Additional Perspectives on the Case of "Chris"

Abstract

In this article, I respond to commentaries by Dr. Karen Skean (2023) and by Dr. Lauren Lipner (2023) on my case study of "Chris" (Yunusova, 2023), a 30-year-old man who presented to treatment with presenting problems related to depression and aspects of complex PTSD. First, I discuss the way in which Skean precisely captures the core processes in my therapy with Chris. This includes (a) how my use of Fosha's AEDP, which emphasizes the development of a close, warm, and open moment-to-moment relationship between therapist and client, incorporated the behavioral concept of exposure; (b) how this use of exposure must be tailored to the individual client in line with Vygotsky's "Zone of Proximal Development"; and (c) the role of memory reconsolidation in helping to revise traumatic memories. I also discuss the deep positive impact of the case of Chris, as supervised by Dr. Skean, on my subsequent development as a therapist. Second, I discuss how valuable I found Dr. Lipner's viewing of my description of the clinical process of therapy with Chris through a theoretical lens quite different from the one I used, including (a) Goldfried's "principles of change," and (b) Safran and Muran's model for identifying and repairing "ruptures in the therapeutic alliance."  Finally, I also respond to Dr. Lipner's question about the way in which I handled the exchange of letters with Chris at the end of our therapy.