Case response III

Nikolai presented with an ‘unusual request’: he was worried about being a good role model for his soon-to-be born son. This was his identified problem and without reading the case further, I immediately had a strong countertransference of shame combined with embarrassment. Coming from a fricative family of five boys, I was quite deficient emotionally in relating to my daughter during her developmental stages. The shame came from the fact that while offering to undergo family therapy with my daughter when she was 14, I never even considered going for individual therapy to help me relate better to my daughter. My sense of embarrassment came from wondering how I could possibly be of help to this sensitive man who already had good insight and was so obviously more emotionally attuned to the needs of his child than I ever was. But further reading disclosed that Nikolai has an alcohol problem.

Nikolai's need to take control and one-upmanship makes sense. It is an adage that an active alcoholic has a big ego with an inferiority complex; so, it is not surprising that he would have projected his sense of inferiority and that I introjected it, all before reading the notes of his first session!

His analyst successfully provided Nikolai, an active alcoholic in denial, with a safe non-confrontational space for three months. This space facilitated Nikolai to admit that he was an ‘alcohol addict’. When in the first session I suspect that the client has an alcohol problem, I have two options: gently raise the issue of their alcohol problem or follow the wisdom of a master therapist, who advised that the purpose of the first session is to bring the client back to the second.

A brief, but clinically validated psychometric test for screening for alcohol problems is the CAGE test, which comprises only four questions (Williams 2014). Answering even one question positively indicates that a person may have a problem with alcohol. The four questions, which can be casually interwo