Has there been any talk of marriage? Is this a relationship of convenience? Was there a reason why she did not go with him to Vienna? Did he miss her? Did he call her at some frequency? I would especially like to know how they met, and what he first found attractive in her. How does Sally fit into his life? What are their future plans? How do they get along, generally? Do either of them have any complaints about the other? How did he get along with his first wife?
He was disappointed at the way she greeted him on his return. How did he greet her? If he noticed her unusual response, why didn't he question further at the time? He seems only interested in his own distress, not in hers. He waits three days and then tells her that he is disappointed. Is this typical of the way they deal with problems?
Sally does not seem very assertive. She may be easily intimidated or victimized. Why is she afraid of looking like was coming on to this other man? Out of a deep insecurity, does she tend to blame herself, or was she actually wanting attention from another man after feeling neglected by Otto? Her "feeling terrible" about the thought of "playing around" could reflect a guilty conscience.
Did Otto pick a woman who is afraid of a man's anger? Hitting his ex-wife can be a sign of his wanting to dominate and hurt women. His shock at her hurt seem remarkably insensitive. Otto may believe that he has not gotten angry at a woman in 20 years. Does he feel anger but not express it openly? Does he get angry at men, children, or animals? His stewing, sleeplessness, itching hands, and inability to get an erection could be symptoms of a man who still wants to attack and hurt someone. We need to understand the purpose of his anger. Is it used to dominate, frighten, or punish another person?
I would want to know more about his work. Is he successful in what he does? Does he like what he does? How ambitious is he? How often does he go away, and for how long? What are his other interests? Are there any other problems--medical, alcohol, drugs? I would ask him to describe his closest friends. Does he have any enemies?
I'd like more details about how he checked up on the man who offended his wife. Who did he speak to? Did he just "bump into" this man on the street, or did he perhaps follow him? What did he say to the man? How did the exchange "explode into a real argument" that caused people to stare? Were any blows exchanged?
In the first stage of Classical Adlerian psychotherapy, the "Empathy & Relationship Stage," I begin by establishing a cooperative working relationship. Otto would be invited to freely discuss his difficulties and feelings. He would also be encouraged to elaborate on his relationship with Sally, his work, and his friendships. I would offer him the feeling of equality, acceptance, understanding, empathy, and hope.
In the next stage, the "Information Stage," I would get an overview of his early childhood situation, including: his description of himself as a child; birth order and description of each sibling; descriptions of each parent and his feelings about them; the parents' relationship; and their method of discipline. I would also ask for several earliest childhood recollections, including the first day of school, and one from adolescence.
In order to gain a binocular view of this situation, I would suggest that Sally come in by herself for at least one session. He is not the only one who may need understanding, empathy, and insight.